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1.
Expert Opin Drug Metab Toxicol ; 15(12): 993-1004, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31794273

RESUMO

Introduction: Pancreatic neuroendocrine tumors (panNETs) represent a rare group of malignancies. For decades, chemotherapy, somatostatin analogs and interferon represented the only systemic therapies; however, over the latest years, new options were registered, including Everolimus, Sunitinib (SUN), and Peptide Receptor Radionuclide Therapy.Areas covered: This review discusses the role of tyrosine kinase inhibitors (TKIs) in advanced panNETs.Expert opinion: TKIs showed an antiangiogenic and antiproliferative impact on advanced panNETs. Sunitinib is the only TKI currently available in clinical practice, having been approved on the basis of relevant results of a specific panNET phase III trial. New TKIs, such as Cabozantinib, Lenvatinib, Pazopanib, Surufatinib are still on investigation in panNETs. Although some phase II studies with the new TKIs yielded better PFS and RR compared with SUN, different study designs and tumor populations may have induced selection biases. However, it was reported that panNETs resistant to SUN could respond to a new TKI, indicating a possible further therapeutic line in this context. The global investigation plan of TKIs in panNETs is not homogeneous and it is difficult to understand what kind of development this can have in the near future for clinical practice.


Assuntos
Tumores Neuroendócrinos/tratamento farmacológico , Neoplasias Pancreáticas/tratamento farmacológico , Inibidores de Proteínas Quinases/administração & dosagem , Inibidores da Angiogênese/administração & dosagem , Inibidores da Angiogênese/farmacologia , Animais , Antineoplásicos/administração & dosagem , Antineoplásicos/farmacologia , Desenvolvimento de Medicamentos , Humanos , Tumores Neuroendócrinos/enzimologia , Tumores Neuroendócrinos/patologia , Neoplasias Pancreáticas/enzimologia , Neoplasias Pancreáticas/patologia , Inibidores de Proteínas Quinases/farmacologia
2.
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
3.
Rom J Ophthalmol ; 63(3): 238-244, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31687625

RESUMO

Objective. To evaluate the correlation between visual outcomes and fluid configuration observed on spectral-domain optical coherence tomography (SD-OCT) in patients with wet age-related macular degeneration (AMD). Methods. Sixty-five eyes of 53 patients with AMD who were administered intravitreal ranibizumab treatment with 12 months of follow-up were included in this retrospective study. Presence of intraretinal cystoid fluid (IRC) and pigment epithelial detachment (PED), thickness of subretinal fluid (SRF), central macular thickness (CMT), and central macular volume (CMV) were assessed. Results. Subretinal fluid was observed in 29 eyes (45%), IRC in 36 eyes (55%), and PED in 39 eyes (60%). Baseline and final best-corrected visual acuity (BCVA) were 0.69±0.4 and 0.60±0.4 logMAR in the IRC negative group and 1.17±0.5 and 0.97±0.5 logMAR in the IRC positive group. BCVA was lower in IRC positive group (baseline p=0.001 and final=0.003); however, marked improvement was detected in both groups. Anatomic improvement and increased visual acuity were observed in groups with and without PED, IRC, and SRF. An inverse correlation was detected between pre-treatment CMT, IRC and post-treatment IRC, and final BCVA. Conclusion. Significant visual and anatomic improvement was observed after one-year of ranibizumab treatment regardless of fluid configuration. However, the presence of IRC was observed to be associated with worse visual acuity. Baseline retinal fluid configuration may have prognostic effects on functional success in patients treated with ranibizumab for wet AMD. Abbreviations. AMD = Age-related macular degeneration, VEGF = Vascular endothelial growth factor, IRC = intraretinal cystoid fluid, PED = pigment epithelial detachment, SRF = subretinal fluid, SD-OCT = spectral-domain ocular coherence tomography, IVR = intravitreal ranibizumab, BCVA = best-corrected visual acuity, FFA = fundus fluorescein angiography, CMT = central macular thickness, CMV = central macular volume.


