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1.
Medicine (Baltimore) ; 100(4): e23675, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33530168

RESUMEN

BACKGROUND: At present, laser is regarded as an effective treatment for macular edema secondary to branch retinal vein occlusion. With the breakthrough of anti-vascular endothelial growth factor drugs in ophthalmology clinical research, the intravitreal injection of ranibizumab is widely applied, but both methods have their limitations, so some clinical studies have combined and applied them together. However, the clinical results are inconsistent and controversial, and there is no relevant system evaluation for the laser combined with intravitreal injection of ranibizumab for treatment of macular edema secondary to branch retinal vein occlusion now. OBJECTIVE: Meta analysis is used to analyze and evaluate the effectiveness and safety of the laser combined with intravitreal injection of ranibizumab for treatment of macular edema secondary to branch retinal vein occlusion. METHOD: CNKI, VIP, WANFANG, China Biology Medicine disc, Web of Science, PubMed, Embase, Cochrane Library have used random controlled clinical trial of laser combined with intravitreal injection of ranibizumab for treatment of macular edema secondary to branch retinal vein occlusion from the establishment of the database to October 2020. Two researchers conducted independent screening, quality assessment and data extraction for the literatures, and used RevMan5.3 to conduct Meta analysis for the included literatures. RESULT: The research has evaluated the effectiveness and safety of the laser combined with intravitreal injection of ranibizumab for treatment of macular edema secondary to branch retinal vein occlusion through the aspects of the best corrected visual acuity 6 months after operation, macular center thickness and the incidence of adverse reactions such as elevated intraocular pressure, endophthalmitis, vitreous hemorrhage and cataract. CONCLUSION: Laser combined with intravitreal injection of ranibizumab for treatment of macular edema secondary to branch retinal vein occlusion has good effect, and the research has provided reliable evidence for the use of clinical treatment of the laser combined with intravitreal injection of ranibizumab for treatment of macular edema secondary to branch retinal vein occlusion.


Asunto(s)
Inhibidores de la Angiogénesis/administración & dosificación , Coagulación con Láser/métodos , Edema Macular/terapia , Ranibizumab/administración & dosificación , Oclusión de la Vena Retiniana/terapia , Terapia Combinada , Humanos , Inyecciones Intravítreas , Edema Macular/etiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Oclusión de la Vena Retiniana/complicaciones , Resultado del Tratamiento , Agudeza Visual
2.
BMJ Case Rep ; 14(2)2021 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-33526522

RESUMEN

A 44-year-old woman presented with decreased vision in both eyes. The retina in both eyes had drusen distributed along vascular arcades, central macula and in peripapillary region. Macula had pigmented scarring and exudation. Fundus autofluorescence showed drusen. Optical coherence tomography showed drusen, subretinal and intraretinal fluid. Fundus fluorescein and indocyanine green angiography showed drusen, retinal pigment epithelial atrophy and vascular network. Younger age at presentation, bilateral symmetry, typical distribution of drusen along the arcades in a radiating pattern, peripapillary involvement, scarring and atrophy at macula were suggestive of doyne honeycomb retinal dystrophy. The reduced vision was due to macular atrophy and an active choroidal neovascular membrane. The patient was treated with antivascular endothelial growth factor injections for choroidal neovascular membrane. Our case highlights the importance of pattern recognition and multimodal imaging for diagnosing the type of macular dystrophy as doyne honeycomb retinal dystrophy, while simultaneously managing choroidal neovascular membrane.


Asunto(s)
Neovascularización Coroidal/diagnóstico por imagen , Angiografía con Fluoresceína , Tomografía de Coherencia Óptica , Adulto , Inhibidores de la Angiogénesis/uso terapéutico , Angiografía , Neovascularización Coroidal/complicaciones , Neovascularización Coroidal/tratamiento farmacológico , Colorantes , Femenino , Fondo de Ojo , Humanos , Verde de Indocianina , Inyecciones Intravítreas , Imagen Multimodal , Drusas del Disco Óptico/complicaciones , Drusas del Disco Óptico/congénito , Drusas del Disco Óptico/diagnóstico por imagen , Ranibizumab/uso terapéutico
3.
Vestn Oftalmol ; 137(1): 83-93, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-33610155

RESUMEN

The problem associated with the prevalence of retinal diseases, and age-related macular degeneration (AMD) in particular, is undoubtedly relevant. This aspect is based on steadily growing statistics on morbidity, a high number of randomized controlled trials (RCT) and published real world data (RWD). The analysis of RCT results being published by researchers on 15.05.19 showed 2915 studies were registered on the subject of retinal diseases; that exceeds the number of studies on glaucoma by approximately 1.38 times (2118 studies) and conjunctival lesions by 2.37 times (1230 studies). AMD is one of the leading causes of irreversible vision loss and blindness; its neovascular form leads to blindness in 80-90% of all cases. Even though the topic of nAMD therapy is widely highlighted in modern ophthalmology, today there are many aspects that require targeted solutions. The main controversial issues that determine the complexity of therapy and patient management include discrepancies in determination of reference points (disease activity criteria) for implementation of anti-VEGF dosing regimens, patients' compliance, prioritization issues in treatment, its continuity with potential for the increase of intervals between injections and monitoring visits.


