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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.
Asia Pac J Ophthalmol (Phila) ; 8(4): 308-313, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31369406

RESUMO

PURPOSE: The aim of the current study was to compare visco-trabeculotomy (VT) with standard trabeculectomy with mitomycin C (Trab-MMC) in the treatment of quiescent neovascular glaucoma (NVG). METHODS: The study was conducted on 51 eyes of 51 patients presenting with NVG and treated at an Ophthalmic Center in Egypt between March 2014 and April 2017. All study eyes were subjected to a standard protocol of intravitreal injection of ranibizumab followed by panretinal photocoagulation. Eyes were then randomized to either VT or Trab-MMC. Study eyes were followed up for at least 18 months. Success was defined as an intraocular pressure of ≤21 mm Hg and without vision-threatening complications. Complications were noted. RESULTS: The mean ±â€ŠSD (range, median) age of the study patients was 54.1 ±â€Š6.4 (40-67, 54.5) and 52.4 ±â€Š8.8 (38-66, 53) years in the VT (26 eyes) and Trab-MMC (25 eyes) groups, respectively (P = 0.45). The mean ±â€ŠSD (range, median) intraocular pressure (IOP) of the study eyes was 45.19 ±â€Š2.97 (39-52, 45.5) and 45.64 ±â€Š3.56 (3-53, 45) mm Hg on maximal medical therapy in the VT and Trab-MMC groups, respectively (P = 0.61). At 18 months' follow-up, the mean ±â€ŠSD (range, median) IOP of the study eyes was 18.19 ±â€Š2.0 (16-23, 17) and 19.92 ±â€Š2.6 (18-26, 19) mm Hg in the VT and Trab-MMC groups, respectively (P = 0.004). There was no difference in postoperative antiglaucoma medication between the 2 groups (P = 0.62). Complications included hyphema and Descemet split in the VT group and an IOP spike in the Trab-MMC group. Success rates were 84.6% and 80% in the VT and Trab-MMC groups, respectively (P = 0.726). CONCLUSIONS: Both VT and Trab-MMC groups are effective in reducing the IOP in cases of NVG after control of neovascularization with anti-vascular endothelial growth factor and pan retinal photocoagulation.


Assuntos
Glaucoma Neovascular/terapia , Pressão Intraocular/fisiologia , Fotocoagulação/métodos , Ranibizumab/administração & dosagem , Trabeculectomia/métodos , Acuidade Visual , Adulto , Idoso , Inibidores da Angiogênese/administração & dosagem , Feminino , Seguimentos , Glaucoma Neovascular/fisiopatologia , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores
3.
Cesk Slov Oftalmol ; 75(1): 25-29, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31382753

RESUMO

OBJECTIVE: To evaluate the anatomical and functional outcome of ranibizumab therapy in patients with idiopathic choroidal neovascularization (CNV). File and Methodology: The group consists of 6 patients. Patients were older 18 years but they were under 50 years of age. The monitoring period lasted 12 months. We confirmed active idiopathic CNV in subfoveal position with fluorescein angiography (FAg) and optical coherence tomography (OCT). The activity of idiopathic CNV we demonstrated with leakage of dye by FAg examination. The presence of serous retinal pigment epithelium detachment and / or subretinal fluid and / or intraretinal edema in the form of intraretinal cysts demonstrated activity of CNV on OCT scans. A decrease of the visual acuity under 85 letters was observed at the ETDRS (Early Treatment Diabetic Retinopathy Study) visual acuity chart. After the initial administration of ranibizumab a pro re nata regimen was used. We indicated repeated injection of ranibizumab in patients with signs of activity of idiopathic CNV on OCT scans or by FAg. Also we indicated repeated injection of ranibizumab in patients with new loss of visual acuity on the ETDRS visual acuity chart connected with signs of activity of CNV on OCT scans or by FAg. RESULTS: On average, we observed the gain of +11 letters on the ETDRS visual acuity chart after 12 months of the follow-up period. On average we observed reduction of central macular thickness -233μm. At the 12th month of follow-up we observed in all patients of our group only inactive scar without exudation. No serous retinal pigment eithelium detachment, subretinal fluid or intraretinal cysts were observed. Only 3 injections of ranibizumab were administered on average to each patient during the 12 months of the follow-up period. CONCLUSION: In our study, we observed the positive effect of ranibizumab on the course of idiopathic CNV. With ranibizumab treatment we achieved regression of CNV with resorption of macular edema in all patients of our group. With the disappearance of the activity of idiopathic CNV ranibizumab gives real hope to improve visual acuity.


