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1.
BMC Ophthalmol ; 21(1): 269, 2021 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-34193089

RESUMO

BACKGROUND: To investigate the diagnostic value of choroidal thickness in the definition of pachychoroid neovasculopathy (PNV), especially in eyes treated with anti-vascular endothelial growth factor (VEGF) therapy. METHODS: Twenty-two consecutive eyes of 11 patients with uni- or bilateral PNV were analyzed. Anti-VEGF treatment was correlated with changes in choroidal thickness on enhanced depth imaging optical coherence tomography. RESULTS: There were 14 eyes with PNV and 8 non-neovascular partner eyes. Mean age was 64.2 ± 4.0 (range: 60-72), total follow-up was 1.8 ± 0.4 (1-2) years. In PNV eyes, choroidal thickness at baseline was 400 ± 58 (269-485) µm. After two years and 13 anti-VEGF injections on average, a mean reduction of - 39 ± 10 (- 26 to - 56) % to final 241 ± 52 (162-327) µm was observed (p < 0.0001). Meanwhile, choroidal thickness in the partner eyes remained stable (p > 0.13 for all comparisons). A significant correlation of choroidal thinning and anti-VEGF injection rate was observed at year one (r = - 0.79; R2 = 0.63; p = 0.00073) and two (r = - 0.69; R2 = 0.48; p = 0.019). While 85.7% of PNV eyes exceeded a pachychoroid threshold of ≥350 µm at baseline, this figure dropped to 21.4% at year one and 0% at year two. CONCLUSION: In PNV, choroidal thickness significantly decreases with anti-VEGF therapy, resembling a "vanishing pachy-choroid", and thus does not represent a valid long-term diagnostic criterium, especially when differentiating PNV from nAMD.


Assuntos
Neovascularização de Coroide , Idoso , Inibidores da Angiogênese/uso terapêutico , Corioide/diagnóstico por imagem , Neovascularização de Coroide/diagnóstico , Neovascularização de Coroide/tratamento farmacológico , Angiofluoresceinografia , Humanos , Injeções Intravítreas , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia de Coerência Óptica , Fator A de Crescimento do Endotélio Vascular , Acuidade Visual
2.
BMJ Case Rep ; 14(7)2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34244184

RESUMO

Ozurdex is a dexamethasone intravitreal implant used for the treatment of macular oedema. A rare but serious complication is the migration of the implant into the anterior chamber (AC) in eyes with absent or incomplete posterior capsules that may lead to corneal decompensation. We report the case of a 75-year-old woman who presented with a 1-day history of decreased vision in her left eye. She had a history of complicated cataract surgery and had received multiple Ozurdex implants for postoperative cystoid macular oedema in the same eye. She had significant left corneal decompensation and a mobile Ozurdex implant in the AC. We report a simple but novel surgical technique for removing an Ozurdex implant from the AC using an intravenous cannula (Venflon). This technique can also be applied to removing a fluocinolone acetonide (Iluvien) implant in similar situations.


Assuntos
Retinopatia Diabética , Edema Macular , Idoso , Câmara Anterior , Cânula , Dexametasona/efeitos adversos , Implantes de Medicamento , Feminino , Fluocinolona Acetonida/uso terapêutico , Glucocorticoides/uso terapêutico , Humanos , Injeções Intravítreas , Edema Macular/tratamento farmacológico
3.
BMC Infect Dis ; 21(1): 676, 2021 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-34247579

RESUMO

BACKGROUND: The objective of this study is to report a case of acute retinal necrosis in which abnormalities in visual function did not correspond to retinal anatomical outcomes. CASE PRESENTATION: A 39-year-old female diagnosed with acute retinal necrosis underwent repeated (nine rounds) intravitreal ganciclovir injection (3 mg/0.1 ml) into the left eye, one injection every 2 weeks. During the therapy, the patient noticed her visual acuity declining gradually. The best corrected visual acuity in the left eye was 20/33. The visual field showed massive visual damage. There was no posterior necrotizing involvement, no macular edema or exudation, and only slight abnormity of the interdigitation zone in the fovea area was visible on OCT. Angio-OCT revealed normal capillary density of three retinal capillary and choriocapillaris layers. The visually evoked potential was normal. The photopic single-flash response showed a declined amplitude of a-wave and b-wave. The amplitudes of photopic 30 Hz flicker were decreased. Multifocal electroretinography revealed macular dysfunction. CONCLUSION: Ganciclovir-associated photoreceptor damage may induce abnormalities in retinal function in response to multiple continuous intravitreal ganciclovir injections at a relatively high dosage (3 mg/0.1 ml).


