Preliminary results of aflibercept in treatment-naive choroidal neovascularization of wet age-related macular degeneration.

BACKGROUND: The aim of this study was to evaluate the early response of aflibercept as first-line therapy in treatment-naive patients with newly diagnosed choroidal neovascularization (CNV) in age-related macular degeneration (AMD). PATIENTS AND METHODS: An analysis of 35 eyes (35 patients, 28 female, 7 male) with treatment-naive active CNV was undertaken. Lesion activity was determined based on fluorescein angiography, clinical and optical coherence tomography (OCT) findings, including the presence of sub-, intraretinal fluid, retinal pigment epithelial (RPE) detachment and hemorrhage. Logarithm of the minimum angle of resolution (LogMAR) charts were used for testing best corrected or best available visual acuity (BCVA). Treatment response was evaluated based on changes in BCVA and lesion activity. RESULTS: Classic or predominantly classic CNV was diagnosed in 7 eyes (20.0%), occult or minimally classic in 21 eyes (60.0%), retinal angiomatous proliferation in 5 eyes (14.3%) and polypoidal choroidal vasculopathy in 2 eyes (5.7%). Lesion activity was evaluated as unchanged in only one eye. In all other eyes, a definite treatment response was observed with complete resolution of fluid in 20 eyes after a single injection. Three eyes did not show improved sub-RPE fluid with smaller pigment epithelial detachments. A rip of the RPE was seen in 3 eyes. All patients maintained vision, 7 patients (7 eyes) gained >15 letters from baseline to month 2 follow-up, of whom 4 reached this level of visual acuity after one injection. The visual acuity gains in this study were maintained through 6 months. CONCLUSION: There seems to be a rapid treatment response to aflibercept independent of the underlying CNV. Aflibercept may be beneficial even in eyes with large pigment epithelial detachments due to exudative AMD.

Serum creatine-kinase-BB concentration in very low birth weight babies with posthemorrhagic ventricular dilatation.

The association between measurements of lateral ventricle dilatation determined by serial ultrasound and brain specific creatine-kinase isoenzyme patterns (CK-BB) is studied in 60 very low birth weight preterm neonates of 1,500 g birth weight or 32 weeks gestation or less. The patients were divided into three groups according to cranial ultrasonographic findings: Group A (n = 20) had isolated peri-intraventricular hemorrhage (PIVH); group B (n = 20) had PIVH and dilated ventricles (VM); group C (n = 20) were normal matched preterms and formed the control group. Compared to control babies or those with isolated PIVH, high serum concentrations of CK-BB were observed after birth in babies with persistent dilated ventricles at two weeks postnatal age (p less than 0.01). No difference was found between CK-BB levels of babies with isolated PIVH and control group (p greater than 0.05). We suggest that an elevated CK-BB value is found in babies with persistent ventricular dilatation suggesting severe and diffuse brain damage after post-hemorrhagic ventriculomegaly (VM).

Rubinstein-Taybi syndrome in the neonate.

Since the first description by Rubinstein and Taybi in 1963 more than 250 cases of this syndrome have been reported in the literature, but only few cases in the neonate. We present a patient with the typical clinical aspect who was diagnosed at birth. Early recognition of this condition is important for counselling the parents.

Serum creatine-kinase-BB and brain damage in high-risk newborn infants. Preliminary study with a new method for CK-BB estimation.

CK-BB activity increases after hypoxic conditions associated with central nervous system disease. Fifty-four high-risk newborn babies were studied with serial measurements of CK-BB activities during the first 3 postnatal days. These values were correlated to their early neurologic outcome at 5 months of age. Data were carried out using a new and very sensitive method for estimating CK-BB activity and showed a good correlation between enzymatic values and the presence of persistent neurologic abnormalities (P less than .05). We conclude that early CK-BB determinations can be used as indicator of neonatal brain damage.

Correlation of raised cord-blood CK-BB and the development of peri-intraventricular hemorrhage in preterm infants.

