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2.
Vestn Oftalmol ; 137(1): 83-93, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33610155

RESUMO

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.


Assuntos
Degeneração Macular , Degeneração Macular Exsudativa , Inibidores da Angiogênese/uso terapêutico , Humanos , Injeções Intravítreas , Degeneração Macular/diagnóstico , Degeneração Macular/tratamento farmacológico , Ranibizumab/uso terapêutico , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular , Acuidade Visual , Degeneração Macular Exsudativa/diagnóstico , Degeneração Macular Exsudativa/tratamento farmacológico
3.
Vestn Oftalmol ; 137(1): 123-129, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33610160

RESUMO

Diabetic retinopathy (DR) and age-related macular degeneration (AMD) comprise a significant socio-medical problem for Russia. The article presents an analysis aimed at identifying the prerequisites for further research on the socio-economic consequences of retinal pathology. Studying the epidemiological aspects of DR and AMD, as well as the conditions for receiving medical aid helped define the main approaches to assessing the economic burden of retinal diseases in Russia. It also revealed the problems associated with completeness of registration and accounting of patients, the disparity between the volume of medical aid required and funding, and between the required and provided assistance for patients with these pathologies in clinical practice. Analysis of the disease cost will allow not only to determine the socio-economic consequences of retinal diseases, but also to find further directions for improving the quality of medical care for patients with DR and AMD in order to reduce its economic cost for the state and society. Evidently, there is a need for comprehensive assessment of the total burden of retinal diseases in Russia that would serve as a basis for subsequent assessment of the economic effectiveness of prevention and treatment measures.


Assuntos
Diabetes Mellitus , Retinopatia Diabética , Degeneração Macular , Efeitos Psicossociais da Doença , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/epidemiologia , Retinopatia Diabética/terapia , Humanos , Degeneração Macular/diagnóstico , Degeneração Macular/epidemiologia , Degeneração Macular/terapia , Federação Russa/epidemiologia , Fatores Socioeconômicos
4.
Asia Pac J Ophthalmol (Phila) ; 10(1): 39-48, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33512827

RESUMO

PURPOSE: The COVID-19 pandemic has put strain on healthcare systems and the availability and allocation of healthcare manpower, resources and infrastructure. With immediate priorities to protect the health and safety of both patients and healthcare service providers, ophthalmologists globally were advised to defer nonurgent cases, while at the same time managing sight-threatening conditions such as neovascular Age-related Macular Degeneration (AMD). The management of AMD patients both from a monitoring and treatment perspective presents a particular challenge for ophthalmologists. This review looks at how these pressures have encouraged the acceptance and speed of adoption of digitalization. DESIGN AND METHODS: A literature review was conducted on the use of digital technology during COVID-19 pandemic, and on the transformation of medicine, ophthalmology and AMD screening through digitalization. RESULTS: In the management of AMD, the implementation of artificial intelligence and "virtual clinics" have provided assistance in screening, diagnosis, monitoring of the progression and the treatment of AMD. In addition, hardware and software developments in home monitoring devices has assisted in self-monitoring approaches. CONCLUSIONS: Digitalization strategies and developments are currently ongoing and underway to ensure early detection, stability and visual improvement in patients suffering from AMD in this COVID-19 era. This may set a precedence for the post COVID-19 new normal where digital platforms may be routine, standard and expected in healthcare delivery.


Assuntos
/epidemiologia , Assistência à Saúde/métodos , Técnicas de Diagnóstico Oftalmológico , Degeneração Macular/diagnóstico , Telemedicina/métodos , Humanos , Degeneração Macular/terapia
5.
Artigo em Inglês | MEDLINE | ID: mdl-33401577

