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1.
Cesk Slov Oftalmol ; 75(3): 138-144, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31779462

RESUMO

PURPOSE: To evaluate the safety and clinical efficacy of ranibizumab (Lucentis) in the treatment of choroidal neovascularization (CNV) caused by diseases other than age-related macular degeneration (AMD). PATIENTS: 21 patients with mean age 61  17.2 years (min 16, max 85) with CNV due to causes other than AMD, in particular pathological myopia (n=11), angioid streaks (n=3), central serous chorioretinopathy (n=2), North Carolina macular dystrophy (n=1), dominant familial drusen (n=1) and idiopathic CNV (n=3). METHODS: The patients were treated at the Ophthalmology Department of the University Hospital in Hradec Kralove with three monthly initial intravitreal injections of ranibizumab 0.5 mg with subsequent treatment regimen pro re nata (PRN). The best corrected visual acuity (BCVA) was evaluated on the ETDRS optotypes (Early Treatment Diabetic Retinopathy Study), central retinal thickness (CRT) was measured by optical coherent tomography (OCT) (Zeiss, Cirrus). These parameters were evaluated before start of the study and then at 1 (BCVA only), 4, 8, and 12 months during treatment. We also evaluated the possible occurrence of ocular and systemic side effects. RESULTS: Statistically significant improvement in the mean of BCVA score of 11.4 letters (p.


Assuntos
Inibidores da Angiogênese , Neovascularização de Coroide , Ranibizumab , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Inibidores da Angiogênese/uso terapêutico , Anticorpos Monoclonais Humanizados , Neovascularização de Coroide/tratamento farmacológico , Humanos , Injeções Intravítreas , Pessoa de Meia-Idade , Ranibizumab/uso terapêutico , Tomografia de Coerência Óptica , Resultado do Tratamento , Acuidade Visual , Adulto Jovem
2.
Vestn Oftalmol ; 135(5. Vyp. 2): 177-183, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31691657

RESUMO

PURPOSE: To study the effect of ranibizumab and aflibercept on the thickness of retinal nerve fiber layer (RNFL) in patients with neovascular age-related macular degeneration (nAMD) and primary open-angle glaucoma (POAG). MATERIAL AND METHODS: The study included 62 patients (62 eyes) with nAMD and comorbid POAG. Patients were divided into two groups depending on the anti-VEGF treatment. The first group included 42 patients (42 eyes) who received injections of ranibizumab. The second group consisted of 20 patients (20 eyes) who received aflibercept. All patients received three injections of ranibizumab or aflibercept with one-month intervals. In addition to standard ophthalmic examination, patients underwent optical coherence tomography of the macular area and peripapillary RNFL. RESULTS: After anti-VEGF treatment, patients of both groups exhibited improvements expressed in reduced macular edema, increased visual acuity and absence of intraocular pressure (IOP) changes, as well as no statistically significant changes in the width and depth of excavation. There was a statistically significant decrease of peripapillary RNFL thickness in the temporal quadrant after treatment. CONCLUSION: The decrease of peripapillary RNFL thickness in the temporal quadrant occurs due to resorption of macular edema. In the absence of statistically significant changes in IOP, width and depth of excavation, intravitreal injections of ranibizumab and aflibercept can be considered safe treatment options for patients with concomitant nAMD and POAG.


Assuntos
Glaucoma , Degeneração Macular , Ranibizumab/uso terapêutico , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Inibidores da Angiogênese , Seguimentos , Glaucoma/tratamento farmacológico , Humanos , Injeções Intravítreas , Fibras Nervosas , Estudos Retrospectivos , Tomografia de Coerência Óptica , Resultado do Tratamento
3.
Buenos Aires; CONETEC; nov. 2019.
Não convencional em Espanhol | BRISA/RedTESA | ID: biblio-1025042

RESUMO

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


Assuntos
Humanos , Bevacizumab/uso terapêutico , Ranibizumab/uso terapêutico , Degeneração Macular/tratamento farmacológico , Avaliação da Tecnologia Biomédica , Análise Custo-Eficiência
4.
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
5.
Ophthalmic Surg Lasers Imaging Retina ; 50(8): 485-491, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31415694

