Intravitreal bevacizumab injection in aggressive posterior retinopathy of prematurity compared with type I retinopathy of prematurity.

PURPOSE: To compare type I retinopathy of prematurity (ROP) with aggressive posterior retinopathy of prematurity (AP-ROP) regarding risk factors, complications and treatment outcomes. METHODS: A prospective cohort approach was applied on premature newborns diagnosed as type I ROP and AP-ROP. An intravitreal injection of bevacizumab (Avastin®) was given to each patient. Demographic features such as gestational age, birth weight, age at the initial injection, involved eye, treatment response, relapses and need to extra interventions were compared. RESULTS: Seventy-seven patients underwent an initial intravitreal injection of bevacizumab (IVB), and 108 eyes were type I ROP and 30 eyes were AP-ROP. There was no significant difference in birth weight and gestational age between two groups. ROP relapsed in eight eyes of four patients with AP-ROP (26.6%), of which six eyes of three patients received re-injection of bevacizumab, and two eyes of one patient underwent a laser treatment. Recurrence occurred in two eyes of one patient with type I ROP (1.8%), which were treated by laser. CONCLUSION: Bilateral eye involvement, relapse and retreatment (IVB, laser and surgical intervention) are more frequent in AP-ROP than type I ROP even when treated with intravitreal bevacizumab injection.

Tear total protein analysis in patients with late sulfur mustard-induced ocular complications: a cross-sectional study.

BACKGROUND: Eyes are the most sensitive organs to sulfur mustard (SM). Late ocular complications have been reported even 15-20 years post-exposure. To date, no study has investigated the composition of tear proteins in tear samples of SM-intoxicated patients. METHODS: Total protein content as well as concentrations of vascular endothelial growth factor (VEGF), calcitonin gene related peptide (CGRP) and substance P were measured in unstimulated tears of chemically-injured patients who suffer from late ocular complications of SM. These levels were compared to corresponding values obtained from tears of healthy control subjects. The concentration of total proteins was measured using the Bradford method and those of VEGF, CGRP and substance P by ELISA. RESULTS: Total protein concentration was significantly lower in tears of the SM compared to control group (p<0.01). In contrast, tear samples of the SM group had significantly higher VEGF and VEGF/total protein compared to control group (p<0.01). Tear CGRP concentration was found to be lower in the SM vs. control group (p<0.05) but no significant difference in CGRP/total protein was observed (p>0.05). Finally, tear substance P concentrations were not found to be significantly different between the two groups (p>0.05). CONCLUSION: The results of this investigation indicated decreased total protein and CGRP, and elevated VEGF concentration in tears of SM-intoxicated patients who suffer from chronic ocular complications.

Comparison of Clinical Outcomes of Intravitreal Bevacizumab and Aflibercept in Type 1 Prethreshold Retinopathy of Prematurity in Posterior Zone II.

Purpose: To evaluate the efficacy and safety of intravitreal injection (IVI) of bevacizumab (IVB) versus aflibercept (IVA) in premature infants with type 1 prethreshold retinopathy of prematurity (ROP) in the posterior Zone II. Methods: The study was a multicenter, historical cohort of premature newborns diagnosed with type 1 prethreshold ROP in the posterior Zone II, treated with IVB or IVA. Demographic features, complications, and treatment outcomes were then compared between the two groups. Results: Seventy-six patients received aflibercept (the IVA group), and 210 received bevacizumab (the IVB group). The two groups were not significantly different in terms of postmenstrual age (PMA) at the time of ROP diagnosis and other known risk factors for ROP development and progression. All eyes in both the groups responded to IVI; however, recurrence was observed in four eyes (1.9%) in the IVB group and 12 (15.8%) in the IVA group (P = 0.001). Recurrence occurred 9.1 ± 0.83 (5-12) and 15.5 ± 0.98 (12-18) weeks after primary treatment in the IVB and IVA groups, respectively (P = 0.000). In the IVA group, retinal vascularization was completed in 38.18 ± 6.5 weeks (21-48) after IVI, and it happened in 23.86 ± 9.3 weeks (13-60) in the IVB group (P = 0.009). Furthermore, vascularization reached the peripheral retina in 73.25 ± 6.5 (56-84) and 58.75 ± 8.8 (45-93) weeks, PMA in the IVA and IVB groups, respectively (P = 0.03). No acute postoperative complications were observed in the treated eyes in either group. Conclusion: This study shows that both IVA and IVB are effective and well tolerated for the management of type 1 prethreshold ROP in the posterior Zone II; however, IVA needs a significantly longer time for vascularization completion and has a higher recurrence rate compared with IVB.

The clinical and paraclinical manifestations of tuberous sclerosis complex in children.

Tuberous sclerosis complex (TSC) is an autosomal-dominant, multi-system, neurocutaneous disorder characterized by hamartomas in multiple organs. This study aimed to evaluate the clinical and paraclinical manifestations of children with TSC. The clinical and paraclinical characteristics of 79 children with TSC were evaluated and the possible correlations between the factors were calculated. Among the studied children which composed of 41 females (51.9%) and 38 males (48.1%), skin manifestations as hypopigmented macules as well as the brain involvement as cortical tubers in all (100%) cases, seizure in 74 (93.7%), and sub-ependymal nodules in 73 (92.4%) patients were the most common findings. The renal angiomyolipoma was diagnosed in 36 (70.6%) out of 51 patients. Subependymal giant cell astrocytoma in 25 (3/54%) out of 46 patients, retinal hamartoma in 15 (42.9%) out of 35 patients, and cardiac rhabdomyoma in 17 (41.3%) out of 46 patients were diagnosed. Furthermore, 50 (63.3%) out of 79 patients had psychological disorders that had a significant correlation with the prevalence of seizures (p = 0.002). Given the multi-systemic involvement of TSC, it is necessary that all organs of the patients even without any related clinical symptom or sign be examined regularly for proper therapeutic intervention and prevent disease progression. The growth of hamartomas in the brain and kidneys can be life-threatening; therefore, these organs have more importance to be regularly followed up and examined.