Asunto(s)
Degeneración Macular , Degeneración Macular Húmeda , Inhibidores de la Angiogénesis/uso terapéutico , Humanos , Inyecciones Intravítreas , Degeneración Macular/diagnóstico , Degeneración Macular/tratamiento farmacológico , Ranibizumab/uso terapéutico , Resultado del Tratamiento , Factor A de Crecimiento Endotelial Vascular , Agudeza Visual , Degeneración Macular Húmeda/diagnóstico , Degeneración Macular Húmeda/tratamiento farmacológico
4.
BMJ Case Rep ; 14(2)2021 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-33526528

RESUMEN

A male infant, born preterm at 32 weeks of gestation, was referred at 36-week postmenstrual age for retinopathy of prematurity (ROP) screening. He had nystagmus, generalised hypopigmentation of skin, hair and eyes with preaxial polydactyly. The fundus was depigmented with prominently visible choroidal vessels. The retinal vessels were dilated, tortuous at zone 1. There was presence of arcading, shunting of vessels with presence of vitreous haemorrhage in the left eye. A diagnosis of aggressive posterior retinopathy of prematurity (APROP) in association with oculocutaneous albinism (OCA) was made.Half-dose intravitreal bevacizumab was used to treat the vascular condition. After 2 weeks, there was complete regression of APROP with a completely mature retina observed at 4 months post-treatment. Herein, we describe the role of red-free light for screening ROP in infants with OCA; challenges in the management of ROP with laser photocoagulation compared with intravitreal anti-vascular endothelial growth factor therapy.


Asunto(s)
Albinismo Oculocutáneo/complicaciones , Inhibidores de la Angiogénesis/uso terapéutico , Bevacizumab/uso terapéutico , Retinopatía de la Prematuridad/tratamiento farmacológico , Humanos , Recién Nacido , Recien Nacido Prematuro , Inyecciones Intravítreas , Masculino , Retinopatía de la Prematuridad/complicaciones , Retinopatía de la Prematuridad/diagnóstico
5.
Niger J Clin Pract ; 24(1): 121-126, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33473037

RESUMEN

Aim: To investigate the effect of intravitreal dexamethasone implant on central foveal thickness and choroidal thickness in retinal vein occlusion. Materials and Methods: Clinical records and optical coherence tomography (OCT) scans of 41 naïve patients with retinal vein occlusion (RVO), who were initially treated with intravitreal dexamethasone (DEX) implant between 2016 and 2017 at Kocatepe University Faculty of Medicine, Department of Ophthalmology were investigated. Collected data included age and sex of the patients, crystalline lens status, baseline and final intraocular pressure, and OCT parameters including central foveal thickness and choroidal thickness. Results: Twenty-two (53.7%) female and 19 (46.3%) male patients were enrolled in the study. There were 30 phakic and 11 pseudophakic patients. The intraocular pressure increased significantly from 15.19 mmHg to 17.8 mmHg (P = 0.005), and cataract extraction was performed in two patients who developed cataract after the treatment. There was a significant decrease in the central foveal thickness from 556 µm to 288 µm (P < 0.001). In addition, although there was no statistically significant change in choroidal thickness in the patients with branched retinal vein occlusion (P = 0.423), the patients with central retinal vein occlusion had statistically significant decrease in choroidal thickness measurements (P = 0.049). Conclusion: Therapeutic effect of the DEX implant not only influences retinal layer. Its influence may also extend further to the choroid layer, thereby leading to decrease in the choroidal thickness. Our results were mostly similar to the results of studies in literature which investigated the effects of the DEX implant therapy on the choroidal thickness of the patients with RVO.


Asunto(s)
Edema Macular , Oclusión de la Vena Retiniana , Coroides , Dexametasona , Implantes de Medicamentos/uso terapéutico , Femenino , Glucocorticoides/uso terapéutico , Humanos , Inyecciones Intravítreas , Edema Macular/tratamiento farmacológico , Masculino , Oclusión de la Vena Retiniana/tratamiento farmacológico , Resultado del Tratamiento , Agudeza Visual
6.
J Med Case Rep ; 15(1): 16, 2021 Jan 20.
Artículo en Inglés | MEDLINE | ID: mdl-33468218

RESUMEN

BACKGROUND: Use of perfluorocarbon liquid (PFCL) has been increasingly growing as an adjuvant in vitreo-retina surgeries. Some commonly encountered complications with its use include subretinal migration, formation of sticky silicone oil or retained PFCL in vitreous cavity and anterior chamber. Scleral rupture during PFCL injection has a rare occurrence. We report an unexpected event of scleral rupture during PFCL injection and discuss the management challenges faced by the surgeon. CASE PRESENTATION: A 66 year indo-aryan male was undergoing pars-plana vitrectomy (PPV) with diagnosis of subtotal rhegmatogenous retinal detachment (RD) with Proliferative Vitreo-retonipathy (PVR)-B. After near total vitrectomy PFCL was being injected and then there was sudden poor visualization of fundus with development of bullous RD and globe hypotony. The surgeon was not able to figure out the cause of hypotony and air was switched on in the infusion cannula. This further complicated the situation resulting in migration of air in the anterior chamber, posterior dislocation of intraocular lens complex, 180° inferior retinal dialysis and ballooning of the conjunctiva which gave a clue of probable scleral rupture. Conjunctival peritomy was performed superiorly and scleral defect was noted. Intraocular tissue incarceration and air leak was visible from the wound. This confirmed scleral rupture during PFCL injection. Repositioning of incarcerated retina was not possible and retinectomy was performed followed by repair of scleral rupture with lots of difficulty in a vitrectomised eye. CONCLUSION: PFCL injection, a crucial step of vitreoretina surgery, should be performed slowly with extreme caution maintaining an optimal intraocular pressure to prevent devastating complications like scleral rupture.


