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PURPOSE: Age-related macular degeneration (AMD) is a complex eye disorder affecting millions worldwide. This article uses deep learning techniques to investigate the relationship between AMD, genetics and optical coherence tomography (OCT) scans. METHODS: The cohort consisted of 332 patients, of which 235 were diagnosed with AMD and 97 were controls with no signs of AMD. The genome-wide association studies summary statistics utilized to establish the polygenic risk score (PRS) in relation to AMD were derived from the GERA European study. A PRS estimation based on OCT volumes for both eyes was performed using a proprietary convolutional neural network (CNN) model supported by machine learning models. The method's performance was assessed using numerical evaluation metrics, and the Grad-CAM technique was used to evaluate the results by visualizing the features learned by the model. RESULTS: The best results were obtained with the CNN and the Extra Tree regressor (MAE = 0.55, MSE = 0.49, RMSE = 0.70, R2 = 0.34). Extending the feature vector with additional information on AMD diagnosis, age and smoking history improved the results slightly, with mainly AMD diagnosis used by the model (MAE = 0.54, MSE = 0.44, RMSE = 0.66, R2 = 0.42). Grad-CAM heatmap evaluation showed that the model decisions rely on retinal morphology factors relevant to AMD diagnosis. CONCLUSION: The developed method allows an efficient PRS estimation from OCT images. A new technique for analysing the association of OCT images with PRS of AMD, using a deep learning approach, may provide an opportunity to discover new associations between genotype-based AMD risk and retinal morphology.
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PURPOSE: To evaluate the effectiveness of intravitreal bevacizumab treatment in patients with diabetic macular edema (DME) by assessing retinal changes using AngioTool software (version 0.6a(02.18.14), National Cancer Institute, Bethesda, Maryland). METHODS: A total of 27 eyes in patients with treatment-naïve DME were included in this prospective study. OCT-A images with a scan area of 6 × 6 mm were obtained. The DME patients with a central macular thickness (CMT) of ≥300 µm received nine bevacizumab injections within 12 months. The demographic, systemic, and ocular parameters, including the best-corrected visual acuity (BCVA) and CMT, were assessed. Explant area, vessels area, vessels percentage area, total number of junctions, total vessels length, average vessels length, the total number of endpoints, and mean lacunarity in the superficial capillary plexus (SCP) were calculated by using AngioTool software. RESULTS: Twenty-nine eyes of DME patients were subjected to the final analysis. Bevacizumab treatment reduced CMT from 401.84 ± 84.54 µm to 328.93 ± 87.17 µm and improved BCVA from 65.18 ± 8.21 at baseline to 72.63 ± 7.43 letters among participants of the study. The anti-VEGF therapy showed no statistically significant changes in parameters calculated by AngioTool software in the study group of patients. CONCLUSION: The fixed-regimen intravitreal bevacizumab therapy was effective in treating DME. AngioTool software is an additional tool that could be used to assess vascular networks. However, the use of OCTA is unlikely to alter DME treatment regimens significantly or to find significant predictors. Perhaps using wide-angle devices or software will give a complete picture of the disease and prove to be more helpful.
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PURPOSE: To evaluate the effectiveness of intravitreal bevacizumab treatment in patients with diabetic macular edema (DME) by assessing retinal changes using optical coherence tomography angiography (OCT-A). METHODS: This prospective study was performed in patients with treatment-naïve DME. The eyes of patients were imaged using a swept-source OCT system with a scan area of 6 × 6 mm. The DME patients with a central macular thickness (CMT) of ≥300 µm received nine bevacizumab injections within 12 months. The demographic, systemic, and ocular parameters, including the best-corrected visual acuity (BCVA), CMT, microaneurysm (MA) count, and foveal avascular zone (FAZ) area in both superficial capillary plexus (SCP) and deep capillary plexus (DCP), as well as vessel density in SCP, were assessed in the patients. In addition, the response (good or poor) of the DME eyes to bevacizumab treatment and the final visual acuity (BCVA of 75 letters) were analyzed. RESULTS: Seventy-seven eyes of DME patients were subjected to the final analysis. Bevacizumab treatment reduced CMT from 425.06 µm (±77.15) to 350.25 µm (±82.04) and improved BCVA by about 8.61 letters (from 64.73 to 73.34) in the patients. The mean number of MAs in SCP decreased from 3.51 ± 2.07 to 2.31 ± 1.15 (p < 0.001) and in DCP from 17.12 ± 11.56 to 12.21 ± 6.99 (p < 0.001), whereas the area of FAZ increased in SCP from 328.22 ± 131.38 to 399.70 ± 156.98 (p < 0.001) and in DCP from 571.13 ± 396.01 to 665.89 ± 412.77 (p = 0.001). The final BCVA letter score and CMT were statistically significant in both poor and good responders, as well as in BCVA < 75 and BCVA ≥ 75 groups. CONCLUSION: The fixed-regimen intravitreal bevacizumab therapy was effective in treating DME. Apart from noninvasive visualization of microvascular damage, OCT-A showed limited usefulness in predicting treatment response. Although the study showed that the number of MAs was significantly reduced during treatment, which is an OCT-A predictor of a good response to bevacizumab treatment at a 12-month visit, commonly observed artifacts may reduce the usefulness of OCT-A.
