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1.
Urologe A ; 59(2): 149-154, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-32076796

RESUMO

In view of a considerable risk of recurrence especially in patients with a high-risk profile after organ-sparing surgery or nephrectomy, adjuvant treatment seems to make sense in renal cell carcinoma. After the failed attempts using older immunotherapeutics or vaccination therapies, new hope was put in the panel of targeted VEGF/R inhibitors. But the results from these studies published so far are also disappointing. In this context the instruments for selecting the best suitable patients for adjuvant trials have to be discussed. It remains to be seen whether using the same selection criteria as in ongoing trials with checkpoint inhibitors will show better results.


Assuntos
Carcinoma de Células Renais/terapia , Quimioterapia Adjuvante/métodos , Neoplasias Renais/terapia , Inibidores de Proteínas Quinases/uso terapêutico , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Antineoplásicos Imunológicos/uso terapêutico , Carcinoma de Células Renais/tratamento farmacológico , Humanos , Neoplasias Renais/tratamento farmacológico , Terapia de Alvo Molecular/métodos , Recidiva Local de Neoplasia , Nefrectomia , Receptores de Fatores de Crescimento do Endotélio Vascular/antagonistas & inibidores
2.
Medicine (Baltimore) ; 98(44): e17599, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689763

RESUMO

This study compares 2 methods of macular function evaluation: the microperimetric examination (mean central retinal sensitivity and fixation stability) and the distance best-corrected visual acuity (BCVA) examination, which is the most frequently used method of assessing macular function in patients with newly diagnosed wet age-related macular degeneration (AMD) who have been treated with anti-vascular endothelial growth factor (VEGF) drug (aflibercept).Prospective analysis was conducted on 44 eyes of 44 patients treated with intravitreal injection of anti-VEGF (aflibercept) because of newly diagnosed neovascular AMD. According to the research protocol, all patients had a 6-month follow-up. The response to treatment was monitored functionallybyMP-1 microperimetry, fixation, and distance BCVA assessment after injection. Improvement of retinal sensitivity and BCVA was found under aflibercept treatment. There was statistically significant improvement in retinal sensitivity in the MP-1 study 3 and 6 months from the beginning of anti-VEGF therapy. Moreover, a significant improvement in retinal sensitivity between 3 and 6 months of observation was demonstrated. At the same time, up to 3 months from the beginning of treatment, BCVA improved significantly compared to the baseline value. In the 6th month of the study BCVA remained stable without further significant improvement.Microperimetric examination with medium sensitivity and fixation stability assessment is a very valuable test determining the retinal function. It is clear that examining the macular morphology itself in modern diagnostics is not enough to assess retinal function. Microperimetry technique is a valuable tool for functional long-term evaluation of retinal function (also for a period of more than 3 months).


Assuntos
Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Retina/efeitos dos fármacos , Fator A de Crescimento do Endotélio Vascular/uso terapêutico , Degeneração Macular Exsudativa/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Receptores de Fatores de Crescimento do Endotélio Vascular/administração & dosagem , Proteínas Recombinantes de Fusão/administração & dosagem , Proteínas Recombinantes de Fusão/farmacologia , Fator A de Crescimento do Endotélio Vascular/administração & dosagem , Fator A de Crescimento do Endotélio Vascular/farmacologia , Acuidade Visual
3.
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
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.
BMJ Case Rep ; 12(9)2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31511273

RESUMO

Peripheral exudative haemorrhagic chorioretinopathy (PEHCR) is considered a variant of polypoidal choroidal vasculopathy. It may have varried presentations and systemic associations. We present a case of PEHCR which dramatically responded to intravitreal steroid and ziv-aflibercept injection. This case not only highlights the promising role of combination therapy with intravitreal steroids and ziv-aflibercept but also the need to look for any associated systemic comorbidity.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Degeneração Macular/tratamento farmacológico , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Hemorragia Retiniana/tratamento farmacológico , Triancinolona Acetonida/uso terapêutico , Idoso , Inibidores da Angiogênese/administração & dosagem , Anti-Inflamatórios/administração & dosagem , Quimioterapia Combinada , Feminino , Humanos , Injeções Intravenosas , Injeções Intravítreas , Receptores de Fatores de Crescimento do Endotélio Vascular/administração & dosagem , Proteínas Recombinantes de Fusão/administração & dosagem , Triancinolona Acetonida/administração & dosagem
6.
Cancer Sci ; 110(11): 3565-3572, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31520559

