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1.
Vestn Oftalmol ; 135(4): 121-127, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31573567

RESUMO

Retinal damage in diabetes is known to manifest in two main ways: diabetic retinopathy and diabetic macular edema. The most effective anti-inflammatory drugs today are glucocorticoids, a classic representative of which is dexamethasone. Two things that should be considered by ophthalmologists in the therapy of macular edema are the switching point to dexamethasone implant when the effectiveness of anti-vasoproliferative drugs is unsatisfactory, and the identification of the main predictors of diabetic macular edema that make glucocorticoids the drugs of first choice. The data from real clinical practice was used to develop the indications for intravitreal administration of a glucocorticoid as the therapy of first choice for diabetic macular edema. Glucocorticoids are prescribed to patients diagnosed with diabetic macular edema who has a history of acute cerebrovascular events, myocardial infarction or other cardiovascular and cerebrovascular diseases, as well as patients with a very high risk of a vascular catastrophe. Intravitreal glucocorticoids can be prescribed to patients who cannot follow the schedule of frequent visits and/or are not able to visit the hospital during the first 6 months after the administration of the drug. Considering the local character of its ophthalmic action, the method can be recommended for treating patients with pseudophakic eyes, persistent diabetic macular edema, or patients who underwent vitrectomy.


Assuntos
Dexametasona/uso terapêutico , Retinopatia Diabética , Edema Macular , Retinopatia Diabética/tratamento farmacológico , Implantes de Medicamento , Humanos , Injeções Intravítreas , Edema Macular/tratamento farmacológico , Acuidade Visual
2.
Medicine (Baltimore) ; 98(42): e17496, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626104

RESUMO

BACKGROUND: Diabetic macular edema is a further complication of diabetes. It is an important type of diabetic eye disease and the main cause of blindness of diabetic patients. Qiming granule is a Chinese patent medicine widely used in the treatment of diabetic macular edema. There are some reports about this medicine for macular edema. At present, there is only 1 systematic review on qiming granule in the treatment of diabetic macular edema. However, there are many defects in this article, so it is necessary to re-summarize and evaluate the existing evidence. METHODS AND ANALYSIS: Three English database and 4 Chinese databases other sources will be searched. Two methodological trained researchers will read the title, abstract and full texts, and independently select the qualified literature according to inclusion and exclusion criteria. After assessment of the risk of bias and data extraction, we will conduct meta-analyses for outcomes including central macular thickness, optimum corrected vision, overall effect rates, and adverse effects. The heterogeneity of data will be investigated by Cochrane χ and I tests. We build 3 hypotheses for subgroup analysis according to the guidance for a credible subgroup effect: Disease status at baseline, duration of intervention, type of concomitant medication. Sensitivity analysis will be conducted to evaluate the stability of the results. Then publication bias assessment will be conducted by funnel plot analysis and Egger test. Finally, we will use the Grading of Recommendations Assessment, Development and Evaluate system to evaluate the quality of evidence. RESULTS: The results of our research will be published in a peer-reviewed journal. CONCLUSION: In our study, the evidence of qiming granule in the treatment of macular edema was comprehensively summarized and carefully evaluated. It will provide more options for clinical treatment of the disease. PROSPERO REGISTRATION NUMBER: CRD42018108626.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Retinopatia Diabética/tratamento farmacológico , Medicamentos de Ervas Chinesas/administração & dosagem , Edema Macular/tratamento farmacológico , Adulto , Idoso , Retinopatia Diabética/etiologia , Feminino , Humanos , Edema Macular/etiologia , Masculino , Metanálise como Assunto , Pessoa de Meia-Idade , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Revisão Sistemática como Assunto , Resultado do Tratamento
3.
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
4.
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
5.
BMC Ophthalmol ; 19(1): 157, 2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31337360

