ABSTRACT
PURPOSE: To evaluate the peri- and post-intravitreal injection (IVI) symptoms reported by patients who have been repeatedly injected for age-related macular degeneration (AMD) and to analyze these according to the protocols of the injector. MATERIALS AND METHODS: Multi-center, cross-sectional, consecutive, analytical survey. RESULTS: The IVI protocols of 106 injectors differed in terms of the number of instillations of povidone-iodine, its contact time, and rinsing of the ocular surface post-injection. In total, 3,738 patients responded to the survey, 60.1% of whom were women; 36.4% had received more than 20 IVIs; 50.7% of patients reported irritation upon application of povidone-iodine. Post-IVI, depending on the symptom in question, between 44.8% and 57.4% of patients reported symptoms of ocular surface change. The number of instillations of povidone-iodine, its contact time with the ocular surface, and abundant rinsing post-IVI increased the immediate symptoms. Patients who received more IVIs were more prone to experiencing gritty eyes, and the incidence of acute pain increased in patients who had previously received over 20 IVIs. Women and patients previously treated for dry eye or glaucoma were at greater risk of worse symptoms. CONCLUSION: Comparing injecting centers' practices with patients' self-assessments showed an aggravation of symptoms of ocular surface changes related to povidone-iodine. This survey contributes to providing data for the implementation of a protocol to improve the quality of life of patients injected repeatedly for AMD.
Subject(s)
Macular Degeneration , Quality of Life , Humans , Female , Male , Intravitreal Injections , Cross-Sectional Studies , Povidone-Iodine/adverse effects , Macular Degeneration/drug therapy , Macular Degeneration/epidemiologyABSTRACT
Choosing a first-line treatment to optimize long-term outcomes is a major challenge for treating patients with neovascular age-related macular degeneration (AMD). The development of several new molecules makes it critical to identify the relevant factors to consider so as to provide an optimal risk-benefit ratio when initiating a treatment in naïve patients with neovascular AMD. This paper proposes a consensus established with the Delphi method (which includes a gradation in a consensus based on an analysis of the convergence rate of answers) to provide criteria that guide the ophthalmologist's decision for treatment initiation and follow-up in neovascular AMD patients. Fourteen questions were submitted to 93 French retina experts. Thirteen (93%) of the questions reached a consensus (≥50% of answers consensual). The criteria recommended to take into account were both efficacy and onset of action of the molecules, their safety, and the ability to decrease injection frequency. The primary criterion of expected efficacy of a molecule is a combination of the gain in visual acuity and resorption of retinal fluid. With regard to safety, experts recommend tighter follow-up for molecules currently in development, and at every scheduled visit, patients should be screened to identify early any potential adverse effects such as intraocular inflammation, retinal vasculitis or vascular occlusion. Experts also emphasize the importance of the packaging of the biological, with a preference toward prefilled syringes. Injection frequency is a key factor, and the authors recommended aiming for a maximal injection interval of 12 to 16 weeks. The stability of that maximum interval is also an important factor to consider in treatment selection.
Subject(s)
Angiogenesis Inhibitors , Wet Macular Degeneration , Angiogenesis Inhibitors/therapeutic use , Consensus , Humans , Intravitreal Injections , Risk Assessment , Vascular Endothelial Growth Factor A , Visual Acuity , Wet Macular Degeneration/diagnosis , Wet Macular Degeneration/drug therapy , Wet Macular Degeneration/epidemiologySubject(s)
Eye Diseases/diagnostic imaging , Fovea Centralis/diagnostic imaging , Hamartoma/diagnostic imaging , Pigment Epithelium of Eye/diagnostic imaging , Eye Diseases/congenital , Female , Fundus Oculi , Hamartoma/blood supply , Hamartoma/congenital , Humans , Retinal Vein/diagnostic imaging , Tomography, Optical Coherence , Young AdultABSTRACT
Vitreoretinal relationships can be evaluated by biomicroscopic examination and ultrasound. We analyzed 220 normal and emmetropic eyes in a population between the ages of 20 to 80 years to evaluate the position of the posterior vitreous surface (prospective study). We found that: Most cases of very partial and very peripheral P.V.D. (71/220 eyes; 32%), especially those confined to the nasal quadrant (50/71 eyes), corresponded to a simple increase of reflectivity of the vitreous base rather to than real PVD. Twenty-five per cent of the patients over the age of 80 years did not have PVD. The frequency of partial PVD located in 2, 3 and 4 quadrants except the posterior pole was very low, regardless of age. These partial PVD are transient. Fifty-eight per cent of the patients over the age of 80 years had a complete PVD. This percentage is clearly lower than that reported by most of the large biomicroscopic studies. The extension of PVD always begins at the vitreous base and ends at the posterior pole. This extension occurs around the age of 60-65 years and results, in most cases (35/38 eyes; 92%), in complete PVD with collapse. A prepapillary ring is a specific sign of complete PVD with or without collapse, but its absence (5/38 eyes) does not indicate the absence of PVD. The frequency of giant lacune is maximal (16/32 eyes; 50%) for young people between the ages of 30 and 40 years, then decreases as PVD becomes complete. The average level of reflectivity of the vitreous body is highest for patients between the ages of 70 and 80 years, but this variation is only very slight. This study also stresses the clinical criteria used to make the ultrasonic differential diagnosis between PVD and giant lacunae.
Subject(s)
Aging , Vitreous Body/diagnostic imaging , Adult , Aged , Aged, 80 and over , Diagnosis, Differential , Eye Diseases/diagnosis , Eye Diseases/diagnostic imaging , Humans , Middle Aged , Prospective Studies , UltrasonographyABSTRACT
El desprendimiento de retina por dehiscencia posterior es una entidad rara. Veintidós casos de DR por rotura del polo posterior han sido operados en el Centro Hospitalario de Rowen, Francia, entre 1979 y 1989. Se utilizaron solamente técnicas de tamponamiento interno con aire, gas (SF6) y silicona. Siempre se practicó una vitrectomía. Una retinopexia (láser argón) se realizó en primera intención, sólo en los casos de roturas extramaculares o utilización de silicona. El éxito anatómico con vitrectomía + SF6 alcanza 73%, y es inferior a otras series debido al alto número de roturas parapapilares y en borde de estafiloma de difícil retinopexia. Cincuenta por ciento de nuestras observaciones obtienen una agudeza visual calculable en postop. Esto se explica por la existencia de un número importante de roturas extramaculares. Los nuevos métodos de examen del cuerpo vítreo y sus relaciones con la retina, nos permiten separar las roturas del polo posterior en dos tipos. Aquellas con DPV completo, sin REM y que habitualmente son los agujeros maculares. En este caso una simple punción-aspiración del líquido retrohialoidio + SF6 bastaría. El otro grupo lo forman las roturas con DPV incompleto y que habitualmente son las roturas extramaculares. En estos casos una vitrectomía se impone
