Aflibercept as primary treatment for myopic choroidal neovascularisation: a retrospective study.

AIM The aim of this study is to evaluate long-term efficacy of intravitreal injections of aflibercept as primary treatment for subfoveal/juxtafoveal myopic choroidal neovascularisation (CNV).METHODS Thirty-eight treatment-naive eyes of thirty-eight patients with subfoveal/juxtafoveal myopic CNV received initial intravitreal aflibercept injections and were followed for at least 18 months. Aflibercept was applied again for persistent or recurrent CNV, as required. Statistical analysis was carried out using SPSS.RESULTS Mean patient age was 45.8 years, and mean eye refractive error was -7.79 D. For the total patient group (n=38 eyes), mean logMAR best-corrected visual acuity (BCVA) significantly improved from 0.69 at baseline to 0.15 at 18 months (P<0.01). Over half of the treated eyes obtained resolution with one aflibercept injection. Patients were also grouped according to age, as <50 years (n=20 eyes) and ≥50 years (n=18 eyes). Mean BCVA improvement was significantly greater in eyes of the younger myopic CNV group, compared with those of ≥50 years (0.21 vs 0.35; P<0.05). The mean number of aflibercept injections was 1.8 for the <50 years myopic CNV group, and 3.6 for the ≥50 years myopic CNV group (P<0.001). Correlation between spherical equivalent refraction and final visual acuity reached statistical significance only for the <50 years myopic CNV group (P<0.001; Levene's correlation).CONCLUSIONS Intravitreal aflibercept provides long-term visual acuity improvement in myopic CNV. The <50 years old myopic CNV group had significantly fewer injections, with greater visual acuity improvement. Intravitreal aflibercept in myopic CNV does not require the three-injection loading phase used for aflibercept treatment of neovascular age-related macular degeneration.

Disease Risk Assessments Involving Companion Animals: an Overview for 15 Selected Pathogens Taking a European Perspective.

Prioritization of companion animal transmissible diseases was performed by the Companion Animals multisectoriaL interprofessionaL Interdisciplinary Strategic Think tank On zoonoses (CALLISTO) project. The project considered diseases occurring in domesticated species commonly kept as pets, such as dogs and cats, but also included diseases occurring in captive wild animals and production animal species. The prioritization process led to the selection of 15 diseases of prime public health relevance, agricultural economic importance, or both. An analysis was made of the current knowledge on the risk of occurrence and transmission of these diseases among companion animals, and from companion animals to man (zoonoses) or to livestock. The literature was scanned for risk assessments for these diseases. Studies were classified as import risk assessments (IRAs) or risk factor analyses (RFAs) in endemic areas. For those pathogens that are absent from Europe, only IRAs were considered; for pathogens present throughout Europe, only RFAs were considered. IRAs were identified for seven of the eight diseases totally or partially absent from Europe. IRAs for classical rabies and alveolar echinococcosis found an increased risk for introduction of the pathogen into officially disease-free areas as a consequence of abandoning national rules and adopting the harmonized EU rules for pet travel. IRAs for leishmaniosis focused on risk associated with the presence of persistently infected dogs in new geographical areas, taking into consideration the risk of disease establishment should a competent vector arise. IRAs for Crimean-Congo haemorrhagic fever and West Nile fever indicated that the likelihood of introduction via companion animals was low. IRAs for bluetongue paid no attention to the risk of introduction via companion animals, which was also the case for IRAs for foot-and-mouth disease, the only disease considered to be absent from Europe. RFAs dealing with the risk factors for companion animals to become infected were identified for eight of the 14 diseases found in Europe or parts of it. RFAs for leptospirosis were most numerous (four studies). The host related risk factor 'age' was identified as significant for dogs in at least two RFAs for cystic echinococcosis and giardiasis. Among husbandry and healthcare related factors, 'eating (uncooked) offal', 'being free roaming' and 'poor deworming practice' were associated with risk for dogs in at least two RFAs for cystic echinococcosis, while 'having received recent veterinary treatment' was identified as a risk factor in at least two studies on infection with extended spectrum beta lactamase-producing bacteria, one in horses and the other in dogs and cats. Finally, although the environmental factors 'season' and 'hydrological density' were identified as significant risk factors for dogs in at least two RFAs for leptospirosis, the inconsistent case definitions used in those studies made comparison of study results problematic. RFAs considering the risk of people becoming infected from companion animals were identified for eight of the 14 diseases found in Europe or parts of it. RFAs for human campylobacteriosis were the most numerous (n = 6). Most studies made an assessment as to whether keeping a pet per se, or keeping a pet with supposed or known risk factors, was a risk factor for people relative to other risks. This allowed some studies to report the population attributable risk or population attributable fraction of the incidence of human disease due to companion animals (for campylobacteriosis, salmonellosis and toxoplasmosis), which is a measure that is easy to perceive for laymen and policy makers. No RFAs were found that dealt with the risk to food animals from companion animals for any of the 15 pathogens investigated. Few risk method-based studies were identified that provided information on risk factors for companion animals and on their role as a source of these 15 selected diseases, indicating a clear knowledge gap. There were not enough assessments for any of the 15 diseases to allow meta-analyses, whether these assessments dealt with companion animal disease risk or companion animal-associated human disease risk. Important method and technology gaps were the lack of harmonization in the case definitions used for a given disease and the lack of good diagnostics allowing pathogen identification to taxonomic levels that are meaningful for risk analysis. Molecular epidemiology studies on zoonotic pathogens, which included companion animals among the potential human risk factors, were not found, although such studies would provide good preliminary insights without requiring any tracing of people or any interviews. In addition to performing further risk studies that take into account these issues, there is a need for responsible pet ownership and continued education of professionals in companion animal zoonoses. Additional risk assessment studies should allow more targeted actions to reduce the risk of zoonotic diseases transferred via companion animals and provide information that will promote risk-awareness in healthy human-animal relationships.