Assuntos
Inibidores da Angiogênese , Neovascularização de Coroide , Ranibizumab , Inibidores da Angiogênese/uso terapêutico , Neovascularização de Coroide/tratamento farmacológico , Angiofluoresceinografia , Humanos , Injeções Intravítreas , Pessoa de Meia-Idade , Ranibizumab/uso terapêutico , Tomografia de Coerência Óptica , Resultado do Tratamento
4.
Vestn Oftalmol ; 135(3): 90-98, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31393451

RESUMO

Pseudophakic cystoid macular edema (CMO) known to appear in 0.1-2.35% of patients after phacoemulsification is one of the common causes of vision decrease during the postoperative period. The authors analyze a case of CMO development in a pseudophakic patient diagnosed 7 months after uncomplicated phacoemulsification. Optical coherence tomography (OCT) was suggested for patients with low vision and a sensation of shroud before the eye for early diagnosis of pathological process. Intravitreal injection of the 0.7 mg dexamethasone micro-implant performed soon after establishing diagnosis was proved to be viable for postoperative CMO arrest in patients without previous treatment. One month after intravitreal implant injection the visual acuity in the patient's eye improved from 0.4 to 0.7, and retinal thickness in the macular area decreased from 705 to 255 µm. The result remained stable for 10 months. Intravitreal micro-implant appeared to have higher efficiency in contrast with traditional treatment methods (according to literature data), which was attributed to direct drug delivery to the area of pathological process. The use of 0.7 mg dexamethasone implant did not increase the intraocular pressure indicating its potential viability for patients with compensated glaucoma.


Assuntos
Edema Macular , Dexametasona , Implantes de Medicamento , Glucocorticoides , Humanos , Injeções Intravítreas , Tomografia de Coerência Óptica
5.
Vestn Oftalmol ; 135(3): 109-112, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31393454

RESUMO

Despite the lack of convincing data on the effectiveness of antibiotic therapy in the prevention of Post-Injection Endophthalmitis (PIE), the use of topical antibiotics for intravitreal injections is still a common practice. Frequent, monthly use of antibiotics results in changes of the composition of conjunctival flora and spontaneous mutations of bacteria, and leads to selective survival of resistant and virulent strains that can cause serious damage inside the eye.


Assuntos
Infecções Oculares Bacterianas , Administração Tópica , Antibacterianos , Antibioticoprofilaxia , Resistência Microbiana a Medicamentos , Humanos , Injeções Intravítreas
6.
Graefes Arch Clin Exp Ophthalmol ; 257(9): 1889-1895, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31256237

RESUMO

PURPOSE: To compare treatment efficacy of anti-VEGF medications following pro re nata (PRN, "as needed", monthly injections only in case of active disease) or treat and extend (T&E, progressive extension of treatment intervals up to 12 weeks depending on the clinical findings) treatment protocols in real-world conditions. METHODS: Retrospective, observational study. Patients diagnosed with age-related macular degeneration and without pre-treatment undergoing routine anti-VEGF treatment in one eye clinic in Switzerland were included. Treatment was performed according to local practices, using ranibizumab or aflibercept, and following T&E or PRN regimens. Changes in logMAR and injection intervals (time between two injections) for specific treatment periods were evaluated descriptively and using mixed models. RESULTS: In total, 1071 patients with 1332 treated eyes (ranibizumab/PRN 722, ranibizumab/T&E 191, aflibercept/T&E 419) were included in the analyses. At baseline, logMAR (mean ± SD) was similar in both ranibizumab treatment groups (PRN 0.63 ± 0.43, T&E 0.57 ± 0.42). In the ranibizumab/PRN group, logMAR was about 0.1 lower for all time intervals in the initial and maintenance phases in comparison with baseline, indicating an improvement in VA. By comparison, logMAR improved more strongly in the ranibizumab/T&E group (16 to < 22 months, - 0.19 [- 0.23-0.15]) in comparison with baseline. Comparing ranibizumab/T&E vs. aflibercept/T&E groups, improvements in logMAR were similar over time. In the maintenance phase, the rate of patients with a clinically relevant improvement in visual acuity (> 0.2 logMAR) was higher in both T&E groups compared with the ranibizumab/PRN group. Injection intervals in the maintenance phase in ranibizumab/T&E group gradually expanded over time; whereas in the aflibercept/T&E group, injection intervals remained relatively stable. CONCLUSIONS: Ranibizumab used according to T&E protocol yielded a stronger improvement in logMAR, compared with PRN protocol with longer injection intervals than aflibercept/T&E. This large real-world data assessment supports previous data on the superiority of T&E treatment.