RESUMO

PURPOSE: To investigate the dynamic changes of hyperreflective foci (HF) in diabetic macular edema (DME) patients during the intravitreal Conbercept treatment in China. METHODS: DME Patients receiving intravitreal Conbercept (IVC) injections during the year 2016-2017 were retrospectively investigated. Thirteen patients (26 eyes) were recruited in this study. They received IVC once a month for 3 consecutive months. The number and location of HFs, the best-corrected visual acuity (BCVA) and central macular thickness (CMT) at each visit were analyzed and compared. RESULTS: After the first injection, BCVA (LogMAR) was increased from 0.75 ± 0.48 to 0.43 ± 0.24 (p < 0.05), CMT improved from 575.9 ± 191.9 to 388.2 ± 198.5 µm (p = 0.014). However, the BCVA and CMT had no statistical difference after the second and third injection as compared with those after the first injection respectively. The baseline number of HFs was 5.39 ± 4.24, 5.15 ± 5.17 and 0.88 ± 1.90 in the inner retinal, outer retinal and subretinal layer respectively. The number of HFs in these three retinal layers decreased significantly after the first injection (p = 0.0045, p < 0.0001 and p = 0.0045, respectively). However, after the second injection, only the number of HFs in the inner retinal layer experienced a further decrease. After the third injection, no statistically significant HFs changes was observed in each retinal layers. Correlation analysis showed that there was a positive significant correlation between the baseline number of HFs in the inner retina, outer retina, subretina and final BCVA (r = 0.571, p = 0.002; r = 0.464, p = 0.017; r = 0.405, p = 0.04 respectively). There was also a significant positive correlation between outer retinal HFs reduction, total retinal HFs reduction and increase of BCVA (r = 0.40, p = 0.043 and r = 0.393, p = 0.04 respectively). There were no severe ocular adverse reactions or systemic adverse events. CONCLUSIONS: Conbercept is effective and safe in the treatment of DME. HFs can act as a biomarker of poor final visual outcome.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Retinopatia Diabética/tratamento farmacológico , Edema Macular/tratamento farmacológico , Proteínas Recombinantes de Fusão/uso terapêutico , Tomografia de Coerência Óptica , Adulto , Idoso , Análise de Variância , Biomarcadores , China , Retinopatia Diabética/diagnóstico por imagem , Retinopatia Diabética/patologia , Feminino , Humanos , Injeções Intravítreas , Macula Lutea/patologia , Edema Macular/diagnóstico por imagem , Edema Macular/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Acuidade Visual
7.
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
8.
BMC Ophthalmol ; 19(1): 133, 2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31226968

RESUMO

BACKGROUND: To evaluate the subfoveal choroidal thickness (SFCT) in eyes with macular edema (ME) secondary to retinal vein occlusion(RVO), and to investigate the short term response after a single intravitreal ranibizumab (IVR) injection. What is more, to compare SFCT and SFCT change between central RVO (CRVO) and branch RVO (BRVO). METHODS: In the retrospective study, we had collected 36-six treatment-naïve patients with unilateral ME secondary to RVO (including 19 CRVO and 17 BRVO). All patients had received IVR injection after newly diagnosed. The SFCT was measured at the onset and after 2 weeks of IVR injection. Paired t test was performed to compare the SFCT of RVO eyes and fellow eyes, as well as the SFCT of pre-injection and post-injection. In further, independent t test was used to compare SFCT and SFCT change between CRVO eyes and BRVO eyes. RESULTS: The mean SFCT at the onset was 326.03 ± 30.86 µm in CRVO eyes, which was significantly thicker than that in contralateral fellow eyes (p < 0.01, paired t test), and reduced to 294.15 ± 30.83 µm rapidly after 2 weeks of IVR injection (p < 0.01, paired t test). Similarly, the SFCT in BRVO eyes was significantly thicker than that in contralateral eyes at the onset, and decreased significantly after IVR injection. However, our findings showed that there was no statistically significant difference in SFCT and SFCT reduction after IVR injection between CRVO eyes and BRVO eyes. CONCLUSIONS: The SFCT in eyes with ME secondary to CRVO and BRVO was significantly thicker than that in fellow eyes, and decreased significantly within a short time in response to a single IVR injection. In further, the study showed that SFCT and SFCT change had no correlation with RVO subtypes.