Asunto(s)
Fluorocarburos/administración & dosificación , Complicaciones Intraoperatorias/etiología , Inyecciones Intravítreas/efectos adversos , Desprendimiento de Retina/cirugía , Rotura/etiología , Esclerótica/lesiones , Vitrectomía/métodos , Vitreorretinopatía Proliferativa/cirugía , Anciano , Lesiones Oculares/etiología , Humanos , Masculino , Cirugía Vitreorretiniana/métodos
7.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artículo en Inglés | MEDLINE | ID: mdl-33431469

RESUMEN

Bilateral sight threatening macular and optic nerve inflammation may occur with dengue fever, necessitating the use of systemic steroids. We report a case of bilateral dengue maculopathy in an elderly woman managed with targeted intravitreal steroid therapy. A 63-year-old woman presented with acute-onset painless diminution of vision in both eyes following a dengue fever episode. She had bilateral foveal inflammatory lesions, macular oedema, small vessel occlusions at the macula and scattered retinal haemorrhages and cotton-wool spots. Following systemic evaluation, intravitreal triamcinolone acetonide injection was performed in both eyes at an interval of 3 days. The foveal lesion and macular oedema resolved quickly in both eyes with a normal foveal architecture at the end of 6-week follow-up. The visual acuity improved considerably in both eyes. Inflammatory retinopathy in dengue fever may be managed with a targeted intravitreal steroid injection approach.


Asunto(s)
Dengue/complicaciones , Glucocorticoides/administración & dosificación , Edema Macular/tratamiento farmacológico , Edema Macular/virología , Triamcinolona Acetonida/administración & dosificación , Dengue/diagnóstico , Dengue/terapia , Femenino , Humanos , Inyecciones Intravítreas , Edema Macular/diagnóstico , Persona de Mediana Edad
8.
Nat Commun ; 12(1): 708, 2021 01 29.
Artículo en Inglés | MEDLINE | ID: mdl-33514724

RESUMEN

We report the development of a platform of dual targeting Fab (DutaFab) molecules, which comprise two spatially separated and independent binding sites within the human antibody CDR loops: the so-called H-side paratope encompassing HCDR1, HCDR3 and LCDR2, and the L-side paratope encompassing LCDR1, LCDR3 and HCDR2. Both paratopes can be independently selected and combined into the desired bispecific DutaFabs in a modular manner. X-ray crystal structures illustrate that DutaFabs are able to bind two target molecules simultaneously at the same Fv region comprising a VH-VL heterodimer. In the present study, this platform is applied to generate DutaFabs specific for VEGFA and PDGF-BB, which show high affinities, physico-chemical stability and solubility, as well as superior efficacy over anti-VEGF monotherapy in vivo. These molecules exemplify the usefulness of DutaFabs as a distinct class of antibody therapeutics, which is currently being evaluated in patients.


Asunto(s)
Anticuerpos Biespecíficos/farmacología , Neovascularización Coroidal/tratamiento farmacológico , Desarrollo de Medicamentos/métodos , Fragmentos Fab de Inmunoglobulinas/farmacología , Ingeniería de Proteínas , Secuencia de Aminoácidos/genética , Animales , Anticuerpos Biespecíficos/genética , Anticuerpos Biespecíficos/uso terapéutico , Anticuerpos Biespecíficos/ultraestructura , Becaplermina/antagonistas & inhibidores , Sitios de Unión de Anticuerpos/genética , Cristalografía por Rayos X , Modelos Animales de Enfermedad , Relación Dosis-Respuesta a Droga , Humanos , Fragmentos Fab de Inmunoglobulinas/genética , Fragmentos Fab de Inmunoglobulinas/uso terapéutico , Fragmentos Fab de Inmunoglobulinas/ultraestructura , Concentración 50 Inhibidora , Inyecciones Intravítreas , Masculino , Modelos Moleculares , Prueba de Estudio Conceptual , Conformación Proteica , Ratas , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores
9.
Adv Exp Med Biol ; 1307: 375-389, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-32488606

RESUMEN

Diabetic macular edema (DME) is the main cause of vision loss in diabetic retinopathy (DR). Although it is one of the main complications of diabetes, the pathogenesis of DME is not completely understood. The hyperglycemic state promotes the activation of multiple interlinked pathways leading to DME. Different classifications have been proposed: based on clinical features, on pathogenesis or on diagnostic tests (optical coherence tomography - OCT and fluorescin angiography - FA). The multimodal imaging allows a better analysis of the morphological features of the DME. Indeed, new inflammatory biomarkers have been identified on OCT. Also, several studies are evaluating the role of the morphological features, identified on multimodal imaging, to find new prognostic factors. Over the past decade, great progresses have been made in the management of DME. Therapeutic alternatives include intraocular injection of anti-vascular endothelial grow factor agents (anti-VEGF) and steroid molecules, focal/grid laser photocoagulation and vitreo-retinal surgery. This review is focused on the description and analysis of the current intravitreal therapeutic pharmacological strategies. Current guidelines recommend anti-VEGF as first line therapy in DME. Corticosteroids are becoming increasingly relevant blocking the inflammatory cascade and indirectly reducing VEGF synthesis.