RESUMO

BACKGROUND AND OBJECTIVE: Difficulty exists in the follow-up of proliferative macular telangiectasia type 2 (MacTel 2) cases after anti-vascular endothelial growth factor (VEGF) treatment due to staining in fluorescein angiography (FA) and alteration in retinal layers by optical coherence tomography (OCT). Herein, the authors report three cases in which OCT angiography (OCTA) could resolve this issue. PATIENTS AND METHODS: In this retrospective, observational case series, diagnosis of MacTel 2 was made based on clinical examination, FA, OCT, and OCTA at presentation. Regression of neovessels was monitored by OCT and OCTA. RESULTS: OCTA could delineate neovessels before treatment in all cases and facilitate differentiation between active and regressed lesions after treatment. Simultaneous OCT images were less easily appreciated due to altered retinal structure secondary to degenerative nature of the disease. CONCLUSION: OCTA could be the tool of choice to monitor neovascular response to anti-VEGF treatment in proliferative MacTel 2. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:485-491.].


Assuntos
Inibidores da Angiogênese/uso terapêutico , Técnicas de Diagnóstico Oftalmológico , Ranibizumab/uso terapêutico , Telangiectasia Retiniana , Idoso , Feminino , Angiofluoresceinografia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Telangiectasia Retiniana/diagnóstico , Telangiectasia Retiniana/tratamento farmacológico , Vasos Retinianos/patologia , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodos
6.
BMC Ophthalmol ; 19(1): 194, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31455273

RESUMO

BACKGROUND: To investigate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in patients with diabetic macular edema (DME) treated monthly with ranibizumab. METHODS: We retrospectively analyzed the medical records of all patients who received intravitreal ranibizumab (IVR) treatment for DME at the First Affiliated Hospital of Nanchang University between December 2015 and December 2017. Clinicopathological parameters, including NLR, were evaluated to identify predictors of better outcomes of IVR monotherapy. RESULTS: Ninety-one treatment-naïve eyes treated with IVR for DME were retrospectively analyzed in this study. Baseline best-corrected visual acuity (BCVA), neutrophils, NLR, monocyte-to-lymphocyte ratio, and platelet-to-lymphocyte ratio were negatively correlated with the changes in BCVA at 24 weeks compared with the baseline, while baseline central retinal thickness and lymphocytes were positively correlated with the changes in BCVA at 24 weeks compared with the baseline. Multiple linear regression analysis revealed that NLR was independently associated with the mean change of BCVA between baseline and week 24. In addition, patients with NLR < 2.27 showed a better improvement in letter score than those with NLR > 2.27. CONCLUSION: Pretreatment NLR is independently associated with the BCVA in DME patients treated with IVR, and higher pretreatment NLR may contribute to inferior BCVA outcomes.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Retinopatia Diabética/diagnóstico , Linfócitos/patologia , Edema Macular/diagnóstico , Neutrófilos/patologia , Ranibizumab/uso terapêutico , Retinopatia Diabética/tratamento farmacológico , Feminino , Angiofluoresceinografia , Humanos , Injeções Intravítreas , Contagem de Leucócitos , Edema Macular/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Tomografia de Coerência Óptica , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Acuidade Visual/fisiologia
7.
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
8.
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
9.
Indian J Ophthalmol ; 67(8): 1368-1371, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31332147

RESUMO

A 48-year-old female presented with complaints of recent onset diminution of vision of the left eye (OS) for the past 2 months. She was highly myopic and was using glasses for the past 30 years. Ocular examination revealed presence of a myopic fundus with high axial lengths in both the eyes. Fundus examination of the OS revealed a myopic tessellated fundus with prominent choroidal vessels and a blunted foveal reflex. There was a small pale whitish lesion just superior to the foveal center. Optical coherence tomography (OCT) scans (both horizontal and vertical) confirmed presence of dome-shaped maculopathy. There was subretinal fluid in the OS. A vertical OCT scan also revealed a subretinal hyperreflective material, which was confirmed to be due to a small mixed type 1 and type 2 choroidal neovascularization (CNV) on swept-source (SS) OCT angiography in the OS. The patient was given intravitreal injection of ranibizumab (0.5 mg/0.05 mL) in the OS. At 1-month follow-up, the subretinal fluid completely resolved. The CNV lesion regressed significantly on SS-OCT angiography. The best-corrected visual acuity improved from 20/80 to 20/20 in the OS, which was maintained at 3 months of follow-up.