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Bevacizumab/farmacologia , Retinopatia Diabética/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Inibidores da Angiogênese/metabolismo , Inibidores da Angiogênese/farmacologia , Inibidores da Angiogênese/uso terapêutico , Bevacizumab/metabolismo , Bevacizumab/uso terapêutico , Retinopatia Diabética/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Pesquisa Qualitativa , Estatísticas não Paramétricas , Tomografia de Coerência Óptica/métodos , Tomografia de Coerência Óptica/estatística & dados numéricosRESUMO
BACKGROUND: The present study examined the relationships among retinal structure, peripheral retinal abnormalities, and epiretinal membrane (ERM) and explored the utility of ultra-wide-field laser scanning ophthalmoscopy in idiopathic ERM assessment. METHODS: The study sample comprised 276 eyes of 276 patients. Ultra-wide field fundus imaging was performed without mydriasis using Optos California. Each patient underwent a Goldmann three-mirror contact lens fundus examination. RESULTS: Ultra-wide field laser scanning ophthalmoscopy revealed peripheral retinal degeneration in 84 (54.54%) eyes in the ERM and in 28 (22.95%) eyes in the control group. Goldmann three-mirror contact lens examination revealed peripheral retinal degeneration in 96 (62.33%) eyes in the ERM group and 42 (34.42%) eyes in the control group. Ultra-wide field ophthalmoscopy enabled the detection of nearly 87% of all peripheral retinal lesions in patients with ERM, but it cannot replace fundus examination with a Goldmann triple mirror or ophthalmoscopy with scleral indentation. CONCLUSIONS: In most patients, idiopathic ERM coexisted with changes in the peripheral retina. Some of these changes promote retinal detachment. Thus, surgeons should consider the risk of retinal tear during vitrectomy, which increases the scope of surgery and may adversely affect prognosis. Although ultra-wide field imaging is a valuable diagnostic method, it is not a substitute for Goldmann three-mirror contact lens fundus examination or ophthalmoscopy with scleral indentation.
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This study evaluated the relationship between the retinal nonperfusion area (NPA) presence and the effectiveness of bevacizumab treatment (IVB) in patients with diabetic macular edema (DME). It also tested the prognostic usefulness of ultra-wide-field fluorescein angiography (UWFFA) and OptosAdvance software for diabetic retinopathy monitoring. Eighty-nine patients with DME with a macular central subfield thickness (CST) ≥ 250 µm, with (N = 49 eyes) and without (N = 49 eyes) retinal NPA, underwent nine bevacizumab injections over 12 months. NPA distribution, leakage area distribution, microaneurysm (MA) count, macular CST, diabetic retinopathy severity, and best-corrected visual acuity (BCVA) were assessed. The results show that bevacizumab reduced the macular CST from 420 to 280 µm (p < 0.001) and improved BCVA (p < 0.001) by about 10 ETDRS letters in both groups of patients. Additionally, the therapy reduced total retinal NPA from 29 (14-36) mm2 to 12 (4-18) mm2 (Me (Q1-Q3); p < 0.001) in patients with diagnosed nonperfusion. The effect of the therapy measured with vascular leakage, MA count, BCVArelative, and CSTrelative strongly depended on the zone of the retina and the NPA distribution. We conclude that the bevacizumab treatment had a positive effect on DME and BCVA in both study groups and on the size of retinal NPA in patients with retinal nonperfusion.