RESUMO

Aflibercept plus 5-fluorouracil/levofolinate/irinotecan (FOLFIRI) is a second-line treatment for metastatic colorectal cancer. This ancillary exploratory analysis of data in Japanese people was aimed at exploring the relationship between a set of potential prognostic biomarkers and efficacy endpoints following aflibercept plus FOLFIRI therapy. Sixty-two patients with metastatic colorectal cancer received aflibercept (4 mg/kg) plus FOLFIRI every 2 weeks. Seventy-eight potential protein biomarkers were chosen for analysis based on their roles in angiogenesis, tumor progression, and tumor-stroma interaction. Plasma levels of biomarkers at baseline and at pre-dose 3 (day 1 of treatment cycle 3) were measured in all patients by ELISA. Relationships between these levels and efficacy endpoints were assessed. Ten potential biomarkers had a ±30% change from baseline to pre-dose 3 (adjusted P < .001), with the greatest changes occurring in placental growth factor (median: +4716%) and vascular endothelial growth factor receptor 1 (+2171%). Baseline levels of eight potential biomarkers correlated with overall survival in a univariate Cox regression analysis: extracellular newly identified receptor for advanced glycation end-products binding protein, insulin-like growth factor-binding protein 1, interleukin-8, kallikrein 5, pulmonary surfactant-associated protein D, tissue inhibitor of metalloproteinases 1, tenascin-C, and tumor necrosis factor receptor 2. None correlated with progression-free survival or maximum tumor shrinkage. Pre-dose 3 levels did not correlate with any efficacy endpoints. Preliminary data show that these eight biomarkers could be associated with overall survival. ClinicalTrials.gov identifier: NCT01882868.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores Tumorais/sangue , Camptotecina/análogos & derivados , Neoplasias do Colo/tratamento farmacológico , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Neoplasias Retais/tratamento farmacológico , Grupo com Ancestrais do Continente Asiático , Camptotecina/uso terapêutico , Neoplasias do Colo/sangue , Neoplasias do Colo/mortalidade , Neoplasias do Colo/patologia , Fluoruracila/uso terapêutico , Humanos , Proteína 1 de Ligação a Fator de Crescimento Semelhante à Insulina/sangue , Interleucina-8/sangue , Japão , Calicreínas/sangue , Leucovorina/uso terapêutico , Fator de Crescimento Placentário/sangue , Prognóstico , Intervalo Livre de Progressão , Estudos Prospectivos , Proteína D Associada a Surfactante Pulmonar/sangue , Receptor para Produtos Finais de Glicação Avançada/sangue , Receptores Tipo II do Fator de Necrose Tumoral/sangue , Neoplasias Retais/sangue , Neoplasias Retais/mortalidade , Neoplasias Retais/patologia , Análise de Regressão , Tenascina/sangue , Inibidor Tecidual de Metaloproteinase-1/sangue , Receptor 1 de Fatores de Crescimento do Endotélio Vascular/sangue
7.
Optom Vis Sci ; 96(9): 686-694, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31479024

RESUMO

SIGNIFICANCE: In patients initially diagnosed as having unilateral polypoidal choroidal vasculopathy, the visual prognosis of the better-seeing eye is highly favorable. If patients are overly pessimistic regarding their vision in the future, physicians can encourage patients by informing them of the small possibility for visual deterioration in the better-seeing eye. PURPOSE: The purpose of this study was to investigate the long-term changes in the visual acuity of the better-seeing eyes in patients with unilateral polypoidal choroidal vasculopathy. METHODS: This retrospective, single-institution study was performed with 221 patients who were diagnosed as having unilateral polypoidal choroidal vasculopathy and who were treated with intravitreal anti-vascular endothelial growth factor. Only patients with an initially uninvolved eye best-corrected visual acuity (BCVA) of 20/40 or better and who were followed up for at least 24 months were included. The changes in the BCVAs of the initially involved and uninvolved eyes as well as the better-seeing eyes were measured. For patients with three or more lines of uninvolved eye visual deterioration, the cause for the visual deterioration was identified. RESULTS: Patients were followed up for a mean of 43.1 ± 11.8 months after diagnosis. During the follow-up period, three or more lines of deterioration in the BCVA were noted in 61 initially involved eyes (27.6%) and 11 uninvolved eyes (4.9%). The reasons for uninvolved eye visual deterioration were neovascularization (n = 8), retinal vein occlusion (n = 2), and posterior capsule opacification (n = 1). At diagnosis, the BCVA of the better-seeing eye was 0.05 ± 0.08 (Snellen equivalents, 20/22). During the follow-up period, three or more lines of deterioration in the BCVA for the better-seeing eye were noted in eight patients (3.6%). CONCLUSIONS: Visual acuity of the better-seeing eye over time remained stable in most patients who were initially diagnosed as having unilateral polypoidal choroidal vasculopathy. As a result, the visual prognosis of the better-seeing eye is highly favorable in this condition.