Assuntos
Ganciclovir/efeitos adversos , Retina/efeitos dos fármacos , Adulto , Relação Dose-Resposta a Droga , Eletrorretinografia , Feminino , Ganciclovir/administração & dosagem , Ganciclovir/uso terapêutico , Humanos , Injeções Intravítreas , Células Fotorreceptoras de Vertebrados/efeitos dos fármacos , Retina/fisiopatologia , Acuidade Visual/efeitos dos fármacos
4.
BMC Ophthalmol ; 21(1): 245, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34088282

RESUMO

BACKGROUND: We aimed to evaluate the efficacy and safety of phacoemulsification with intravitreal 3 mg triamcinolone acetonide injection in preventing postoperative inflammation and complications in patients with non-infectious anterior uveitis and panuveitis complicated cataract. METHOD: In this retrospective cohort study, 140 uveitic cataract patients who received phacoemulsification and intraocular lens implantation in Shanxi Eye hospital from January 2018 to January 2020 were reviewed. The IVTA group (51 eyes of 41 patients) received intravitreal injection of 3 mg triamcinolone acetonide (TA) at the end of surgery, and the control group (51 eyes of 41 patients) without injection matched by propensity score matching were enrolled. Outcome measures were best corrected visual acuity (BCVA), anterior chamber inflammation, intraocular pressure, corneal endothelial cell density, central macular thickness and complications within 3 months follow-up. RESULTS: The degree of postoperative anterior chamber inflammation in the IVTA group was lighter than that in the control group (P < 0.05). The postoperative logMAR BCVA of anterior uveitis was better and improved more quickly in the IVTA group(P < 0.05). Postoperative time of using corticosteroids was shorter in the IVTA group as compared to the control group (P < 0.05). The central macular thickness at postoperative month 1 was statistically significantly lower in the IVTA group (P < 0.05). There were no statistically significant differences between the two groups in postoperative corneal endothelial cell density and intraocular pressure (P > 0.05). Two of 51 eyes (3.9%) in the IVTA group and 8 of 51 eyes (15.7%) in the control group had recurrence of uveitis; 6 of 45 eyes (13.3%) in the control group developed cystoid macular edema but none in the IVTA group; 11 of 51 eyes (21.6%) in the IVTA group and 22 of 51 eyes (43.1%) in the control group developed posterior synechiae postoperatively. CONCLUSIONS: Intraoperative Intravitreal injection of 3 mg TA is an effective and safe adjunctive therapy for preventing postoperative inflammation and complications to promote early recovery for anterior uveitis or panuveitis complicated cataract patients following phacoemulsification. TRIAL REGISTRATION: This retrospective cohort study was in accordance with the tenets of the Helsinki Declaration and was approved by the Shanxi Eye Hospital Ethics Committee. Written informed consent was obtained from all participants for their clinical records to be used in this study.


Assuntos
Catarata , Facoemulsificação , Uveíte , Glucocorticoides/uso terapêutico , Humanos , Inflamação , Injeções Intravítreas , Estudos Retrospectivos , Triancinolona Acetonida/uso terapêutico , Uveíte/complicações , Uveíte/tratamento farmacológico , Uveíte/prevenção & controle , Acuidade Visual , Corpo Vítreo
5.
Medicine (Baltimore) ; 100(19): e25684, 2021 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-34106593

RESUMO

OBJECTIVE: There is no review or meta-analysis to compare the efficacy and safety of methotrexate plus anti-vascular endothelial growth factor (anti-VEGF) therapy in patients with diabetic macular edema (DME). It is worthy to critically review the evidence of the assessment of combined therapies to inform clinical practice. Therefore, the purpose of this study was to compare the efficacy and safety of methotrexate plus anti-VEGF therapy in the treatment of DME and to provide evidence for clinical practice. METHODS: The electronic databases of EMBASE, PubMed, Cochrane Library, and Web of Science were searched from the inception to April 2021 using the following key terms: "diabetic macular edema," "methotrexate," and "anti-vascular endothelial growth factor," for all relevant studies. Additionally, the reference lists from published original articles and relevant reviews were assessed to identify more relevant studies. Only English publications were included. Data were extracted by review of each study for population, mean age, gender, follow-up duration, study design, publishing date, characteristics, and outcomes assessment. The present study was performed using Review Manager (RevMan Version 5.3, The Cochrane Collaboration, Copenhagen, Denmark). RESULTS: We hypothesized that combined therapies would provide better therapeutic benefits compared to single method. OSF REGISTRATION NUMBER: 10.17605/OSF.IO/APD6 V.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Antirreumáticos/uso terapêutico , Retinopatia Diabética/tratamento farmacológico , Edema Macular/tratamento farmacológico , Metotrexato/uso terapêutico , Receptores de Fatores de Crescimento do Endotélio Vascular/antagonistas & inibidores , Quimioterapia Combinada , Humanos , Injeções Intravítreas , Edema Macular/etiologia
6.
Vestn Oftalmol ; 137(3): 115-120, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34156786