RESUMO

The purpose of the current study is to evaluate the incidence of age-related macular degeneration (AMD) in dyslipidemia-related diseases with or without the use of fibrate. Patients were defined as dyslipidemia-related diseases according to the diagnostic code and lab exam arrangement, then the population was divided into those with fibrate application and those without via 1:2 ratios of propensity-score matching. The primary outcome is the development of AMD after dyslipidemia-related diseases by the Cox proportional hazard regression. Besides, the relationship between the medical compliance of fibrate, presented as medical possession ratio (MPR), and the AMD development was also analyzed. A total of 22,917 patients and 45,834 individuals were enrolled in the study and control groups. There were 572 and 1181 events of any AMD development in the study and control groups which showed identical risk of AMD (aHR: 0.94, 95% CI: 0.85-1.04). However, a reduced risk of any AMD was found in those patients reached a baseline MPR more than 20% (aHR: 0.729, 95% CI: 0.599-0.887, p = 0.0016) and overall MPR more than 5% three years after the diagnosis of dyslipidemia-related diseases (aHR: 0.712, 95% CI: 0.557-0.909, p = 0.0065). Besides, a lower risk of dry-AMD was also found in those patients with the above conditions (aHR: 0.736, 95% CI: 0.599-0.906, p = 0.0038 and aHR: 0.721, 95% CI: 0.557-0.934, p = 0.0133, respectively). In conclusion, the use of fibrate with fair initial medical compliance will decrease the incidence of AMD in patients with dyslipidemia-related diseases, especially for the development of dry-AMD.


Assuntos
Dislipidemias , Ácidos Fíbricos , Degeneração Macular , Adesão à Medicação , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Dislipidemias/complicações , Feminino , Ácidos Fíbricos/uso terapêutico , Humanos , Incidência , Degeneração Macular/epidemiologia , Degeneração Macular/prevenção & controle , Masculino , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Medição de Risco , Adulto Jovem
6.
Biomed Pharmacother ; 133: 111041, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33378949

RESUMO

Poly (ADP-ribose) polymerase 1 (PARP1)-dependent cell death in the retinal pigment epithelium (RPE) is implicated in dry age-related macular degeneration (AMD). Although PARP1 inhibitors are available for treating dry AMD, their delivery route is not ideal for patients. The aim of this study was to test the efficacy of a novel PARP1-inhibitory compound (PIC) in vitro and in vivo. This study presents PIC, a novel small molecule, with superior efficacy to PARP1 inhibitors in the market. PIC demonstrated a distinctive inhibitory profile against PARP isotypes than the FDA-approved PARP1 inhibitors. PIC inhibited PARP1 activation at an IC50 of 0.41 ± 0.15 nM in an enzyme-based assay in vitro and at IC50 and EC50 in ARPE-19 cells of 0.11 ± 0.02 nM and 0.22 ± 0.02 nM, respectively, upon H2O2 insult. PIC also moderated mitochondrial fission and depolarization and maintained cellular energy levels under oxidative stress in ARPE-19 cells. Furthermore, PIC demonstrated good corneal penetration in a rat model, presenting PIC as a promising candidate for eye drop therapeutics for dry AMD. When PIC was administered as an eye drop formulation, RPE morphology was preserved, maintaining the thickness of the outer nuclear layers under sodium iodate (SI) treatment in rats. In SI-treated rabbits, eye drop administration of PIC also retained the structural and functional integrity when analyzed using funduscopy and electroretinogram. Collectively, our data portray PIC as an attractive treatment measure for dry AMD.


Assuntos
Degeneração Macular/tratamento farmacológico , Poli(ADP-Ribose) Polimerase-1/antagonistas & inibidores , Inibidores de Poli(ADP-Ribose) Polimerases/farmacologia , Epitélio Pigmentado da Retina/efeitos dos fármacos , Administração Oftálmica , Animais , Antioxidantes/farmacologia , Linhagem Celular , Modelos Animais de Doenças , Humanos , Iodatos , Degeneração Macular/induzido quimicamente , Degeneração Macular/enzimologia , Degeneração Macular/patologia , Masculino , Mitocôndrias/efeitos dos fármacos , Mitocôndrias/metabolismo , Mitocôndrias/patologia , Absorção Ocular , Soluções Oftálmicas , Estresse Oxidativo/efeitos dos fármacos , Poli(ADP-Ribose) Polimerase-1/metabolismo , Inibidores de Poli(ADP-Ribose) Polimerases/administração & dosagem , Coelhos , Ratos Sprague-Dawley , Epitélio Pigmentado da Retina/enzimologia , Epitélio Pigmentado da Retina/patologia
9.
Drugs Today (Barc) ; 56(11): 699-704, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33332477

RESUMO

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.