Assuntos
Corioide/patologia , Edema Macular/patologia , Oclusão da Veia Retiniana/patologia , Adulto , Idoso , Inibidores da Angiogênese/uso terapêutico , Feminino , Humanos , Injeções Intravítreas , Edema Macular/tratamento farmacológico , Edema Macular/etiologia , Masculino , Pessoa de Meia-Idade , Ranibizumab/uso terapêutico , Oclusão da Veia Retiniana/complicações , Oclusão da Veia Retiniana/tratamento farmacológico , Estudos Retrospectivos
9.
Asia Pac J Ophthalmol (Phila) ; 8(3): 200-205, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31165603

RESUMO

PURPOSE: To investigate long-term outcomes of pro re nata (PRN) treatment protocol of ranibizumab for diabetic macular edema (DME) adopted from the first month of therapy without 3 loading doses. DESIGN: Retrospective interventional study. METHODS: We analyzed 180 eyes of 144 patients treated with ranibizumab for DME with a minimum follow-up of 1 year during December 2013 to December 2017. Data of all patients with treatment-naive center-involving DME who received at least 1 intravitreal injection of ranibizumab during the study period were drawn from a locally adapted electronic form for DME. The primary outcome measure was change in best-corrected visual acuity (BCVA) from baseline at 1-year follow-up, with intergroup comparisons in BCVA between eyes receiving 1, 2, and 3 injections in the first 3 months of treatment. RESULTS: The mean baseline BCVA was 0.47 ± 0.30 logMAR, which improved to 0.38 ± 0.3 logMAR (P = 0.003) at 3 months and stabilized at 0.35 ± 0.27 logMAR at 1 year (P = 0.46 vs BCVA at 3 months) and 0.34 ± 0.26 logMAR at 2 years of follow-up (P = 0.44 vs BCVA at 3 months). At 3 months, 24 eyes (13%) underwent 1 intravitreal injection, 52 eyes (29%) had 2 injections, and the majority (n = 104 eyes, 58%) had 3 injections on a monthly basis. During the first year, the group that received only 1 injection in the first 3 months also required fewer injections and fewer follow-up visits compared with those receiving 2 or 3 injections in the first 3 months. CONCLUSIONS: One-third of eyes with DME responded well to PRN treatment strategy from the first month without 3 loading doses of ranibizumab. Baseline visual acuity is the best predictor of vision at 1 and 2 years of follow-up.


Assuntos
Retinopatia Diabética/tratamento farmacológico , Macula Lutea/patologia , Edema Macular/tratamento farmacológico , Ranibizumab/administração & dosagem , Acuidade Visual , Adulto , Idoso , Idoso de 80 Anos ou mais , Inibidores da Angiogênese/administração & dosagem , Retinopatia Diabética/complicações , Retinopatia Diabética/diagnóstico , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Humanos , Injeções Intravítreas , Edema Macular/diagnóstico , Edema Macular/etiologia , Masculino , Microscopia Acústica , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Tomografia de Coerência Óptica , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores
10.
BMC Ophthalmol ; 19(1): 123, 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-31151389

RESUMO

BACKGROUNDS: To assess the changes in individual retinal layer thickness and visual function associated with gains in visual acuity after an intravitreal conbercept injection in the diabetic macular edema (DME) on spectral domain optical coherence tomography (SD-OCT) and microperimetry during 1-year follow-up. METHODS: Retrospective observational study. Twenty patients with clinically significant DME in the study eye were imaged by SD-OCT every 3 months and MP1 microperimeter in the third month while receiving anti-vascular endothelial growth factor (VEGF) (conbercept) treatment. In each patient, seven retinal layers were segmented in 98 scans covering a 6 mm × 6 mm area of the macula at baseline and during 1 year of treatment. An automatic, full-threshold microperimetry of the central field (10° × 10°, 40 stimulated points) with the MP1 microperimeter. Thickness and microperimetry changes were quantitatively measured and evaluated for their correlation with increases in visual acuity. RESULTS: Although thicknesses of the inner nuclear layer (INL) and the outer nuclear layer (ONL) were reduced the most after treatment (p < 0.05), decreases of the ganglion cell layer (GCL) (r = 0.591, p = 0.006) and inner plexiform layer (IPL) (r = 0.663, p = 0.001) in central subfield area was associated with best-corrected visual acuity (BCVA) gain, and had the best estimation of BCVA gain (adjust R2 = 0.544). Mean macular sensitivity in the central subfield was also well correlated with BCVA gain (r = 0.531, p = 0.016). CONCLUSIONS: Neural recovery occurred after the resolution of edema during conbercept treatment, due to the decreases in GCL and IPL associating with gains in vision and improved microperimetry.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Retinopatia Diabética/tratamento farmacológico , Edema Macular/tratamento farmacológico , Proteínas Recombinantes de Fusão/uso terapêutico , Retina/patologia , Acuidade Visual/fisiologia , Idoso , Retinopatia Diabética/fisiopatologia , Feminino , Humanos , Macula Lutea/fisiologia , Edema Macular/fisiopatologia , Masculino , Pessoa de Meia-Idade , Células Ganglionares da Retina/patologia , Estudos Retrospectivos
12.
Korean J Ophthalmol ; 33(3): 259-266, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31179657