Assuntos
Angiofluoresceinografia/métodos , Macula Lutea/diagnóstico por imagem , Ranibizumab/administração & dosagem , Líquido Sub-Retiniano/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Acuidade Visual , Degeneração Macular Exsudativa/tratamento farmacológico , Idoso , Inibidores da Angiogênese/administração & dosagem , Feminino , Seguimentos , Fundo de Olho , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Degeneração Macular Exsudativa/diagnóstico , Degeneração Macular Exsudativa/fisiopatologia
4.
Rom J Ophthalmol ; 63(3): 281-286, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31687633

RESUMO

Objective: To describe the chronological features of choroidal neovascular membrane (CNV) development subsequent to accidental firing of diode laser into the eye of a young female during hair epilation. Methods: Descriptive case report. Results: The patient presented one week after the laser injury to a local ophthalmologist complaining of RE (right eye) blurred central vision. Snellen's visual acuity (VA) was 6/ 7.5. Optical coherence tomography (OCT) showed focal disruption of the ellipsoid and the interdigitation zones. Four weeks later, she presented with worsening symptoms and RE VA 6/ 15. Funduscopy revealed a perifoveal grayish lesion with adjacent retinal hemorrhage, which, on fluorescein angiography, was leaking, compatible with CNV. OCT showed a dome-shaped sub-retinal pigment epithelium lesion with extension into the subretinal space and little subretinal fluid. The patient was treated with one intravitreal bevacizumab injection. There was rapid regression of the CNV and improvement of VA to 6/ 7.5 at one-month visit and to 6/ 6 at 6-month visit. Conclusion: All the laser procedures should be conducted with intensive care for both the patient and the laser surgeon since inadvertent effects are constantly being reported due to lack of adherence to safety measures.


Assuntos
Neovascularização de Coroide/etiologia , Remoção de Cabelo/efeitos adversos , Terapia a Laser/efeitos adversos , Acuidade Visual , Adulto , Inibidores da Angiogênese/administração & dosagem , Bevacizumab/administração & dosagem , Neovascularização de Coroide/diagnóstico , Feminino , Remoção de Cabelo/métodos , Humanos , Injeções Intravítreas , Receptores de Fatores de Crescimento do Endotélio Vascular/antagonistas & inibidores , Tomografia de Coerência Óptica
5.
J Oncol Pharm Pract ; 25(8): 2049-2051, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31694494

RESUMO

Hemangioblastomas of central nervous system are rare and indolent. Twenty-five percent of cases are in association with von Hippel-Lindau disease. Surgery is the standard therapy but un-resectable or recurrent cases need radiation or systemic therapy. Defective von Hippel-Lindau tumor suppressor gene leads to vascular endothelial growth factor overexpression and enhance angiogenesis. Here we report a 19-year-old male, diagnosed at pediatric age, who had retinal and spinal cord hemangioblastomas. He was treated 34 months with bevacizumab, afterwards 12 months with thalidomide and tertiary therapy with pazopanib for 9 months which still goes on. In case of need, radiation and surgical procedures were performed. Vascular endothelial growth factor inhibition continuity is a good therapeutic option, which improves outcomes of von Hippel-Lindau-related hemangioblastomas.


Assuntos
Inibidores da Angiogênese/administração & dosagem , Hemangioblastoma/tratamento farmacológico , Doença de von Hippel-Lindau/complicações , Inibidores da Angiogênese/uso terapêutico , Hemangioblastoma/etiologia , Humanos , Masculino , Retina/patologia , Medula Espinal/patologia , Talidomida/administração & dosagem , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Adulto Jovem , Doença de von Hippel-Lindau/tratamento farmacológico
6.
Turk J Ophthalmol ; 49(5): 258-269, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31650792