Assuntos
Anticorpos Monoclonais Humanizados/farmacologia , Degeneração Macular/tratamento farmacológico , Fator A de Crescimento do Endotélio Vascular , Inibidores da Angiogênese/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Humanos , Injeções Intravítreas , Japão , Receptores de Fatores de Crescimento do Endotélio Vascular , Proteínas Recombinantes de Fusão
10.
Cochrane Database Syst Rev ; 12: CD013154, 2020 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-33331670

RESUMO

BACKGROUND: Age-related macular degeneration (AMD) is a highly prevalent condition in an ever-increasing elderly population. Although insidious in the early stages, advanced AMD (neovascular and atrophic forms) can cause significant visual disability and economic burden on health systems worldwide. The most common form, geographic atrophy, has no effective treatment to date, whereas neovascular AMD can be treated with intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections. Geographic atrophy has a slow disease progression and patients tend to have preserved central vision until the final stages. This tendency, coupled with the use of modern imaging modalities, provides a large window of opportunity to intervene with validated methods to assess treatment efficacy. As geographic atrophy is an increasingly common condition with no effective intervention, many treatments are under investigation, one of which is visual cycle modulators. These medications have been shown to reduce lipofuscin accumulation in pre-clinical studies that have led to several clinical trials, reviewed herein. OBJECTIVES: To assess the efficacy and safety of visual cycle modulators for the prevention and treatment of geographic atrophy secondary to AMD. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2020, Issue 1); MEDLINE Ovid; Embase Ovid; Web of Science Core Collection; Scopus; Association for Research in Vision and Ophthalmology (ARVO) website; ClinicalTrials.gov and the WHO ICTRP to 11 January 2020 with no language restrictions. We also searched using the reference lists of reviews and existing studies and the Cited Reference Search function in Web of Science to identify further relevant studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and quasi-randomised clinical studies (if available) that compared visual cycle modulators to placebo or no treatment (observation) in people diagnosed with AMD (early, intermediate or geographic atrophy). DATA COLLECTION AND ANALYSIS: Two authors independently assessed risk of bias in the included studies and extracted data. Both authors entered data into RevMan 5. We resolved discrepancies through discussion. We graded the certainty of the evidence using the GRADE approach. MAIN RESULTS: We included three RCTs from the USA; one of these had clinical sites in Germany. Two studies compared emixustat to placebo while the other compared fenretinide to placebo. All assigned one study eye per participant and, combined, have a total of 821 participants with a majority white ethnicity (97.6%). All participants were diagnosed with geographic atrophy due to AMD based on validated imaging modalities. All three studies have high risk of attrition bias mainly due to ocular adverse effects of emixustat and fenretinide. We considered only one study to be adequately conducted and reported with high risk of bias in only one domain (attrition bias). We considered the other two studies to be poorly reported and to have high risk of attrition bias and reporting bias. People with geographic atrophy treated with emixustat may not experience a clinically important change in best-corrected visual acuity (BCVA) between baseline and 24 months compared to people treated with placebo (mean difference (MD) 1.9 Early Treatment Diabetic Retinopathy Study (ETDRS) letters, 95% confidence interval (CI) -2.34 to 6.14, low-certainty evidence). Emixustat may also result in little or no difference in loss of 15 ETDRS letters or more of BCVA compared with placebo at 24 months (16.4% versus 18%) (risk ratio (RR) 0.91, 95% CI 0.59 to 1.4, low-certainty evidence). In terms of disease progression, emixustat may result in little or no difference in the annual growth rate of geographic atrophy compared with placebo (mean difference MD 0.09 mm2/year (95% CI -0.26 to 0.44, low-certainty evidence). All three studies reported adverse events of both drugs (emixustat: moderate-certainty evidence; fenretinide: low-certainty evidence). The main adverse events were ocular in nature and associated with the mechanism of action of the drugs. Delayed dark adaptation (emixustat: 54.5%; fenretinide: 39.3%) and chromatopsia (emixustat: 22.6%; fenretinide: 25.2%) were the most common adverse events reported, and were the most prevalent reasons for study dropout in emixustat trials. These effects were dose-dependent and resolved after drug cessation. No specific systemic adverse events were considered related to emixustat; only pruritus and rash were considered to be due to fenretinide. One emixustat study reported six deaths, none deemed related to the drug. None of the included RCTs reported the other pre-specified outcomes, including proportion of participants losing 10 letters or more, and mean change in macular sensitivity. We planned to investigate progression to advanced AMD (geographic atrophy or neovascular AMD) in prevention studies, including participants with early or intermediate AMD, but we identified no such studies. Two of the included studies reported an additional outcome - incidence of choroidal neovascularisation (CNV) - that was not in our published protocol. CNV onset may be reduced in those treated with emixustat but the evidence was uncertain (risk ratio (RR) 0.67, 95% CI 0.27 to 1.65, low-certainty evidence), or fenretinide (RR 0.5, 95% CI 0.26 to 0.98, low-certainty evidence) compared to placebo. A dose-dependent relationship was observed with emixustat. AUTHORS' CONCLUSIONS: There is limited evidence to support the use of visual cycle modulators (emixustat and fenretinide) for the treatment of established geographic atrophy due to AMD. The possible reduction in the incidence of CNV observed with fenretinide, and to a lesser extent, emixustat, requires formal assessment in focused studies.


