Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.870
Filtrar
1.
Adv Gerontol ; 32(4): 599-601, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31800189

RESUMO

The article compares the course of age-related macular degeneration in elderly patients in three groups after complex therapy (intravitreal administration of angiogenesis blockers and photodynamic therapy). 339 case histories of persons with an average age of 75,6±9,7 years were analyzed (p<0,05). A slight decrease in the area of pathological autofluorescence and retinal thickness according to optical coherence tomography was revealed in all three groups of increased visual acuity. The best effect of combination therapy was observed in the first six months, no further positive dynamics was observed. Thus, timely diagnosis and complex therapy slows down and sometimes stops the progression of age-related macular degeneration and vision loss.


Assuntos
Inibidores da Angiogênese , Degeneração Macular , Retina , Idoso , Idoso de 80 Anos ou mais , Inibidores da Angiogênese/administração & dosagem , Inibidores da Angiogênese/farmacologia , Angiofluoresceinografia , Humanos , Injeções Intravítreas , Degeneração Macular/tratamento farmacológico , Fotoquimioterapia , Retina/efeitos dos fármacos , Retina/patologia , Estudos Retrospectivos , Resultado do Tratamento
2.
J Biomed Nanotechnol ; 15(12): 2305-2320, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31748013

RESUMO

Verteporfin photodynamic therapy (PDT) has been approved for the treatment of exudative age-related macular degeneration (AMD) for over a decade. However, its extensive application has been impeded by inevitably collateral tissue damage and immediate induction of angiogenesis, in addition to the need of multiple treatments. In order to develop prospective photosensitizers for clinical use, a triphenyl phosphonium-modified cationic liposomal hypocrellin B (TPP cationic LHB) for angiogenic targeting and endothelial internalization was constructed. With optimal PDT parameters, TPP cationic LHB can lead to death of choroid-retinal vascular endothelial cells while cause negligible damage to collateral retinal pigment epithelium cells. This is likely due to the mitochondria targeting and effective intracellular singlet oxygen generation of TPP cationic LHB in vascular endothelial cells. Additionally, in vivo chick chorioallantoic membrane assay indicated the elevated neovessel-targeting ability and photo-induced anti-angiogenic activity of TPP cationic LHB. Furthermore, TPP cationic LHB PDT is able to maintain neovessel occlusion for an extended period of time compared with verteporfin PDT, without inducing significant increased expression of some angiogenic factors, such as vascular endothelial growth factor and integrin αvß3. This study describes a facile strategy that may be useful for developing new-generation photosensitizers to circumvent the limitations of PDT treatment of exudative AMD.


Assuntos
Degeneração Macular , Perileno/análogos & derivados , Fotoquimioterapia , Quinonas/uso terapêutico , Animais , Neovascularização de Coroide , Células Endoteliais , Lipossomos , Degeneração Macular/tratamento farmacológico , Perileno/uso terapêutico , Fármacos Fotossensibilizantes , Estudos Prospectivos , Fator A de Crescimento do Endotélio Vascular
4.
Buenos Aires; CONETEC; nov. 2019.
Não convencional em Espanhol | BRISA/RedTESA | ID: biblio-1025042