Assuntos
Macula Lutea/patologia , Ranibizumab/administração & dosagem , Receptores de Fatores de Crescimento do Endotélio Vascular/administração & dosagem , Proteínas Recombinantes de Fusão/administração & dosagem , Acuidade Visual , Degeneração Macular Exsudativa/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Inibidores da Angiogênese/administração & dosagem , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Receptores de Fatores de Crescimento do Endotélio Vascular/antagonistas & inibidores , Estudos Retrospectivos , Tomografia de Coerência Óptica , Resultado do Tratamento , Degeneração Macular Exsudativa/diagnóstico
7.
Graefes Arch Clin Exp Ophthalmol ; 257(9): 1897-1913, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31327036

RESUMO

PURPOSE: Putative roles of long non-coding RNAs (lncRNAs) as indicators for diabetic retinopathy (DR) and associated complications are beginning to emerge. We aimed to evaluate a panel of circulating hyperglycemia-related lncRNAs: RNCR2, NEAT2, CDKN2B-AS1, and PVT1 in type 2 diabetes patients with/without DR and to correlate their levels with the clinical characteristics and response to aflibercept intravitreal injection in terms of visual acuity (VA) improvement, central macular thickness (CMT) decline, and macular edema resolution after 4 weeks of the initial injection. METHODS: Pre-treatment plasma relative expression levels of the specified lncRNAs were quantified in 130 consecutive patients with diabetes (75 and 55 with/without DR, respectively) and 108 controls using quantitative real-time PCR. RESULTS: One month after aflibercept injection, significant reductions in CMT and VA were observed in DR cohorts. The four lncRNAs were over-expressed in DM compared with those in controls. However, downregulated baseline plasma levels of RNCR2 and NEAT2 were observed in glycemic-controlled DR patients. None of the lncRNAs showed a correlation with the severity of retinopathy or drug response. CONCLUSION: Though circulating levels of the analyzed lncRNAs did not show an association with DR progression or aflibercept therapy response, the expression pattern demonstrated good diagnostic performance in differentiating DM from controls and DR.


Assuntos
Retinopatia Diabética/sangue , RNA Longo não Codificante/sangue , Receptores de Fatores de Crescimento do Endotélio Vascular/administração & dosagem , Proteínas Recombinantes de Fusão/administração & dosagem , Retinopatia Diabética/tratamento farmacológico , Retinopatia Diabética/genética , Progressão da Doença , Feminino , Regulação da Expressão Gênica , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , RNA/genética , RNA Longo não Codificante/genética , Receptores de Fatores de Crescimento do Endotélio Vascular/antagonistas & inibidores , Retina/patologia , Estudos Retrospectivos , Tomografia de Coerência Óptica , Resultado do Tratamento , Acuidade Visual
8.
Expert Opin Drug Saf ; 18(9): 803-815, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31309853

RESUMO

Introduction: Intravitreal anti-VEGF is the most effective therapy for wet AMD, although systemic effects on the endothelium cannot be excluded. Areas covered: The purpose of this review was to evaluate risk of thromboembolic events associated with intravitreal anti-VEGF. Expert opinion: Current data are insufficient to confirm the safety of these compounds, due to the paucity of specific studies. Thus, pharmacovigilance for all anti-VEGF should be improved to verify the true role of anti-VEGF in the occurrence of systemic adverse events.