Asunto(s)
Diabetes Mellitus , Retinopatía Diabética , Edema Macular , Inhibidores de la Angiogénesis/uso terapéutico , Diabetes Mellitus/tratamiento farmacológico , Retinopatía Diabética/diagnóstico por imagen , Retinopatía Diabética/tratamiento farmacológico , Glucocorticoides/uso terapéutico , Humanos , Inyecciones Intravítreas , Edema Macular/diagnóstico por imagen , Edema Macular/tratamiento farmacológico , Tomografía de Coherencia Óptica
10.
JAMA ; 324(23): 2383-2395, 2020 12 15.
Artículo en Inglés | MEDLINE | ID: mdl-33320223

RESUMEN

Importance: Vitreous hemorrhage from proliferative diabetic retinopathy can cause loss of vision. The best management approach is unknown. Objective: To compare initial treatment with intravitreous aflibercept vs vitrectomy with panretinal photocoagulation for vitreous hemorrhage from proliferative diabetic retinopathy. Design, Setting, and Participants: Randomized clinical trial at 39 DRCR Retina Network sites in the US and Canada including 205 adults with vison loss due to vitreous hemorrhage from proliferative diabetic retinopathy who were enrolled from November 2016 to December 2017. The final follow-up visit was completed in January 2020. Interventions: Random assignment of eyes (1 per participant) to aflibercept (100 participants) or vitrectomy with panretinal photocoagulation (105 participants). Participants whose eyes were assigned to aflibercept initially received 4 monthly injections. Both groups could receive aflibercept or vitrectomy during follow-up based on protocol criteria. Main Outcomes and Measures: The primary outcome was mean visual acuity letter score (range, 0-100; higher scores indicate better vision) over 24 weeks (area under the curve); the study was powered to detect a difference of 8 letters. Secondary outcomes included mean visual acuity at 4 weeks and 2 years. Results: Among 205 participants (205 eyes) who were randomized (mean [SD] age, 57 [11] years; 115 [56%] men; mean visual acuity letter score, 34.5 [Snellen equivalent, 20/200]), 95% (195 of 205) completed the 24-week visit and 90% (177 of 196, excluding 9 deaths) completed the 2-year visit. The mean visual acuity letter score over 24 weeks was 59.3 (Snellen equivalent, 20/63) (95% CI, 54.9 to 63.7) in the aflibercept group vs 63.0 (Snellen equivalent, 20/63) (95% CI, 58.6 to 67.3) in the vitrectomy group (adjusted difference, -5.0 [95% CI, -10.2 to 0.3], P = .06). Among 23 secondary outcomes, 15 showed no significant difference. The mean visual acuity letter score was 52.6 (Snellen equivalent, 20/100) in the aflibercept group vs 62.3 (Snellen equivalent, 20/63) in the vitrectomy group at 4 weeks (adjusted difference, -11.2 [95% CI, -18.5 to -3.9], P = .003) and 73.7 (Snellen equivalent, 20/40) vs 71.0 (Snellen equivalent, 20/40) at 2 years (adjusted difference, 2.7 [95% CI, -3.1 to 8.4], P = .36). Over 2 years, 33 eyes (33%) assigned to aflibercept received vitrectomy and 34 eyes (32%) assigned to vitrectomy received subsequent aflibercept. Conclusions and Relevance: Among participants whose eyes had vitreous hemorrhage from proliferative diabetic retinopathy, there was no statistically significant difference in the primary outcome of mean visual acuity letter score over 24 weeks following initial treatment with intravitreous aflibercept vs vitrectomy with panretinal photocoagulation. However, the study may have been underpowered, considering the range of the 95% CI, to detect a clinically important benefit in favor of initial vitrectomy with panretinal photocoagulation. Trial Registration: ClinicalTrials.gov Identifier: NCT02858076.