Assuntos
Neovascularização de Coroide/diagnóstico por imagem , Doenças Retinianas/diagnóstico por imagem , Inibidores da Angiogênese/uso terapêutico , Neovascularização de Coroide/tratamento farmacológico , Corantes/administração & dosagem , Feminino , Angiofluoresceinografia/métodos , Humanos , Verde de Indocianina/administração & dosagem , Injeções Intravítreas , Pessoa de Meia-Idade , Ranibizumab/uso terapêutico , Doenças Retinianas/tratamento farmacológico , Líquido Sub-Retiniano , Tomografia de Coerência Óptica/métodos , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Transtornos da Visão/diagnóstico , Acuidade Visual
10.
Folia Med (Plovdiv) ; 61(2): 240-248, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31301668

RESUMO

BACKGROUND: There is an ambiguity regarding the therapy of choice for patients with macular edema following branch retinal vein occlusion (BRVO). AIM: The purpose of the study was to compare the efficacy and safety of ranibizumab (3 injections 0.5 mg) versus ranibizumab (1 injection 0.5 mg) with laser photocoagulation (LP) versus dexamethamethasone intravitreal (IVT) implant (0.7 mg) with or without LP in patients with macular edema following BRVO. MATERIALS AND METHODS: 60 eyes of 60 patients were divided into 4 groups. Group 1 received IVT ranibizumab (3 injections 0.5 mg), Group 2 received IVT ranibizumab (1 injection 0.5 mg) + LP, Group 3 received dexamethasone IVT implant (0.7 mg), and Group 4 received dexamethasone IVT implant (0.7 mg) + LP. The endpoints were the difference in mean changes in best corrected visual acuity (BCVA), central macular thickness (CMT), and inter-group differences in contrast sensitivity (CS), retinal sensitivity (RS), and intraocular pressure (IOP). RESULTS: BCVA gains in Group 1 (18.00±8.51) patients were significantly (p < 0.05) higher than patients in Groups 2 (10.00±10.26), 3 (9.50±9.60), and 4 (10.50±10.97), after 6 months of therapy. No significant inter-group variation was found in the CMT, CS, and RS. CONCLUSIONS: Ranibizumab (3 injections 0.5 mg) showed significantly higher BCVA gains at 6 months post-therapy. Improvements in the BCVA, CMT, CS, and RS were comparable initially in all the therapies.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Dexametasona/uso terapêutico , Glucocorticoides/uso terapêutico , Fotocoagulação a Laser/métodos , Edema Macular/terapia , Ranibizumab/uso terapêutico , Idoso , Sensibilidades de Contraste , Implantes de Medicamento , Feminino , Humanos , Pressão Intraocular , Injeções Intravítreas , Edema Macular/etiologia , Edema Macular/patologia , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Oclusão da Veia Retiniana/complicações , Resultado do Tratamento , Acuidade Visual , Corpo Vítreo
11.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 41(3): 359-366, 2019 Jun 30.
Artigo em Chinês | MEDLINE | ID: mdl-31282330