RESUMO

PURPOSE: To evaluate the changes in visual acuity (VA) and central macular thickness (CMT) after intravitreal dexamethasone (IVD) implantation in intravitreal bevacizumab (IVB) treatment-resistant cases with pseudophakic cystoid macular edema (PCME). METHODS: This study included 10 PCME cases who underwent uneventful phacoemulsification and intraocular lens implantation with similar methods and six PCME cases referred to our hospital for treatment of low VA after cataract surgery. Due to the persistence of PCME, both topical steroid and anti-inflammatory medication were administered first, followed by IVB injection. IVD implantation was performed for all IVB treatment-resistant cases. VA and CMT values were compared before and at three months after the first IVD implantation. RESULTS: The mean VA values before and at 3 months after the first IVD implantation were 0.69 ± 0.19 logarithm of the minimum angle of resolution (logMAR) (1.50 to 0.10 logMAR) and 0.26 ± 0.07 logMAR (1.00 to 0.00 logMAR), respectively (p < 0.001). The mean CMT was 476.13 ± 135.13 mm (314 to 750 mm) and 294.06 ± 15.26 mm (222 to 480 mm), respectively (p < 0.001). The mean number of implanted IVD was 1.44 ± 0.89 (1 to 4) and the mean follow-up time was 7.4 ± 4.6 months (6 to 24 months). After IVD implantation therapy, the mean VA and CMT values were 0.19 ± 0.05 logMAR (0.70 to 0.00 logMAR) and 268.38 ± 31.35 mm (217 to 351 mm), respectively. CONCLUSIONS: To the best of our knowledge, this is the first report to show the efficacy of IVD implantation even after repeated IVB injections in treatment-resistant PCME. IVD implantation is both a safe and effective method for decreasing PCME after both uneventful and complicated cataract surgery.


Assuntos
Bevacizumab/administração & dosagem , Dexametasona/administração & dosagem , Resistência a Medicamentos , Macula Lutea/patologia , Edema Macular/tratamento farmacológico , Pseudofacia/complicações , Acuidade Visual , Idoso , Inibidores da Angiogênese/administração & dosagem , Implantes de Medicamento , Feminino , Glucocorticoides/administração & dosagem , Humanos , Injeções Intravítreas , Edema Macular/diagnóstico , Masculino , Pessoa de Meia-Idade , Facoemulsificação , Pseudofacia/diagnóstico , Receptores de Fatores de Crescimento do Endotélio Vascular/antagonistas & inibidores , Tomografia de Coerência Óptica
13.
Graefes Arch Clin Exp Ophthalmol ; 257(7): 1547-1554, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31081526

RESUMO

PURPOSE: To assess the efficacy of intravitreal aflibercept in patients suffering from post-radiation macular edema following plaque radiotherapy for choroidal melanoma. METHODS: This prospective, interventional case series included patients affected by radiation maculopathy (RM) with macular edema secondary to ruthenium-106 plaque brachytherapy for choroidal melanoma. The effect of intravitreal aflibercept on best-corrected visual acuity (BCVA), central foveal thickness (CFT) detected by spectral domain optical coherence tomography (sd-OCT), and Horgan's grading scale of RM was evaluated throughout the 24-month follow-up. Intraocular pressure (IOP) and possible complications were also recorded. RESULTS: Nine eyes of 9 patients were included. A mean of 4.4 ± 1.2 injections were given over the 24 months. At the end of follow-up, mean BCVA was significantly improved, from 0.9 ± 0.19 logMAR at baseline to 0.56 ± 0.3 logMAR (P = 0.028), and mean CFT was significantly decreased, from 546 ± 123 µm at baseline to 223 ± 34 µm (P < 0.001). Intravitreal aflibercept lowered baseline maculopathy stage as well. No significant change in IOP values and no complications, such as endophthalmitis, was recorded. CONCLUSION: Intravitreal aflibercept is an effective treatment for patients with radiation-induced macular edema, allowing functional and anatomical improvements to be achieved with a relatively low number of injections.