Asunto(s)
Inhibidores de la Angiogénesis/administración & dosificación , Retinopatía Diabética/complicaciones , Fotocoagulación , Receptores de Factores de Crecimiento Endotelial Vascular/administración & dosificación , Proteínas Recombinantes de Fusión/administración & dosificación , Retina/cirugía , Vitrectomía , Hemorragia Vítrea/tratamiento farmacológico , Hemorragia Vítrea/cirugía , Anciano , Inhibidores de la Angiogénesis/efectos adversos , Extracción de Catarata , Intervalos de Confianza , Femenino , Humanos , Inyecciones Intravítreas , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Proteínas Recombinantes de Fusión/efectos adversos , Resultado del Tratamiento , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Agudeza Visual , Vitrectomía/efectos adversos , Hemorragia Vítrea/etiología
11.
PLoS One ; 15(12): e0243626, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33347461

RESUMEN

Proliferative vitreoretinopathy (PVR) is a progressive disease that develops in a subset of patients who undergo surgery for retinal detachment repair, and results in significant vision loss. PVR is characterized by the migration of retinal pigment epithelial (RPE) cells into the vitreous cavity, where they undergo epithelial-to-mesenchymal transition and form contractile membranes within the vitreous and along the retina, resulting in recurrent retinal detachments. Currently, surgical intervention is the only treatment for PVR and there are no pharmacological agents that effectively inhibit or prevent PVR formation. Here, we show that a single intravitreal injection of the polyether ionophore salinomycin (SNC) effectively inhibits the formation of PVR in a mouse model with no evidence of retinal toxicity. After 4 weeks, fundus photography and optical coherence tomography (OCT) demonstrated development of mean PVR grade of 3.5 (SD: 1.3) in mouse eyes injected with RPE cells/DMSO (vehicle), compared to mean PVR grade of 1.6 (SD: 1.3) in eyes injected with RPE cells/SNC (p = 0.001). Additionally, immunohistochemistry analysis showed RPE cells/SNC treatment reduced both fibrotic (αSMA, FN1, Vim) and inflammatory (GFAP, CD3, CD20) markers compared to control RPE cells/DMSO treatment. Finally, qPCR analysis confirmed that Tgfß, Tnfα, Mcp1 (inflammatory/cytokine markers), and Fn1, Col1a1 and Acta2 (fibrotic markers) were significantly attenuated in the RPE cells/SNC group compared to RPE/DMSO control. These results suggest that SNC is a potential pharmacologic agent for the prevention of PVR in humans and warrants further investigation.


Asunto(s)
Ionóforos/uso terapéutico , Piranos/uso terapéutico , Vitreorretinopatía Proliferativa/tratamiento farmacológico , Animales , Modelos Animales de Enfermedad , Femenino , Inyecciones Intravítreas , Ionóforos/administración & dosificación , Ratones , Ratones Endogámicos C57BL , Piranos/administración & dosificación , Epitelio Pigmentado de la Retina/efectos de los fármacos , Epitelio Pigmentado de la Retina/patología , Vitreorretinopatía Proliferativa/patología
12.
Vestn Oftalmol ; 136(6. Vyp. 2): 147-154, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-33371643

RESUMEN

PURPOSE: To compare the effectiveness and safety of panretinal laser photocoagulation targeting far-periphery (sPRP) versus conventional panretinal laser photocoagulation (cPRP) in patients with ischemic central retinal vein occlusion (iCRVO) in terms of the degree of macular edema. MATERIAL AND METHODS: The study included eight (5 males and 3 females, mean age 59.4±17.2 years) and seven (6 males and 1 female, mean age 75.7±9.1 years) patients in sPRP and cPRP groups, respectively. iCRVO was defined as a CRVO case with baseline best corrected visual acuity (BCVA) of <0.2, central retinal thickness (CRT) of >500 µm and severe intraretinal hemorrhages. sPRP included dense photocoagulation of far-periphery over 360˚ and standard photocoagulation of the mid-periphery. Primary outcome measures were CRT and macular volume at the end of the follow-up. BCVA served as the secondary outcome measure. RESULTS: The median of the follow-up period was 9.5 months (ranged from 1.5 to 19 months). In the sPRP group, at the end of the follow-up both CRT and macular volume significantly decreased from 892.0±149.4 µm to 391.8±131.2 µm (p<0.001) and from 16.6±4.1 mm3 to 9.7±1.4 mm3, respectively (p=0.008). In the cPRP group, at the end of the follow-up CRT and macular volume changes were statistically insignificant: from 761.0±162.1 µm to 705.0±181.8 µm (p=0.46) and from 13.6± 3.2 mm3 to 11.8±1.7 mm3, respectively (p=0.38). At the end of the follow-up, cPRP group did not have changes in BCVA, while in the sPRP group BCVA increased statistically significantly from 1.45±0.6 LogMAR (≈0.06) to 1.1±0.6 LogMAR (≈0.14) (p=0.03). There were no adverse events or complications associated with laser treatment in any of the study patients. CONCLUSION: This study demonstrates the superiority of sPRP compared with cPRP for treatment of patients with iCRVO, showing that selective laser treatment of the far-periphery results in significant reduction of macular edema associated with severe retinal ischemia.