Assuntos
Inibidores da Angiogênese/efeitos adversos , Tromboembolia/induzido quimicamente , Degeneração Macular Exsudativa/tratamento farmacológico , Inibidores da Angiogênese/administração & dosagem , Inibidores da Angiogênese/farmacologia , Humanos , Injeções Intravítreas , Farmacovigilância , Tromboembolia/epidemiologia , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores
9.
BMC Ophthalmol ; 19(1): 156, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31331298

RESUMO

BACKGROUND: We report a case of macular hole (MH) formation and retinal detachment after intravitreal conbercept injection for the treatment of choroidal neovascularization (CNV) secondary to degenerative myopia. CASE PRESENTATION: A 60-year-old woman presented with blurred vision in her left eye was diagnosed as CNV secondary to degenerative myopia. Intravitreal injection of conbercept, an anti -vascular endothelial growth factor (VEGF) agent, was uneventfully performed in the left eye. Unfortunately, a full thickness MH and retinal detachment was found three weeks postoperatively by ophthalmoscopy and spectral-domain optical coherence tomography. Vitrectomy, internal limiting membrane peeling and silicone oil tamponade were then performed, and macular retina was reattached soon after surgery. However, MH still kept open during three months' follow-up. CONCLUSION: MH is a quite rare complication of intravitreal anti- VEGF agent injection, tangential contraction secondary to CNV shrinkage and regression caused by anti-VEGF agent is proposed to be the major pathogenesis of MH formation.


Assuntos
Inibidores da Angiogênese/efeitos adversos , Neovascularização de Coroide/tratamento farmacológico , Miopia Degenerativa/complicações , Proteínas Recombinantes de Fusão/efeitos adversos , Descolamento Retiniano/induzido quimicamente , Perfurações Retinianas/induzido quimicamente , Feminino , Humanos , Injeções Intravítreas , Pessoa de Meia-Idade
10.
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
11.
BMC Ophthalmol ; 19(1): 153, 2019 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-31324161

RESUMO

BACKGROUND: There is no consensus on the optimal initial treatment for polypoidal choroidal vasculopathy (PCV). Our study aimed to report the efficacy of repeated injections of intravitreal ranibizumab with or without photodynamic therapy for the treatment of PCV and to determine the possible factors predictive of visual outcomes. METHODS: The results of the initial treatment of 40 patients with PCV with 3 monthly injections of ranibizumab were retrospectively reviewed. We compared the results in terms of the best corrected visual acuity (BCVA), the central retinal thickness (CRT), the number of injections, the regression rates of polyps and the rates of the reduction of subretinal fluid. RESULTS: At the 3-month follow-up, the mean BCVA was significantly increased by 7.3 ± 12.4 letters compared to baseline (p < 0.01). At the 12-month follow-up, the mean BCVA was increased by 3.4 ± 15.4 letters compared to baseline, and there was no significant difference (p > 0.05). The mean CRT at the 12-month follow-up was 593.58 ± 243.64 µm, with an average decrease of 101.55 ± 256.07 µm compared to baseline (p < 0.01). Fifteen eyes (18.8%) showed the complete regression of polyps, and 22 eyes (27.5%) showed a reduction in polyps. The baseline VA, the reduction in subretinal fluids and the greatest lesion diameter were significant independent factors that were predictive of improved VA at the final follow-up. CONCLUSIONS: Three monthly injections of ranibizumab as an initial treatment could significantly improve VA in PCV patients in the short term. At 12 months postinjection, ranibizumab treatment could stabilize VA in most PCV patients. The baseline VA, the reduction in subretinal fluids and the greatest lesion diameter were predictive factors for the relative improvement of VA at the final follow-up.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Neovascularização de Coroide/tratamento farmacológico , Ranibizumab/uso terapêutico , Idoso , Feminino , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Fotoquimioterapia/métodos , Pólipos/tratamento farmacológico , Estudos Retrospectivos , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Acuidade Visual
12.
Semin Ophthalmol ; 34(6): 420-435, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31314638

RESUMO

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


Assuntos
Degeneração Macular/tratamento farmacológico , Receptores de Fatores de Crescimento do Endotélio Vascular/administração & dosagem , Proteínas Recombinantes de Fusão/administração & dosagem , Acuidade Visual , Relação Dose-Resposta a Droga , Humanos , Injeções Intravítreas , Macula Lutea/patologia , Receptores de Fatores de Crescimento do Endotélio Vascular/antagonistas & inibidores , Tomografia de Coerência Óptica , Resultado do Tratamento
13.
Curr Opin Ophthalmol ; 30(5): 326-330, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31313750

RESUMO

PURPOSE OF REVIEW: To review recent studies on potential neurodevelopmental impacts on the pediatric population through general anesthesia events or intravitreal anti-vascular endothelial growth factor (VEGF) injection. RECENT FINDINGS: Studies on this topic have been extensive with varied reported neurodevelopmental outcomes. Initial investigations in rodents and primates showed negative impact of anesthetics on neurodevelopment. Subsequent retrospective human reviews had mixed results whereas more recent sibling and prospective studies have been published without evidence of clinically significant impact. A similar narrative has more recently come to play regarding the long-term effects of intravitreal injections used in neonates with retinopathy of prematurity. Publications initially indicated a negative correlation whereas later reviews have found no difference between those receiving injections versus laser treatment. SUMMARY: Given that recent data on both general anesthesia events and intravitreal anti-VEGF injections do not show a long-term negative neurodevelopmental impact, ocular procedures needed to improve a pediatric patient's vision or quality of life should not be delayed.