RESUMO

Objectives: To assess outcomes of a risk-based algorithm-guided treatment protocol for neovascular age-related macular degeneration. Materials and Methods: Two hundred and ten eyes of 184 patients managed with anti-vascular endothelial growth factor (anti-VEGF) agents according to a protocol consisting of one of three initial regimens depending on risk with at least 2 years of follow-up were retrospectively evaluated. The "short-term monthly injections" protocol was used for low-risk patients with low-risk lesions and good fellow-eye vision. Patients with low-risk lesions but without good fellow-eye vision, or those with good fellow-eye vision and high-risk lesions were managed according to the "short-term treat-and-extend (TREX)" protocol. The "extended TREX" protocol was for patients with high-risk lesions and low fellow-eye visual acuity. Results: The initial treatment plan consisted of short-term monthly injections in 62 eyes (30%), the short-term TREX regimen in 120 eyes (57%), and the extended TREX regimen in 28 eyes (13%). Overall, 63% of cases met the criteria for cessation of treatment. Approximately 58% of these cases had recurrence, at a mean of 13 months. The mean change in VA from baseline was +9.0 letters at 12 months and +8.0 letters at 24 months. VA improved during a mean follow-up of 46.8±22 months, with a mean of 3.4±1.6 anti-VEGF injections per year. Conclusion: The risk-based algorithm-guided treatment protocol yielded visual outcomes similar to those of the common alternative treatment and monitoring regimens, with a dramatically reduced number of injections, as required by the individual lesion and vision in the fellow eye.


Assuntos
Algoritmos , Gerenciamento Clínico , Ranibizumab/administração & dosagem , Medição de Risco/métodos , Acuidade Visual , Degeneração Macular Exsudativa/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Inibidores da Angiogênese/administração & dosagem , Feminino , Angiofluoresceinografia , Seguimentos , Fundo de Olho , Humanos , Injeções Intravítreas , Macula Lutea/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular , Degeneração Macular Exsudativa/diagnóstico
8.
Ophthalmic Physiol Opt ; 39(6): 432-440, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31602674

RESUMO

PURPOSE: A vignette study to examine treatment decisions made by UK hospital optometrists in patients with neovascular age-related macular degeneration (nAMD) and the effect of optometrists' experience on agreement. METHODS: Patients with nAMD attending Manchester Royal Eye Hospital, Manchester, UK were identified as potential candidates for the case series of vignettes. The cases were chosen to reflect a varied case-mix with respect to difficulty as well as ensuring good quality of the images. Each vignette included a history summary consisting of the number of previous injections given and visual acuity measurements at baseline, the previous visit, and the current visit. Images were compiled to show baseline fundus photographs and ocular coherence tomography (OCT) images with the current visit images on which the treatment decision was to be made along with the images from the previous visit. Hospital optometrists were recruited and asked to complete the series of vignettes, deciding if treatment was required at that visit and how confident they felt with that decision. Their responses were compared to the reference standard created by a consensus of consultant ophthalmologists with a sub-speciality interest in medical retina. RESULTS: Regarding treatment decision for optometrists, the percentage correct value was 75% with the sensitivity being 75.6% (95% CI 70.1-80.3) and the specificity as 75.1% (95% CI 72.1-77.8). No statistically significant difference was found between differing levels of experience. However, there was a significant difference in confidence levels between groups. Potentially sight threatening decisions accounted for 6.4% of the optometrists' decisions, 3.5% were made with a high confidence rating suggesting no discussion with an ophthalmologist was required. CONCLUSIONS: Although the optometrists showed modest agreement with the reference standard in a series of cases that have higher than average complexity, the optometrists showed a similar amount of variability within their treatment decisions compared to the reference standard. The optometrists were therefore not inferior in their performance compared to the ophthalmologists and this can be seen as supporting evidence for their extended role within this clinical area. Experience did not have an effect on 'correct' treatment decisions although there was a statistically significant effect on increasing confidence of treatment decision.