Long-term control of choroidal neovascularisation secondary to angioid streaks treated with intravitreal bevacizumab (Avastin).

AIM: To evaluate the efficacy of intravitreal bevacizumab (IB) in the long-term control of subfoveal choroidal neovascularisation (CNV) associated with angioid streaks (AS). METHODS: Patients with unilateral active CNV associated with AS were enrolled. Exclusion criteria were previous treatment for CNV and comorbidity. Postoperative visual acuity was defined as a gain or loss of two or more lines of best-corrected visual acuity (BCVA). Post-treatment CNV size was dichotomised into "increased," if the CNV area had grown by > or =200 microm(2), and "stable/reduced" if it had decreased by > or =200 microm(2) or had not changed by more than 200 microm(2). Patients were retreated if no further improvement or worsening was noted. RESULTS: Patients were five males and six females aged 33 to 58 years (mean 46.8 (SD 9.2)), who received a mean number of 3.5 (1.3) IB treatments (min: 2; max: 6). The mean retreatment interval was 3 (1.5) months (min: 1; max: 6). The mean follow-up duration was 23.8 (2.9) months. At 20 months all patients had stable/reduced CNV size and stable/improved BCVA. The mean BCVA rose significantly from 0.28 (0.2) at baseline to 0.56 (0.29) at 20 months (p<0.0001). CONCLUSION: IB is a promising tool for the long-term control of CNV in AS. Further studies are required to validate these findings.

Comparison of BSE prevalence estimates from EU countries for the period July to December 2001 to the OIE and EU GBR classifications.

Consequent upon the bovine spongiform encephalopathy (BSE) crisis, the European Union (EU) Commission enacted various decisions, which demanded that all bovine animals over 30 months of age should be examined by one of the approved rapid tests when slaughtered for human consumption. All cattle over 24 months of age subject to 'special emergency slaughtering' or died on the farm or in transit or suspect of BSE infection should also be examined by one of the approved rapid tests. According to a specific commission decision, Sweden and Finland were to test only a sample of bovine animals over 30 months of age subject to normal slaughter. Testing commenced on 1 January 2001. The authors evaluate the results of more than 5 million tests performed in the second semester 2001 from across the EU. The prevalence of BSE in the risk categories considered (emergency slaughter, fallen stock and healthy slaughtered), and the probability distribution of true-positive, false-positive and false-negative results are estimated by second-order Bayesian analysis. The results of the validation of tests performed in the EU are also considered by estimation of the probability distribution of their sensitivity and specificity. The prevalence of infection estimated in the cattle population of each EU country is compared against the criteria given in the OIE Terrestrial Animal Health Code and is also used to evaluate the consistency of the results of EU Geographical BSE Risk with the actual infection levels in the countries. Finally, the capability of the two current approaches to BSE surveillance (i.e. the testing of all slaughtered and dead cattle as applied in the EU and a surveillance system targeted at animals in risk categories only) to detect the infection in a given population are discussed.