Assuntos
Corioide/irrigação sanguínea , Neovascularização de Coroide/fisiopatologia , Pólipos/fisiopatologia , Acuidade Visual/fisiologia , Idoso , Inibidores da Angiogênese/uso terapêutico , Neovascularização de Coroide/diagnóstico , Neovascularização de Coroide/tratamento farmacológico , Feminino , Angiofluoresceinografia , Seguimentos , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Pólipos/diagnóstico , Pólipos/tratamento farmacológico , Prognóstico , Ranibizumab/uso terapêutico , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Estudos Retrospectivos , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores
8.
Arch. Soc. Esp. Oftalmol ; 94(9): 430-435, sept. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-186221

RESUMO

Objetivo: Evaluar los resultados visuales y anatómicos de aflibercept en pacientes naïve con degeneración macular asociada a la edad neovascular (DMAEnv) no seleccionados tras un año de tratamiento en régimen bimestral fijo en un entorno de práctica clínica real. Métodos: Estudio retrospectivo, serie de casos consecutivos no aleatorizados que incluye 35 pacientes naïve, 38 ojos con DMAEnv, tratados con aflibercept intravítreo (Eylea(R)). Los pacientes recibieron una dosis de carga de 3 inyecciones mensuales (2 mg/0,05 ml) seguida de inyecciones cada 2 meses. Resultados: Tras la dosis de carga y a los 12 meses de tratamiento, el cambio en la mejor agudeza visual corregida (MAVC) mejoró significativamente respecto a la MAVC basal (ETDRS 50,5 ± 14,5 y 53,1 ± 14,5 vs. 39,6 ± 14,7, respectivamente, p < 0,05). Al mes 3 y al mes 12, la proporción de pacientes que mejoró la agudeza visual en ≥ 15 letras fue de 37,1% y de 45,7%, respectivamente. La disminución media del espesor central de la retina fue también significativa tras la dosis de carga (239,6 ± 52,0 μm) y al mes 12 (227 ± 53,2μm) comparada con los valores pretratamiento (370,3 ± 117,6; p < 0,001). También se observó la resolución del desprendimiento del epitelio pigmentario en 14 de los 20 ojos (70%) con ese desprendimiento previo al tratamiento. Conclusión: Mejorías funcionales y anatómicas significativas fueron observadas tras el tratamiento con aflibercept intravítreo en pacientes naïve con DMAEnv en práctica clínica real


Objective: To investigate the visual and anatomical outcomes of aflibercept as therapy in patients with treatment-naïve neovascular age-related macular degeneration during one year in routine clinical practice. Methods: The study was a retrospective, case series, including 35 patients, 38 eyes, with neovascular age-related macular degeneration that received aflibercept injections (Eylea(R)). Patients received a loading dose of 3 monthly injections (2 mg / 0.05 ml) followed by intravitreal injections every 2 months. Results: At 3 and 12 months, the mean best-corrected visual acuity improved significantly as compared with baseline (ETDRS 50.5 ± 14.5 and 53.1 ± 14.5 vs. 39.6 ± 14.7, respectively, P < .05). At 3 and 12 months, the proportion of patients who improved visual acuity by ≥ 15 letters was 37.1% and 45.7%, respectively. The mean decrease in central macular thickness was also significant after loading dose (239.6 ± 52.0μm) and at 12 month (227 ± 53.2 μm) compared with pre-treatment values (370.3 ± 117, 6) (P < .001). Resolution of pigment epithelial detachment (PED) was also observed in 14 out of 20 (70%) eyes with PED at baseline. Conclusion: Aflibercept administered by fixed dosing over one year improved visual acuity and macular morphology in treatment-naïve eyes in routine daily practice