Assuntos
Inibidores da Angiogênese/administração & dosagem , Competência Clínica , Tomada de Decisões , Hospitais , Oftalmologistas/normas , Optometristas/normas , Degeneração Macular Exsudativa/tratamento farmacológico , Humanos , Injeções Intravítreas , Curva ROC , Tomografia de Coerência Óptica , Reino Unido , Degeneração Macular Exsudativa/diagnóstico
9.
Zhonghua Yan Ke Za Zhi ; 55(10): 791-795, 2019 Oct 11.
Artigo em Chinês | MEDLINE | ID: mdl-31607068

RESUMO

Pathological myopia refers to high myopia with fundus pathological changes. Choroidal neovascularization is one of its serious complications, and also the main cause of visual loss. Currently, the first-line treatment is anti-VEGF treatment, with good efficacy, high safety, good prognosis, and other advantages of vision. Commonly used anti-VEGF drugs include bevacizumab, ranibizumab, aflibercept, and conbercept. The main treatment strategies include 1+pro re nata and 3+pro re nata, and the standard of REPAIR test is often used to evaluate the re-injection. This article reviews the advantages of anti-VEGF therapy, drug selection, treatment strategy, and re-injection criteria. (Chin J Ophthalmol, 2019, 55:791-795).


Assuntos
Inibidores da Angiogênese/uso terapêutico , Bevacizumab/uso terapêutico , Neovascularização de Coroide/tratamento farmacológico , Miopia Degenerativa/complicações , Ranibizumab/uso terapêutico , Inibidores da Angiogênese/administração & dosagem , Bevacizumab/administração & dosagem , Neovascularização de Coroide/etiologia , Humanos , Injeções Intravítreas , Ranibizumab/administração & dosagem , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular , Acuidade Visual
10.
Laryngoscope ; 129(10): 2210-2215, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31566760

RESUMO

OBJECTIVES/HYPOTHESIS: The objective of this study was to report for the first time on the results of submucosal injections of bevacizumab used in conjunction with cyanoacrylate glue sclerotherapy in hereditary hemorrhagic telangiectasia (HHT). STUDY DESIGN: Retrospective analytic chart review. METHODS: We performed a chart review that included all patients with HHT treated with intranasal bevacizumab and cyanoacrylate glue for refractory epistaxis at Lariboisiere University Hospital from 2013 with a minimum follow-up of 6 months. We injected 100 mg (25 mg/mL) of bevacizumab diluted in 2 mL of serum at the base of the telangiectasias, and sclerotherapy with an injection of cyanoacrylate glue was used adjunctively. Treatment efficacy was based on changes in Epistaxis Severity Scores (ESS) and the Bergler-Sadick Scale. Quality of life and patient satisfaction were evaluated using the Cantril Self-Anchoring Ladder (CL) and Likert scale, respectively. RESULTS: Thirty-one patients were included, with a mean follow-up of 26.6 months. The average ESS score significantly decreased from 7.82 to 3.89 (P < .05). The Bergler-Sadick score significantly improved (P < .05) following the treatment, including the frequency (from 2.74 to 1.64) and the quantity (from 2.54 to 1.51) scales. Quality of life was significantly improved (P < .05) using the CL score (from 4.16 to 7.22). The Likert satisfaction scale related to the treatment efficacy was high, with an average of 7.03 out of 10. No complications were noted. CONCLUSIONS: Submucosal injections of bevacizumab in conjunction with cyanoacrylate glue sclerotherapy significantly reduced epistaxis and improved the quality of life in HHT. Prospective comparative studies are needed to further evaluate the significance of this treatment modality. LEVEL OF EVIDENCE: 3b Laryngoscope, 129:2210-2215, 2019.


Assuntos
Inibidores da Angiogênese/administração & dosagem , Bevacizumab/administração & dosagem , Cianoacrilatos/administração & dosagem , Epistaxe/tratamento farmacológico , Adesivo Tecidual de Fibrina/administração & dosagem , Telangiectasia Hemorrágica Hereditária/tratamento farmacológico , Administração Intranasal , Adulto , Idoso , Idoso de 80 Anos ou mais , Epistaxe/etiologia , Feminino , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Telangiectasia Hemorrágica Hereditária/complicações , Resultado do Tratamento
11.
Gynecol Oncol ; 155(2): 186-191, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31519320