RESUMO

Objective To observe the imaging features of optical coherence tomography angiography(OCTA)in eyes with wet age-related macular degeneration(wAMD)after treatment with 3+pro re nata(3+PRN)of intravitreal anti-Ranibizumab.Methods This study included 8 treatment-naive eyes with wAMD diagnosed by fluorescein fundus angiography(FFA)and indocyanine green angiography(ICGA)from September 2016 to May 2017.All the patients were treated with 3+PRN of intravitreal anti-Ranibizumab(0.5 mg/0.05 ml).We performed OCTA with 6 mm×6 mm scans at baseline and 1,3,and 6 months after treatment.We analyzed best corrected visual acuity(BCVA)(logMAR),type of choroidal neovascular(CNV),and morphological features and changes of CNV,central retinal thickness(CRT),outer retina vessel density(ORVD),and choroidal capillary vessel density(CCVD).Results A total of 8 eyes were examined in 8 patients[4 males and 4 females with a mean age of(70.9±10.6)years of age].Three eyes had type Ⅰ CNV and 5 eyes had type Ⅱ CNV.At baseline,month 1,month 3,and month 6,BCVA was 0.55(0.33,0.87),0.35(0.24,0.84),0.35(0.22,0.58),and 0.26(0.10,0.58)logMAR,respectively(all P>0.05).CRT was(271.88±91.95),(204.00±45.78),(196.00±31.14),and(219.25±71.32)µm,respectively,and there was a statistical significance between CRT at baseline and CRT at month 3(t=2.211,P=0.044).ORVD was(41.38±2.77)%,(41.73±3.60)%,(42.53±1.95)%,and(41.40±2.33)%,respectively(all P>0.05).CCVD was(64.38±2.24)%,(64.96±1.39)%,(64.16±1.39)%,and(64.63±1.86)%,respectively(all P>0.05).Correlation analysis showed BCVA was significantly correlated with both CRT(P=0.009, RR=0.457)and CCVD(P=0.001,RR=0.574),but not with ORVD(P=0.093,RR=0.302).The morphological features at baseline showed that 2 eyes were lump-like,2 eyes were line-like,2 eyes were tangles,1 eye was elliptical ring-like,and 1 eye was fragment.At month 1,the morphologies were improved in 7 eyes,including the CNV showed decreased maximum diameter,rupture/fragment,loss of peripheral capillaries,decreased numbers and density,and reduced maximum cross-sectional area;the condition became worse in 1 eye,including the CNV showed ring formation,increased density,and increased maximum diameter.At month 3,the morphologied of 7 eyes were improved,while no obvious change was seen in 1 eye.At month 6,the CNV became normalized in 5 eyes but worsened in 3 eyes.No intraocular infection or other intravitreal injection-related complication was observed during the follow-up.Conclusion Observing CNV characteristics using OCTA technology can be used to evaluate the efficacy of Ranibizumab in patients with wAMD and guide the treatment and follow-up of wAMD patients.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Angiografia , Ranibizumab/uso terapêutico , Tomografia de Coerência Óptica , Degeneração Macular Exsudativa/diagnóstico por imagem , Degeneração Macular Exsudativa/terapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Acuidade Visual
12.
Ophthalmic Surg Lasers Imaging Retina ; 50(7): 437-443, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31344243

RESUMO

BACKGROUND AND OBJECTIVE: To evaluate changes in retrobulbar blood flow by using color Doppler ultrasonography (CDUS) after intravitreal ranibizumab injection in patients with neovascular age-related macular degeneration (AMD). PATIENTS AND METHODS: Eighteen patients who had undergone intravitreal ranibizumab (0.05 mg/0.05 mL) injection due to choroidal neovascular membrane (CNVM) were included in the study. Contralateral eyes of the patients were also analyzed. Peak systolic velocity (PSV), end diastolic velocity (EDV), pulsatility index (PI), and resistivity index (RI) were measured from the ophthalmic artery (OA), central retinal artery (CRA), lateral posterior ciliary artery (LPCA), and medial posterior ciliary artery (MPCA) for all patients pre-injection, and at 1 day, 1 week, and 1 month after ranibizumab injection. RESULTS: The mean age of the 18 patients included in the study was 66.94 years (± 8.3 years). Of these 18 patients, eight were female and 10 were male. After Bonferroni's correction for multiple comparisons was carried out, there were significant differences only in some values of LPCA; these included the decrease in EDV and an increase in PI values of LPCA between the pre-injection and post-injection of the first month measurements in uninjected eyes (P = .002, P = .002), and a decrease in PI value of LPCA between post-injection first day and first week measurements in injected eyes (P = .004). There were no statistically significant differences in other parameters. CONCLUSION: Ocular blood flow velocities may change after intravitreal ranibizumab injection in patients with CNVM. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:437-443.].