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Inibidores da Angiogênese/administração & dosagem , Bevacizumab/administração & dosagem , Capilares/efeitos dos fármacos , Retinopatia Diabética/tratamento farmacológico , Edema Macular/tratamento farmacológico , Vasos Retinianos/efeitos dos fármacos , Idoso , Inibidores da Angiogênese/efeitos adversos , Bevacizumab/efeitos adversos , Capilares/diagnóstico por imagem , Capilares/fisiopatologia , Permeabilidade Capilar/efeitos dos fármacos , Estudos de Casos e Controles , Retinopatia Diabética/diagnóstico por imagem , Retinopatia Diabética/fisiopatologia , Feminino , Angiofluoresceinografia , Humanos , Injeções Intravítreas , Edema Macular/diagnóstico , Edema Macular/fisiopatologia , Masculino , Microcirculação/efeitos dos fármacos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Vasos Retinianos/diagnóstico por imagem , Vasos Retinianos/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Acuidade Visual/efeitos dos fármacosRESUMO
PURPOSE: To report 12-month outcomes of a Polish National Treatment Program using aflibercept and ranibizumab in eyes with wet, age-related macular degeneration in routine clinical practice. MATERIAL AND METHODS: This was a non-randomized, retrospective, observational multicenter study. Anonymous data contained in the electronic Therapeutic Program Monitoring System were utilized in this study. RESULTS: The study population consisted of 2828 eyes from 2718 patients. The median age was 76.0 [70.0, 81.0] years; 61.7% were female. Best corrected visual acuity increased from 58.86 [50.05, 69.95] letters to 65.1 [50.1, 73.9] letters (p < 0.001). The median change in best corrected visual acuity was 0.0 [-4.0, 12.2] letters: 2.9 [-2.9, 15.1] letters for treatment-naïve eyes and 0.0 [-4.0, 8.8] letters for those continuing treatment (p < 0.001). The median central retinal thickness was significantly reduced from 341.0 [281.0, 422.0] to 275.0 [221.0, 344.0] µm (p < 0.001). The median number of visits was 9.0 [8.0, 9.0]. The median number of injections was 7.0 [6.0, 8.0]: 8.0 [7.0, 8.0] for treatment-naïve eyes and 6.0 [5.0, 7.0] for those continuing treatment (p < 0.001). CONCLUSION: Eyes treated as part of the Polish therapeutic program gained functional stability and morphological improvement. Treatment-naïve eyes showed the greatest functional benefit.
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Inibidores da Angiogênese/uso terapêutico , Neovascularização de Coroide/tratamento farmacológico , Ranibizumab/uso terapêutico , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Degeneração Macular Exsudativa/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Neovascularização de Coroide/diagnóstico , Neovascularização de Coroide/fisiopatologia , Feminino , Seguimentos , Humanos , Injeções Intravítreas , Masculino , Polônia , Retina/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Acuidade Visual/fisiologia , Degeneração Macular Exsudativa/diagnóstico , Degeneração Macular Exsudativa/fisiopatologiaRESUMO
RATIONALE: Conjunctival papilloma is a benign neoplastic lesion of epithelial origin, with a minimal tendency toward malignancy and an exophytic growth type. Etiological factors that contribute to the appearance of papilloma are UV exposure, HPV infection, smoking, and immunodeficiency. A case report of limbal conjunctival papilloma treatment with topical interferon alpha-2b eye drops applied to the conjunctival sac. PATIENT CONCERNS: A 49-year-old female patient treated in the Clinical Department of Ophthalmology for conjunctival lesion located in the temporal quadrant near the limbus of the right eye. Ocular examination of the patient's eye did not show any abnormalities: visual acuity-20/20, intraocular pressure-16 mmHg. DIAGNOSES: During physical examination, a broad-based pink lesion of size 4âmm ×â6âmm was found in interpalpebral bulbar conjunctiva with prominent feeder vessels and soft consistency. Lesion in the biomicroscopic examination did not show any sign of malignancy. In Swept Source Optical Coherence Tomography (SS-OCT) there was no sign of infiltration into sclera or cornea. In vivo confocal microscopy (IVCM) examination, revealed loss of the normal conjunctival epithelium - hyper-reflective cells, variation of cell size. A clinical diagnosis of limbal conjunctival papilloma was made. INTERVENTIONS: Interferon alpha-2b 1 million IU/ml eye drops were applied 4 times a day for 5 months. The treatment lasted 5 months without changing the dosing regimen. Three months after the start of the interferon treatment, a complete regression of the lesion was achieved. Treatment was continued for the following 2 months. Controlled IVCM after 6 months showed only few hyper-reflective cells and fibrotic tissue. OUTCOMES: Treatment of conjunctival papilloma with topical interferon alpha-2b led to the complete regression of the lesion. Although after the therapy the conjunctiva appears normal both in slit lamp and in the OCT examination, there is a noticeable fibrosis of the tissue in confocal microscopy. During the 14-month follow-up period, there were no recurrent lesions. LESSONS: In this study, topical interferon alpha-2b has been shown to be an effective and safe therapy for small-to-medium-size conjunctival papilloma without any sign of malignancy.