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Inibidores da Angiogênese/uso terapêutico , Degeneração Macular/tratamento farmacológico , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Avaliação de Medicamentos , Seguimentos , Macula Lutea/patologia , Degeneração Macular/patologia , Descolamento Retiniano/tratamento farmacológico , Descolamento Retiniano/etiologia , Hemorragia Retiniana/etiologia , Epitélio Pigmentado da Retina/patologia , Estudos Retrospectivos , Resultado do Tratamento , Acuidade Visual
9.
Arch. Soc. Esp. Oftalmol ; 94(9): 460-464, sept. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-186227

RESUMO

Varón de 61 años, con antecedentes personales de coroiditis serpiginosa (CS), que presentó metamorfopsia y disminución de agudeza visual (AV) en su ojo derecho (OD). En la exploración, mediante Swept-Source OCT-angiografía (SS OCT-A), se pudo observar una hemorragia peripapilar secundaria a una neovascularización coroidea (NVC). El paciente fue tratado mediante aflibercept intravítreo, presentando una evolución favorable en su sintomatología y en los hallazgos de la SS OCT-A. La NVC es una complicación que puede aparecer hasta en el 25% de los casos tras CS. Un diagnóstico preciso, mediante SS OCT-A, unido al tratamiento precoz con aflibercept, nos llevó a obtener unos óptimos resultados, tanto clínicos como anatómicos


A case is presented of a 61 year-old man with a personal history of serpiginous choroiditis (SC), who presented with metamorphopsia and decreased visual acuity (VA) in his right eye (RE). In the examination, using Swept Source OCT-angiography (SS OCT-A), peripapillary haemorrhage secondary to a choroidal neovascularisation (CNV) was observed. The patient was treated with intravitreal aflibercept, having a favourable outcome on his symptomatology and in the SS OCT-A findings. CNV is a complication that can appear in up to 25% of cases after SC. An accurate diagnosis using SS OCT-A, with early treatment with aflibercept, led us to obtain optimal clinical and anatomical results


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Angiogênese/uso terapêutico , Neovascularização de Coroide/etiologia , Angiofluoresceinografia , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Tomografia de Coerência Óptica , Inibidores da Angiogênese/administração & dosagem , Neovascularização de Coroide/diagnóstico por imagem , Neovascularização de Coroide/tratamento farmacológico , Injeções Intravítreas , Imagem Óptica , Receptores de Fatores de Crescimento do Endotélio Vascular/administração & dosagem , Proteínas Recombinantes de Fusão/administração & dosagem
10.
J Immunol Res ; 2019: 8535273, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31467935

RESUMO

Background: Age-related macular degeneration (AMD), the most common cause of blindness in the developed world, usually affects individuals older than 60 years of age. The majority of visual loss in this disease is attributable to the development of choroidal neovascularization (CNV). Mononuclear phagocytes, including monocytes and their tissue descendants, macrophages, have long been implicated in the pathogenesis of neovascular AMD (nvAMD). Current therapies for nvAMD are based on targeting vascular endothelial growth factor (VEGF). This study is aimed at assessing if perturbation of chemokine signaling and mononuclear cell recruitment may serve as novel complementary therapeutic targets for nvAMD. Methods: A promiscuous chemokine antagonist (BKT130), aflibercept treatment, or combined BKT130+aflibercept treatment was tested in an in vivo laser-induced model of choroidal neovascularization (LI-CNV) and in an ex vivo choroidal sprouting assay (CSA). Quantification of CD11b+ cell in the CNV area was performed, and mRNA levels of genes implicated in CNV growth were measured in the retina and RPE-choroid. Results: BKT130 reduced the CNV area and recruitment of CD11b+ cells by 30-35%. No effect of BKT130 on macrophages' proangiogenic phenotype was demonstrated ex vivo, but a lower VEGFA and CCR2 expression was found in the RPE-choroid and a lower expression of TNFα and NOS1 was found in both RPE-choroid and retinal tissues in the LI-CNV model under treatment with BKT130. Conclusions: Targeting monocyte recruitment via perturbation of chemokine signaling can reduce the size of experimental CNV and should be evaluated as a potential novel therapeutic modality for nvAMD.