Assuntos
Inibidores da Angiogênese/uso terapêutico , Neovascularização de Coroide/tratamento farmacológico , Ranibizumab/uso terapêutico , Degeneração Macular Exsudativa/tratamento farmacológico , Idoso , Velocidade do Fluxo Sanguíneo/fisiologia , Neovascularização de Coroide/fisiopatologia , Feminino , Hemodinâmica/fisiologia , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Órbita/irrigação sanguínea , Degeneração Macular Exsudativa/fisiopatologia
13.
BMC Ophthalmol ; 19(1): 133, 2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31226968

RESUMO

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


Assuntos
Corioide/patologia , Edema Macular/patologia , Oclusão da Veia Retiniana/patologia , Adulto , Idoso , Inibidores da Angiogênese/uso terapêutico , Feminino , Humanos , Injeções Intravítreas , Edema Macular/tratamento farmacológico , Edema Macular/etiologia , Masculino , Pessoa de Meia-Idade , Ranibizumab/uso terapêutico , Oclusão da Veia Retiniana/complicações , Oclusão da Veia Retiniana/tratamento farmacológico , Estudos Retrospectivos
14.
Semin Ophthalmol ; 34(3): 168-176, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31132283

RESUMO

Purpose: To compare the responses of types 1 (sub-pigment epithelial) and 2 (subretinal) neovascularization in neovascular age-related macular degeneration (AMD) to anti-vascular endothelial growth factor (VEGF) treatment. Methods: Fifty-five treatment-naïve neovascular AMD eyes (53 patients) were retrospectively included for analysis. All patients were treated with three loading injections of anti-VEGF agent, followed by further injections as required. The lesion size and vascular density of type 1 and 2 lesions before and after treatment for 12 months were analyzed using optical coherence tomography angiography (OCTA). Results: The mean lesion size of the type 1 neovascularization group (42 eyes) showed no significant change from 2.12 ± 1.01 mm2 at baseline to 2.08 ± 0.91 mm2 at 12 months (P = .682). However, the mean lesion size of type 2 neovascularization significantly decreased from 1.23 ± 0.93 mm2 at baseline to 0.79 ± 0.61 mm2 at 12 months (P = .022). The proportion of eyes with lesion sizes that decreased by more than 40% from baseline was also significantly higher for the type 2 compared to the type 1 neovascularization group (46.2% versus 11.9%, P = .007). Vascular density showed no significant changes for both groups after treatment and showed no association with the change in lesion size. There was no significant difference between the groups in terms of visual acuity improvement. Conclusion: OCTA analysis revealed different responses to anti-VEGF treatment depending on the location of neovascularization in neovascular AMD. Type 2 neovascularization was significantly regressed compared to type 1 neovascularization after anti-VEGF treatment. However, the changes in vascular density and visual outcome showed no significant differences between groups after 12 months of treatment.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Neovascularização de Coroide/tratamento farmacológico , Ranibizumab/uso terapêutico , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Degeneração Macular Exsudativa/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodos , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Acuidade Visual
15.
Ophthalmol Retina ; 3(5): 410-416, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31044732