Asunto(s)
Oclusión de la Vena Retiniana , Adulto , Anciano , Anciano de 80 o más Años , Inhibidores de la Angiogénesis/uso terapéutico , Femenino , Humanos , Inyecciones Intravítreas , Isquemia , Coagulación con Láser , Rayos Láser , Masculino , Persona de Mediana Edad , Oclusión de la Vena Retiniana/complicaciones , Oclusión de la Vena Retiniana/diagnóstico , Oclusión de la Vena Retiniana/cirugía , Tomografía de Coherencia Óptica , Resultado del Tratamiento , Agudeza Visual
13.
Vestn Oftalmol ; 136(6. Vyp. 2): 227-234, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-33371654

RESUMEN

Age-related macular degeneration is an advanced chronic disease and the main cause of vision loss in geriatric patients. Optical coherence tomography (OCT) is a modern method of retinal imaging allowing to detect different types of fluid: intraretinal fluid (IRF), subretinal fluid (SRF) and fluid under pigment epithelial detachment (PED). Finding relevant imaging biomarkers is necessary for identification of basic activity criteria of the disease, choosing treatment algorithms, determining treatment duration and termination criteria, and predicting the outcomes. Presence of IRF is associated with poor functional outcomes. Its presence is an indication for early beginning of treatment aimed at full resorption of the fluid with further possible careful extension of anti-VEGF therapy intervals with a regular follow-up. Degenerative intraretinal cysts developing in the background of subretinal fibrosis in absence of choroidal neovascularization (CNV) should be a sign for discontinuation of anti-VEGF therapy due to the lack of targets. Presence of SRF is associated with favorable outcomes and good treatment prognosis and is not a barrier to the extension of treatment intervals even up to the maximum of 16 weeks as described in existing randomized controlled trials, on the condition of no other CNV activity. PED with active CNV is one of the biomarkers that reveal the need for long-term aggressive therapy. In case of its size gain, it is necessary to restart the anti-VEGF treatment to prevent visual loss in the long-term. Combination of different fluid types is a sign of lasting disease history with a poor outcome prognosis. In this case, anti-VEGF treatment should be started as soon as possible with long-term fixed regimen or Treat-and-extend (T&E) with minimal suitable interval for the patient and precise monitoring of the condition of retina until complete suppression of activity. Developing a personalized approach in each case plays an important role in preserving visual functions.


Asunto(s)
Neovascularización Coroidal , Degeneración Macular , Anciano , Inhibidores de la Angiogénesis/uso terapéutico , Biomarcadores , Neovascularización Coroidal/diagnóstico , Neovascularización Coroidal/tratamiento farmacológico , Neovascularización Coroidal/etiología , Humanos , Inyecciones Intravítreas , Degeneración Macular/tratamiento farmacológico , Pronóstico , Ranibizumab/uso terapéutico , Retina , Tomografía de Coherencia Óptica , Factor A de Crecimiento Endotelial Vascular , Agudeza Visual
14.
Drugs Today (Barc) ; 56(11): 699-704, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33332477

RESUMEN

Given the success in stabilizing vision with current anti-vascular endothelial growth factor (VEGF) options, one main target for future anti-VEGF drug development includes creating medications with longer durations of action. Achieving this goal will decrease the number of overall injections and follow-up visits required to ensure better patient compliance. The smallest anti-VEGF created so far is brolucizumab (Beovu; Novartis). It is a 26-kDa IgG single-chain antibody fragment that delivers 11 times more anti-VEGF per injection than aflibercept. Brolucizumab was approved by the U.S. Food and Drug Administration (FDA) in late 2019 for the treatment of wet age-related macular degeneration, and has been also approved for the same indication in Japan and the European Union in 2020. In this article, we compare brolucizumab to current FDA-approved anti-VEGF treatments, address the studies associated with brolucizumab, discuss brolucizumab's side effects, and conclude with recommendations.


Asunto(s)
Anticuerpos Monoclonales Humanizados/farmacología , Degeneración Macular/tratamiento farmacológico , Factor A de Crecimiento Endotelial Vascular , Inhibidores de la Angiogénesis/uso terapéutico , Anticuerpos Monoclonales Humanizados/uso terapéutico , Humanos , Inyecciones Intravítreas , Japón , Receptores de Factores de Crecimiento Endotelial Vascular , Proteínas Recombinantes de Fusión
15.
Klin Monbl Augenheilkd ; 237(11): 1320-1325, 2020 Nov.
Artículo en Inglés, Alemán | MEDLINE | ID: mdl-33202460

RESUMEN

Using mobile OCT equipment and remote ophthalmological diagnosis of n = 1538 diabetics in 17 diabetes practices in Germany, we found diabetic macular edema in 10.1% of the patients and retinal bleedings or microaneurysms in 15.6%. In 1.62% of the diabetics examined, the size of the edema was > 0.4 mm², in 7% the retinal thickness was > 300 µm and thus in need of treatment. An intravitreal anti-VEGF injection was administered prior to the examination in only 10% of the patients with diabetic macular edema. By means of mobile tele-eye consultation and remote ophthalmological diagnosis using the cloud-based patient file certified as medical device IIa, patients with diabetic macular edema were identified and informed on site quickly and definitively. The data and images were made available to all attending physicians and ophthalmic surgeons.