RESUMO

INTRODUCCIÓN: La degeneración macular asociada a la edad (DMAE) es una patología que afecta la mácula (zona central de la retina) y evoluciona frecuentemente a una disminución de la agudeza visual, constituyendo la principal causa de ceguera en mayores de 50 años en países desarrollados. Existen dos formas de presentación, la seca y la húmeda o exudativa, que representan el 90% y 10% de los casos respectivamente. La húmeda se caracteriza por la formación anormal de nuevos vasos coroideos (neovascularización), exudación y edema de la retina. Esta forma es la responsable del 90% de los casos de pérdida grave de la visión y se estima que el 70% de los ojos con signos de neovascularización evolucionarán a pérdida severa de la visión a los dos años del diagnóstico. Por lo cual es fundamental el inicio temprano del tratamiento y su mantenimiento adecuado para limitar la progresión de la pérdida de la agudeza visual. OBJETIVO: El objetivo del presente informe es evaluar la eficacia, seguridad, los costos asociados al uso de bevacizumab para degeneración macular húmeda asociada a la edad, en comparación con ranibizumab. DESCRIPCIÓN DE LA TECNOLOGÍA: Bevacizumab, un anticuerpo monoclonal IgG1 humanizado recombinante, se une al FCEV e inhibe su interacción con los receptores Flt1 y KDR en la superficie de las células endoteliales. En el proceso, previene la proliferación de células endoteliales y la formación de nuevos vasos sanguíneos. BÚSQUEDA BIBLIOGRÁFICA: Se realizó una búsqueda en las principales bases de datos bibliográficas: PubMed, CRD (del inglés Centre for Reviews and Dissemination- University of York), en Tripdatabase, en los sitios web de financiadores de salud y de sociedades científicas, así como en los buscadores genéricos de internet se buscó con el nombre de la tecnología y sus sinónimos y/o la patología. Se priorizó la inclusión de revisiones sistemáticas (RS), ensayos clínicos controlados aleatorizados (ECAs), evaluaciones de tecnologías sanitarias (ETS), evaluaciones económicas, guías de práctica clínica (GPC) y políticas de cobertura de diferentes sistemas de salud. RESULTADOS: Se incluyeron cuatro RS con metaanálisis, un metaanálisis de elaboración propia, cuatro GPC y cinco informes de ETS de bevacizumab para degeneración macular asociada a la edad. Todos los estudios incluidos fueron realizados con la administración de bevacizumab de marca comercial Avastin®. La evidencia hallada no mostró diferencias entre bevacizumab y ranibizumab en lo que respecta a la agudeza visual a uno y dos años de seguimiento. Asimismo, mostró que la mejoría en la calidad de vida y los eventos adversos serían similares entre estos tratamientos. En lo que se refiere específicamente a la endoftalmitis, la incidencia también resultó similar en ambos grupos. CONCLUSIONES: La evidencia disponible no mostró diferencias entre el bevacizumab y el ranibizumab en lo que se refiere a la eficacia y seguridad. No está demostrado que exista mayor riesgo de endoftalmitis asociado al uso de bevacizumab fraccionado. Este riesgo potencial de endoftalmitis puede ser mitigado con métodos de fraccionamiento adecuado. El tratamiento con bevacizumab es notablemente menos costoso que ranibizumab o aflibercept y recomendar su utilización redundará en un mayor acceso.


Assuntos
Humanos , Bevacizumab/uso terapêutico , Ranibizumab/uso terapêutico , Degeneração Macular/tratamento farmacológico , Avaliação da Tecnologia Biomédica , Análise Custo-Eficiência
6.
Expert Opin Ther Pat ; 29(10): 761-767, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31540558

RESUMO

Introduction: Macular degeneration (MD) and macular edema (ME) are ophthalmologic diseases affecting an increasing number of the aging population. Until recently, there were few therapeutic options for both conditions but the last two decades saw important advances. Areas covered: This review summarizes the agents used for the treatment of age-related MD (AMD), which include verteporfin, for photodynamic therapy, and anti-VEGF agents, the aptamer pegaptanib, the monoclonal antibodies (MAbs) ranibizumab (Lucentis®) and bevacizumab (Avastin®) and the fusion protein aflibercept (Eylea®). All these drugs are effective only for the wet form of AMD, whereas for the dry form there is no treatment available. ME is, on the other hand, treated with nonsteroidal anti-inflammatory drugs and carbonic anhydrase (CA) inhibitors. Recently, MAbs such as ranibizumab and bevacizumab were also shown to be effective for the management of the cystoid and diabetic ME. Expert opinion: There are important advances made in the field in the last years but longer-acting anti-VEGF agents or drugs with less ocular side effects are needed. Many such agents are in clinical development.


Assuntos
Desenvolvimento de Medicamentos , Degeneração Macular/tratamento farmacológico , Edema Macular/tratamento farmacológico , Idoso , Inibidores da Angiogênese/administração & dosagem , Inibidores da Angiogênese/farmacologia , Animais , Humanos , Degeneração Macular/fisiopatologia , Degeneração Macular/prevenção & controle , Edema Macular/fisiopatologia , Edema Macular/prevenção & controle , Patentes como Assunto , Fotoquimioterapia/métodos
7.
Expert Opin Investig Drugs ; 28(10): 861-869, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31513439