Assuntos
Quimiocinas/antagonistas & inibidores , Neovascularização de Coroide/tratamento farmacológico , Monócitos/efeitos dos fármacos , Idoso , Idoso de 80 Anos ou mais , Animais , Antígeno CD11b/metabolismo , Movimento Celular/efeitos dos fármacos , Quimiocinas/metabolismo , Neovascularização de Coroide/etiologia , Neovascularização de Coroide/metabolismo , Neovascularização de Coroide/patologia , Feminino , Humanos , Lasers , Macrófagos/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Pessoa de Meia-Idade , Monócitos/metabolismo , Óxido Nítrico Sintase Tipo I/metabolismo , Ratos , Ratos Long-Evans , Receptores CCR2/metabolismo , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Retina/metabolismo , Retina/patologia , Fator de Necrose Tumoral alfa/metabolismo , Fator A de Crescimento do Endotélio Vascular/metabolismo
11.
Ophthalmic Surg Lasers Imaging Retina ; 50(8): 510-513, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31415698

RESUMO

BACKGROUND AND OBJECTIVE: To describe a novel, simple technique for surgically draining a bullous serous pigment epithelial detachment (PED). PATIENTS AND METHODS: Pars plana vitrectomy was performed with confirmed elevation of the hyaloid face. Proportional diathermy allowed stepwise entry into the PED superotemporally through an initially small, needle-point focus while providing control of any potential bleeding. Thick fluid was aspirated with a soft-tipped cannula, fluid-air exchange was performed, and intravitreal bevacizumab was injected before removing the cannulas. RESULTS: The PED was successfully completely drained intraoperatively and remained flat at 1 week postoperatively. However, the draining site ultimately closed, and continued exudation from choroidal neovascularization led to recurrent PED and eventual nonhemorrhagic retinal pigment epithelial tear despite aggressive treatment with aflibercept and photodynamic therapy. The early visual acuity benefit may relate to resolution of hyperopic shift. CONCLUSION: Serous PED can be surgically reduced without hemorrhagic complications, but long-term success depends upon control of the underlying choroidal neovascularization. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:510-513.].


Assuntos
Descolamento Retiniano/cirurgia , Epitélio Pigmentado da Retina/cirurgia , Vitrectomia/métodos , Idoso , Inibidores da Angiogênese/uso terapêutico , Bevacizumab/uso terapêutico , Neovascularização de Coroide/etiologia , Feminino , Humanos , Fotoquimioterapia/métodos , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Descolamento Retiniano/tratamento farmacológico
12.
Optom Vis Sci ; 96(7): 531-535, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31274742

RESUMO

SIGNIFICANCE: Perifoveal exudative vascular anomalous complex (PEVAC) is a recently described macular entity, which can be confused with other well-known vascular lesions such as retinal angiomatous proliferation. Perifoveal exudative vascular anomalous complex is more common than previously believed and is usually unresponsive to anti-vascular endothelial growth factor treatment. Clinicians should be aware of this disorder. PURPOSE: The purpose of this study was to report a case of PEVAC using multimodal imaging in a Chinese patient with diabetes mellitus but without diabetic retinopathy, followed by a brief review of the relevant literature. CASE REPORT: A 53-year-old Chinese woman with a 7-year history of diabetes mellitus presented with complaints of a 1-month history of deterioration of visual acuity in her right eye. Complete ophthalmic examination, including fundus examination of the right eye, revealed an isolated lesion immediately temporal to the fovea, accompanied by small hemorrhages and small, hard intraretinal exudates. Fluorescein fundus angiography revealed a well-defined hyperfluorescent lesion in the early phase but with leakage in the late phase. Optical coherence tomography revealed an oval lesion with a hyperreflective wall and relatively dark lumen, intraretinal cystic spaces, and hard exudates. Two intravitreal injections of aflibercept resulted in reduced blood flow in the PEVAC lesion, but with more hemorrhaging and hard exudates and no improvement in visual acuity. CONCLUSIONS: Perifoveal exudative vascular anomalous complex is an isolated, perifoveal, aneurysmal abnormality. It can occur in healthy patients, in addition to those with diabetes mellitus without retinopathy. In contrast to similar macular vascular anomalies, PEVAC does not typically respond to anti-vascular endothelial growth factor therapy.