RESUMO

Retinal pigment epithelial tear (RPET) occurs in a number of diseases, most often in age-related macular degeneration (AMD). RPET develops in the setting of retinal pigment epithelium (RPE) detachment and represents a violation of the integrity of its monolayer accompanied by the formation of a demarcation line between the RPE atrophy area and RPE folds. Its incidence varies widely. In the earlier studies, diagnosis of RPET was performed using fluorescent angiography or angiography with indocyanine green (ICG-FA). The advent of optical coherence tomography made the detection of RPET easier and more accessible. The mechanism of RPET formation is quite polymorphic and ambiguous. Scientific literature contains descriptions of the occurrence of RPET when using both ranibizumab and aflibercept, and bevacizumab in equal proportions, implying that the drug choice does not affect the occurrence of complications. Continuous monitoring and adherence to anti-VEGF therapy leads to better anatomical and functional results in the long term, which is crucial for improving the quality of life of patients with age-related macular degeneration. This article reviews the literature and presents current data on RPET, identifies risk factors and mechanisms of its development, provides classification, and describes modern options for its diagnosis and treatment.


Assuntos
Degeneração Macular , Perfurações Retinianas , Inibidores da Angiogênese/uso terapêutico , Angiofluoresceinografia , Humanos , Injeções Intravítreas , Degeneração Macular/diagnóstico , Degeneração Macular/tratamento farmacológico , Degeneração Macular/epidemiologia , Qualidade de Vida , Ranibizumab/uso terapêutico , Epitélio Pigmentado da Retina , Pigmentos da Retina/uso terapêutico , Tomografia de Coerência Óptica , Fator A de Crescimento do Endotélio Vascular , Acuidade Visual
7.
Transl Vis Sci Technol ; 10(7): 19, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34128964

RESUMO

Purpose: Axitinib, a tyrosine kinase inhibitor, is a potent inhibitor of vascular endothelial growth factor (VEGF) receptors -1, -2 and -3. Suprachoroidal (SC) delivery of axitinib, combined with pan-VEGF inhibition activity of axitinib, has the potential to provide additional benefits compared to the current standard of care with intravitreal anti-VEGF-A agents. This study evaluated the ocular pharmacokinetics and systemic disposition of axitinib after SC administration in rabbits. Methods: Rabbits received axitinib as either a single SC injection (0.03, 0.10, 1.00, or 4.00 mg/eye; n = 4/group) or a single intravitreal injection (1 mg/eye; n = 4/group) in three separate studies. Axitinib concentrations were measured in several ocular compartments and in plasma at predetermined timepoints for up to 91 days. The pharmacokinetics parameters were estimated by noncompartmental analysis. Results: A single SC injection of axitinib suspension (1 mg/eye) resulted in an 11-fold higher mean axitinib exposure in the posterior eye cup, compared with intravitreal injection. Sustained levels of axitinib in the retinal pigment epithelium-choroid-sclera (RCS) and retina were observed throughout the duration of studies after a single SC axitinib injection (0.1 and 4.0 mg/eye), with low exposure in the vitreous humor, aqueous humor, and plasma. Axitinib levels in the RCS were 3 to 5 log orders higher than the reported in vitro (VEGF receptor-2 autophosphorylation inhibition) 50% inhibitory concentration value after 0.1 and 4.0 mg/eye dose levels throughout the 65-day and 91-day studies, respectively. Conclusions: This study demonstrates that SC axitinib suspension has a favorable pharmacokinetics profile with potential as a long-acting therapeutic candidate targeted to affected choroid and retinal pigment epithelium in neovascular age-related macular degeneration. Translational Relevance: Suprachoroidal axitinib suspension has potential to decrease the treatment burden in neovascular age-related macular degeneration, as a long-acting therapeutic candidate, and could yield greater efficacy, as a potent tyrosine kinase pan-VEGF inhibitor, compared with current standard anti-VEGF-A therapies.


Assuntos
Corioide , Fator A de Crescimento do Endotélio Vascular , Animais , Axitinibe , Injeções Intravítreas , Coelhos , Retina
8.
Indian J Ophthalmol ; 69(7): 1862-1866, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34146045

RESUMO

Purpose: The aim of this study was to evaluate the association of morphological features of subretinal hyperreflective material (SHRM) with visual acuity (VA), geographic atrophy (GA) and scar formation in eyes with neovascular age-related macular degeneration (neovascular AMD) and to compare with controls of neovascular AMD without SHRM. Methods: Retrospective analysis of 157 wet AMD eyes with SHRM and 50 eyes without SHRM treated with Anti-VEGF. Baseline spectral domain-OCT characteristics (SHRM location, height, width, area, reflectivity, border definition) were collected and were correlated with VA at baseline, 3, 6, 12 months and looked for development of scar and geographical atrophy (GA) and were compared to the control group. Results: When compared to the control, baseline parameters with a significant predictive value of 12-VA were presence of SHRM, foveal involvement of SHRM, high reflective SHRM, well-defined SHRM borders and thick SHRM. VA was decreased with greater SHRM height, width and area (P < 0.001). Decreasing reflectivity of SHRM lesions and disappearance of SHRM correlated with better VA at 12 months (P < 0.05). At 12 months, scar and GA was present more often in eyes with persistent SHRM than in eyes with SHRM that resolved and those without SHRM in the control group. Conclusion: SHRM can be considered as a surrogate OCT biomarker in predicting final visual outcome in neovascular age-related macular degeneration. Baseline parameters predicting poorer vision at 12-follow-up were presence of SHRM involving the fovea, well-defined SHRM borders, greater SHRM height, width and area and persistence of SHRM with Anti-VEGF therapy.