RESUMO

Introduction: The Tie-2/Angiopoietin pathway is a therapeutic target for the treatment of neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME). Activation of Tie-2 receptor via Ang-1 maintains vascular stability to limit exudation. Ang-2, a competitive antagonist to Ang-1, and VE-PTP, an endothelial-specific phosphatase, interfere with the Tie-2-Ang-1 axis, resulting in vascular leakage. Areas covered: Faricimab, a bispecific antibody that inhibits VEGF-A and Ang-2, is in phase 3 trials for nAMD and DME. Nesvacumab is an Ang-2 inhibitor; when coformulated with aflibercept, it failed to show benefit over aflibercept monotherapy in achieving visual gains in phase 2 studies of nAMD and DME. ARP-1536 is an intravitreally administered VE-PTP inhibitor undergoing preclinical studies. AKB-9778 is a subcutaneously administered VE-PTP inhibitor that, when combined with monthly ranibizumab, reduced DME more effectively than ranibizumab monotherapy in a phase 2 study. AKB-9778 monotherapy did not reduce diabetic retinopathy severity score compared to placebo. AXT107, currently in the preclinical phase, promotes conversion of Ang-2 into a Tie-2 agonist and blocks signaling through VEGFR2 and other receptor tyrosine-kinases. Expert opinion: Tie-2/Angiopoietin pathway modulators show promise to reduce treatment burden and improve visual outcomes in nAMD and DME, with potential to treat cases refractory to current treatment modalities.


Assuntos
Inibidores da Angiogênese/administração & dosagem , Retinopatia Diabética/tratamento farmacológico , Degeneração Macular/tratamento farmacológico , Inibidores da Angiogênese/farmacologia , Angiopoietina-1/antagonistas & inibidores , Angiopoietina-2/antagonistas & inibidores , Animais , Retinopatia Diabética/fisiopatologia , Humanos , Degeneração Macular/fisiopatologia , Edema Macular/tratamento farmacológico , Edema Macular/fisiopatologia , Receptor TIE-2/efeitos dos fármacos , Receptor TIE-2/metabolismo , Transdução de Sinais/efeitos dos fármacos
8.
Klin Monbl Augenheilkd ; 236(9): 1081-1090, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31509858

RESUMO

Currently, for non-exudative age-related macular degeneration (AMD), therapy is not possible-in contrast to the exudative form. Many patients hope for a preventive effect and a slower progression of the disease from the dietary supplements on the market. The substances contained in them are supposed to reduce the oxidative environment in the outer retina and, thereby, slow down the cell damage and the progression of AMD. The Age-Related Eye Disease Studies (AREDS) examined certain supplements for their effectiveness in reducing the risk of AMD progression. They are the only interventional large-scale, prospective, randomized and controlled clinical trials and are repeatedly used as the basis for dietary supplementation in AMD. This article discusses the rationale for the use of certain ingredients of AREDS supplements and critically examines the results of AREDS. Furthermore, the modern term "lifestyle" will be discussed in the context of AMD as a possibility to influence the progression of this disease.


Assuntos
Suplementos Nutricionais , Degeneração Macular , Vitaminas , Antioxidantes , Progressão da Doença , Humanos , Estilo de Vida , Degeneração Macular/tratamento farmacológico , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto
9.
Cell Physiol Biochem ; 53(2): 400-412, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31403270

RESUMO

BACKGROUND/AIMS: Mutations in ABCA4 cause Stargardt macular degeneration, which invariably ends in legal blindness. We studied two common mutants, A1038V (in NBD1) and G1961E (in NBD2), with the purpose of exploring how they interact with the cell's quality control mechanism. The study was designed to determine how these mutants can be rescued. METHODS: We expressed wt and mutant ABCA4 in HEK293 cells and studied the effect of the mutations on trafficking and processing and the ability of correctors to rescue them. We used a combination of western blotting, confocal microscopy and surface biotinylation coupled with pulldown of plasma membrane proteins. RESULTS: G1961E is sensitive to inhibitors of the aggresome, tubacin and the lysosome, bafilomycin A. Both mutants cause a reduction in heat shock protein, Hsp27. Incubation of HEK293 cells expressing the mutants with VX-809, an FDA approved drug for the treatment of cystic fibrosis, increased the levels of A1038V and G1961E by 2- to 3-fold. Importantly, VX-809 increased the levels of both mutants at the plasma membrane suggesting that trafficking had been restored. Transfecting additional Hsp27 to the cells also increased the steady state levels of both mutants. However, in combination with VX-809 the addition of Hsp27 caused a dramatic increase in the protein expression particularly in the G1961 mutant which increased approximately 5-fold. CONCLUSION: Our results provide a new mechanism for the rescue of ABCA4 trafficking mutants based on the restoration of Hsp27. Our results provide a pathway for the treatment of Stargardt disease.