RESUMO

OBJECTIVE: The AGO-OVAR16 study was designed to test the efficacy, safety, and tolerability of pazopanib maintenance after first-line chemotherapy in patients with newly diagnosed advanced ovarian cancer (AOC). METHODS: Nine hundred and forty patients with histologically confirmed AOC, International Federation of Gynecology and Obstetrics (FIGO) stage II-IV, were randomized in a 1:1 ratio to receive either 800 mg pazopanib once daily or placebo for up to 24 months, unless there was disease progression, toxicity, withdrawal of consent, or death. The primary endpoint (investigator-assessed progression-free survival [PFS]) was met and previously reported. The results of final analyses of overall survival (OS) are reported here. RESULTS: A third OS interim analysis showed futility and led to study closure and a final OS analysis after last patient last visit. At the time of the final OS analysis, 494 (89.7% of the planned 551) events had occurred. No difference was observed in OS between pazopanib and placebo. The hazard ratio (HR) was 0.960 (95% confidence interval [CI]: 0.805-1.145), and the median OS from randomization was 59.1 months in pazopanib and 64.0 months in placebo arms. For the East Asian patients, similar to the first three interim OS analyses, a numerical negative trend was observed favoring placebo (HR, 1.332; 95% CI: 0.863-2.054). Exploratory analyses showed a trend for a longer time to first subsequent anti-cancer therapy or death with pazopanib over placebo (HR, 0.829; 95% CI: 0.713-0.965), with a median estimate of 19.0 and 14.5 months, respectively. No new safety signals were observed. CONCLUSION: Although pazopanib prolonged PFS, this was not associated with improvement in median OS. CLINICAL TRIAL INFORMATION: ClinicalTrials.gov: NCT00866697.


Assuntos
Inibidores da Angiogênese/administração & dosagem , Carcinoma Epitelial do Ovário/tratamento farmacológico , Neoplasias Ovarianas/tratamento farmacológico , Pirimidinas/administração & dosagem , Sulfonamidas/administração & dosagem , Adulto , Idoso , Carcinoma Epitelial do Ovário/mortalidade , Intervalo Livre de Doença , Método Duplo-Cego , Esquema de Medicação , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/mortalidade , Qualidade de Vida , Resultado do Tratamento , Adulto Jovem
12.
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
13.
Acta Diabetol ; 56(12): 1341-1350, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31541334

RESUMO

AIMS: To provide 2-year follow-up data on eyes with diabetic macular edema (DME) that were non-responsive after three initial anti-vascular endothelial growth factor (VEGF) injections, comparing functional and anatomical outcomes under continued anti-VEGF therapy versus dexamethasone (DEX) implant. METHODS: Multicenter, retrospective chart review comparing eyes with treatment-naïve DME and a suboptimal response to a loading phase of anti-VEGF therapy (3 injections given monthly) which were then treated with (a) further anti-VEGF (n = 72) or (b) initially switched to DEX implant (n = 38). Main outcome measures were change in visual acuity (VA) and central subfield thickness (CST) from the end of the loading phase to 24 months. RESULTS: In 79% of the 12-month study population (87/110 eyes), 24-month data were available. One quarter of eyes in each group switched treatments during the second year. Eyes that were switched early to DEX implant maintained the functional and anatomical improvements at 24 months which were seen in the first year (from month 3: + 8.9 letters, - 214 µm). Eyes that were switched from anti-VEGF therapy to steroids in the second year improved VA and reduced CST at 24 months (from month 12: + 6.8 letters, p = 0.023; - 226 µm, p = 0.004). In eyes continued on anti-VEGF therapy, VA and CST were stable at 24 months (from month 3: + 2.8 letters, p = 0.254; - 24 µm, p = 0.243). Eyes that were non-responsive to anti-VEGF therapy for 12 months had similar chances to experience a VA gain from further therapy as eyes that were non-responsive for 3 months only (23.8 vs. 31.0%, p = 0.344). CONCLUSIONS: The beneficial effect of an early switch to DEX implant in DME non-responders seen at month 12 was maintained during the second year. A later switch from anti-VEGF to steroids still provided significant improvement. Eyes continued on anti-VEGF over a period of 24 months maintained vision. A quarter of eyes, which had not improved vision at 12 months, exhibited a delayed response to treatment.