Assuntos
Degeneração Macular Exsudativa , Inibidores da Angiogênese/uso terapêutico , Estudos de Casos e Controles , Angiofluoresceinografia , Humanos , Injeções Intravítreas , Ranibizumab/uso terapêutico , Estudos Retrospectivos , Tomografia de Coerência Óptica , Fator A de Crescimento do Endotélio Vascular , Acuidade Visual , Degeneração Macular Exsudativa/diagnóstico , Degeneração Macular Exsudativa/tratamento farmacológico
9.
J Ayub Med Coll Abbottabad ; 33(2): 183-187, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34137525

RESUMO

BACKGROUND: Anti-VEGF agents have been proven to be effective in treating macular oedema secondary to a multitude of pathological conditions. However, in large clinical trial settings, the results may be overstated. This study aimed to evaluate the short-term efficacy of intraocular Bevacizumab in consecutive patients with macular oedema being treated in a 'real-world' setting in Pakistan. METHODS: A prospective study was conducted at Amanat Eye Hospital, Rawalpindi from August 2018 to November 2019. Thirty-five eyes of 29 patients with macular oedema were treated with monthly intravitreal Bevacizumab injections for three consecutive months. Best-corrected visual acuity (BCVA), and OCT parameters including central retinal thickness (CRT) and macular volume were assessed prior to the injections and then 4 weeks post the final injection and compared. RESULTS: BCVA improved from 1.00±0.44 at baseline to 0.83±0.48 four weeks after the third intravitreal injection. CRT decreased significantly from 492.77±192.31 at baseline to 362.91±126.11 (p<0.05), and macular volume decreased significantly from 11.61±2.39 at baseline to 9.87±1.68 (p<0.05) four weeks after the third intravitreal injection. No systemic or ocular complications were observed during the course of the study. CONCLUSIONS: Treatment with intravitreal Bevacizumab injections was found safe and resulted in clinically and statistically significant improvement in SD-OCT parameters and visual acuity in patients with macular oedema secondary to various retinal pathologies. However, the improvement in a real-world setting was sub-optimal in comparison to larger clinical trials for specific diseases in the developed world.


Assuntos
Inibidores da Angiogênese/administração & dosagem , Bevacizumab/administração & dosagem , Edema Macular/tratamento farmacológico , Idoso , Humanos , Injeções Intravítreas , Edema Macular/fisiopatologia , Masculino , Pessoa de Meia-Idade , Paquistão , Estudos Prospectivos , Oclusão da Veia Retiniana/tratamento farmacológico , Oclusão da Veia Retiniana/fisiopatologia , Tomografia de Coerência Óptica , Acuidade Visual
10.
Transl Vis Sci Technol ; 10(6): 11, 2021 05 03.
Artigo em Inglês | MEDLINE | ID: mdl-34111259

RESUMO

Purpose: What are the patient characteristics predictive of response to ranibizumab treatment? Methods: Model-based characterization of best-corrected visual acuity (BCVA) time profiles of patients with neovascular age-related macular degeneration under ranibizumab or sham treatment based on 24-month observations of BCVA in 2419 patients from randomized multicenter phase 3 trials of ranibizumab: ANCHOR, MARINA, PIER, and HARBOR. Goodness-of-fit plots and precision of parameter estimates were used for measure of accuracy. Results: The model incorporates a long-term effect on disease progression and an additive and more potent short-term effect of ranibizumab. Response to ranibizumab treatment and progression of the disease were found to be a function of seven baseline characteristics (visual acuity, age, leakage size, central retinal lesion thickness, presence or absence of cyst, type of choroidal neovascularization (CNV), and size of pigment epithelium detachment). A composite score of these seven baseline characteristics was derived and used to categorize response to ranibizumab treatment. The ranibizumab treatment arms of two proof-of-concept studies held out from the model development were used to validate the methodology. Conclusions: A composite score based on seven patient characteristics prior to treatment could be used to discriminate patients with predicted insufficient response to anti-vascular endothelial growth factor treatment. Translational Relevance: The method could be used to create a virtual ranibizumab treatment arm in clinical trials or to reduce the size of a ranibizumab active control arm.


