RESUMO
PURPOSE: To evaluate long-term outcome of intravitreal anti-vascular endothelial growth factor monotherapy in retinal angiomatous proliferation. METHODS: Twenty-one treatment-naive eyes were included in this prospective, interventional case series. Treatment was three monthly injections of bevacizumab and/or ranibizumab with a modified PrONTO-style regimen. Best-corrected visual acuity (BCVA) was evaluated. The influence of baseline BCVA and pretreatment pigment epithelial detachment on BCVA outcome or retreatment were assessed by Pearson correlation analysis. RESULTS: Results were evaluated at 2 years and 3 years for 21 and 13 eyes, respectively. Mean baseline BCVA improved significantly from 44.5 (± 11.0) (20/32) to 51.1 (± 9.7) (20/24) and 50.8 (± 10.4) letters (20/24) at 2 and 3 years, respectively (P = 0.02 and P = 0.049). Pigment epithelial detachment correlated negatively with BCVA outcome (r = -0.65, P = 0.002 and r = -0.67, P = 0.01 at 2 years and 3 years, respectively) and was significantly associated with retreatment (r = 0.62, P = 0.003 and r = 0.87, P < 0.0001 at 2 years and 3 years, respectively). Complete occlusion of the lesion was obtained in 71% and 69% of eyes at 2 years and 3 years, respectively, with a mean of 9.4 injections at 3 years. CONCLUSION: Intravitreal anti-vascular endothelial growth factor monotherapy was a valid option for retinal angiomatous proliferation. Stable or improved visual acuity was obtained in 95% and 100% of eyes at 2 years and 3 years, respectively.
Assuntos
Inibidores da Angiogênese/uso terapêutico , Neovascularização Retiniana/tratamento farmacológico , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Degeneração Macular Exsudativa/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais Humanizados/uso terapêutico , Bevacizumab , Feminino , Angiofluoresceinografia , Seguimentos , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Ranibizumab , Neovascularização Retiniana/fisiopatologia , Epitélio Pigmentado da Retina/patologia , Retratamento , Tomografia de Coerência Óptica , Resultado do Tratamento , Acuidade Visual/fisiologia , Degeneração Macular Exsudativa/fisiopatologiaRESUMO
The purpose of this paper is to review the surgical options available for the management of pediatric glaucoma, to evaluate their advantages and disadvantages together with their long-term efficacy, all with the intent to give guidelines to physicians on which elements are to be considered when taking a surgical decision. Currently there is a range of surgical procedures that are being used for the management of pediatric glaucoma. Within these, some are completely new approaches, while others are improvements of the more traditional procedures. Throughout this vast range of surgical options, angle surgery remains the first choice in mild cases and both goniotomy and trabeculotomy have good success rates. Trabeculectomy with or without mitomycin C (MMC) is preferred in refractory cases, in aphakic eyes, and in older children. GDIs have a good success rate in aphakic eyes. Nonpenetrating deep sclerectomy is still rarely used; nevertheless the results of ongoing studies are encouraging. The different clinical situations should always be weighed against the risks associated with the procedures for the individual patients. Glaucomatous progression can occur many years after its stabilization and at any time during the follow-up period; for this reason life-long assessment is necessary.
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Glaucoma/terapia , Mitomicina/uso terapêutico , Trabeculectomia/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Glaucoma/patologia , Humanos , Lactente , MasculinoRESUMO
INTRODUCTION: Oxidative stress, a consequence of excessive production of reactive oxygen species (ROS), is a factor in the development of many diseases, including diabetes and its complications. Alpha-lipoic acid (ALA), a natural thiol antioxidant, has been shown to have beneficial effects on oxidative stress parameters in various tissues. This article is an up-to-date review of current thinking regarding ALA and its use in providing antioxidant (AO) drug therapy for ocular dysfunction due to diabetic retinopathy (DR). AREAS COVERED: ALA prevents micro- and macro-vascular damage through normalized pathways downstream of mitochondrial overproduction of ROS, and preserves pericyte coverage of retinal capillaries. In addition, clinical studies suggest that oral administration of ALA can improve insulin sensitivity in patients with type-2 diabetes. Moreover, ALA treatment has been shown to suppress expression of vascular endothelial growth factor (VEGF), angiopoietin 2 and erythropoietin via blockade of superoxide formation. EXPERT OPINION: The diverse beneficial effects of ALA, many of which have only recently been uncovered, suggest that it acts by multiple mechanisms on oxidative stress parameters. Consequently, ALA supplementation is an achievable adjunct therapy to help prevent vision loss in diabetic patients. Finally, further research to better understand the mechanism of ALA will be useful for the development of more effective therapies in patients affected by DR.
Assuntos
Antioxidantes/uso terapêutico , Retinopatia Diabética/tratamento farmacológico , Ácido Tióctico/uso terapêutico , Animais , Diabetes Mellitus Experimental/tratamento farmacológico , Diabetes Mellitus Experimental/metabolismo , Retinopatia Diabética/metabolismo , HumanosRESUMO
The management of diabetic macular edema (DME) has been revolutionized in recent years. Focal and focal/ grid laser photocoagulation have been the mainstay of treatment for DME for much time. However, nowadays, there is growing evidence that intravitreal VEGF-inhibitors (combined or not with laser photocoagulation) provide better visual outcome in patients with diabetic retinopathy. Hence, anti-VEGF injections are considered the new gold standard to treat diabetic macular edema and eyes with a reduced visual function. Further studies assessing different treatment regimens are underway to define better clinical care pathways.