RESUMO

PURPOSE: Intravitreal anti-vascular endothelial growth factor (VEGF) injections are used commonly in the treatment of diabetic retinopathy (DR), but the need for treatment and frequency of administration vary considerably among patients. There is no way to predict which patients will require treatment and how frequently injections will be needed. This study aimed to identify factors associated with receiving anti-VEGF injections and the number of treatments received in an 18-month period in patients with diabetes. DESIGN: Retrospective cohort study. PARTICIPANTS: Two thousand nine hundred sixteen patients with diabetes treated at the Kellogg Eye Center Retina Clinic from June 1, 2016, through December 31, 2017. METHODS: Retrospective analysis was performed with institutional review board approval using data collected from diabetic patients treated at the retina clinic at the Kellogg Eye Center. Logistic regression was used to identify demographic and medical factors associated with receiving at least 1 injection. Negative binomial regression was used to model the number of anti-VEGF injections. MAIN OUTCOME MEASURES: Receiving at least 1 anti-VEGF injection and the number of anti-VEGF injections received during the study period. RESULTS: Systolic blood pressure and a diagnosis of DR were associated significantly with receiving an injection. A history of kidney disease was associated positively with the number of injections received. Type 1 diabetes was associated negatively with receiving an injection and the number of injections. Current hemoglobin A1c level was not associated with either receiving an injection or the number of injections. CONCLUSIONS: Elevated blood pressure is associated significantly with the need for treatment with anti-VEGF injections in patients with diabetes, and a diagnosis of type 1 diabetes is associated negatively with both receiving treatment and the number of injections. Of note, current glycemic control is not associated significantly with either outcome measure. To our knowledge, these associations have not been previously reported, and imply that factors that confer risk for DR development may not be the same that confer risk for treatment.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Bevacizumab/uso terapêutico , Pressão Sanguínea/fisiologia , Diabetes Mellitus/fisiopatologia , Retinopatia Diabética/tratamento farmacológico , Ranibizumab/uso terapêutico , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Retinopatia Diabética/fisiopatologia , Feminino , Humanos , Injeções Intravítreas , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Adulto Jovem
16.
Int Ophthalmol ; 39(10): 2361-2371, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31119505

RESUMO

PURPOSE: To evaluate changes in macular vessel density following intravitreal anti-VEGF injection in patients with diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR). METHODS: In this retrospective case series, optical coherence tomography angiography (OCTA) images from 55 eyes of 35 patients with either DME (46 eyes) or PDR (9 eyes) were included. Macular capillary vessel density at the level of the superficial retinal capillary plexus (SCP), deep retinal capillary plexus (DCP) and total retinal capillary plexus (TCP) before and after anti-VEGF treatment was calculated. Longitudinal changes in vessel density following serial anti-VEGF treatment were analyzed in a subset of eyes. RESULTS: Vessel density in the SCP, DCP or TCP was not found to be significantly different after one, two or three intravitreal injections (p > 0.05 for all time points). Subgroup analysis revealed no significant change in the DME and PDR subgroups (all p > 0.05). Multivariate analysis revealed no effect of type of injected anti-VEGF agent or presence of previous treatment on VD measurements (all p > 0.05). There was no correlation between the anatomic response of DME to treatment and VD measurements. CONCLUSIONS: In this study, macular vessel density remained statistically unchanged following up to three intravitreal injections of any anti-VEGF agent. This indicates that there may not be an early effect of anti-VEGF treatment on macular vessel density and its effect on macular perfusion may not be a direct change in microvascular flow.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Bevacizumab/uso terapêutico , Retinopatia Diabética/tratamento farmacológico , Macula Lutea/irrigação sanguínea , Ranibizumab/uso terapêutico , Vasos Retinianos/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Retinopatia Diabética/patologia , Feminino , Angiofluoresceinografia/métodos , Humanos , Edema Macular/tratamento farmacológico , Edema Macular/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodos , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores
17.
Ophthalmic Res ; 62(2): 93-100, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31121579