Assuntos
Degeneração Macular , Ranibizumab , Inibidores da Angiogênese/uso terapêutico , Humanos , Injeções Intravítreas , Degeneração Macular/tratamento farmacológico , Ranibizumab/uso terapêutico , Tomografia de Coerência Óptica , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/uso terapêutico
11.
Artigo em Inglês | MEDLINE | ID: mdl-34070071

RESUMO

Although optical coherence tomography (OCT) parameters have assisted in the diagnosis of polypoidal choroidal vasculopathy (PCV), its potential to evaluate treatment outcomes has not been established. The purpose of this pilot study was to evaluate baseline OCT parameters that may influence treatment outcome in PCV eyes with combination therapy. In this single-centered, prospective study, patients were recruited with at least one treatment-naïve PCV eye and treated with combination therapy of intravitreal anti-vascular endothelial growth factor and photodynamic therapy. Best-corrected distance and near visual acuity (DVA and NVA), and contrast sensitivity (CS) were recorded at baseline and six months after treatment. OCT parameters were determined. Twenty-six eyes of 26 patients aged between 51 to 83 years were evaluated. In eyes that had disrupted external limiting membrane (ELM), photoreceptors inner and outer segment (IS-OS) junction at 1000 micron of fovea at baseline showed low mean visual functions after 6 months of treatment. Eyes with foveal sub-retinal fluid (SRF) and polyp at central 1000 micron of fovea at baseline showed significantly worse DVA and CS after six months. Thus, the presence of foveal SRF, foveal polyp, disrupted ELM, and IS-OS junction at baseline significantly influenced the six months' visual outcome in PCV eyes treated with combination therapy.


Assuntos
Inibidores da Angiogênese , Tomografia de Coerência Óptica , Idoso , Idoso de 80 Anos ou mais , Inibidores da Angiogênese/uso terapêutico , Angiofluoresceinografia , Seguimentos , Humanos , Injeções Intravítreas , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento , Acuidade Visual
12.
Phytomedicine ; 88: 153604, 2021 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-34130054

RESUMO

BACKGROUND: Blue light can directly penetrate the lens and reach the retina to induce retinal damage, causing dry age-related macular degeneration (dAMD). Cynaroside (Cyn), a flavonoid glycoside, was proved to alleviate the oxidative damage of retinal cells in vitro. However, whether or not Cyn also exerts protective effect on blue light-induced retinal degeneration and its mechanisms of action are unclear. PURPOSE: This study aims to evaluate the protective effects of Cyn against blue-light induced retinal degeneration and its underlying mechanisms in vitro and in vivo. STUDY DESIGN/METHODS: Blue light-induced N-retinylidene-N-retinylethanolamine (A2E)-laden adult retinal pigment epithelial-19 (ARPE-19) cell damage and retinal damage in SD rats were respectively used to evaluate the protective effects of Cyn on retinal degeneration in vitro and in vivo. MTT assay and AnnexinV-PI double staining assay were used to evaluate the in vitro efficacy. Histological analysis, TUNEL assay, and fundus imaging were conducted to evaluate the in vivo efficacy. ELISA assay, western blot, and immunostaining were performed to investigate the mechanisms of action of Cyn. RESULTS: Cyn decreased the blue light-induced A2E-laden ARPE-19 cell damage and oxidative stress. Intravitreal injection of Cyn (2, 4 µg/eye) reversed the retinal degeneration induced by blue light in SD rats. Furthermore, Cyn inhibited the nuclear translocation of NF-κB and induced autophagy, which led to the clearance of overactivated pyrin domain containing 3 (NLRP3) inflammasome in vitro and in vivo. CONCLUSION: Cyn protects against blue light-induced retinal degeneration by modulating autophagy and decreasing the NLRP3 inflammasome.


Assuntos
Apoptose/efeitos dos fármacos , Glucosídeos/farmacologia , Luteolina/farmacologia , Substâncias Protetoras/farmacologia , Degeneração Retiniana/tratamento farmacológico , Animais , Apoptose/fisiologia , Autofagia/efeitos dos fármacos , Linhagem Celular , Glucosídeos/administração & dosagem , Humanos , Inflamassomos/metabolismo , Injeções Intravítreas , Luz/efeitos adversos , Luteolina/administração & dosagem , Masculino , NF-kappa B/metabolismo , Estresse Oxidativo/efeitos dos fármacos , Substâncias Protetoras/administração & dosagem , Ratos Sprague-Dawley , Degeneração Retiniana/etiologia , Degeneração Retiniana/patologia , Epitélio Pigmentado da Retina/efeitos dos fármacos , Epitélio Pigmentado da Retina/patologia
13.
J Pak Med Assoc ; 71(4): 1184-1188, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34125768

RESUMO

OBJECTIVE: To assess the rate of infectious endophthalmitis with anti-vascular endothelial growth factor injection, and to evaluate institutional procedure protocol in this regard. METHODS: The retrospective consecutive case series was conducted at Shifa International Hospital, Islamabad, Pakistan, from August 2018 to January 2019, and comprised 5-year data from August 2014 to July 2019 related to patients who underwent intravitreal anti-vascular endothelial growth factor injections. Data was analysed using SPSS 21. RESULTS: Of the 7,542 injections administered to 2,734 patients, 5,976(79.2%) were bevacizumab, 1,081(14.3%) ranibizumab and 485(6.4%) aflibercept. There was 1(0.01%) case of infectious endophthalmitis which was treated with 25 gauge pars plana vitrectomy. CONCLUSIONS: The institutional procedure protocol was found to be effective as the rate of infectious endophthalmitis was lower than what is reported in literature.