Assuntos
Braquiterapia/efeitos adversos , Neoplasias da Coroide/radioterapia , Edema Macular/tratamento farmacológico , Melanoma/radioterapia , Receptores de Fatores de Crescimento do Endotélio Vascular/administração & dosagem , Proteínas Recombinantes de Fusão/administração & dosagem , Radioisótopos de Rutênio/uso terapêutico , Acuidade Visual , Idoso , Neoplasias da Coroide/diagnóstico , Relação Dose-Resposta a Droga , Relação Dose-Resposta à Radiação , Feminino , Angiofluoresceinografia , Seguimentos , Fóvea Central/patologia , Fóvea Central/efeitos da radiação , Fundo de Olho , Humanos , Injeções Intravítreas , Edema Macular/diagnóstico , Edema Macular/etiologia , Masculino , Melanoma/diagnóstico , Pessoa de Meia-Idade , Estudos Prospectivos , Receptores de Fatores de Crescimento do Endotélio Vascular/antagonistas & inibidores , Tomografia de Coerência Óptica , Resultado do Tratamento
14.
Asia Pac J Ophthalmol (Phila) ; 8(3): 236-246, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31132002

RESUMO

PURPOSE: To evaluate the current anti-vascular endothelial growth factor (anti-VEGF) treatments for macular edema due to central retinal vein occlusions. METHODS: PubMed, EMBASE, the Cochrane Library were systematically searched for studies between January 2013 and July 2018. Reference lists of published articles were searched and if necessary, authors were contacted to provide additional data. Meta-analysis was performed using Comprehensive Meta-analysis software. The best-corrected visual acuity (BCVA), central foveal thickness (CFT), injection frequency, and adverse events were evaluated. RESULTS: Seventeen studies involving 1070 eyes were included in the meta-analysis. The mean differences in 12-month changes in BCVA and CFT were 14.4 ETDRS letters (P < 0.001) and -289.2 µm (P < 0.001), respectively. Visual acuity gains were maintained at 24 months (14.2 letters, P < 0.001) and CFT continued to reduce (-327.45 µm, P < 0.001). The incidence of severe adverse events was low and similar across all anti-VEGF therapies. Prospective studies administered a greater number of injections compared with retrospective studies, being 6.6 and 4.4 injections, respectively over 12 months (P < 0.001). CONCLUSIONS: Intravitreal treatment with anti-VEGF agents demonstrated significant anatomical and functional gains in treating macular edema due to central retinal vein occlusions.


Assuntos
Bevacizumab/administração & dosagem , Fóvea Central/patologia , Edema Macular/tratamento farmacológico , Ranibizumab/administração & dosagem , Oclusão da Veia Retiniana/complicações , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Acuidade Visual , Inibidores da Angiogênese/administração & dosagem , Humanos , Injeções Intravítreas , Edema Macular/diagnóstico , Edema Macular/etiologia , Oclusão da Veia Retiniana/diagnóstico , Oclusão da Veia Retiniana/tratamento farmacológico , Tomografia de Coerência Óptica , Resultado do Tratamento
15.
Bioanalysis ; 11(9): 875-886, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31070047

RESUMO

Aim: Novel bifunctional VEGF-A neutralizing therapies are being developed for the treatment of retinal vascular diseases such as age-related macular degeneration and diabetic retinopathy. In developing new therapeutic drugs, only small aqueous humor sample volumes are available for analyzing several parameters. Highly sensitive detection methods must be applied in analyzing VEGF-A levels in ocular fluids in order to demonstrate VEGF-A suppression following drug administration. Experimental: A highly sensitive immunoassay for VEGF-A was developed on the single molecule array (Simoa) platform, and validated before being used for the analysis of clinical aqueous humor samples from patients treated with anti-VEGF-A therapeutics. Results: This highly sensitive immunoassay allows the detection of baseline VEGF-A levels and suppression effects after drug administration, even in sample volumes as low as 12 µl. Conclusion: The Simoa VEGF-A assay is a valuable tool for the reliable monitoring of VEGF-A suppression after intravitreal administration of anti-VEGF-A drugs.