Assuntos
Transportadores de Cassetes de Ligação de ATP/metabolismo , Aminopiridinas/farmacologia , Benzodioxóis/farmacologia , Transportadores de Cassetes de Ligação de ATP/genética , Aminopiridinas/uso terapêutico , Anilidas/farmacologia , Benzodioxóis/uso terapêutico , Membrana Celular/metabolismo , Regulador de Condutância Transmembrana em Fibrose Cística/genética , Regulador de Condutância Transmembrana em Fibrose Cística/metabolismo , Regulação da Expressão Gênica/efeitos dos fármacos , Células HEK293 , Proteínas de Choque Térmico HSP27/metabolismo , Humanos , Ácidos Hidroxâmicos/farmacologia , Leupeptinas/farmacologia , Lisossomos/metabolismo , Degeneração Macular/congênito , Degeneração Macular/tratamento farmacológico , Degeneração Macular/metabolismo , Degeneração Macular/patologia , Mutação , Transporte Proteico/efeitos dos fármacos
10.
Health Qual Life Outcomes ; 17(1): 140, 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412873

RESUMO

BACKGROUND: Although visual acuity and optical coherence tomography (OCT) are most widely used as outcomes in treatment of neovascular age-related Macular Degeneration (nAMD), patient reported outcome measures are increasingly recognized. National Eye Institute Visual Function Questionnaire (NEI-VFQ 25) was developed to capture the perceived visual function. Yet, evidence of psychometric performance in the target population is required. The aim of this study was to examine the psychometric properties of NEI-VFQ 25 in a Norwegian cohort of newly diagnosed nAMD patients followed with a Treat and Extend (T/E) protocol. METHODS: Patients receiving intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection treatment according to a T/E protocol completed a Norwegian translation of NEI-VFQ 25, EuroQoL Health Questionnaire (EQ-5D), and Patient acceptable symptom state (PASS 5) at baseline, 3, 6 and 12 months. In addition, a control population completed the same questionnaires. Visual acuity was assessed with LogMar for best/treated eye. Validity testing comprised face validity by a 0-10 numeric rating scale about relevance of NEI-VFQ 25 as well as regression analyses and correlations between NEI-VFQ 25 and other relevant variables. Reliability was examined with Intraclass Correlation Coefficient (ICC) and Cronbach's alpha for internal consistency were performed. Responsiveness, discriminatory power and predictive value were also explored. RESULTS: Number of respondents at baseline, after 3, 6 and 12 months was 197, 186, 176 and 168, respectively. The control population comprised 26 individuals. Face validity of NEI-VFQ 25 had a mean (SD) of 7.8 (1.7) (n = 84). NEI-VFQ was significantly correlated to visual acuity and PASS 5 as well as EQ-5D at baseline. Reliability (ICC) of the overall and sub scores for the patients/controls ranged from 0.49-0.97/0.59-0.97. Cronbach's alpha was 0.61-0.85. Discriminatory power was confirmed by significant differences of the overall score between controls and patients (P < 0.001). NEI-VFQ 25 indicates responsiveness showing overall score improved significantly (P ≤ 0.001) from baseline to 3 months. NEI-VFQ 25, general health and visual acuity at baseline were the strongest predictors for how patients reported vision after 6 months follow-up. CONCLUSION: NEI-VFQ 25 showed acceptable psychometric performance, which supports that the Norwegian version can be used to monitor patients treated for nAMD.