Asunto(s)
Diabetes Mellitus , Retinopatía Diabética , Edema Macular , Retinopatía Diabética/tratamiento farmacológico , Retinopatía Diabética/terapia , Humanos , Inyecciones Intravítreas , Edema Macular/tratamiento farmacológico , Edema Macular/terapia , Retina , Tomografía de Coherencia Óptica
16.
Arch. Soc. Esp. Oftalmol ; 95(11): 559-564, nov. 2020. ilus
Artículo en Español | IBECS | ID: ibc-197748

RESUMEN

Las endoftalmitis asociadas a la ampolla de filtración tras cirugía filtrante de glaucoma son poco frecuentes, de inicio tardío y la mayoría están asociadas a una blebitis. Los agentes causales suelen ser estreptococos o bacterias gramnegativas. Existen pocos casos descritos en la literatura de endoftalmitis causada por Moraxella nonliquefaciens y la mayoría están asociados a una blebitis tras cirugía filtrante de glaucoma. Presentamos el caso de una paciente de 90 años con endoftalmitis en ojo derecho por Moraxella nonliquefaciens asociada a blebitis 10 años después de la cirugía de glaucoma. Tras el tratamiento, se observó la desaparición de la blebitis 2 semanas después y resolución de la vitritis 29 días después, con recuperación de la visión a valores previos (20/200). La endoftalmitis por Moraxella nonliquefaciens es rara y está asociada a blebitis de inicio tardío tras una cirugía filtrante de glaucoma. A pesar de la virulencia del cuadro, el pronóstico visual suele ser favorable


Bleb-related endophthalmitis is rare and appears months or years after surgery. The causative agents are usually streptococci or gram-negative bacteria. There are few cases in the literature of endophthalmitis caused by Moraxella nonliquefaciens, and most are delayed-onset associated with blebitis after glaucoma filtration surgery. The case is presented of a 90-year-old patient with endophthalmitis in the right eye due to Moraxella nonliquefaciens associated with blebitis 10 years after glaucoma surgery. After treatment, disappearance of blebitis is observed 2 weeks later and resolution of vitritis 29 days later, with recovery of vision to previous values (20/200). Endophthalmitis due to Moraxella nonliquefaciens is rare, and is associated with late onset blebitis after glaucoma filtration surgery. Despite the virulence of the clinical symptoms, the visual prognosis is usually favourable


Asunto(s)
Humanos , Femenino , Anciano de 80 o más Años , Endoftalmitis/microbiología , Endoftalmitis/patología , Infecciones por Moraxellaceae/patología , Vesícula/patología , Endoftalmitis/tratamiento farmacológico , Vancomicina/administración & dosificación , Antibacterianos/administración & dosificación , Ceftazidima/administración & dosificación , Inyecciones Intravítreas , Agudeza Visual , Infecciones por Moraxellaceae/tratamiento farmacológico , Moraxella/aislamiento & purificación
17.
Cesk Slov Oftalmol ; 76(2): 88-93, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33126803

RESUMEN

PURPOSE: To assess the effect of intravitreal aflibercept on pigment epithelial detachment (PED) secondary to occult choroidal neovascularization (CNV) in treatment-naive patients. PATIENTS AND METHODS: Retrospective analysis of thirty-six patients (thirty-eight eyes) with mean age 77 (SD ± 7), who were treated with aflibercept 2.0 mg (Eylea, Bayer) at the Department of Ophthalmology of 1st Faculty of Medicine of the Charles University and the Military University Hospital Prague. All patients were treated in fixed regimen, which means 3 loading doases 1 month apart, followed by further 2-monthly doses over total 12-month period. Best corrected visual acuity (BCVA) was evaluated on Early Treatment Diabetic Retinopathy Study (ETDRS) charts. Diameters as PED height, width and central retinal thickness (CRT) were assesed using spectral-domain optical coherence tomography. All previously mentioned were analyzed et the baseline and than at every visit. Therapy complications were also evaluated. RESULTS: Borderline significant improvement in the mean of BCVA score of 3.2 letters (SD ± 11.6, p = 0.05) at the end of follow-up period was observed. Mean PED height at 12 months significantly decreased by 140 µm (SD ± 238, p < 0.01). Reductions in PED height were correlated with reductions in central macular thickness (R = 0.94, p < 0.001) simultaneously with PED width (R = 0.45, p < 0.01). There was no significant correlation between PED height decrease and visual acuity. PED rupture was observed in 3 eyes (8 %). CONCLUSION: Aflibercept intravitreal therapy in fixed regimen in patients with PED secondary to occult CNV shows great anatomical effect. However, correlation between PED diameters and visual acuity was not observed.


Asunto(s)
Desprendimiento de Retina , Epitelio Pigmentado de la Retina , Anciano , Inhibidores de la Angiogénesis/uso terapéutico , Humanos , Inyecciones Intravítreas , Receptores de Factores de Crecimiento Endotelial Vascular/uso terapéutico , Proteínas Recombinantes de Fusión/uso terapéutico , Desprendimiento de Retina/complicaciones , Desprendimiento de Retina/tratamiento farmacológico , Estudios Retrospectivos , Tomografía de Coherencia Óptica
18.
Cesk Slov Oftalmol ; 76(4): 1-3, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33086850

RESUMEN

The issue of macular retinal degeneration is one of the key areas of ophthalmology. Recent advances in the targeted delivery of vascular endothelial growth factor (VEGF) suppressants have significantly impacted the patient's prognosis in the form of a significant deceleration in disease progression. Some of the drugs have gradually found their use in other indications (central retinal vein occlusion or diabetic macular edema). The following text gives a brief look at the physiology of VEGF, but not only in the eye, but throughout the human body, particularly in the context of adverse effects resulting from systemic inhibition of its effects.