Assuntos
Humor Aquoso/química , Imunoensaio/métodos , Limite de Detecção , Fator A de Crescimento do Endotélio Vascular/análise , Calibragem , Complicações do Diabetes/tratamento farmacológico , Humanos , Edema Macular/tratamento farmacológico , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores
16.
J Coll Physicians Surg Pak ; 29(5): 426-429, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31036111

RESUMO

OBJECTIVE: To measure the changes in ganglion cell complex as measured on optical coherence tomography (OCT) after intravitreal injection of bevacizumab (Avastin). STUDY DESIGN: Quasi-experimental study. PLACE AND DURATION OF STUDY: Department of Ophthalmology, Lahore General Hospital, Lahore, from March 2017 to April 2018. METHODOLOGY: Patients presenting to the Eye OPD were assessed for diabetic macula edema requiring intravitreal injection of anti-VEGF. Patients having any coexisting ocular pathology hindering the OCT measurement, i.e. corneal opacity, vitreous hemorrhage, retinal detachment or having macular edema secondary to other cases were excluded. Retinal ganglion cell complex thickness and signal strength was measured in superior, inferior, supero-nasal, superotemporal, infero-nasal and infero-temporal quadrants on OCT. Pre-injection, visual acuity was measured, OCT performed and the findings were recorded on a designed proforma. Post-injection, the patients were called for follow-up after one month at which time same measurements were evaluated. All the injections were administered by a single surgeon. RESULTS: The thickness of ganglion cell complex increased significantly (p <0.001) one month after Intravitreal injection of bevacizumab. CONCLUSION: Intravitreal administration of bevacizumab in diabetic macular edema affects the measurement of retinal ganglion cell complex thickness on OCT.


Assuntos
Inibidores da Angiogênese/administração & dosagem , Bevacizumab/administração & dosagem , Retinopatia Diabética/tratamento farmacológico , Edema Macular/tratamento farmacológico , Células Ganglionares da Retina/efeitos dos fármacos , Idoso , Inibidores da Angiogênese/uso terapêutico , Bevacizumab/uso terapêutico , Retinopatia Diabética/diagnóstico , Feminino , Humanos , Injeções Intravítreas , Edema Macular/diagnóstico , Masculino , Pessoa de Meia-Idade , Tomografia de Coerência Óptica , Resultado do Tratamento , Acuidade Visual/efeitos dos fármacos
17.
Invest Ophthalmol Vis Sci ; 60(6): 2134-2139, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-31100106

RESUMO

Purpose: There is no prevention or treatment for diabetic retinal neurodegeneration (DRN), which is a complication of diabetes that can occur independently of diabetic retinopathy (DR). We hypothesized that an intravitreal fluocinolone acetonide (FAc) implant may affect the rate of DRN when used in patients with diabetic macular edema (DME). Methods: In this retrospective analysis, optical coherence tomography with neuroretinal analysis was obtained at 3-month intervals from 130 patients in the USER study both before (mean duration 903 days, range 35-4005 days) and after administration of FAc (mean 408 days, range 7 to 756 days). The rate of DRN was defined as the change over time on inner neuroretinal thickness using logistic regression. A DRN rate was calculated independently for two areas: region 1 located within 1.5 mm of the fovea, and region 2 from 1.5 mm to 3.0 mm from the fovea. Results: In regions of the macula more than 1.5 mm from the central fovea, there was a statistically significant decrease in the rate of DRN in the post-FAc period. The pre-FAc neuroretinal loss in this area occurred at 4.0 µm/y, compared with a post-FAc loss rate of 1.1 µm/y (P = 0.001). Conclusions: This retrospective study suggests that FAc may decelerate the rate of inner retinal thinning in patients with persistent DME. Further prospective studies are necessary to determine the effects of FAc on the rate of DRN in patients with DME.