RESUMO

PURPOSE: To evaluate the efficacy of intravitreal conbercept injections in patients with treatment-resistant neovascular age-related macular degeneration (nvAMD). METHODS: Retrospective review of patients with resistance (persistent exudation) to ranibizumab (0.5 mg) that were switched to treatment with 3 monthly intravitreal injections of conbercept (0.5 mg), followed by dosing on an as-needed basis. The demographic data, visual acuities, central retinal thickness (CRT), and the maximum pigment epithelial detachment (PED) height were reviewed. RESULTS: Outcomes observed in 34 eyes from 26 patients with a mean of 7.68 (range 6-14) previous ranibizumab injections were compiled. Twelve months after switching to conbercept, there were significant reductions of CRT (402.59 ± 163.85 vs. 473.18 ± 164.84 µm, p = 0.002) and maximum PED height (218.59 ± 106.89 vs. 295.32 ± 179.80 µm, p = 0.006) compared with the baseline. No statistical change in visual acuity logarithm of the minimal angle of resolution occurred after 12 months (0.68 ± 0.48 vs. 0.78 ± 0.63 letters, p = 0.17) despite 27 of 34 eyes (79.41%) remaining stable or having improvement visual acuity. CONCLUSIONS: Intravitreal injections of conbercept appear to be beneficial in patients with nvAMD who exhibit persistent fluid despite previous treatment with ranibizumab.


Assuntos
Inibidores da Angiogênese/administração & dosagem , Neovascularização de Coroide/tratamento farmacológico , Degeneração Macular/tratamento farmacológico , Proteínas Recombinantes de Fusão/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Neovascularização de Coroide/fisiopatologia , Feminino , Humanos , Injeções Intravítreas , Degeneração Macular/fisiopatologia , Masculino , Pessoa de Meia-Idade , Ranibizumab/uso terapêutico , Retina/patologia , Estudos Retrospectivos , Acuidade Visual/fisiologia
18.
Ophthalmol Retina ; 3(3): 220-229, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-31014698

RESUMO

PURPOSE: To compare the 12-month real-world visual and disease activity outcomes of eyes with polypoidal choroidal vasculopathy (PCV) treated with a combination of photodynamic therapy (PDT) and anti-vascular endothelial growth factor (VEGF) injections (combination group) versus those eyes treated with anti-VEGF monotherapy alone with rescue PDT being used as required (monotherapy group). DESIGN: Database comparative observational study. PARTICIPANTS: Eyes with PCV as graded in the Fight Retinal Blindness! database from Australia, New Zealand, Singapore, and Switzerland. METHODS: Clinical information from a multisite, international registry of neovascular age-related macular degeneration was analyzed with an intention-to-treat approach. MAIN OUTCOME MEASURES: Primary outcome measure was the change in visual acuity in logMAR letters over 12 months between the two groups analyzed with intention-to-treat approach. RESULTS: Forty-one and 152 eyes received combination therapy and anti-VEGF monotherapy, respectively. All anti-VEGF agents were pooled, and bevacizumab represented 66.1% of injections administered. The adjusted mean change in visual acuity between the combination group and monotherapy group at 12 months was +16.9 letters (95% confidence interval [CI], 10.6-23.3 letters) and +8.2 letters (95% CI, 5.2-11.3 letters), respectively (P = 0.02). Proportion of inactive lesions and mean time to inactivity was 85.3% and 80.7 days (95% CI, 62.8-98.5 days), respectively, in the combination group compared with 76.8% and 150.4 days (95% CI, 132.8-168.0 days), respectively, in the monotherapy group (P = 0.01). The mean number of injections of anti-VEGF agent between the combination and monotherapy groups was 4.3 injections (95% CI, 3.6-5.2 injections) and 6.4 injections (95% CI, 5.9-6.9 injections), respectively (P = 0.01). CONCLUSIONS: The real-world outcomes for treatment of PCV showed larger gains in vision, higher proportion of inactive lesions, quicker time to inactivity, and fewer injections administered in the combination group compared with the monotherapy group. These findings are consistent with current evidence reporting the advantages of combination therapy for PCV.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Cegueira/prevenção & controle , Neovascularização de Coroide/diagnóstico por imagem , Fotoquimioterapia/métodos , Idoso , Bevacizumab/uso terapêutico , Estudos de Coortes , Feminino , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Ranibizumab/uso terapêutico , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Acuidade Visual
19.
Medicine (Baltimore) ; 98(17): e15409, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31027141