Polypoidal choroidal vasculopathy in Italy.

PURPOSE: To report on the frequency and clinical features of polypoidal choroidal vasculopathy (PCV) in a consecutive series of elderly Italian patients presenting with macular exudation. METHODS: The authors conducted a retrospective study on a series of 194 consecutive patients 50 years or older with newly diagnosed exudative maculopathy and the presumed diagnosis of age-related macular degeneration (ARMD). Color and/or red-free photographs and fluorescein and indocyanine green angiography were performed in all patients. RESULTS: Of the 194 patients, 19 (9.8%) were diagnosed with PCV. The remaining 175 (90.2%) patients had ARMD complicated by choroidal neovascularization. No age or sex differences were observed between the two groups. The disease was unilateral in 103 (58.9%) of 175 ARMD cases compared with 15 (78.9%) of 19 PCV cases (P = 0.09). Nine (47.3%) of 19 patients with PCV had an extramacular choroidal neovascularization, compared with only 5 (2.9%) of 175 patients with ARMD (P < 0.0001). Significant drusen were present in the fellow eyes of 66 (64.1%) of 103 unilateral cases in the ARMD group and in 4 (26.7%) of 15 patients with unilateral disease in the PCV group (P = 0.006). CONCLUSIONS: Polypoidal choroidal vasculopathy is not an uncommon disease in Italy and should be suspected in patients presenting with extramacular lesions and no large drusen in the fellow eye.

Optical coherence tomography findings in diabetic macular edema before and after vitrectomy.

BACKGROUND AND OBJECTIVE: To assess the role of optical coherence tomography (OCT) in the evaluation and follow-up after vitrectomy for diabetic macular edema. MATERIALS AND METHODS: The 18 eyes of 12 patients affected by presumed diabetic vitreous-induced macular edema underwent biomicroscopy with a Goldmann contact lens, fluorescein angiography, and OCT. RESULTS: OCT revealed two patterns of edema. The first group (15 eyes) was characterized by widespread thickening of the neurosensory retina with an increased nonhomogeneous reflectivity of the inner retinal layers; cystoid-like spaces of absent or reduced reflectivity in the neurosensory retina were also present. In the second group (3 eyes), a cystoid macular edema with a dome-shaped foveal profile because of a markedly increased retinal thickness in the foveal region was observed. The disappearance of the physiologic foveal profile was always seen. Biomicroscopy revealed an increased reflex of the inner limiting membrane in the first group and minimal alterations in the second one. Four patients (7 eyes) underwent vitrectomy with posterior hyaloid removal. In 5 eyes, the patients experienced a visual improvement greater than two Snellen lines. The restoration of the normal foveal profile and the reduction of the retinal thickness on the OCT were evident in all cases one month after surgery. CONCLUSION: OCT appears to be a useful tool in the diagnosis and management of diabetic macular edema and in the monitoring of the morphological changes after vitrectomy.

Detection of tenascin-C in surgically excised choroidal neovascular membranes.

BACKGROUND: Increase of tenascin-C (TN-C) expression has been found in pathologic tissues in which angiogenesis occurs. The aim of this study was to investigate TN-C expression in human choroidal neovascularization (CNV). METHODS: Ten choroidal neovascular membranes were surgically removed from 10 patients with age-related macular degeneration (n=6) and multifocal choroiditis (n=4). All membranes underwent immunohistochemical evaluation using monoclonal antibodies against TN-C and factor VIII. RESULTS: All membranes were positive for TN-C, which was abundantly and diffusely expressed in the extracellular matrix. CONCLUSIONS: Our results support the concept that TN-C has a role in cell proliferation and neovascularization in humans. TN-C, as a marker of angiogenesis, may provide novel rationales for the development of pharmacologic therapies for neovascular disorders, particularly CNV.