Assuntos
Inibidores da Angiogênese/administração & dosagem , Dexametasona/administração & dosagem , Retinopatia Diabética/tratamento farmacológico , Edema Macular/tratamento farmacológico , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Idoso , Bevacizumab/administração & dosagem , Retinopatia Diabética/epidemiologia , Esquema de Medicação , Implantes de Medicamento , Resistência a Medicamentos/efeitos dos fármacos , Substituição de Medicamentos , Feminino , Humanos , Injeções Intravítreas , Edema Macular/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/imunologia , Acuidade Visual/efeitos dos fármacos
14.
Middle East Afr J Ophthalmol ; 26(2): 55-59, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31543660

RESUMO

PURPOSE: The aim of this study was to compare the pain scores of the patients during intravitreal injection of ranibizumab and aflibercept based on patient feedback. MATERIALS AND METHODS: Seventy-two eyes of 72 patients, who had not previously undergone any intravitreal injection procedures, were included in this study. Thirty-eight patients received ranibizumab, and 34 patients received aflibercept injections. The pain was measured by visual analog scale (VAS). Patients were asked to rate their pain experienced during the injection between 0 (no pain) and 10 (worst pain ever felt) on VAS just after the injection. RESULTS: VAS pain scores in ranibizumab and aflibercept groups were 3.28 ± 2.45 and 4.20 ± 2.30, respectively. There was a significant difference in average VAS pain scores between groups (P = 0.04). CONCLUSION: VAS pain scores in aflibercept group were found to be significantly higher than the scores in the ranibizumab group.


Assuntos
Inibidores da Angiogênese/administração & dosagem , Dor Ocular/diagnóstico , Injeções Intravítreas/efeitos adversos , Ranibizumab/administração & dosagem , Receptores de Fatores de Crescimento do Endotélio Vascular/administração & dosagem , Proteínas Recombinantes de Fusão/administração & dosagem , Idoso , Dor Ocular/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Retrospectivos , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Degeneração Macular Exsudativa/tratamento farmacológico
15.
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
16.
Lancet ; 394(10208): 1551-1559, 2019 10 26.
Artigo em Inglês | MEDLINE | ID: mdl-31522845

RESUMO

BACKGROUND: Despite increasing worldwide use of anti-vascular endothelial growth factor agents for treatment of retinopathy of prematurity (ROP), there are few data on their ocular efficacy, the appropriate drug and dose, the need for retreatment, and the possibility of long-term systemic effects. We evaluated the efficacy and safety of intravitreal ranibizumab compared with laser therapy in treatment of ROP. METHODS: This randomised, open-label, superiority multicentre, three-arm, parallel group trial was done in 87 neonatal and ophthalmic centres in 26 countries. We screened infants with birthweight less than 1500 g who met criteria for treatment for retinopathy, and randomised patients equally (1:1:1) to receive a single bilateral intravitreal dose of ranibizumab 0·2 mg or ranibizumab 0·1 mg, or laser therapy. Individuals were stratified by disease zone and geographical region using computer interactive response technology. The primary outcome was survival with no active retinopathy, no unfavourable structural outcomes, or need for a different treatment modality at or before 24 weeks (two-sided α=0·05 for superiority of ranibizumab 0·2 mg against laser therapy). Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, NCT02375971. INTERPRETATION: Between Dec 31, 2015, and June 29, 2017, 225 participants (ranibizumab 0·2 mg n=74, ranibizumab 0·1 mg n=77, laser therapy n=74) were randomly assigned. Seven were withdrawn before treatment (n=1, n=1, n=5, respectively) and 17 did not complete follow-up to 24 weeks, including four deaths in each group. 214 infants were assessed for the primary outcome (n=70, n=76, n=68, respectively). Treatment success occurred in 56 (80%) of 70 infants receiving ranibizumab 0·2 mg compared with 57 (75%) of 76 infants receiving ranibizumab 0·1 mg and 45 (66%) of 68 infants after laser therapy. Using a hierarchical testing strategy, compared with laser therapy the odds ratio (OR) of treatment success following ranibizumab 0·2 mg was 2·19 (95% Cl 0·99-4·82, p=0·051), and following ranibizumab 0·1 mg was 1·57 (95% Cl 0·76-3·26); for ranibizumab 0·2 mg compared with 0·1 mg the OR was 1·35 (95% Cl 0·61-2·98). One infant had an unfavourable structural outcome following ranibizumab 0·2 mg, compared with five following ranibizumab 0·1 mg and seven after laser therapy. Death, serious and non-serious systemic adverse events, and ocular adverse events were evenly distributed between the three groups. FINDINGS: In the treatment of ROP, ranibizumab 0·2 mg might be superior to laser therapy, with fewer unfavourable ocular outcomes than laser therapy and with an acceptable 24-week safety profile. FUNDING: Novartis.