Assuntos
Degeneração Macular/psicologia , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Degeneração Macular/tratamento farmacológico , Masculino , Noruega , Reprodutibilidade dos Testes , Traduções , Fator A de Crescimento do Endotélio Vascular/uso terapêutico , Acuidade Visual
11.
Expert Opin Ther Pat ; 29(10): 749-752, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31456444

RESUMO

Introduction: Age-related macular degeneration (AMD) is the leading cause of central vision loss in developed countries. Effective therapy for AMD is currently limited to the treatment of the patient with intravitreal injections of anti-VEGF drugs. Areas covered: A method for the management of age-related macular degeneration (AMD) is claimed. It consists of the administration of pure botulinum-toxin or a serogroup of recombinant botulinum-toxins or their peptide fragments or neurotoxin associated with accessory proteins in extra-ocular regions of the eye. The toxin modifies the retinal pigment epithelium, maintaining its structure and function, and delaying the various stages of the macular degeneration. Expert opinion: The botulinum-toxin (BT) is administrated as extra-ocular infusions avoiding the risk of direct intraocular injection and the complications associated with the patients. The possibility to administer BT with accessory proteins (hemagglutinin, monoclonal antibody (anti-VEGF)), makes the novel system interesting for developing combined approaches for AMD treatment. The use of BT (alone or conjugated to other agents) as a method for treating or preventing AMD requires necessarily a patient case report study, as well as the in vitro or in vivo data, for supporting all the claims of the present patent.


Assuntos
Toxinas Botulínicas/administração & dosagem , Degeneração Macular/tratamento farmacológico , Epitélio Pigmentado da Retina/efeitos dos fármacos , Humanos , Degeneração Macular/fisiopatologia , Patentes como Assunto , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores
12.
Expert Opin Pharmacother ; 20(15): 1879-1891, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31298960

RESUMO

Introduction: Investigational anti-VEGF treatments for neovascular age-related macular degeneration (nAMD) aim to improve visual outcomes and reduce treatment burden; these include long-acting agents, combination strategies, topical agents, sustained-release, and genetic therapies. Areas covered: The authors provide a comprehensive review of investigational therapies for nAMD, focusing on therapies currently in clinical trial. Expert opinion: Long-acting anti-VEGF agents have demonstrated promising results in phase 3 studies, and include Brolucizumab, a single-chain antibody fragment, and Abicipar, a designed ankyrin repeat protein (DARPin). Other unique anti-VEGF agents in current trials include Conbercept - a fusion protein of the VEGF receptor domains, KSI-301 - an anti-VEGF antibody biopolymer conjugate, and OPT-302 - an inhibitor of VEGF-C/D. Strategies to activate the Tie-2 receptor, some in combination with VEGF inhibition, are of interest, with recent trials of Faricimab, ARP-1536, and nesvacumab. Topical anti-VEGF ± anti-PDGF agents, such as pazopanib, squalamine lactate, regorafenib, and LHA510 have shown limited efficacy and/or have not been advanced, although PAN-90806 continues to advance with promising initial results. Sustained-release anti-VEGF treatments, to address treatment burden, include the ranibizumab Port Delivery System, GB-102, NT-503, hydrogel depot, Durasert, and ENV1305. Similarly, genetic therapies, including RGX-314 and ADVM-022, aim to provide sustained anti-VEGF expression from the retina.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Degeneração Macular/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Inibidores da Angiogênese/farmacologia , Humanos , Degeneração Macular/patologia
13.
Semin Ophthalmol ; 34(6): 420-435, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31314638

RESUMO

Background: Age-related macular degeneration is the leading cause of blindness in adults over the age of 50 in the United States of America. Neovascular age-related macular degeneration (nAMD) is sight-threatening, but can be treated by three currently utilized, intravitreally administered drugs: aflibercept, bevacizumab, and ranibizumab. Ziv-aflibercept is an analogue of aflibercept, containing the same active molecule in a different buffer solution, and its recent availability has prompted numerous pre-clinical and clinical trials addressing its viability for intraocular use, summarized herein. Results: Trial outcomes demonstrate that ziv-aflibercept has a similar safety profile to other indicated drugs with effective maintenance or improvement of best-corrected visual acuity (BCVA) and reduction of retinal fluid or central foveal thickness (CFT). Clinical trials of ziv-aflibercept in other neovascular disorders such as diabetic macular edema (DME) and retinal vein occlusion (RVO) have shown similar results. Conclusion: Further prospective, randomized studies of ziv-aflibercept are needed, particularly in eyes with nAMD.