OCT imaging of choroidal neovascularisation and its role in the determination of patients' eligibility for surgery.

AIM: To evaluate the optical coherence tomographic characteristics of choroidal neovascularisation (CNV) in age related macular degeneration (AMD) and in idiopathic and inflammatory CNV. The use of this technique in the selection of patients for surgery is discussed. METHODS: Ocular coherence tomography (OCT), fluorescein, and indocyanine green angiography were performed in 23 patients affected by AMD complicated by well defined CNV and in 10 patients affected by inflammatory or idiopathic CNV. The neovascular membrane was surgically removed in five age related CNVs, two inflammatory choroidopathies, and two idiopathic CNVs. RESULTS: In inflammatory and idiopathic CNV, the OCT displayed a neovascularisation on the retinal pigment epithelium (RPE). In three cases the CNV was excised with an improvement of visual acuity equal to or greater than two Snellen lines; in a fourth case, the visual acuity after surgery was unchanged. In the cases of AMD the OCT fell into three different patterns: (A) CNV above the RPE (five cases); (B) focal, irregular thickening of the retinal pigment epithelial band (12 cases); (C) CNV above and below the RPE (six cases). The five pattern A CNV patients underwent the surgical excision of the neovascularisation. In four cases the visual acuity improved by two or more Snellen lines; in the fifth case the visual acuity remained unchanged. CONCLUSIONS: The authors suggest that the surgical removal of early age related CNV could be performed in those cases where the OCT shows a neovascular membrane on the RPE, as in idiopathic and inflammatory CNVs.

Usefulness of fluorescein angiography in predicting the size of the atrophic area after surgical excision of choroidal neovascularization.

Twenty consecutive patients affected by age-related macular degeneration (AMD) complicated by subfoveal and juxtafoveal choroidal neovascularization (CNV) underwent a surgical removal of the membrane. The patients were divided into two groups: group A = CNVs 2 months. The surgical excision of the CNV was also performed in 10 cases of multifocal choroidopathies and idiopathic CNV. The atrophic area after surgery was larger in AMD than in multifocal choroidopathies or idiopathic CNV (p < 0.001). In AMD the atrophic area after surgical excision of the CNV was larger in group B than in group A (p < 0.05). The area of the CNV + the hyperfluorescent halo observed in the late phase of fluorescein angiography before surgery was 84.6% of the atrophic area after surgery. Our observations could be helpful to the surgeon for a more accurate evaluation of the expected size of the atrophic area after surgical removal of a CNV, thus allowing a better selection of the patients for whom surgery could be of some benefit.

Optical coherence tomography (OCT) in idiopathic polypoidal choroidal vasculopathy (IPCV).

PURPOSE: Idiopathic polypoidal choroidal vasculopathy (IPCV) is a distinct clinical entity characterized by an edematous maculopathy and typical choroidal vascular change. The purpose of this study is to evaluate the use of optical coherence tomography (OCT) for diagnosing of this disease. METHODS: 4 patients affected by IPVC (mean age 71-84 years) underwent biomicroscopy with a three mirror conctact lens, fluorescein angiography (FA), indocyanine green angiography (ICGA) and OCT (Humphrey Zeiss) scan. RESULTS: in all 4 cases OCT tomograms acquired at the location of the typical choroidal abnormalities demonstrated by ICGA, revealed a characteristic hyper-reflectivity in the choroidal layers. CONCLUSION: ICGA is essential to diagnose IPVC, but OCT may be able to identify characteristic reflectivity patterns.

Corrective osteotomy for the treatment of genu procurvatun. Surgery.

The authors present the method known as proximal tibial osteotomy for the treatment of genu procurvatum. The importance of an accurate preoperative study, particularly aimed at avoiding negative repercussions on the position of the patella, and of a correct anatomical exposure with isolation of the peroneal nerve for any iatrogenic lesions, must be emphasized; a condylic plate was used to stabilize osteotomy was stabilized, adapting well to the anatomy of the region, and allowing us to obtain correction of any associated deformities on the frontal plane.