Assuntos
Diabetes Mellitus/diagnóstico , Doenças Retinianas/diagnóstico , Vasos Retinianos/anormalidades , Malformações Vasculares/diagnóstico , Inibidores da Angiogênese/uso terapêutico , Grupo com Ancestrais do Continente Asiático , Exsudatos e Transudatos , Feminino , Angiofluoresceinografia/métodos , Fóvea Central , Humanos , Injeções Intravítreas , Pessoa de Meia-Idade , Imagem Multimodal , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Doenças Retinianas/tratamento farmacológico , Doenças Retinianas/fisiopatologia , Vasos Retinianos/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Malformações Vasculares/tratamento farmacológico , Malformações Vasculares/fisiopatologia , Acuidade Visual/fisiologia
13.
Arch Soc Esp Oftalmol ; 94(9): 430-435, 2019 Sep.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31182243

RESUMO

OBJECTIVE: To investigate the visual and anatomical outcomes of aflibercept as therapy in patients with treatment-naïve neovascular age-related macular degeneration during one year in routine clinical practice. METHODS: The study was a retrospective, case series, including 35 patients, 38 eyes, with neovascular age-related macular degeneration that received aflibercept injections (Eylea®). Patients received a loading dose of 3monthly injections (2mg / 0.05ml) followed by intravitreal injections every 2 months. RESULTS: At 3 and 12 months, the mean best-corrected visual acuity improved significantly as compared with baseline (ETDRS 50.5±14.5 and 53.1±14.5 vs. 39.6±14.7, respectively, P<.05). At 3 and 12 months, the proportion of patients who improved visual acuity by ≥15 letters was 37.1% and 45.7%, respectively. The mean decrease in central macular thickness was also significant after loading dose (239.6±52.0µm) and at 12 month (227±53.2µm) compared with pre-treatment values (370.3±117, 6) (P<.001). Resolution of pigment epithelial detachment (PED) was also observed in 14 out of 20 (70%) eyes with PED at baseline. CONCLUSION: Aflibercept administered by fixed dosing over one year improved visual acuity and macular morphology in treatment-naïve eyes in routine daily practice.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Degeneração Macular/tratamento farmacológico , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Avaliação de Medicamentos , Feminino , Seguimentos , Humanos , Macula Lutea/patologia , Degeneração Macular/patologia , Masculino , Descolamento Retiniano/tratamento farmacológico , Descolamento Retiniano/etiologia , Hemorragia Retiniana/etiologia , Epitélio Pigmentado da Retina/patologia , Estudos Retrospectivos , Resultado do Tratamento , Acuidade Visual
14.
Ophthalmic Surg Lasers Imaging Retina ; 50(6): 398-400, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31233159

RESUMO

Choroidal osteoma is a rare, classically unilateral tumor. Less than half of the cases are complicated by the onset of choroidal neovascularization (CNV). The authors describe a case of bilateral choroidal osteoma in a 10-year-old female patient complicated by the onset of bilateral CNV. The diagnosis was made by multimodal imaging and ultrasonography. Best-corrected visual acuity (BCVA) was 20/63 for the right eye (OD) and 20/25 for the left eye (OS). Interestingly, CNV OD resulted exudative, whereas no signs of fluid were detected OS. OCT angiography (OCTA) clearly detected the presence of CNV in both eyes. The patient underwent a single 1.0 mg/0.025 mL aflibercept injection OD. At follow-up, BCVA improved to 20/32 OD after 1 month and to 20/25 after 3 months, with no exudation recurrence. Both BCVA and imaging findings were unremarkable OS, thus suggesting the possible "quiescent" nature of this CNV. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:398-400.].