Asunto(s)
Retinopatía Diabética , Degeneración Macular , Edema Macular , Inhibidores de la Angiogénesis/uso terapéutico , Bevacizumab/uso terapéutico , Retinopatía Diabética/tratamiento farmacológico , Humanos , Inyecciones Intravítreas , Degeneración Macular/tratamiento farmacológico , Edema Macular/tratamiento farmacológico , Edema Macular/etiología , Ranibizumab/uso terapéutico , Receptores de Factores de Crecimiento Endotelial Vascular/uso terapéutico , Proteínas Recombinantes de Fusión/uso terapéutico , Factor A de Crecimiento Endotelial Vascular , Agudeza Visual
19.
Dtsch Arztebl Int ; 117(29-30): 513-520, 2020 Jul 20.
Artículo en Inglés | MEDLINE | ID: mdl-33087239

RESUMEN

BACKGROUND: Age-related macular degeneration (AMD) is thought to cause approximately 9% of all cases of blindness worldwide. In Germany, half of all cases of blindness and high-grade visual impairment are due to AMD. In this review, the main risk factors, clinical manifestations, and treatments of this disease are presented. METHODS: This review is based on pertinent publications retrieved by a selective search in PubMed for original articles and reviews, as well as on current position statements by the relevant specialty societies. RESULTS: AMD is subdivided into early, intermediate, and late stages. The early stage is often asymptomatic; patients in the other two stages often have distorted vision or central visual field defects. The main risk factors are age, genetic predisposition, and nicotine consumption. The number of persons with early AMD in Germany rose from 5.7 million in 2002 to ca. 7 million in 2017. Late AMD is subdivided into the dry late form of the disease, for which there is no treatment at present, and the exudative late form, which can be treated with the intravitreal injection of VEGF inhibitors. CONCLUSION: More research is needed on the dry late form of AMD in particular, which is currently untreatable. The treatment of the exudative late form with VEGF inhibitors is labor-intensive and requires a close collaboration of the patient, the ophthalmologist, and the primary care physician.


Asunto(s)
Degeneración Macular , Alemania/epidemiología , Humanos , Inyecciones Intravítreas , Degeneración Macular/diagnóstico , Degeneración Macular/epidemiología , Degeneración Macular/terapia , Factores de Riesgo
20.
Graefes Arch Clin Exp Ophthalmol ; 258(12): 2621-2628, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33009973

RESUMEN

PURPOSE: To estimate the impact of delayed care during the coronavirus disease 2019 (COVID-19) pandemic on the outcomes of patients with neovascular age-related macular degeneration (AMD). METHODS: Consecutive patients with diagnosis of neovascular AMD were consecutively enrolled between March 9, 2020, and June 12, 2020, (during and immediately after the Italian COVID-19 quarantine). During the inclusion (or pandemic) visit (V0), patients received a complete ophthalmologic evaluation, including optical coherence tomography (OCT). Best-corrected visual acuity (BCVA) and OCT findings from the two preceding visits (V-1 and V-2) were compared with data at V0. RESULTS: One-hundred patients (112 eyes) were enrolled in this study. The time interval between following visits was 110.7 ± 37.5 days within V0 and V-1 and 80.8 ± 39.7 days within V-1 and V-2, respectively (P < 0.0001). BCVA was statistically worse at the V0 visit as compared with the immediately preceding (V-1) visit (0.50 ± 0.43 LogMAR and 0.45 ± 0.38 LogMAR at the V0 and V-1 visits, respectively; P = 0.046). On structural OCT, 91 out of 112 (81.2%) neovascular AMD eyes displayed the evidence of exudative disease activity at the V0 visit, while 77 (68.7%) eyes exhibited signs of exudation at the V-1 visit (P = 0.022). No differences in terms of BCVA and OCT findings were detected between the V-1 and V-2 visits. In multiple regression analysis, the difference in BCVA between V0 and V-1 visits was significantly associated with the interval time within these two visits (P = 0.026). CONCLUSION: The COVID-19 pandemic-related postponement in patient care proved to be significantly associated with worse short-term outcomes in these patients.


Asunto(s)
Inhibidores de la Angiogénesis/uso terapéutico , Betacoronavirus , Neovascularización Coroidal/tratamiento farmacológico , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Neovascularización Retiniana/tratamiento farmacológico , Tiempo de Tratamiento , Degeneración Macular Húmeda/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Bevacizumab/uso terapéutico , Neovascularización Coroidal/diagnóstico por imagen , Neovascularización Coroidal/fisiopatología , Femenino , Humanos , Inyecciones Intravítreas , Masculino , Persona de Mediana Edad , Pandemias , Cuarentena , Ranibizumab/uso terapéutico , Receptores de Factores de Crecimiento Endotelial Vascular/uso terapéutico , Proteínas Recombinantes de Fusión/uso terapéutico , Neovascularización Retiniana/diagnóstico por imagen , Neovascularización Retiniana/fisiopatología , Líquido Subretiniano , Tomografía de Coherencia Óptica , Resultado del Tratamiento , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Agudeza Visual/fisiología , Degeneración Macular Húmeda/diagnóstico por imagen , Degeneración Macular Húmeda/fisiopatología
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