Assuntos
Anti-Inflamatórios/administração & dosagem , Retinopatia Diabética/tratamento farmacológico , Fluocinolona Acetonida/administração & dosagem , Glucocorticoides/administração & dosagem , Degeneração Retiniana/tratamento farmacológico , Idoso , Feminino , Humanos , Injeções Intravítreas , Modelos Logísticos , Edema Macular/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Retrospectivos , Tomografia de Coerência Óptica
18.
Indian J Ophthalmol ; 67(6): 975-977, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31124539

RESUMO

A 13-year-old boy with a 4-year history of idiopathic pediatric uveitis and recurrent uveitic macular edema had failed conventional immunomodulatory therapy and presented to us with a vision of 6/24 [right eye (OD)] and 6/9 [left eye (OS)]. Fluorescein angiography showed diffuse vascular leakage along with cystoid macular edema (CME). Intravenous tocilizumab (10 mg/kg body) was given as 14 injections over 12 months. Repeat fluorescein angiography every 3 months showed a dramatic improvement in the vascular leakage and resolution of CME. At 13 months OF follow-up, vision had improved to 6/9p (OD) and 6/6(OS) with no recurrence of inflammation or CME.


Assuntos
Anticorpos Monoclonais Humanizados/administração & dosagem , Macula Lutea/patologia , Edema Macular/tratamento farmacológico , Uveíte/tratamento farmacológico , Adolescente , Angiofluoresceinografia , Seguimentos , Fundo de Olho , Humanos , Injeções Intravenosas , Edema Macular/complicações , Edema Macular/diagnóstico , Masculino , Tomografia de Coerência Óptica , Uveíte/complicações , Uveíte/diagnóstico , Acuidade Visual
19.
JAMA ; 321(19): 1880-1894, 2019 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-31037289

RESUMO

Importance: Intravitreous injections of antivascular endothelial growth factor agents are effective for treating diabetic macular edema (DME) involving the center of the macula (center-involved DME [CI-DME]) with visual acuity impairment (20/32 or worse). The best approach to treating patients with CI-DME and good visual acuity (20/25 or better) is unknown. Objective: To compare vision loss at 2 years among eyes initially managed with aflibercept, laser photocoagulation, or observation. Design, Setting, and Participants: Randomized clinical trial conducted at 91 US and Canadian sites among 702 adults with type 1 or type 2 diabetes. Participants had 1 study eye with CI-DME and visual acuity of 20/25 or better. The first participant was randomized on November 8, 2013, and the final date of follow-up was September 11, 2018. Interventions: Eyes were randomly assigned to 2.0 mg of intravitreous aflibercept (n = 226) as frequently as every 4 weeks, focal/grid laser photocoagulation (n = 240), or observation (n = 236). Aflibercept was required for eyes in the laser photocoagulation or observation groups that had decreased visual acuity from baseline by at least 10 letters (≥ 2 lines on an eye chart) at any visit or by 5 to 9 letters (1-2 lines) at 2 consecutive visits. Main Outcomes and Measures: The primary outcome was at least a 5-letter visual acuity decrease from baseline at 2 years. Antiplatelet Trialists' Collaboration adverse events (defined as myocardial infarction, stroke, or vascular or unknown death) were reported. Results: Among 702 randomized participants (mean age, 59 years; 38% female [n=264]), 625 of 681 (92% excluding deaths) completed the 2-year visit. For eyes with visual acuity that decreased from baseline, aflibercept was initiated in 25% (60/240) and 34% (80/236) in the laser photocoagulation and observation groups, respectively. At 2 years, the percentage of eyes with at least a 5-letter visual acuity decrease was 16% (33/205), 17% (36/212), and 19% (39/208) in the aflibercept, laser photocoagulation, and observation groups, respectively (aflibercept vs laser photocoagulation risk difference, -2% [95% CI, -9% to 5%]; relative risk, 0.88 [95% CI, 0.57-1.35; P = .79]; aflibercept vs observation risk difference, -3% [95% CI, -11% to 4%]; relative risk, 0.83 [95% CI, 0.55-1.27; P = .79]; laser photocoagulation vs observation risk difference, -1% [95% CI, -9% to 6%]; relative risk, 0.95 [95% CI, 0.64-1.41; P = .79]). Antiplatelet Trialists' Collaboration vascular events occurred in 15 (7%), 13 (5%), and 8 (3%) participants in the aflibercept, laser photocoagulation, and observation groups. Conclusions and Relevance: Among eyes with CI-DME and good visual acuity, there was no significant difference in vision loss at 2 years whether eyes were initially managed with aflibercept or with laser photocoagulation or observation and given aflibercept only if visual acuity worsened. Observation without treatment unless visual acuity worsens may be a reasonable strategy for CI-DME. Trial Registration: ClinicalTrials.gov Identifier: NCT01909791.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Retinopatia Diabética/terapia , Fotocoagulação a Laser , Edema Macular/terapia , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Acuidade Visual , Conduta Expectante , Idoso , Inibidores da Angiogênese/efeitos adversos , Retinopatia Diabética/tratamento farmacológico , Retinopatia Diabética/fisiopatologia , Retinopatia Diabética/cirurgia , Progressão da Doença , Feminino , Humanos , Fotocoagulação a Laser/efeitos adversos , Edema Macular/tratamento farmacológico , Edema Macular/fisiopatologia , Edema Macular/cirurgia , Masculino , Pessoa de Meia-Idade , Proteínas Recombinantes de Fusão/efeitos adversos , Transtornos da Visão/etiologia
20.
Medicine (Baltimore) ; 98(22): e15798, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31145307