Assuntos
Fenretinida/uso terapêutico , Atrofia Geográfica/tratamento farmacológico , Atrofia Geográfica/prevenção & controle , Degeneração Macular/complicações , Éteres Fenílicos/uso terapêutico , Propanolaminas/uso terapêutico , Conduta Expectante , Idoso , Idoso de 80 Anos ou mais , Neovascularização de Coroide/epidemiologia , Ensaios Clínicos Fase II como Assunto , Progressão da Doença , Fenretinida/efeitos adversos , Atrofia Geográfica/etiologia , Humanos , Incidência , Éteres Fenílicos/efeitos adversos , Placebos/uso terapêutico , Propanolaminas/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Acuidade Visual/efeitos dos fármacos
11.
Vestn Oftalmol ; 136(6. Vyp. 2): 227-234, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33371654

RESUMO

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.


Assuntos
Neovascularização de Coroide , Degeneração Macular , Idoso , Inibidores da Angiogênese/uso terapêutico , Biomarcadores , Neovascularização de Coroide/diagnóstico , Neovascularização de Coroide/tratamento farmacológico , Neovascularização de Coroide/etiologia , Humanos , Injeções Intravítreas , Degeneração Macular/tratamento farmacológico , Prognóstico , Ranibizumab/uso terapêutico , Retina , Tomografia de Coerência Óptica , Fator A de Crescimento do Endotélio Vascular , Acuidade Visual
12.
ACS Appl Mater Interfaces ; 12(52): 57710-57720, 2020 Dec 30.
Artigo em Inglês | MEDLINE | ID: mdl-33320520

RESUMO

There is a continuing, urgent need for an ophthalmic (eye) drop for the clinical therapy of age-related macular degeneration (AMD), a leading cause of blindness. Here, we report the first formulation of an eye drop that is effective via autophagy for AMD treatment. This eye drop is based on a single natural product derivative (ACD), which is an amphiphilic molecule containing a 6-aminohexanoate group (H2N(CH2)5COO-). We demonstrate that this eye drop reverses the abnormal angiogenesis induced in a primate model of AMD that has the pathological characteristics close to that of human AMD. The ACD molecule was self-assembled in an aqueous environment leading to nanoparticles (NPs) about 9.0 nm in diameter. These NPs were encapsulated in calcium alginate hydrogel. The resulting eye drop effectively slowed the release of ACD and displayed extended release periods in both simulated blood (pH 7.4) and inflammatory (pH 5.2) environments. We show that the eye drop penetrated both the corneal and blood-eye barriers and reached the fundus. With low cellular toxicity, the drop targeted S1,25D3-membrane-associated rapid response steroid-binding protein (1,25D3-MARRS) promoting autophagy in a dose-dependent manner. In addition, the drop inhibited cell migration and tubular formation. On the other hand, when protein 1,25D3-MARRS was knocked down, the eye drop did not exhibit such inhibition functionalities. Our study indicates that the 6-aminohexanoate group on self-assembled NPs encapsulated in hydrogel leads to the positive in vivo outcomes. The present formulation offers a promising approach for clinical treatment of human AMD.