Assuntos
Inibidores da Angiogênese , Endoftalmite , Inibidores da Angiogênese/uso terapêutico , Bevacizumab/uso terapêutico , Endoftalmite/tratamento farmacológico , Endoftalmite/epidemiologia , Endoftalmite/etiologia , Humanos , Incidência , Injeções Intravítreas , Paquistão/epidemiologia , Estudos Retrospectivos , Centros de Atenção Terciária , Fator A de Crescimento do Endotélio Vascular/uso terapêutico
14.
Indian J Ophthalmol ; 69(6): 1469-1474, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34011722

RESUMO

Purpose: The aim of this study was to evaluate the safety, efficacy, and morphological response of intravitreal ranibizumab biosimilar (Razumab) in neovascular age-related macular degeneration (n-AMD) up to 12 weeks. Methods: Retrospective analysis of 20 eyes of n-AMD receiving 4 weekly intravitreal Razumab. Main outcome measures were mean change in best-corrected visual acuity (BCVA), intraretinal-fluid (IRF), subretinal-fluid (SRF), central-subfield thickness (CSFT), maximum central-retinal thickness (CRT), and dimensions of pigment epithelial detachment (PED) from baseline to weeks 4, 8 and 12. Results: Improvement in BCVA was seen at all visits, although not significantly (4 weeks: P = 0.18; 8 weeks: P = 0.4; 12 weeks: P = 0. 06). At 12 weeks, 90% of eyes either maintained or had an improvement in BCVA, with 40% of them showing an improvement of ≥3-lines and only 5% of them losing ≥3-lines of visual acuity. The median PED height and PED width reduced by 20.5 µm (P = 0.03) and 557.5 µm (P = 0.14), respectively, along with a mean reduction of 57.26 µmin CSFT (P < 0.001) and 44.15 µm in CRT (P = 0.004), respectively, at 12 weeks. On qualitative analysis, resolution of SRF and IRF was observed in 45% and 25% of eyes ' at 12 weeks. There were no serious ocular or systemic side effects identified. Conclusion: In real-world scenario, Razumab is an efficacious and economical anti-vascular endothelial growth factor (anti-VEGF) agent for optimal management of n-AMD. The therapeutic outcomes demonstrated reasonable stabilization and improvement in visual acuity, favorable anatomical outcomes pertaining to OCT-biomarkers with an acceptable safety profile.


Assuntos
Medicamentos Biossimilares , Degeneração Macular , Inibidores da Angiogênese/uso terapêutico , Biomarcadores , Humanos , Lactente , Injeções Intravítreas , Degeneração Macular/tratamento farmacológico , Ranibizumab/uso terapêutico , Estudos Retrospectivos , Tomografia de Coerência Óptica , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular
15.
Indian J Ophthalmol ; 69(6): 1475-1481, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34011723

RESUMO

Purpose: Identification of nonresponders prior to anti-vascular endothelial growth factor (anti-VEGF) therapy would help in the judicious clinical management of diabetic macular edema (DME) patients. Thus, a systematic study was initiated to identify nonresponding DME patient population undergoing ranibizumab treatment to figure out additional inflammatory components that may contribute to their nonresponsiveness to anti-VEGF therapy. Methods: A total of 40 patients recruited to this investigator-initiated trial received intravitreal ranibizumab monthly for 3 months. The fourth- and fifth-month injections were according to PRN protocol and the sixth-month injection was mandatory. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and VEGF in aqueous humor were measured for all the patients. Patients were grouped into responders/nonresponders on the formulated criteria and the levels of key pro-inflammatory cytokines were also measured between the two groups at baseline, 2 month and 5 months using cytometric bead array (CBA). Results: Eleven patients were categorized (29.72%) as responders and 10 patients (27.02%) as nonresponders. Nonresponders showed poorer BCVA (P = 0.024, 0.045, and 0.048 for 4, 5, and 6 months) and higher CMT (P = 0.021, 0.0008 and <0.0001 for baseline, 1, 2, 3, 4, 5, and 6 months) compared to responders. The cytokines IL-8, MCP-1 were significantly up regulated (P = 0.0048 and 0.029 for MCP-1 and IL-8) in nonresponders. Conclusion: Elevated MCP-1 and IL-8 levels found in the nonresponders could be used as a prognostic marker to identify these groups of patients and can help in developing alternative treatment options along with anti-VEGF therapy.