Assuntos
Degeneração Macular/tratamento farmacológico , Receptores de Fatores de Crescimento do Endotélio Vascular/administração & dosagem , Proteínas Recombinantes de Fusão/administração & dosagem , Acuidade Visual , Relação Dose-Resposta a Droga , Humanos , Injeções Intravítreas , Macula Lutea/patologia , Receptores de Fatores de Crescimento do Endotélio Vascular/antagonistas & inibidores , Tomografia de Coerência Óptica , Resultado do Tratamento
14.
Graefes Arch Clin Exp Ophthalmol ; 257(10): 2119-2125, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31286206

RESUMO

PURPOSE: To analyze and compare loss to follow-up (LTFU) rates between patients with diabetic retinopathy (DR) and those with neovascular age-related macular degeneration (nAMD) in patients, receiving treatment with anti-vascular endothelial growth factor (VEGF), under universal health coverage. METHODS: We retrospectively analyzed the relevant data of 1264 patients receiving anti-VEGF therapy, in this cohort study. The observation period ranged from September 01, 2015 to December 31, 2018. Intervals between each procedure and the subsequent follow-up examination were measured. Demographic data, visual acuity (VA), the type of transport for treatment access, and distance between the residence and clinic were evaluated as risk factors for LTFU. RESULTS: We collected data for 841 patients with nAMD (age, 81.0 (± 8.1 years)) and 423 patients with DR (age, 67.7 (± 12.1 years)). The rate of LTFU, for at least 6 months, was 28.8% and 2.9% for patients with DR and nAMD, respectively (p < 0.001). In the DR group, 18.9% patients were lost to follow-up exceeding > 12 months. Multivariate regression analysis showed that advanced age, lack of mobility, and need for assisted transport, poor final VA despite treatment, and decrease in vision during the observational period were independent risk factors for LTFU exceeding 12 months (p < 0.05). CONCLUSIONS: We found a high long-term LTFU rate for patients with DR, despite treatment under universal health coverage. Considering the risk of disease progression, particularly in patients with chronic DR, strategies for better compliance and adherence to therapy should be considered for optimized patient care.


Assuntos
Retinopatia Diabética/tratamento farmacológico , Cobertura do Seguro , Degeneração Macular/tratamento farmacológico , Cooperação do Paciente , Ranibizumab/administração & dosagem , Receptores de Fatores de Crescimento do Endotélio Vascular/administração & dosagem , Proteínas Recombinantes de Fusão/administração & dosagem , Acuidade Visual , Idoso , Idoso de 80 Anos ou mais , Inibidores da Angiogênese/administração & dosagem , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/economia , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Humanos , Injeções Intravítreas , Macula Lutea/patologia , Degeneração Macular/diagnóstico , Degeneração Macular/economia , Masculino , Receptores de Fatores de Crescimento do Endotélio Vascular/antagonistas & inibidores , Estudos Retrospectivos , Tomografia de Coerência Óptica , Resultado do Tratamento
15.
Klin Monbl Augenheilkd ; 236(9): 1076-1080, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31362320

RESUMO

BACKGROUND: Non-neovascular age-related macular degeneration (AMD) is not yet treatable. This article summarises current clinical research approaches. The reasons for the current lack of success are analysed. METHODS: Literature and databank search. RESULTS: The number of therapeutic approaches and mechanisms is limited. Only reduction in lipofuscin containing deposits is specific for AMD. Further approaches include modulation of inflammation and neuroprotection. Confirmatory studies have failed to demonstrate efficacy in AMD, i.e. slowing or stopping AMD progression. DISCUSSION: To increase the probability of success for future developments, the pharmacological target space needs to be broadened. This may be achieved by application of molecular network analyses. As visual acuity is commonly not primarily affected by non-neovascular AMD, research on patient perspective is required to define reasonable target profiles for future therapies.