Assuntos
Coristoma/complicações , Neoplasias da Coroide/complicações , Neovascularização de Coroide/etiologia , Osteoma/complicações , Inibidores da Angiogênese/uso terapêutico , Criança , Neovascularização de Coroide/tratamento farmacológico , Feminino , Humanos , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Resultado do Tratamento
15.
Ophthalmic Res ; 62(2): 116-122, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31112967

RESUMO

AIM: To compare the efficacy of aflibercept (Eylea®), a potent antivascular endothelial growth factor (VEGF) agent, with betamethasone (Celestone®) and placebo for the treatment of formed corneal neovascularization in a rabbit model. METHODS: A central corneal chemical burn was created in the right eye of 24 New Zealand albino rabbits. Four weeks later, the rabbits were randomly divided into 4 equal groups for subconjunctival injection of aflibercept, betamethasone, aflibercept+ betamethasone, or saline (control). Digital photographs taken at weekly intervals were rated by 2 masked observers for extent, centricity, and density of corneal neovascularization according to a predefined scale. The percentage of corneal surface involved by neovascularization was quantified by image analysis software (Fiji-J). The change in corneal neovascularization from treatment administration (4 weeks after injury) to 4 weeks later (8 weeks after injury) was assessed. The rabbits were then euthanized, and their eyes were enucleated and processed for histopathological and immunofluorescence studies. RESULTS: There was no significant difference in the change in corneal neovascularization after treatment among the 4 groups according to the digital images (p > 0.15) or histological evaluation with hematoxylin and eosin (p > 0.08). On immunofluorescence assay, a lower VEGF concentration was observed in all treatment groups compared to the control group. CONCLUSIONS: In this rabbit model, corneal neovascularization induced by chemical burn failed to regress with treatment with aflibercept, betamethasone, or their combination.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Betametasona/uso terapêutico , Neovascularização da Córnea/tratamento farmacológico , Glucocorticoides/uso terapêutico , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Animais , Modelos Animais de Doenças , Feminino , Injeções Intraoculares , Coelhos , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores
17.
JAMA ; 321(19): 1880-1894, 2019 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-31037289

RESUMO

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


Assuntos
Inibidores da Angiogênese/uso terapêutico , Retinopatia Diabética/terapia , Fotocoagulação a Laser , Edema Macular/terapia , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Acuidade Visual , Conduta Expectante , Idoso , Inibidores da Angiogênese/efeitos adversos , Retinopatia Diabética/tratamento farmacológico , Retinopatia Diabética/fisiopatologia , Retinopatia Diabética/cirurgia , Progressão da Doença , Feminino , Humanos , Fotocoagulação a Laser/efeitos adversos , Edema Macular/tratamento farmacológico , Edema Macular/fisiopatologia , Edema Macular/cirurgia , Masculino , Pessoa de Meia-Idade , Proteínas Recombinantes de Fusão/efeitos adversos , Transtornos da Visão/etiologia
18.
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
19.
BMC Pharmacol Toxicol ; 20(1): 29, 2019 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-31088543

RESUMO

BACKGROUND: To investigate the one-year visual and anatomical outcomes of combination therapy with intravitreal aflibercept (IVA) and photodynamic therapy (PDT) for treating polypoidal choroidal vasculopathy (PCV). METHODS: This was a retrospective case-series study, including 30 eyes from 30 patients with treatment-naïve PCV treated by combination therapy with IVA and PDT. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), complete polyp regression rate, and dry macula rate were recorded every 3 months during 12-month follow-up. Clinical factors associated with final visual outcome and retreatment were investigated. RESULTS: The mean LogMAR BCVA was significantly improved from 0.73 ± 0.65 at baseline to 0.51 ± 0.60 (p = 0.01), and the mean CRT was also significantly improved from 339 ± 96 µm at baseline to 244 ± 43 µm at 12-month follow-up (p <  0.001). Complete regression of polypoidal lesions was 76.7%, and dry macula rate was 100% at 12 months. Better final BCVA was associated with younger age and better baseline BCVA (p = 0.02 and p <  0 001). The patients without complete polyp regression at 3-month follow-up were associated with retreatment (p = 0.03). CONCLUSION: In this study, combination therapy with IVA and PDT had significant visual and anatomical improvements to PCV patients during one-year follow-up. Better baseline BCVA and younger age were found to be associated with better visual outcome.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Luz , Degeneração Macular/tratamento farmacológico , Fotoquimioterapia , Fármacos Fotossensibilizantes/uso terapêutico , Receptores de Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Verteporfina/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Acuidade Visual/efeitos dos fármacos
20.
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
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