Assuntos
Diabetes Mellitus , Retinopatia Diabética , Edema Macular , Inibidores da Angiogênese/uso terapêutico , Quimiocina CCL2/uso terapêutico , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/tratamento farmacológico , Humanos , Interleucina-8/uso terapêutico , Injeções Intravítreas , Edema Macular/diagnóstico , Edema Macular/tratamento farmacológico , Edema Macular/etiologia , Ranibizumab/uso terapêutico , Tomografia de Coerência Óptica , Fator A de Crescimento do Endotélio Vascular , Acuidade Visual
16.
BMJ Health Care Inform ; 28(1)2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34035050

RESUMO

BACKGROUND/AIMS: To assess the outcomes of home monitoring of distortion caused by macular diseases using a smartphone-based application (app), and to examine them with hospital-based assessments of visual acuity (VA), optical coherence tomography-derived central macular thickness (CMT) and the requirement of intravitreal injection therapy. DESIGN: Observational study with retrospective analysis of data. METHODS: Participants were trained in the correct use of the app (Alleye, Oculocare, Zurich, Switzerland) in person or by using video and telephone consultations. Automated threshold-based alerts were communicated based on a traffic light system. A 'threshold alarm' was defined as three consecutive 'red' scores, and turned into a 'persistent alarm' if present for greater than a 7-day period. Changes of VA and CMT, and the requirement for intravitreal therapy after an alarm were examined. RESULTS: 245 patients performing a total of 11 592 tests (mean 46.9 tests per user) were included and 85 eyes (164 alarms) examined. Mean drop in VA from baseline was -4.23 letters (95% CI: -6.24 to -2.22; p<0.001) and mean increase in CMT was 29.5 µm (95% CI: -0.08 to 59.13; p=0.051). Sixty-six eyes (78.5%) producing alarms either had a drop in VA, increase in CMT or both and 60.0% received an injection. Eyes with persistent alarms had a greater loss of VA, -4.79 letters (95% CI: -6.73 to -2.85; p<0.001) or greater increase in CMT, +87.8 µm (95% CI: 5.2 to 170.4; p=0.038). CONCLUSION: Smartphone-based self-tests for macular disease may serve as reliable indicators for the worsening of pathology and the need for treatment.


Assuntos
Injeções Intravítreas/estatística & dados numéricos , Degeneração Macular , Consulta Remota/estatística & dados numéricos , Smartphone , Acuidade Visual/fisiologia , Idoso , Feminino , Humanos , Degeneração Macular/diagnóstico , Degeneração Macular/patologia , Masculino , Aplicativos Móveis , Estudos Retrospectivos , Tomografia de Coerência Óptica
17.
BMC Ophthalmol ; 21(1): 201, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33962570

RESUMO

BACKGROUND: Numerous cases with ocular toxicity secondary to tamoxifen have been reported, and became more apparent with keratopathy, cataract, optic neuritis, macular holes, crystalline retinopathy with or without cystoid macular edema (CME). Withdrawing tamoxifen with the approval of the oncologist is the major treatment for cases with tamoxifen-induced retinopathy. CASE PRESENTATION: We herein reported a patient with a two-year history of painless and reduced visual acuity in both eyes who received tamoxifen therapy for 6 years. Tamoxifen-induced rentinopathy with CME showed significant development even though the patient has already discontinued tamoxifen treatment for 6 months. Anatomic improvements after intravitreal ranibizumab injection in both eyes were significant but were temporary. Surprisingly, CME in both eyes has been resolved spontaneously after 10 months in the penultimate visit without any therapy. CONCLUSION: Intravitreal ranibizumab injection temporarily improved the anatomy of the eyes in a case with tamoxifen-induced CME, and only tamoxifen withdrawal can bring a sustained effect.


Assuntos
Edema Macular , Bevacizumab/uso terapêutico , Humanos , Injeções Intravítreas , Edema Macular/induzido quimicamente , Edema Macular/tratamento farmacológico , Ranibizumab/uso terapêutico , Tamoxifeno/efeitos adversos , Tomografia de Coerência Óptica , Acuidade Visual
18.
J Fr Ophtalmol ; 44(6): 822-827, 2021 Jun.
Artigo em Francês | MEDLINE | ID: mdl-33994049

RESUMO

INTRODUCTION: Combined retinal detachment and choroidal detachment (RDCD) is a serious type of retinal detachment occurring mainly in high myopes, which poses many pre-, intra- and postoperative difficulties that can affect the visual prognosis. MATERIAL AND METHODS: Personal technique used in 8 patients with RDCD, consisting of intravitreal injection (IVI) of a viscoelastic (VE) device 2 to 3 days prior to vitrectomy. RESULTS: Reattachment of the choroid in all patients, with return to normal IOP, allowing vitrectomy to be performed under optimal conditions. DISCUSSION: RDCD often occurs in high myopia, especially in the case of an associated giant tear, the mechanism of which involves severe hypotony, resulting in a vicious cycle including development of the choroidal detachment (CD), partial retinal reattachment, normalization of the IOP, redetachment of the retina, and once again, hypotony. Preoperative viscoelastic IVI can break this vicious cycle and reattach the choroid, often within 24 to 48hours. This thus facilitates RD surgery without the intra- and postoperative technical difficulty of managing the CD. CONCLUSION: Viscoelastic IVI is a simple, safe, inexpensive and reproducible technique for the treatment of CD associated with RD in order to prepare for RD surgery under the usual conditions without a CD.