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Doenças da Túnica Conjuntiva/tratamento farmacológico , Interferon alfa-2/uso terapêutico , Papiloma/tratamento farmacológico , Administração Tópica , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
PURPOSE: To describe the findings of in vivo confocal microscopy (IVCM) and anterior segment optical coherence tomography (AS-OCT) in a case of bilateral acute microcystic epitheliopathy after daily soft contact lens wear. METHODS: IVCM and AS-OCT were used in the course of the bilateral epitheliopathy of a 23-year-old patient at the acute stage of the disease and at recovery after four days of treatment. The images were analyzed and compared. RESULTS: On AS-OCT of the right eye, general hyperreflectivity and the increased thickness of the central corneal epithelium to 150 µm with numerous hyporeflective small, oval cysts were revealed and resolved completely at day 4 after diagnosis and treatment. AS-OCT scans of the left eye revealed oval shaped, hyperreflective material within the corneal epithelium. IVCM of both eyes showed numerous microcysts of different sizes filled with hyperreflective material mostly within superficial epithelial layers. Epithelial cells showed a polymorphism along with disruption of a cytoarchitecture. Basal epithelial cells and anterior stroma showed inflammatory changes. Posterior corneal stroma and endothelium presented normal morphology. CONCLUSIONS: Microcystic keratitis appeared as localized microcystic inflammation of epithelium on AS-OCT, which was confirmed by IVCM. Both IVCM and AS-OCT are helpful diagnostic instruments in case of cystic inflammation of corneal epithelium.
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BACKGROUND: Despite the significant impact of retinal diseases such as wet age-related macular degeneration (wAMD) and diabetic macular edema (DME), there is a limited understanding of how these conditions are managed in Central and Eastern Europe (CEE). OBJECTIVES: To provide a comprehensive overview of the clinical and economic burden of wAMD and DME in CEE and the status quo associated with their management. METHODS: A narrative literature review was undertaken to identify existing data on wAMD and DME, including epidemiology, economic burden, clinical guidelines, and available and reimbursed treatments. Data were collected from relevant sources such as PubMed, ophthalmology associations, national statistical offices, and government agency websites; practical viewpoints were provided by local ophthalmologists and healthcare economics experts in CEE. RESULTS: Epidemiological data on wAMD and DME are limited in CEE, and intercountry comparison is difficult because of differences in data collection methodologies. There are effective treatment options for wAMD and DME, and international guidelines advocate the use of intravitreal anti-vascular endothelial growth factor injections as first-line therapy. Local expert organizations broadly support these recommendations; nevertheless, no clinical practice guidelines exist on the treatment of wAMD and DME in CEE. Access to and reimbursement of anti-vascular endothelial growth factor agents vary significantly in the region and, as a result, many patients remain untreated or inadequately treated. CONCLUSIONS: There is an urgent need for the creation of a wAMD/DME treatment program in CEE to ensure that patients have timely access to the most appropriate treatments.