Assuntos
Inibidores da Angiogênese/administração & dosagem , Fotocoagulação a Laser , Ranibizumab/administração & dosagem , Retinopatia da Prematuridade/terapia , Inibidores da Angiogênese/efeitos adversos , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Injeções Intravítreas , Fotocoagulação a Laser/efeitos adversos , Masculino , Ranibizumab/efeitos adversos , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores
17.
Nepal J Ophthalmol ; 11(21): 98-101, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31523075

RESUMO

INTRODUCTION: Intravitreal anti VEGF agents are used in a variety of retinal pathologies to decrease the VEGF levels resulting due to breakdown of the blood retinal barrier hence decrease the exudation from vessels which causes macular edema (ME). CASE: A 61year old patient presented with sudden decrease in vision in both eyes with a history of systemic malignant hypertension leading to macular edema as documented on optical Coherence Tomography (OCT) in both eyes. The foveal thickness (FT)of 536 and 328 microns (µ) were observed in the right and left eye each. He was advised intravitreal anti vascular endothelial growth factor (VEGF) in both eyes and advised complete systemic evaluation with the physician. Following one month postintravitreal bevacizumab ( IVB) injection in right eye, marked visual improvement was noted with concomitant significant reduction in macular edema in both eyes. OBSERVATION: Single Bevacizumab injection with control of hypertension in our patient resulted in rapid resolution of the macular edema and early visual recovery. Intravitreal anti VEGF is an effective treatment option in eyes due to hypertensivemaculopathy especially to gain speedy visual recovery. CONCLUSION: The case gives a unique outlook to the course of ME in the single patient with malignant HTN with or without IVB injection. We believe that anti VEGF injections may result in rapid recovery in vision and minimize the risk of permanent vision loss in eyes with malignant hypertension.


Assuntos
Bevacizumab/administração & dosagem , Hipertensão Maligna/complicações , Macula Lutea/diagnóstico por imagem , Edema Macular/etiologia , Acuidade Visual , Inibidores da Angiogênese/administração & dosagem , Angiofluoresceinografia , Fundo de Olho , Humanos , Injeções Intravítreas , Edema Macular/diagnóstico , Edema Macular/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Tomografia de Coerência Óptica/métodos , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores
18.
Ophthalmic Res ; 62(4): 225-230, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31554001

RESUMO

Over the past two decades, the Diabetic Retinopathy Clinical Research Network (now known as the DRCR Retina Network) has contributed to multiple and substantial advances in the clinical care of diabetic eye disease. Network studies helped establish anti-vascular endothelial growth factor (VEGF) agents as an effective alternative to panretinal photocoagulation for eyes with proliferative diabetic retinopathy (PDR) and as first-line therapy for eyes with visual impairment for diabetic macular edema (DME), defined treatment algorithms for the use of intravitreal medications in these conditions, and provided critical data to understand how to better evaluate the diabetic eye using optical coherence tomography and other imaging modalities. Ongoing DRCR.net studies will address whether anti-VEGF therapy is effective at preventing vision-threatening complications in eyes with severe non-proliferative diabetic retinopathy, if photobiomodulation has a beneficial effect in eyes with DME, and whether initiation of DME treatment with bevacizumab and rescue with aflibercept can provide visual outcomes as good as those achieved with aflibercept alone. Future plans for the Network also include the expansion into non-diabetic eye disease in areas such as age-related macular degeneration.


