Long-term effect of antiangiogenic therapy for retinopathy of prematurity up to 5 years of follow-up.

PURPOSE: To evaluate ocular function and systemic development in premature infants treated with intravitreal bevacizumab injections for retinopathy of prematurity over a period of 5 years. METHODS: A prospective, interventional, noncomparative case study. The primary outcome measure was visual acuity. The secondary outcomes were structural assessment, other ocular functional measurements, and developmental state. RESULTS: Eighteen eyes of 13 consecutive patients were divided into 3 groups: Group 1, Stage 4 unresponsive to previous conventional treatment (n = 4); Group 2, in which conventional treatment was difficult or impossible because of inadequate visualization of the retina (n = 5); and Group 3, newly diagnosed high-risk prethreshold or threshold retinopathy of prematurity (n = 9). All patients showed initial regression of neovascularization. One patient was diagnosed with recurrence of neovascularization and was treated with intravitreal bevacizumab. Visual acuity was preserved, and median vision was 20/25 (excluding 2 operated eyes). Twelve eyes developed mainly low myopia over the years, with an overall mean value of 3.2 diopters. Electroretinograph was normal in 4 eyes that had no previous detachment. One patient showed delay in growth and neurodevelopment, whereas all the others were within the normal range. CONCLUSION: Five years of follow-up in a small series suggest that intravitreal bevacizumab for retinopathy of prematurity results in apparently preserved ocular function and systemic development.

Safety of intravitreal quinupristin/dalfopristin in an animal model.

AIM: To determine whether different intravitreal doses of quinupristin/dalfopristin lead to electroretinographic or histological changes in the rabbit retina over one month period after injection. METHODS: Eighteen New Zealand white rabbits were divided into three treatment groups (groups 1 to 3) and different intravitreal doses of quinupristin/dalfopristin were tested in each group. The right eye was injected with the drug and the left eye received intravitreal injection of 5% dextrose water and served as control eye. The doses delivered to each group were 0.1 mg/0.1 mL, 1 mg/0.1 mL and 10 mg/0.1 mL. Simultaneous, bilateral, dark-adapted electroretinography and clinical images of both eyes were obtained in all groups before injection (baseline) and after 7, 14, 21 and 28d, followed by enucleation for histological examination. RESULTS: Subjects in the group 1 showed no signs of toxicity in the electroretinogram when compared with groups 2 and 3 (Kruskall-Wallis test, P=0.000). By day 7, no electrical response to light stimuli was recorded in the treated eyes in groups 2 and 3, consistent with severe damage due to retinal toxicity. Light microscopy revealed no significant histopathological changes in the group 1, while rabbits in groups 2 and 3 had signs of granulomatous inflammation in most cases. CONCLUSION: Intravitreal 0.1 mg/0.1 mL doses of quinupristin/dalfopristin do not lead to electroretinographic or histological signs of retinal toxicity compared with 1 mg/0.1 mL and 10 mg/0.1 mL in this rabbit model.

Vitrectomy with complete posterior hyaloid removal for ischemic central retinal vein occlusion: series of cases.

BACKGROUND: Central retinal vein occlusion (CRVO) is a common retinal vascular disorder with potentially complications: (1) persistent macular edema and (2) neovascular glaucoma. No safe treatment exists that promotes the return of lost vision. Eyes with CRVO may be predisposed to vitreous degeneration. It has been suggested that if the vitreous remains attached to the macula owing to a firm vitreomacular adhesion, the resultant vitreous traction can cause inflammation with retinal capillary dilation, leakage and subsequent edema6. The roll of vitrectomy in ischemic CRVO surgical procedures has not been evaluated. CASE PRESENTATION: This is a non comparative, prospective, longitudinal, experimental and descriptive series of cases. Ten eyes with ischemic CRVO. Vitrectomy with complete posterior hyaloid removal was performed. VA, rubeosis, intraocular pressure (IOP), and macular edema were evaluated clinically. Multifocal ERG (m-ERG), fluorescein angiography (FAG) and optic coherence tomography (OCT) were performed. Follow-up was at least 6 months. Moderate improvement of visual acuity was observed in 60% eyes and stabilized in 40%. IOP changed from 15.7 +/- 3.05 mmHg to 14.9 +/- 2.69 mmHg post-operative and macular edema from 976 +/- 196 microm to 640 +/- 191 microm to six month. The P1 wave amplitude changed from 25.46 +/- 12.4 mV to 20.54 +/- 11.2 mV. CONCLUSION: A solo PPV with posterior hyaloid removal may help to improve anatomic and functional retina conditions in some cases. These results should be considered when analyzing other surgical maneuvers.

Spontaneous closure of a large traumatic macular hole in a young patient.

PURPOSE: To report the spontaneous resolution of a traumatic macular hole that was considerably larger than in previously reported cases. DESIGN: Observational case report. METHODS: The clinical and angiographic data of the patient were reviewed. RESULTS: A traumatic 600 x 400 micro macular hole was observed to spontaneously resolve 5 weeks after trauma in a 15-year-old patient. Visual acuity only slightly improved consequently (from counting fingers at 4 meters to 20/200). The clinical appearance of the fovea after macular hole resolution raised the suggestion that a postconcussion retinal necrosis was the mechanism behind the lesion formation in this case. CONCLUSIONS: Spontaneous resolution of a traumatic macular hole is an outcome not limited to small lesions. Larger macular holes may represent retinal tissue loss and consequently a less favorable visual prognosis.

Enlarged diode laser spot using indirect ophthalmoscope delivery in conjunction with indocyanine green to treat large choroidal neovascularizations.

BACKGROUND AND OBJECTIVE: To evaluate the effectiveness of a new method of delivering diode laser (810 nm) spots through an indirect ophthalmoscope in conjunction with intravenous indocyanine green to treat choroidal neovascularizations (CNVs) larger than 5,400 microm. PATIENTS AND METHODS: A prospective, non-comparative, interventional case series study was conducted with 8 patients with CNV secondary to age-related macular degeneration. Laser pulses were applied to the CNV within 5 minutes of an intravenous injection of 25 mg of indocyanine green. The laser spot was enlarged up to one disc diameter by shortening the distance between the indirect ophthalmoscope and the 20-diopter viewing lens. The follow-up period was 3 months. RESULTS: Three eyes had an improvement in visual acuity of more than 2 lines, and fluorescein angiography showed stabilization of the membrane and reduction of the hemorrhages and subretinal fluid at the last follow-up. Three other eyes maintained the same visual acuity and two had a decrease in visual acuity of more than 2 lines at the 3-month follow-up examination. CONCLUSION: Laser treatment delivered through an indirect ophthalmoscope system may be used as a palliative treatment for CNVs larger than 5,400 microm.

Tractional retinal detachment after intravitreal injection of bevacizumab in proliferative diabetic retinopathy.

PURPOSE: To assess the short-term complications of a single dose of intravitreal bevacizumab in patients with proliferative diabetic retinopathy (PDR). METHODS: Retrospective review of 343 patients with PDR who were treated with intravitreal injection of bevacizumab (2.5 mg/0.1 mL). RESULTS: Five patients (1.45%) presented tractional retinal detachment 1 to 6 weeks (mean 3 weeks) after intravitreal injection. All cases underwent pars plana vitrectomy, removal of all epiretinal fibrovascular membranes, further endolaser panretinal photocoagulation, and silicone tamponade. CONCLUSION: Tractional retinal detachment may occur in a short time post intravitreal injection of bevacizumab in patients with proliferative diabetic retinopathy with extensive areas of ischemia and fibrovascular proliferations, and may require prompt vitreoretinal surgery.