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Efeitos Psicossociais da Doença , Atenção à Saúde/economia , Política de Saúde/economia , Edema Macular/epidemiologia , Degeneração Macular Exsudativa/epidemiologia , Europa (Continente)/epidemiologia , Guias como Assunto/normas , Humanos , Mecanismo de Reembolso , Doenças Retinianas/terapiaRESUMO
BACKGROUND: Treatment of neovascular age-related macular degeneration (nAMD) remains a major challenge in ophthalmology. It is essential to determine which of VEGF inhibition non-responders can benefit from photodynamic therapy (PDT). As AMD is strongly related to gene polymorphisms, genetic factors can modify efficacy of treatment. Swept-source optical coherence tomography (SS-OCT) gives exceptional insight into the retina and choroid. SS-OCT usefulness needs to be evaluated in nAMD patients. METHODS: Prospective 6-month study included consecutive 110 patients (110 eyes) with predominantly classic neovascular AMD treated with photodynamic therapy. Only non-responders to anti-VEGF were included in the study. Greatest linear dimension (GLD) of the lesion, best corrected visual acuity (BCVA), central subfield macular thickness (CSMT) and central choroidal thickness were assessed and compared between CFH and ARMS2 genotype groups. Success rate was the main endpoint. It was defined as not active CNV in the center of the fovea and no worsening in BCVA. Multiple regression was used to assess gene polymorphisms influence on PDT results. Wilcoxon tests were performed to determine significance of changes from baseline values. RESULTS: Following genotype frequencies were obtained-CFH CC 35 patients (31.8%), CT 52 (47.3%), TT 23 (20.9%); ARMS2 TT 28 patients (25.4%), GT 43 (39.1%), GG 39 (35.4%) success rate in CC/CT/TT CFH and TT/GT/GG ARMS2 groups were as follows respectively: 22.9%, 28.8%, 30.4% and 28.6%, 25.6%, 28.2%. The differences were not significant with highest odds ratio TT vs. CC CFH 1.57 (95% CI 0.48-5.2, p=0.4). Significant increase in GLD was observed only in CC CFH group. Overall mean following measured parameters were obtained at baseline/day 7/month 3/month 6 (significant changes from baseline are marked with asterisk): GLD-3825±1301µm/3901±1579µm/3861±1463µm/3925±1523µm; CSMT-405±203µm/434±257µm*/321±163µm*/295±157*µm; CCT-235±103µm/278±157*µm/211±113µm*/201±107*µm; BCVA-49.3±12.5/43.2±14.2*/49.6±11.6/48.7±12.2 letters on ETDRS charts. In all patients classic component of the lesion was assessed with SS-OCT with no need to be reaffirmed in FA. Thus FA was used mainly for lesion size calculation. CONCLUSIONS: Common genetic factors seem not to influence PDT effectiveness in VEGF inhibitors non-responders. SS-OCT is a valuable tool of nAMD monitoring, especially for choroid assessment. Deterioration of retinal structure and function is observed one week after PDT. It is related to increase in both retinal and choroidal thickness and is accompanied by mild temporary BCVA decrease.
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Degeneração Macular/tratamento farmacológico , Degeneração Macular/genética , Fotoquimioterapia/métodos , Proteínas/genética , Tomografia de Coerência Óptica/métodos , Idoso , Inibidores da Angiogênese/uso terapêutico , Fator H do Complemento/genética , Feminino , Predisposição Genética para Doença/genética , Humanos , Degeneração Macular/diagnóstico por imagem , Masculino , Testes Farmacogenômicos , Fármacos Fotossensibilizantes/uso terapêutico , Polimorfismo de Nucleotídeo Único , Falha de Tratamento , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidoresRESUMO
Currently in Poland neovascular form of age-related macular degeneration (AMD) is treated with vascular endothelial growth factor (VEGF) inhibitors--ranibizumab, aflibercept and bevacizumab. Photodynamic therapy is still refunded, although it is very rarely used. It can be estimated that only small minority (about 5-10%) of cases are properly treated due to mainly refunding restrictions in Poland. In countries with wider access to treatment 50% reduction in AMD-related blindness incidence was noted. Low-cost off-label anti-VEGF agent bevacizumab is almost inaccessible in Polish public health system because of law regulations. In order to increase availability of anti-VEGF injections vials of all mentioned drugs are divided which raises safety concerns. Despite new potent drug in the market aflibercept, cost of treatment remains very high. The optimal treatment regimen includes three monthly injections, after which is usually used pro re nata therapy based primarily on the outcome of macular optical coherence tomography. Routinely recommended antibiotic prophylaxis of injection-related endophthalmitis probably has no meaning apart from the generation of resistance.