Assuntos
Doenças da Coroide , Descolamento Retiniano , Corioide , Humanos , Injeções Intravítreas , Descolamento Retiniano/cirurgia , Estudos Retrospectivos , Vitrectomia
19.
J Fr Ophtalmol ; 44(6): 777-785, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34053770

RESUMO

BACKGROUND: Non-arteritic anterior ischemic optic neuropathy (NAION) is a common cause of vision loss but no treatment has demonstrated its efficiency. A preliminary study showed an improvement on the visual acuity (VA) in a group of patients who received intravitreal administration of triamcinolone acetonide (IVTA) versus a non-treated group. In the present series, the visual outcome of IVTA in NAION was evaluated on a larger group of patients. METHODS: This retrospective, unmasked and non-randomized study took place at Reims University Hospital between 2009 and 2017. The data of consecutive patients presenting with isolated optic disc edema characteristic of recent NAION (<1month of visual acuity loss) were included. After informed consent, a single intravitreal injection of filtrated 4mg/0.1mL triamcinolone acetonide were administered. Twenty-seven control patients chose not to be injected and therefore served as controls. LogMar visual acuity (VA), VA rating (VAR) (1 line=0.1LogMAR=5 VAR letters), retinal nerve fiber layer thickness assessed by OCT and static visual field were evaluated at presentation, after 7days, after 3months and after 6months. RESULTS: Sixty-eight patients with NAION were evaluated. Forty-one received IVTA, 29 were injected within 15days after the onset of symptoms and 12 after 15days. There was a higher proportion of patients improving VA of 2 lines or more (10 or more VAR letters) in the injected group (49%) compared with the non-injected group (11%, P=0.019). Among the patients injected before 15days, the proportion improving for 2 lines or more (55% vs. 11%, respectively, P=0.013) and for 3 lines or more (45% vs. 11%, respectively, P=0.035) were significantly higher than in the non-injected group. Also, comparing the VA at presentation with the VA after 6months in the injected eyes, it improved significantly (P=0.003) and also in the subgroup injected within 15days (P=0.0007) but not in the injected group after 15days (P=0.801). Visual field improvement was only observed in the subgroup of patients injected within 15days with a significant improvement of the mean deviation (dB) within 6months (P=0.015). CONCLUSIONS: This follow-up study confirms the results of the previous series displaying an apparent benefit of intravitreal steroids injected in the acute phase of NAION. Only patients receiving IVTA within 15days from onset of NAION have a significant improvement of VA and visual field during the follow-up period of 6months.


Assuntos
Neuropatia Óptica Isquêmica , Seguimentos , Glucocorticoides/uso terapêutico , Humanos , Injeções Intravítreas , Neuropatia Óptica Isquêmica/tratamento farmacológico , Estudos Retrospectivos , Tomografia de Coerência Óptica , Triancinolona Acetonida
20.
Aging (Albany NY) ; 13(9): 12359-12377, 2021 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-33952723

RESUMO

Age-related macular degeneration (AMD) is a worldwide leading cause of blindness affecting individuals over 50 years old. The most aggressive form, wet AMD, is characterized by choroidal neovascularization (CNV) and inflammation involving microglia recruitment. By using a laser-induced CNV mouse model, we provide evidence for a key role played by miR-142-3p during CNV formation. MiR-142-3p was overexpressed in murine CNV lesions and its pharmacological inhibition decreased vascular and microglia densities by 46% and 30%, respectively. Consistently, miR-142-3p overexpression with mimics resulted in an increase of 136% and 126% of blood vessels and microglia recruitment. Interestingly, miR-142-3p expression was linked to the activation state of mouse microglia cells as determined by morphological analysis (cell solidity) through a computational method. In vitro, miR-142-3p overexpression in human microglia cells (HMC3) modulated microglia activation, as shown by CD68 levels. Interestingly, miR142-3p modulation also regulated the production of VEGF-A, the main pro-angiogenic factor. Together, these data strongly support the unprecedented importance of miR-142-3p-dependent vascular-inflammation axis during CNV progression, through microglia activation.


Assuntos
Neovascularização de Coroide/tratamento farmacológico , Neovascularização de Coroide/genética , Lasers , MicroRNAs/farmacologia , Animais , Neovascularização de Coroide/patologia , Modelos Animais de Doenças , Injeções Intravítreas/métodos , Ativação de Macrófagos/genética , Degeneração Macular/tratamento farmacológico , Degeneração Macular/metabolismo , Camundongos , Microglia/efeitos dos fármacos , Microglia/metabolismo
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