Mortality from primary malignant brain tumors in the Province of Bologna, Italy, 1986-1988.

INTRODUCTION: We performed a study of mortality from primary malignant brain tumors (PMBT) in the province of Bologna, Italy, during the years 1986 to 1988. MATERIALS AND METHODS: The study was based on death certificates from the Cancer Registry of the province of Bologna. We verified death certificates for both false-positive and false-negative cases. RESULTS: The crude mortality rate was 6.7/100,000 population per year. The age and sex-adjusted mortality rate, standardized to the Italian population (Italy 81), was 5.34/100,000 (95% CI = 3.9 to 6.7). CONCLUSION: Our figures are higher than those previously reported in Italy, but are similar to values of incidence and mortality found in northern Europe and in North America.

Bilateral Acanthamoeba keratitis in a gas-permeable contact lens wearer.

Acanthamoeba keratitis is an uncommon but potentially devastating complication of contact lens wear that has been reported with increasing frequency since its first description in 1974. We describe a case of bilateral Acanthamoeba keratitis, which occurred in a 24-year-old man, wearing gas-permeable contact lenses. This is to our knowledge the first case of Acanthamoeba keratitis reported in Italy, and the fourth bilateral case reported in the literature. Medical therapy (carried out after the first week by a different institution, due to the absence of essential antiamebic drugs on the Italian market) was effective in stopping the progression of the disease.

Mortality from motor neuron disease in the province of Bologna, Italy, 1986 through 1988.

We performed a study on mortality from motor neuron disease in the province of Bologna, Italy, during the years 1986 through 1988. The study was based on death certificates from the Cancer Registry of the Province of Bologna. We verified death certificates for both false-positive and false-negative cases. The crude mortality rate was 1.93/100,000 population per year. The age and sex mortality rate, standardized on the Italian population, was 1.40/100,000 (95% confidence interval, 1.05 to 1.83). Our figures are higher than those previously reported both as the incidence and as mortality in Italy, but these data are similar to values that have been found in northern Europe and in North America.

Spectrophotometric determination of glutathione and of its oxidation product in pharmaceutical dosage forms.

A simple and sensitive spectrophotometric method suitable for the stability control of pharmaceutical dosage forms containing glutathione (gamma-glutamyl-cysteinyl-glycine), GSH, is described. Besides GSH, the method quantitatively determines its oxidation product, GSSG. The colour reactions of GSH and GSSG with ammonium tetrachloropalladate have been investigated and the optimum reaction conditions, spectral characteristics and composition of the yellow water-soluble complexes have been established. The assay results of pharmaceutical formulations showed good accuracy and precision over the concentration range of 5 x 10(-5)-6 x 10(-4) M GSH.

[Macular syndrome in choroidal cavernous hemangioma: the role of laser treatment]. / Syndrome maculaire au cours des hémangiomes caverneux choroïdiens: le rôle du traitement au laser.

On the basis of a series of case with natural history of choroidal cavernous hemangioma (21 cases with follow-up of up to 13 years) the authors suggest a classification of macular syndromes (types I, II and III) in choroidal cavernous hemangioma. They also suggest that partial barrage of the tumor can be sufficient to arrest or prevent further V.A. impairment.

Bilateral extensive xanthelasma palpebrarum.

A case of xanthelasma palpebrarum with extensive and disfiguring involvement of all four eyelids in a patient without abnormal serum lipid levels is reported.

[Subretinal neovascularization in childhood--a rare observation]. / Subretinale Gefässneubildungen im Kindesalter--einige seltene Beobachtungen.

The authors report on a number of cases of juvenile subretinal neovascularization. The causes identified were degeneration, parasites, trauma, and virus infections; there are also idiopathic cases.

[Laser treatment of diabetic maculopathy]. / Die Laserbehandlung der diabetischen Makulopathie.

The authors report on the techniques of laser treatment of diabetic maculopathy: focal direct laser coagulation of I.R.M.A. in exudative maculopathy; laser grid photocoagulation in edematous maculopathy.