Assuntos
Produtos Biológicos/química , Degeneração Macular/tratamento farmacológico , Terapia de Alvo Molecular , Nanopartículas/química , Soluções Oftálmicas/química , Soluções Oftálmicas/farmacologia , Animais , Autofagia/efeitos dos fármacos , Movimento Celular/efeitos dos fármacos , Neovascularização de Coroide/complicações , Células Endoteliais da Veia Umbilical Humana/citologia , Células Endoteliais da Veia Umbilical Humana/efeitos dos fármacos , Humanos , Macaca mulatta , Degeneração Macular/complicações , Degeneração Macular/patologia , Modelos Moleculares , Conformação Molecular , Soluções Oftálmicas/uso terapêutico
13.
Arch. Soc. Esp. Oftalmol ; 95(12): 603-606, dic. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-197759

RESUMO

Las distrofias en patrón de la retina son un grupo heterogéneo de maculopatías, en general, bilaterales y simétricas, que curiosamente se pueden asociar a diferentes enfermedades sistémicas. En este artículo se describe el caso de una paciente con distrofia en patrón unilateral que presentó asociada enfermedad de McArdle y fibrosis pulmonar idiopática


Retinal pattern dystrophies are a heterogeneous group of generally bilateral and symmetrical maculopathies that, curiously, can be associated with different systemic diseases. This article describes a patient with unilateral pattern dystrophies, as well as associated McArdle disease and idiopathic pulmonary fibrosis


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Degeneração Macular/patologia , Distrofias Retinianas/patologia , Doença de Depósito de Glicogênio Tipo V/patologia , Fibrose Pulmonar Idiopática/patologia , Fibrose Pulmonar Idiopática/diagnóstico por imagem , Degeneração Macular/diagnóstico por imagem , Distrofias Retinianas/diagnóstico por imagem , Distrofias Retinianas/complicações , Radiografia , Tomografia de Coerência Óptica , Fibrose Pulmonar Idiopática/complicações , Degeneração Macular/complicações , Doença de Depósito de Glicogênio Tipo V/complicações
14.
Medicine (Baltimore) ; 99(46): e23200, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181699

RESUMO

BACKGROUND: As an increasing age-related eye disease, age-related macular degeneration (AMD) is becoming a common cause of irreversible visual loss in elder population. The mechanism of AMD remains uncertain and covers a complex risk factors. Choroidal vascularity index (CVI) is a sensitive parameter obtained by enhanced depth imaging of optical coherence tomography which allows the choroid in more detail and accurate assessment in the pathogenesis of AMD. The objective of this current study is to evaluate choroidal structural alternations measured by CVI in AMD. METHODS: We will review 4 English databases (PubMed, Embase, Cochrane Library, and Web of Science) from their inception until present to select eligible articles. English-language and case-control studies will be accepted. The data extraction content and quantitative analysis will be performed systematically by 2 independent authors. The primary outcome is the alternation of CVI in AMD. The secondary outcomes consist of choroidal thickness (CT), luminal area (LA), stromal area (SA), and total choroidal area (TCA). Subgroup analysis, sensitivity analysis, and publication bias will be performed to check the robustness of the pooled outcome data. RESULTS: Changes of quantitative parameters such as CVI will be obtained in patients with AMD. CONCLUSION: This study will elucidate alternations of choroidal vascular and stromal component in AMD and provide robust evidence on the pathophysiology of AMD. REGISTRATION NUMBER: INPLASY.


Assuntos
Corioide/lesões , Degeneração Macular/complicações , Corioide/anormalidades , Corioide/fisiopatologia , Protocolos Clínicos , Humanos , Metanálise como Assunto , Revisões Sistemáticas como Assunto
15.
Rev Med Liege ; 75(11): 711-716, 2020 Nov.
Artigo em Francês | MEDLINE | ID: mdl-33155444

RESUMO

Age-related Macular Degeneration (AMD) is the leading cause of blindness and visual impairment in developed countries for people older than 50 years. This disease can lead to loss of autonomy, which can be managed in Functional Revalidation Center.