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Degeneração Macular/tratamento farmacológico , Neovascularização Patológica/tratamento farmacológico , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Anticorpos Monoclonais Humanizados/administração & dosagem , Anticorpos Monoclonais Humanizados/economia , Bevacizumab , Esquema de Medicação , Humanos , Neovascularização Patológica/etiologia , Fotoquimioterapia/economia , Polônia , Ranibizumab , Receptores de Fatores de Crescimento do Endotélio Vascular/administração & dosagem , Receptores de Fatores de Crescimento do Endotélio Vascular/economia , Receptores de Fatores de Crescimento do Endotélio Vascular/provisão & distribuição , Proteínas Recombinantes de Fusão/administração & dosagem , Proteínas Recombinantes de Fusão/economia , Proteínas Recombinantes de Fusão/provisão & distribuição , Reembolso de IncentivoRESUMO
The prevalence of benign prostate hyperplasia (BPH) and cataract increases with age. Both diseases may develop concomitantly and may affect almost 50% of elderly men as comorbidities. Cataract is treated surgically and it has been reported that there may be an association between use of alpha-blockers for BPH, particularly alpha1A-adrenergic receptor selective drugs, and complications of cataract surgery known as Intraoperative Floppy Iris Syndrome (IFIS). The article reviews literature published on this topic and provides recommendations on how to reduce incidence of iatrogenic IFIS or its severity and outcomes in patients with BPH.
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PURPOSE: To determine whether gene polymorphisms of the major genetic risk factor for age-related macular susceptibility 2 (ARMS2 A69S) and the complement factor H Y402H influence the response to a variable-dosing treatment regimen with ranibizumab for age-related macular degeneration. METHODS: This prospective cohort study included 90 patients (90 eyes) with exudative age related macular degeneration (AMD) treated with ranibizumab. Patients underwent a 1-year treatment as in the Study of Ranibizumab in Patients with Subfoveal Choroidal Neovascularization Secondary to Age-Related Macular Degeneration (Mitchell et al.). Injections were administered monthly when a patient lost five letters on the Early Treatment Diabetic Retinopathy Study chart or gained 100 µm in central subfield retinal thickness (CSRT). Genotypes (rs10490924 and rs1061170) were analyzed using gene sequence analysis. Best-corrected visual acuity (BCVA) and CSRT values were compared between ARMS2 and complement factor H genotypes. Multiple regression analysis was used to assess the statistical significance. RESULTS: Mean increase in visual acuity was 4.44±8.12 letters with a 103.63±94.7 µm decrease in CSRT. BCVA improvement was statistically significant in all genotype groups except in homozygous 69S in the AMRS2 gene. CSRT and BCVA changes were correlated (r=0.2521; 95% CI: 0.04746-0.4364, p=0.0165). Multiple regression analysis revealed a significant impact of 69S (p=0.015) on the change in BCVA. CONCLUSIONS: Visual acuity did not improve during the study in patients homozygous for ARMS2 69S, despite a decrease in CSRT. Further investigation is needed to confirm our findings and understand the mechanisms involved.
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Inibidores da Angiogênese/administração & dosagem , Inibidores da Angiogênese/uso terapêutico , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais/uso terapêutico , Degeneração Macular/tratamento farmacológico , Degeneração Macular/genética , Idoso , Substituição de Aminoácidos/genética , Anticorpos Monoclonais Humanizados , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Genótipo , Humanos , Degeneração Macular/fisiopatologia , Masculino , Ranibizumab , Análise de Regressão , Retina/patologia , Retina/fisiopatologia , Resultado do Tratamento , Acuidade VisualRESUMO
Diabetic macular edema is very important medical and social problem and major cause of severe and permanent visual acuity depression in the working-age population. Rapid diagnostics with optical coherence tomography, color fundus photography, fluorescein angiography and appropriate treatment in patients with diabetes stops or retards progress of diabetic macular edema.
