RESUMO
Long-lasting anti-vascular endothelial growth factor (anti-VEGF) agents have become an option to reduce treatment frequency, with ongoing research exploring optimal responses and safety profiles. This review delves into molecular targets, pharmacological aspects, and strategies for achieving effective and enduring disease control in neovascular age-related macular degeneration (AMD). The molecular pathways involved in macular neovascularization, including angiogenesis and arteriogenesis, are explored. VEGF, PlGF, Ang-1, and Ang-2 play crucial roles in regulating angiogenesis, influencing vessel growth, maturation, and stability. The complex interplay of these factors, along with growth factors like TGFß and bFGF, contributes to the pathogenesis of neovascular membranes. Current anti-VEGF therapies, including bevacizumab, ranibizumab, aflibercept, brolucizumab, and faricimab, are discussed with a focus on their pharmacokinetics and clinical applications. Strategies to achieve sustained disease control in AMD involve smaller molecules, increased drug dosages, and novel formulations. This narrative review provides a comprehensive overview of the molecular targets and pharmacological aspects of neovascular AMD treatment.
Assuntos
Inibidores da Angiogênese , Degeneração Macular , Terapia de Alvo Molecular , Humanos , Degeneração Macular/tratamento farmacológico , Degeneração Macular/metabolismo , Inibidores da Angiogênese/uso terapêutico , Inibidores da Angiogênese/farmacologia , Terapia de Alvo Molecular/métodos , Fator A de Crescimento do Endotélio Vascular/metabolismo , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Animais , Neovascularização Patológica/tratamento farmacológico , Neovascularização Patológica/metabolismoRESUMO
A 62-year-old white woman presented with a diagnosis of blue rubber bleb nevus syndrome (BRBNS). The right eye appeared enophthalmic, yet the patient complained of episodes of right proptosis on bending forward. The remainder of the examination was unremarkable. Orbital ultrasound (US) in an upright posture revealed a single low reflectivity cavity (4.27 mm x 2.82 mm) of uncertain interpretation. In a forward-leaning posture the lesion increased in size (maximum thickness of 13.72 mm), demonstrating multiple low reflectivity spaces with highly reflective septae. This case first reports the use of US with postural changes to assess the presence of orbital venous malformation in BRBNS. The expansile nature upon postural changes supports the venous origin of the orbital lesion.
Assuntos
Neoplasias Gastrointestinais/diagnóstico por imagem , Nevo Azul/diagnóstico por imagem , Órbita/irrigação sanguínea , Neoplasias Orbitárias/diagnóstico por imagem , Postura , Neoplasias Cutâneas/diagnóstico por imagem , Malformações Vasculares/diagnóstico por imagem , Veias/anormalidades , Feminino , Neoplasias Gastrointestinais/patologia , Humanos , Pessoa de Meia-Idade , Nevo Azul/patologia , Neoplasias Orbitárias/patologia , Neoplasias Cutâneas/patologia , Ultrassonografia , Veias/diagnóstico por imagemRESUMO
Here, we report a patient who developed diplopia secondary to a right cranial nerve III and IV palsy, as well as fever and headache. Cerebrospinal fluid analysis (CSF) showed high varicella-zoster virus (VZV)-DNA viral load (>300,000,000 copies/ml). VZV antibodies in CSF was ≥1:16. Diagnosis of neurological reactivation of VZV infection was made without the presence of characteristic vesicular rash. Quantitative real-time PCR for VZV and intrathecal dosage of VZV IgM and IgG should be performed in cases suspected for viral encephalitis and also in all patients with not otherwise attributable cranial nerve lesions.
Assuntos
Doenças dos Nervos Cranianos/diagnóstico , DNA Viral/genética , Diplopia/diagnóstico , Herpes Zoster/diagnóstico , Herpesvirus Humano 3/patogenicidade , Anticorpos Antivirais/líquido cefalorraquidiano , Doenças dos Nervos Cranianos/complicações , Doenças dos Nervos Cranianos/patologia , Doenças dos Nervos Cranianos/virologia , DNA Viral/líquido cefalorraquidiano , Diplopia/etiologia , Diplopia/patologia , Diplopia/virologia , Herpes Zoster/complicações , Herpes Zoster/patologia , Herpes Zoster/virologia , Herpesvirus Humano 3/genética , Herpesvirus Humano 3/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Carga Viral , Ativação ViralRESUMO
AIM: To evaluate safety, efficacy, and patient adherence of intracameral lidocaine as supplement of classic topical anesthetic drops in cataract surgery. METHODS: A prospective and controlled trial including a large cohort of 1650 individuals suffering with bilateral cataract not complicated, in program by phacoemulsification surgery, were randomly assigned to 2 different groups for the type of anesthesia received, 0.4% oxybuprocaine hydrochloride (INN) drops, and INN drops associated to intracameral 1% lidocaine hydrochloride monohydrate. At the end of surgery, tables were assigned to each patient indicating the degree of pain (0-3) felt during the operation. RESULTS: Thirty-two percent of patients in group 1 declared to have not felt any pain against the 77% of patients in group 2. Fifty-nine percent of patients in group 1 complained about only a slight discomfort against 20% of group 2 patients. Only a small percentage of patients in group 1 (5%) admitted severe pain, while no patient in group 2 admitted severe pain. Four patients of group 2 reported an episode of transient amaurosis, lasting several hours after surgery. CONCLUSION: Intracameral administration of lidocaine is a simple and secure method able to increase the analgesia during the cataract surgery, eliminating the discomfort and increasing also the cooperation of the patients during the steps of manipulation.