RESUMO

BACKGROUND: This meta-analysis compared the efficacy and safety of dexamethasone intravitreal implant (DEX) and anti-vascular endothelial growth factor (anti-VEGF) in the treatment of macular edema (ME) secondary to branch retinal vein occlusion (BRVO). METHODS: The PubMed, Embase, Cochrane Library, and Web of Science databases were comprehensively searched for published studies comparing DEX with anti-VEGF for the treatment of ME caused by BRVO. Outcomes of the selected studies included best-corrected visual acuity (BCVA), central macular thickness (CMT), and adverse events. Review Manager (RevMan) 5.3 was used to analyze the data. RESULTS: Six trials comparing the efficacy and safety of DEX with anti-VEGF were included in this meta-analysis. At 1 month, DEX achieved a mean BCVA superior to that achieved by anti-VEGF (MD = -0.11, P < .0001), in addition to a superior mean BCVA change (MD = -0.35, P < .00001). At 3 months, the mean BCVA showed a significant difference (MD = -0.06, P = .03) between DEX and anti-VEGF treatment, while the mean BCVA change was similar to that with anti-VEGF treatment (MD = -0.06, P = .11). However, neither mean BCVA nor mean BCVA change showed a significant difference between DEX and anti-VEGF treatment at 6 months (MD = 0.08, P = .06; MD = 0.06, P = .43, respectively). Mean CMT and mean CMT change were significantly lower in the DEX group than in the anti-VEGF group at 1 month (MD = -53.63 µm, P < .00001; MD = -60.1 µm, P = .005, respectively). However, at 3 months, mean CMT and mean CMT change were similar between DEX and anti-VEGF treatment (MD = 17.4 µ, P = .74; MD = 18.01 µm, P = .72, respectively). Although mean CMT in the anti-VEGF group was not significantly lower than that in the DEX group at 6 months (MD = 55.53, P = .07), the mean CMT change from baseline achieved by the anti-VEGF treatment was significantly superior to that obtained with DEX (MD = 75.53, P = .0002). Concerning adverse events, no statistically significant differences were observed in the incidence of cataract (OR = 4.25, P = .07), but the use of DEX led to a higher risk of intraocular pressure elevation compared with anti-VEGF treatment (OR = 12.04, P = .006). CONCLUSIONS: Our results show that visual acuity recovery and CMT were better in the DEX group than in the anti-VEGF group after 1 and 3 months, although the difference in CMT at 3 months was not significant. However, there were no significant differences in terms of visual acuity and CMT between the two groups after 6 months of follow-up. Therefore, DEX may be recommended as the first treatment option in ME associated with BRVO.


Assuntos
Dexametasona/administração & dosagem , Glucocorticoides/administração & dosagem , Edema Macular/tratamento farmacológico , Oclusão da Veia Retiniana/complicações , Fatores de Crescimento do Endotélio Vascular/antagonistas & inibidores , Idoso , Implantes de Medicamento , Feminino , Humanos , Injeções Intravítreas , Macula Lutea/patologia , Edema Macular/etiologia , Edema Macular/patologia , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento , Acuidade Visual/efeitos dos fármacos , Corpo Vítreo
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