Assuntos
Degeneração Macular , Cegueira , Humanos , Degeneração Macular/terapia
16.
Cesk Slov Oftalmol ; 76(4): 1-3, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33086850

RESUMO

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.


Assuntos
Retinopatia Diabética , Degeneração Macular , Edema Macular , Inibidores da Angiogênese/uso terapêutico , Bevacizumab/uso terapêutico , Retinopatia Diabética/tratamento farmacológico , Humanos , Injeções Intravítreas , Degeneração Macular/tratamento farmacológico , Edema Macular/tratamento farmacológico , Edema Macular/etiologia , Ranibizumab/uso terapêutico , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Fator A de Crescimento do Endotélio Vascular , Acuidade Visual
17.
Dtsch Arztebl Int ; 117(29-30): 513-520, 2020 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-33087239

RESUMO

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.


Assuntos
Degeneração Macular , Alemanha/epidemiologia , Humanos , Injeções Intravítreas , Degeneração Macular/diagnóstico , Degeneração Macular/epidemiologia , Degeneração Macular/terapia , Fatores de Risco
18.
Med Sci (Paris) ; 36(10): 886-892, 2020 Oct.
Artigo em Francês | MEDLINE | ID: mdl-33026331

RESUMO

Age-related macular degeneration (AMD) is a complex, highly heritable, multifactorial disease caused by the interplay of age and genetic and environmental risk factors. No treatment has yet been found to treat the slowly progressing atrophic form of AMD. All forms of AMD are invariably associated with an accumulation of mononuclear phagocytes (MP) in the subretinal space, a family of cells that include inflammatory and resident macrophages. We here present an overview of the inflammatory process occurring in AMD and discuss the origin of MPs and the consequences of their accumulation in the subretinal space. Finally, we will review the role played by the established risk factors for AMD to promote the switch from beneficial inflammation in early stage to a deleterious inflammation in the advanced stage of the disease.


Assuntos
Inflamação/complicações , Degeneração Macular/etiologia , Olho/imunologia , Olho/metabolismo , Olho/patologia , Humanos , Privilégio Imunológico/fisiologia , Inflamação/metabolismo , Mediadores da Inflamação/metabolismo , Mediadores da Inflamação/fisiologia , Degeneração Macular/epidemiologia , Degeneração Macular/imunologia , Degeneração Macular/metabolismo , Fatores de Risco
19.
Vestn Oftalmol ; 136(5): 136-141, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33056975

RESUMO

At present, age-related macular degeneration (AMD) takes third place among the causes of blindness and low vision in the middle-aged and senile persons. The medical and social significance of this pathology is motivated by the possibility of losing central vision and general ability to perform professional duties. One of the modern methods of diagnostics of this disease is eye fundus autofluorescence. Its introduction into everyday clinical practice increases the effectiveness of detecting early signs of AMD and helps clarify the indications for the appointment of conservative treatment.


Assuntos
Degeneração Macular , Baixa Visão , Cegueira , Fundo de Olho , Humanos , Degeneração Macular/diagnóstico , Pessoa de Meia-Idade
20.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2380-2383, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018485

RESUMO

This paper presents a novel method to model the deformations that occur in the retina due to macular disorders such as Age-related Macular Degeneration (AMD). In this model, the retinal pigment epithelium (RPE) covered with cones and rods is considered as a uniform layer of known pixels. The projected image on these pixels is perceived as per this model. Furthermore, this model can efficiently be used to generate the test patterns for an accurate and efficient method for monitoring macular disorder. In this proposed model, two major geometric shapes of retinal deformation are taken into account. Both colourful and grayscale images are employed to estimate the perceived images under various circumstances and inputs. Based on these results, the proposed model can be used for the assessment of the progression of macular disorders.Clinical relevance-Retinal Pigment Epithelium (RPE), Field of view (FOV), Visual Distortion (VD).


Assuntos
Degeneração Macular , Humanos , Degeneração Macular/diagnóstico , Retina , Células Fotorreceptoras Retinianas Cones , Epitélio Pigmentado da Retina , Células Fotorreceptoras Retinianas Bastonetes
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