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Retinopatia Diabética/diagnóstico , Retinopatia Diabética/terapia , Edema Macular/diagnóstico , Edema Macular/terapia , Adulto , Diagnóstico Precoce , Humanos , Pessoa de Meia-IdadeRESUMO
PURPOSE: To compare anterior segment measurements and morphology of 2 optical coherence tomography (OCT) systems. SETTING: Department of Ophthalmology, District Railway Hospital, and the Nursing Department and Social Medical Issues, Health Care Division, Silesian Medical University, Katowice, Poland. METHODS: In normal eyes and in eyes with corneal and trabecular-iris angle disorders, the central corneal thickness (CCT), trabecular-iris angle, and angle-opening distance at the nasal and temporal angles were measured 3 times during 1 visit using the Visante time-domain OCT system and the RTVue-100 Fourier-domain corneal anterior module OCT system. Anterior segment morphology was assessed and compared. RESULTS: Fifty-four eyes were evaluated. The mean values (+/-SD) by time-domain OCT and Fourier-domain OCT were, respectively, automatic CCT, 535 +/- 33.07 microm and 538 +/- 31.82 microm; manual CCT, 545 +/- 30.91 microm and 542 +/- 30.57 microm; nasal trabecular-iris angle, 34.7 +/- 9.5 degrees and 35.2 +/- 8.9 degrees; temporal trabecular-iris angle, 35.3 +/- 8.5 degrees and 35.5 +/- 9 degrees; nasal angle-opening distance, 435 +/- 95 microm and 444 +/- 98 microm; and temporal angle-opening distance, 443 +/- 103 microm and 452 +/- 99 microm. There was no significant difference between mean values, and they were highly correlated. On morphologic analysis, time-domain OCT had lower resolution; however, all anterior chamber structures were visible on 1 image. Fourier-domain OCT provided precise information about small areas of the anterior chamber. CONCLUSION: Fourier-domain OCT provided accurate anterior eye segment measurements that agreed with those obtained with time-domain OCT.
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Segmento Anterior do Olho/patologia , Doenças da Córnea/diagnóstico , Tomografia de Coerência Óptica/métodos , Doenças da Úvea/diagnóstico , Adulto , Feminino , Análise de Fourier , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia de Coerência Óptica/instrumentaçãoRESUMO
VEGF, an endothelial specific growth factor, stimulates vascular permeability and angiogenesis. VEGF is involved in many physiological and pathological processes including embryogenesis, wound healing, tumor growth, choroidal neovascularization and many others. Authors discuss VEGF structure, known isoforms and their mechanisms of function, focusing on VEGF influence on eye tissues.
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Endotélio Vascular/fisiopatologia , Olho/irrigação sanguínea , Degeneração Macular/fisiopatologia , Fator A de Crescimento do Endotélio Vascular/metabolismo , Humanos , Neovascularização Patológica , Neovascularização Fisiológica , Fator A de Crescimento do Endotélio Vascular/químicaRESUMO
Wet AMD remains a therapeutic challenge. VEGF inhibitors are new promising group of medical agents undergoing advanced clinical trials. Oncology is the main specialty using anti-VEGF therapy. Two agents were designed from the beginning as ophthalmologic medicines. These are pegaptanib and ranibizumab. In the paper there is mechanism, efficacy and safety data presented, especially coming from multi-center randomized clinical trials. Monoclonal VEGF-antibodies (ranibizumab and bevacizumab) seem to be most effective in wet AMD treatment. Because of important physiological VEGF role long-term observation is needed to confirm safety of VEGF inhibition.
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Inibidores da Angiogênese/farmacologia , Anticorpos Monoclonais/farmacologia , Aptâmeros de Nucleotídeos/farmacologia , Degeneração Macular/tratamento farmacológico , Retina/efeitos dos fármacos , Fator A de Crescimento do Endotélio Vascular/metabolismo , Anticorpos Monoclonais Humanizados , Humanos , Degeneração Macular/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Ranibizumab , Resultado do TratamentoRESUMO
Authors present one of the ocular diabetic complications--diabetic keratoepitheliopathy. The aim of this article is to summarize the knowledge about diabetic keratoepitheliopathy, its causes, manifestations and treatment options. Diabetes mellitus is associated with structural and functional disturbances in eyelids, conjunctiva and cornea. There are also changes in tear film present. Diabetic neuropathy resulting from the biochemical poor control of diabetes is the probable basic cause of the pathology. Mechanisms responsible for these changes are still not well understood. The corneal and conjunctival complications may occur spontaneously. But more often they arise from undue stress of intraocular surgery procedures. The incidence of diabetic keratoepitheliopathy in diabetic patients is high. However, it is rarely diagnosed. Effectiveness of symptomatic treatment with use of common medications is not satisfactory and it needs further investigation.