RESUMO

BACKGROUND: Previous clinical trials have reported that ranibizumab can be used to treat diabetic retinopathy (DR) effectively. However, no study has been conducted to evaluate its efficacy for patients with DR systematically. Thus, this study will specifically and systematically assess the efficacy and safety of ranibizumab for DR. METHODS: Cochrane Library, EMBASE, PUBMED, Web of Science, Google Scholar, Cumulative Index to Nursing and Allied Health Literature, China National Knowledge Infrastructure, and Chinese Biomedical Literature Database will be searched from inceptions to the March 20, 2019 for studies related to the topic. This study will only consider publicly released randomized controlled trials for evaluating the effect and safety of ranibizumab for DR. No language restrictions will be imposed for all databases search. Methodological quality of each included trial will be assessed by Cochrane risk of bias tool. Statistical analysis will be performed by Stata 12.0 software. RESULTS: This study will provide recent summary evidence of ranibizumab for DR. Primary outcomes include percentages with retinopathy improvement, and cumulative probabilities for retinopathy worsening. Secondary outcome consist of visual function, best-corrected visual acuities, central subfield thickness, total macular volume, peripheral visual field loss, retinal neovascularization, and adverse events. CONCLUSION: The findings of this study may provide theoretical basis for clinical practice refer and may benefit more patients with DR.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Retinopatia Diabética/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto , Ranibizumab/uso terapêutico , Revisão Sistemática como Assunto , Humanos
20.
Doc Ophthalmol ; 139(1): 67-74, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30980231

RESUMO

PURPOSE: To determine the physiology of the macula by the focal macular electroretinograms (fmERGs) in patients with branch retinal vein occlusion with macular edema (BRVOME) treated by intravitreal injections of ranibizumab (IVR). METHODS: We studied 17 eyes of 17 patients with BRVOME. The contralateral unaffected eyes served as controls. All patients were treated with an IVR at monthly intervals for 3 consecutive months. The baseline best-corrected visual acuity (BCVA), optical coherence tomographic (OCT) findings, and fmERGs were compared to the post-treatment values. The fmERGs were elicited by a 15° circular spot or a superior or inferior semicircular spot. The center of the spot was placed on the fovea. The amplitudes of the a- and b-waves, photopic negative response (PhNR), and sum of the oscillatory potentials (ΣOPs: sum of OP1, OP2, and OP3 amplitudes) were measured. In addition, the implicit times of the a- and b-waves were also measured. RESULTS: The BCVA improved significantly from 0.39 ± 0.28 logMAR units to 0.17 ± 0.18 logMAR units after the resolution of the central macular edema (P < 0.01). All components of the fmERGs elicited by the semicircular stimulus spot placed on the occluded side were smaller than that elicited from the corresponding area of the control eyes. The b-wave amplitudes increased significantly from 0.49 ± 0.25 to 0.75 ± 0.36 µV following the IVR injections, but the amplitudes of the a-wave and PhNR remained reduced (P < 0.05). The amplitudes of the PhNR and ΣOPs elicited by stimulating the non-occluded side were reduced with relative preservation of the a- and b-waves (P < 0.05). They recovered after the treatment from 0.27 ± 0.15 to 0.50 ± 0.30 and 0.33 ± 0.15 to 0.53 ± 0.19 µV, respectively. CONCLUSIONS: IVRs improved the macular function not only on the occluded side but also on the non-occluded side. On the occluded side, the BRVOME affects the function of all retinal layers of the macula. Even after the IVR, the function of the photoreceptors and retinal ganglion cells remained abnormal. On the non-occluded side, the inner retinal function improved after the IVR.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Macula Lutea/fisiopatologia , Edema Macular/tratamento farmacológico , Ranibizumab/uso terapêutico , Oclusão da Veia Retiniana/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Eletrorretinografia , Feminino , Angiofluoresceinografia , Humanos , Injeções Intravítreas , Edema Macular/diagnóstico por imagem , Edema Macular/fisiopatologia , Masculino , Pessoa de Meia-Idade , Oclusão da Veia Retiniana/diagnóstico por imagem , Oclusão da Veia Retiniana/fisiopatologia , Tomografia de Coerência Óptica , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Acuidade Visual/fisiologia
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