Assuntos
Anestesia Geral/efeitos adversos , Injeções Intravítreas/efeitos adversos , Transtornos do Neurodesenvolvimento/etiologia , Inibidores da Angiogênese/administração & dosagem , Animais , Criança , Humanos , Recém-Nascido , Procedimentos Cirúrgicos Oftalmológicos , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores
14.
Carbohydr Polym ; 220: 185-190, 2019 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-31196539

RESUMO

Posterior eye segment diseases are treated through monthly intravitreal injections, that evoke serious side effects. A promising approach to reduce injection frequency consists in producing biodegradable microspheres (MPs) releasing the protein in the vitreous body for long times. Moreover, a rational design of these MPs requires a discouraged diffusion/sedimentation within the intravitreal space, which are detrimental for the vision and the control over drug release kinetics. In this work, poly(lactic-co-glycolic acid) (PLGA)-based MPs encapsulating bovine serum albumin (BSA) were coated with hyaluronic acid (HA) at two molecular weights and tested for their release, diffusion and degradation features in simulated vitreous body (SVB). Results indicate that HA corona prolongs MP degradation time and BSA release. Furthermore, HA coating increased the affinity between MPs and SVB, thereby repressing device transport compared to control PLGA MPs. Results hold promise for the possible application of HA-decorated MPs for intravitreal injection of protein drugs.


Assuntos
Portadores de Fármacos/uso terapêutico , Liberação Controlada de Fármacos , Injeções Intravítreas/métodos , Microesferas , Corpo Vítreo/efeitos dos fármacos , Difusão , Sistemas de Liberação de Medicamentos/métodos , Oftalmopatias/tratamento farmacológico , Humanos , Ácido Hialurônico/química , Copolímero de Ácido Poliláctico e Ácido Poliglicólico/química , Soroalbumina Bovina/química
15.
BMC Ophthalmol ; 19(1): 128, 2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31185956

RESUMO

BACKGROUND: The aim of the present study was to evaluate the efficacy and safety of intravitreal conbercept combined with trabeculectomy and panretinal photocoagulation for neovascular glaucoma (NVG). METHODS: Fifty patients (54 eyes) with NVG were included in this prospective study. Fifty-two eyes initially underwent intravitreal conbercept (0.5 mg/0.05 ml) treatment followed by trabeculectomy and panretinal photocoagulation. Preoperative and postoperative best-corrected visual acuity (BCVA), intraocular pressure (IOP), the number of antiglaucoma medications, and surgical complications were recorded. The levels of VEGF-A, TGF-ß1 and PLGF in aqueous humour samples collected during surgery were measured by enzyme-linked immunosorbent assay (ELISA). Light microscopy and transmission electron microscopy were used to observe the surgically excised trabecular tissue; enucleation was performed in 2 eyes, and light microscopy was used as the histopathological control. RESULTS: The follow-up period after trabeculectomy was 1 year. Of the 52 eyes, 39 completed 1 year of follow-up, and 13 were lost to follow-up. Recurrence of iris neovascularization was observed in 5 eyes, 9 had hyphema, 16 had filter-bled scarring, and no eye had complications attributable to the drug. The mean IOP was reduced from 48.1 ± 14.2 to 23.2 ± 8.7 mmHg, and the mean number of antiglaucoma medications used decreased from 3.0 (3.0, 4.0) to 1.0 (0.0, 1.0) after 1 year (both P < 0.05). The complete success rate was 76.9, 76.9, 71.0, 51.6, and 32.3% at 1 week, 1 month, 3 months, 6 months and 12 months, respectively, when the cut-off IOP was 18 mmHg. After patients underwent intravitreal injection, the concentrations of VEGF-A and TGF-ß1 in the aqueous humour in NVG patients decreased from 168.8 ± 13.4 and 159.6 ± 15.4 pg/ml to 160.2 ± 7.6 and 151.9 ± 2.3 pg/ml, respectively (both P < 0.05). Light microscopy revealed neovascularization regression in the iris in specimens treated with intravitreal conbercept. Electron microscopy revealed trabecular endothelial cell degeneration in the conbercept-treated specimens. CONCLUSIONS: Our initial findings suggest that intravitreal conbercept is an effective treatment for managing NVG that has fewer short-term postoperative complications. TRIAL REGISTRATION: Current Controlled Trials ChiCTR1800019918 , 8 December 2018, retrospectively registered.