This study concerns the prognostic value of total cord-blood CK-BB activity measured with a new method in preterm infants at risk of PIVH. Twenty-six patients with gestational age less than 36 weeks were studied. The presence of PIVH was proved by either ultrasound scans or autopsy. Total CK-BB values in cord-blood of infants who developed PIVH were significantly higher than those of patients without cerebral bleeding (P less than 0.001).

Accuracy of Apgar score and arterial cord-blood pH in diagnosis of perinatal brain-damage assessed by CK-BB isoenzyme measurement.

This study was carried out on 45 newborns to evaluate the accuracy of 1 minute Apgar score and umbilical arterial pH for prediction of the risk of perinatal brain damage. Using a new and very sensitive method for CK-BB determination, which is considered a good indicator of brain damage, CK-BB was used as reference. Patients with low Apgar score at one minute of life had significantly higher cord blood CK-BB values than the control group (p less than 0.01). No difference was found between the control group and the group with umbilical cord blood acidosis (p less than 0.2).

Megaloblastic anaemia in one of monozygous twins breast fed by their vegetarian mother.

Megaloblastic anaemia in infancy is uncommon in western countries. We describe a case of an exclusively breast-fed monozygous twin with severe vitamin B12 deficiency with haematologic and neurologic abnormalities. Treatment with vitamin B12 resulted in a rapid haematological and clinical improvement.

Neurosonographic and biochemical correlates of periventricular leukomalacia in low-birth-weight infants.

The incidence of periventricular leukomalacia (PVL) was investigated by ultrasound in a group of 119 consecutively scanned low-birth-weight infants during a period of 3 years. The overall incidence of PVL was 6.7% while the incidence of peri-intraventricular hemorrhage was 44.5%. Ultrasound evidence of posthemorrhagic lesions was seen early and related strongly to follow-up findings. Evidence of cystic degeneration appeared later. The presence of PVL was confirmed by computed tomography at 5 months of age and anticipated by serial measurements of creatine kinase brain isoenzyme performed in the first 60 h of life. A significant correlation was observed between neurosonographic findings of PVL and high cord blood values of enzymatic pattern (p less than 0.02). Both were correlated with poor neurodevelopmental outcome at 12 months corrected age.

Prognostic value of serum creatine kinase brain isoenzyme in term babies with perinatal hypoxic injuries.

Creatine kinase brain isoenzyme (CK-BB) may be released into the serum after brain injury. Its concentration was measured serially in a group of 80 term infants at risk of perinatal hypoxic damage. Their neurodevelopmental outcome was furthermore assessed at 12 months of age. Our results are consistent with the hypothesis that infants with high CK-BB concentration, measured in serum with a new and very sensitive method for enzyme analysis, have more frequently poor short-term outcome (p less than 0.02). These data suggest that early CK-BB measurement may be clinically useful to identify newborns at high risk for neurologic or developmental sequelae.

Biochemical timing of peri-intraventricular hemorrhage assessed by perinatal CPK-BB isoenzyme measurements.

Precise diagnosis of peri-intraventricular hemorrhage (PIVH) requires brain real-time ultrasound imaging procedure (US). However, maximal diagnostic efficiency of US lies between day 4 and 14 since fresh blood may initially appear sonolucent. Because of this supposed interval required for clot formation to become visible on US, serum CPK-BB estimations were performed in the first 60 hours of life to determine precise biochemical timing of PIVH. A group of 50 preterm infants less than 1500 g birth weight (1120 +/- 320 g) and 34 weeks gestation (30 +/- 3.7 weeks) was studied. Serial CPK-BB measurements were performed in serum immediately after birth (T0), then serially at time T1 (6-10 h), T2 (20-30 h), T3 (40-60 h). The incidence of PIVH diagnosed on the third day of life was 30%. Total CPK-BB values at T0 in infants who developed PIVH were significantly higher than those of patients without cerebral bleeding (70.8 +/- 30.5 vs 20.9 +/- 10.7 U/l) (p less than 0.05). The same statistically significant results were not observed analysing the CPK-BB values at T1, T2 and T3. These results suggest that most pathological conditions responsible for enzyme release occur in the pre- or perinatal period.