Assuntos
Inibidores da Angiogênese , Degeneração Macular , Inibidores da Angiogênese/farmacologia , Inibidores da Angiogênese/uso terapêutico , Humanos , Degeneração Macular/tratamento farmacológico , Acuidade Visual
16.
Yonsei Med J ; 60(7): 679-686, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31250582

RESUMO

PURPOSE: Statins, metformin, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin receptor blockers (ARBs) have been suggested for treating age-related macular degeneration (AMD) due to their pleiotropic effects. Therefore, we investigated whether these drugs prevent AMD. MATERIALS AND METHODS: We conducted a nested case-control study using the Korean National Health Insurance Service database. Using risk-set sampling of age, sex, cohort entry date, and follow-up duration, we identified incident patients with AMD and 10 matching controls in cohorts with diabetes mellitus or cardiovascular diseases. Exposure was assessed within one year before the index date using patient prescription records. We conducted conditional logistic regression to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) to evaluate the association between cardiovascular medications and AMD. RESULTS: Our study included 2330 cases and 23278 controls from a cohort of 231274 patients. The ORs (95% CI) for AMD occurrence in users prescribed with statins, metformin, ACE inhibitors, and ARBs were 1.12 (0.94-1.32), 1.15 (0.91-1.45), 0.90 (0.61-1.34), and 1.21 (1.05-1.39), respectively. A duration-response was not observed. CONCLUSION: Statins, metformin, ACE inhibitors, and ARBs did not inhibit AMD in elderly patients. The absence of a duration-response supports the lack of a causal relationship.


Assuntos
Antagonistas de Receptores de Angiotensina/farmacologia , Inibidores da Enzima Conversora de Angiotensina/farmacologia , Inibidores de Hidroximetilglutaril-CoA Redutases/farmacologia , Degeneração Macular/tratamento farmacológico , Metformina/farmacologia , Idoso , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Modelos Logísticos , Masculino , Metformina/uso terapêutico
17.
BMC Ophthalmol ; 19(1): 129, 2019 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-31208350

RESUMO

BACKGROUND: To evaluate the retinal function before and soon after an intravitreal injection of an anti-vascular endothelial growth factor (anti-VEGF) agents. METHODS: Seventy-nine eyes of 79 patients that were treated by an intravitreal injection of an anti-VEGF agent for age-related macular degeneration (AMD), diabetic macular edema (DME), or retinal vein occlusion (RVO) with macular edema (ME) were studied. The RETeval® system was used to record 28 Hz flicker electroretinograms (ERGs) from the injected and non-injected eyes before (Phase 1, P1), within 2 h after the injection (P2), and 2 to 24 h after the injection (P3). Patients were grouped by disease or by the injected agent and compared. The significance of the changes in the implicit times and amplitudes was determined by t tests. RESULTS: The amplitudes were not significantly different at the three phases. The implicit time of the injected eye was 31.2 ± 3.2 msec at P1, and it was not significantly different at P2 (31.7 ± 3.1 msec) but it was significantly longer at P3 (32.2 ± 3.3 msec, P < 0.01, ANOVA for both). The implicit time in the non-injected fellow eye was 30.5 ± 3.3 msec at P1, and it was significantly longer at P2 (31.1 ± 3.2 msec) and phase 3 (31.3 ± 3.4 msec, P < 0.01, ANOVA for both). CONCLUSIONS: The results indicate that an intravitreal anti-VEGF injection will increase the implicit times not only in the injected eye but also in the non-injected eye soon after the intravitreal injection.


Assuntos
Inibidores da Angiogênese/administração & dosagem , Degeneração Macular/tratamento farmacológico , Edema Macular/tratamento farmacológico , Ranibizumab/administração & dosagem , Retina/fisiopatologia , Oclusão da Veia Retiniana/tratamento farmacológico , Idoso , Análise de Variância , Retinopatia Diabética/tratamento farmacológico , Eletrorretinografia , Feminino , Humanos , Injeções Intravítreas , Degeneração Macular/fisiopatologia , Edema Macular/fisiopatologia , Masculino , Pessoa de Meia-Idade , Oclusão da Veia Retiniana/fisiopatologia , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Acuidade Visual/fisiologia
18.
Klin Monbl Augenheilkd ; 236(9): 1091-1095, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31216585

RESUMO

Despite the success of anti-VEGF therapy (VEGF: vascular endothelial growth factor) in neovascular age-related macular degeneration (AMD) in the last decade, many unmet needs in AMD management remain. In order to improve patient eye health and relieve the burden on health systems, the development of new intervention options appears to be of great importance if they can delay or even prevent the progression of an early form into a late form. In the field of physical treatment for non-exudative AMD, there is no recognised therapy procedure to date. It now appears appropriate to pursue further research efforts in the field of intraocular blue filter lenses and subthreshold laser treatment in prospective studies. The following article provides an overview of the current strategies of physical therapy for non-exudative AMD.