Assuntos
Glaucoma Neovascular/tratamento farmacológico , Proteínas Recombinantes de Fusão/administração & dosagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Humor Aquoso/metabolismo , Feminino , Glaucoma Neovascular/metabolismo , Glaucoma Neovascular/fisiopatologia , Humanos , Pressão Intraocular/fisiologia , Injeções Intravítreas , Fotocoagulação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Trabeculectomia , Fator de Crescimento Transformador beta1/análise , Fator A de Crescimento do Endotélio Vascular/análise , Acuidade Visual/fisiologia , Adulto Jovem
16.
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
17.
Asia Pac J Ophthalmol (Phila) ; 8(3): 200-205, 2019 May-Jun.
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
18.
Indian J Ophthalmol ; 67(7): 1105-1108, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31238421

RESUMO

Purpose: To determine the effect of ultra-widefield fluorescein angiography (UWFFA)-guided targeted retinal photocoagulation (TRP) in branch retinal vein occlusion (BRVO) with macular edema after intravitreal Ranibizumab (RBZ). Methods: 33 eyes of 32 treatment naïve patients diagnosed as BRVO with macular edema were prospectively randomized to 0.5 mg Ranibizumab only (RBZ group) (n = 17) or Ranibizumab with UWFFA-guided laser (RBZ + TRP group) (n = 16). Both groups received three injections at monthly intervals and PRN henceforth. RBZ + TRP group additionally underwent UWFFA-guided TRP of peripheral capillary nonperfusion areas 1 week post injection. Outcome measures included improvement in visual acuity, central subfoveal thickness (CST), and the number of injections required with a minimum follow-up of 9 months. Results: Both groups showed significant improvement in mean BCVA (25.7 ± 8.19 letters, P < 0.001 vs. 23.38 ± 7.56 letters, P < 0.001; in RBZ and RBZ + TRP group, respectively) and reduction in mean central subfoveal thickness (379.12 ± 242.7 µm, P < 0.001 vs. 253.75 ± 137.9 µm, P < 0.001 in RBZ and RBZ + TRP group, respectively) at 9 months. The number of injections in the RBZ group (5.76 ± 1.3) was significantly greater than RBZ + TRP (4.06 ± 0.99) (P < 0.001). Both groups had significant improvement in contrast sensitivity and mean deviation on visual fields; however, the difference between the groups was not significant (P = 0.62 and P = 0.79, respectively). Conclusion: UWFFA-guided TRP reduced the number of injections of Ranibizumab in patients having BRVO with macular edema, while maintaining similar benefits in the improvement of BCVA, central subfoveal thickness without deleterious effect on the visual field, and contrast sensitivity.


Assuntos
Fotocoagulação a Laser/métodos , Edema Macular/terapia , Ranibizumab/administração & dosagem , Retina/cirurgia , Oclusão da Veia Retiniana/terapia , Acuidade Visual , Inibidores da Angiogênese/administração & dosagem , Feminino , Angiofluoresceinografia , Seguimentos , Fundo de Olho , Humanos , Injeções Intravítreas , Edema Macular/diagnóstico , Edema Macular/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Retina/diagnóstico por imagem , Oclusão da Veia Retiniana/complicações , Oclusão da Veia Retiniana/diagnóstico , Tomografia de Coerência Óptica , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores
19.
Indian J Ophthalmol ; 67(7): 1109-1113, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31238422

RESUMO

Purpose: To compare the effectiveness of treatment with intravitreal bevacizumab (IVB) and ziv-aflibercept (IVZ) in patients with macular edema (ME) post-branch retinal vein occlusion (BRVO). Methods: Patients with treatment naïve ME post-BRVO were included retrospectively if they received either IVB (0.05 ml/1.25 mg) or IVZ (0.05 ml/1.25 mg) monotherapy with a follow up of 12 months. Results: Thirty-two and 17 eyes received IVB and IVZ, respectively. The mean improvement in best corrected visual acuity (BCVA) was 0.36 ± 0.3 logarithm of minimum angle of resolution (logMAR) in the IVB group and 0.27 ± 0.3 in the IVZ group (P = 0.35). The mean change in central macular thickness was 178.9 ± 180.9 and 173.5 ± 344.4 µm in IVB and IVZ groups, respectively (P = 0.94). The mean number of injections was higher in the IVB group (4.0 ± 1.8) compared with 1.82 ± 0.8 in the IVZ group (P < 0.0001). The IVZ group had significantly fewer number of visits (P < 0.0001) and longer maximum treatment-free intervals (P = 0.0081). Conclusion: IVZ appears to be cost-effective with the similar visual outcome and less number of visits in comparison to IVB.


Assuntos
Bevacizumab/administração & dosagem , Receptores de Fatores de Crescimento do Endotélio Vascular/administração & dosagem , Proteínas Recombinantes de Fusão/administração & dosagem , Retina/diagnóstico por imagem , Oclusão da Veia Retiniana/tratamento farmacológico , Acuidade Visual , Idoso , Inibidores da Angiogênese/administração & dosagem , Relação Dose-Resposta a Droga , Feminino , Angiofluoresceinografia , Seguimentos , Fundo de Olho , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Oftalmoscopia , Receptores de Fatores de Crescimento do Endotélio Vascular/antagonistas & inibidores , Oclusão da Veia Retiniana/diagnóstico , Microscopia com Lâmpada de Fenda , Tomografia de Coerência Óptica , Resultado do Tratamento
20.
Indian J Ophthalmol ; 67(7): 1114-1118, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31238423

RESUMO

Purpose: To report the visual and anatomical outcomes of intravitreal ziv-aflibercept (IVZ) and bevacizumab (BVZ) monotherapy in treatment-naive polypoidal choroidal vasculopathy (PCV). Methods: This was a retrospective case series of 16 eyes (8 eyes each in IVZ and BVZ groups). The study period was from January 2016 to March 2018. The inclusion criteria were treatment-naive PCV patients who were treated with either IVZ or BVZ monotherapy on pro re nata protocol and followed up monthly for 6 months. The change in best-corrected visual acuity (BCVA), central macular thickness (CMT), and pigment epithelial detachment (PED) height was measured at baseline and 6 months. Results: A total of 16 eyes were studied. IVZ group had an improvement in BCVA by 0.15 logarithm of minimum angle of resolution (logMAR; approximately 1.5 lines) at 6 months, whereas BVZ group had a reduction in BCVA by 0.21 logMAR (approximately 2 lines) (P = 0.027). Five patients and one patient in IVZ and BVZ groups, respectively, had ≥5 letters gain of BCVA. IVZ group had significant reduction in PED height (P = 0.048), whereas the change in CMT was not significant at 6 months (P = 0.681). The mean number of injections (2.87 ± 0.83 in IVZ and 2.25 ± 0.89 BVZ group; P = 0.168) and longest treatment-free interval (3.00 ± 2.20 months in IVZ and 2.12 ± 1.96 months in BVZ group; P = 0.41) were not significantly different. Conclusion: The visual and anatomical outcomes in terms of PED reduction in treatment-naive PCV patients were better in IVZ group compared with BVZ. IVZ monotherapy is a viable, cost-effective alternative in these patients with good safety profile.


Assuntos
Bevacizumab/administração & dosagem , Doenças da Coroide/tratamento farmacológico , Corioide/irrigação sanguínea , Pólipos/diagnóstico por imagem , Receptores de Fatores de Crescimento do Endotélio Vascular/administração & dosagem , Proteínas Recombinantes de Fusão/administração & dosagem , Acuidade Visual , Inibidores da Angiogênese/administração & dosagem , Corioide/patologia , Doenças da Coroide/diagnóstico , Relação Dose-Resposta a Droga , Feminino , Angiofluoresceinografia , Seguimentos , Fundo de Olho , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Pólipos/diagnóstico , Receptores de Fatores de Crescimento do Endotélio Vascular/antagonistas & inibidores , Estudos Retrospectivos , Tomografia de Coerência Óptica , Resultado do Tratamento
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