Assuntos
Inibidores da Angiogênese/administração & dosagem , Protocolos Clínicos , Retinopatia Diabética/terapia , Fotocoagulação a Laser/métodos , Retina/diagnóstico por imagem , Acuidade Visual , Retinopatia Diabética/diagnóstico , Humanos , Injeções Intravítreas , Tomografia de Coerência Óptica
19.
BMJ Case Rep ; 12(8)2019 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-31401582

RESUMO

A 65-year-old man was referred to our department with complaints of blurred vision in the left eye. Funduscopic examination revealed areas of retinochoroidal atrophy along the retinal veins bilaterally and bone spicule pigmentation along the nasal and superior temporal venous branches, as well as macular oedema in the left eye. Fluorescein angiography, visual field test, optical coherence tomography and electrophysiological examination were performed, and results were compatible with the diagnosis of pigmented paravenous retinochoroidal atrophy (PPRCA). Treatment with topical dorzolamide and intravitreal bevacizumab in the left eye resulted in poor anatomical and visual response. There is scarce documentation of macular involvement with non-inflammatory unilateral cystoid macular oedema in PPRCA in the literature. Further investigation is required to elucidate the pathogenesis of PPRCA and to properly manage these patients.


Assuntos
Oftalmopatias Hereditárias/complicações , Edema Macular/complicações , Degeneração Retiniana/complicações , Idoso , Inibidores da Angiogênese/administração & dosagem , Bevacizumab/administração & dosagem , Inibidores da Anidrase Carbônica/administração & dosagem , Oftalmopatias Hereditárias/diagnóstico por imagem , Oftalmopatias Hereditárias/tratamento farmacológico , Oftalmopatias Hereditárias/patologia , Angiofluoresceinografia , Humanos , Injeções Intraoculares , Edema Macular/diagnóstico por imagem , Edema Macular/tratamento farmacológico , Edema Macular/patologia , Masculino , Degeneração Retiniana/diagnóstico por imagem , Degeneração Retiniana/tratamento farmacológico , Degeneração Retiniana/patologia , Sulfonamidas/administração & dosagem , Tiofenos/administração & dosagem , Tomografia de Coerência Óptica
20.
Future Oncol ; 15(24s): 35-40, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31385535

RESUMO

Lenvatinib is a tyrosine kinase inhibitor (TKI) with antiproliferative and antiangiogenic effects indicated for the treatment of progressive, locally advanced or metastatic progressive thyroid carcinoma, refractory to radioactive iodine therapy. Antiangiogenic therapies induce ischemic necrosis of tumor tissue, with increased risk of hemorrhagic complications. The management of hemorrhagic risk is based on precautionary measures and for any surgical procedure, it is advised to interrupt the treatment in order to avoid complications. 'Flare-up' of tumor activity may follow TKI interruption. However, it is not known if continuing TKIs during minimally invasive interventions is safe. We report here the first case in which an embolization of metastasis is performed without interrupting lenvatinib treatment. The procedure was successful and free of complications.


Assuntos
Adenoma Oxífilo/tratamento farmacológico , Embolização Terapêutica , Compostos de Fenilureia/administração & dosagem , Quinolinas/administração & dosagem , Neoplasias da Glândula Tireoide/tratamento farmacológico , Adenoma Oxífilo/diagnóstico por imagem , Adenoma Oxífilo/patologia , Inibidores da Angiogênese/administração & dosagem , Inibidores da Angiogênese/efeitos adversos , Terapia Combinada , Humanos , Ílio/efeitos dos fármacos , Ílio/patologia , Radioisótopos do Iodo/administração & dosagem , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Estadiamento de Neoplasias , Compostos de Fenilureia/efeitos adversos , Quinolinas/efeitos adversos , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/patologia
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