Assuntos
Inibidores da Angiogênese , Degeneração Macular , Inibidores da Angiogênese/uso terapêutico , Humanos , Degeneração Macular/tratamento farmacológico , Modalidades de Fisioterapia , Estudos Prospectivos , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores
19.
Ophthalmol Retina ; 3(5): 393-399, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31044729

RESUMO

PURPOSE: To report outcomes in patients with neovascular age-related macular degeneration (nAMD) after treatment with aflibercept for up to 4 years using a treat-and-extend (T&E) regimen. DESIGN: Observational study. PARTICIPANTS: Patients with newly diagnosed nAMD treated with aflibercept in a T&E protocol. METHODS: Subjects received 3 injections of aflibercept at monthly intervals followed by a T&E protocol for at least 12 months. At each clinical visit after the loading phase, OCT and best-corrected visual acuity (BCVA) testing were performed to monitor disease activity. MAIN OUTCOME MEASURES: Change in BCVA over time, number of injections and visits per year, and percentage of patients reaching a treatment interval of ≥12 weeks. RESULTS: Of 231 consecutive eyes (231 patients) with a mean follow-up time of 2.9 (1-5.5) years, 173 were followed up for ≥2 years, 112 were followed up for ≥3 years, and 62 were followed up for ≥4 years. Mean BCVA increased from 59.8 letters (20/60) at diagnosis to 65.8 letters (20/50) after the loading phase (+6.0 letters; standard deviation [SD], 11.1) and to 65.5 letters at 12 months (+5.7 letters; [SD], 17). After 4 years of treatment, mean BCVA was maintained insignificantly better than baseline (63.4 letters, +3.6 letters gain, SD, 20.6; P > 0.05). To achieve this, a mean of 7.7 (±1.2) injections and 4.4 (±1.6) clinic visits in the first year and 4.4 (±1.9) injections and 4.3 (±1.3) clinical visits per year thereafter were required. By 2 years of follow-up, 46.9% of patients reached a treatment interval of ≥12 weeks. CONCLUSIONS: By using a T&E regimen, patients with nAMD maintained stable visual function over 4 years in a real-world setting with a reasonable treatment burden.


Assuntos
Inibidores da Angiogênese/administração & dosagem , Degeneração Macular/tratamento farmacológico , Receptores de Fatores de Crescimento do Endotélio Vascular/administração & dosagem , Proteínas Recombinantes de Fusão/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Esquema de Medicação , Feminino , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acuidade Visual
20.
BMC Pharmacol Toxicol ; 20(1): 29, 2019 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-31088543

RESUMO

BACKGROUND: To investigate the one-year visual and anatomical outcomes of combination therapy with intravitreal aflibercept (IVA) and photodynamic therapy (PDT) for treating polypoidal choroidal vasculopathy (PCV). METHODS: This was a retrospective case-series study, including 30 eyes from 30 patients with treatment-naïve PCV treated by combination therapy with IVA and PDT. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), complete polyp regression rate, and dry macula rate were recorded every 3 months during 12-month follow-up. Clinical factors associated with final visual outcome and retreatment were investigated. RESULTS: The mean LogMAR BCVA was significantly improved from 0.73 ± 0.65 at baseline to 0.51 ± 0.60 (p = 0.01), and the mean CRT was also significantly improved from 339 ± 96 µm at baseline to 244 ± 43 µm at 12-month follow-up (p <  0.001). Complete regression of polypoidal lesions was 76.7%, and dry macula rate was 100% at 12 months. Better final BCVA was associated with younger age and better baseline BCVA (p = 0.02 and p <  0 001). The patients without complete polyp regression at 3-month follow-up were associated with retreatment (p = 0.03). CONCLUSION: In this study, combination therapy with IVA and PDT had significant visual and anatomical improvements to PCV patients during one-year follow-up. Better baseline BCVA and younger age were found to be associated with better visual outcome.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Luz , Degeneração Macular/tratamento farmacológico , Fotoquimioterapia , Fármacos Fotossensibilizantes/uso terapêutico , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Verteporfina/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Acuidade Visual/efeitos dos fármacos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA