Abstracts e Highlights degli articoli piu' interessanti, riguardanti la retina pubblicati sulle riviste peer-reviewed Luglio 2011
A cura del dr Giulio Bamonte e e del dr Roberto dell'Omo
SCORE Study Report 11: Incidences of Neovascular Events in Eyes with Retinal Vein Occlusion
Nello studio SCORE (triamcinolone vs standard of care-laser per BRVO-Osservazione per CRVO), il trattamento con triamcinolone non diminuisce l'incidenza di eventi neovascolari, rispetto allo standard of care. In pazienti con CRVO e BRVO neovasi iridei o glaucoma neovascolare si repertano nel 8,5% e 2,5% rispettivamente, mentre NVD o NVE nel 8,8% e 7,6%. Predittivo per lo sviluppo di eventi neovascolari l'area di non perfusione al baseline. Rispetto alla storica soglia dei 10 Diametri papillari, si assiste a neovascolarizzazine anche con aree non perfuse di grandezza inferiore ai 5 dp.
Ophthalmology Pages 1364-1372
Clement K. Chan, Michael S. Ip, Paul C. VanVeldhuisen, Neal L. Oden, Ingrid U. Scott, Michael J. Tolentino, Barbara A. Blodi and SCORE Study Investigator Group
Purpose: To investigate in The Standard Care versus COrticosteroid for REtinal Vein Occlusion (SCORE) Study: (1) incidences of neovascular events and retinal capillary nonperfusion (abbreviated as “nonperfusion”), and their relationship with treatment groups; (2) neovascular incidences by nonperfusion status; and (3) pertinent baseline factors for their potential risk for neovascular events.
Design: Two multicenter, randomized clinical trials, 1 evaluating participants with central retinal vein occlusion (CRVO) and the other evaluating participants with branch retinal vein occlusion (BRVO). Participants: At 36 months, data were available for 81 participants with CRVO and 128 with BRVO. Intervention: Standard care (observation or grid photocoagulation) versus 1 or 4 mg intravitreal triamcinolone. Main Outcome Measures: Neovascularization of the iris (NVI), neovascular glaucoma (NVG), disc or retinal neovascularization (NVD/NVE), preretinal or vitreous hemorrhage (PRH/VH), and nonperfusion.
Results: The cumulative 36-month incidences for CRVO and BRVO eyes, respectively, were 8.5% and 2.4% for NVI or NVG; 8.8% and 7.6% for NVD/NVE or PRH/VH. There were no differences in incidences of neovascular events or risk of nonperfusion when comparing the 3 treatment groups within diseases. For CRVO at 36 months, 16.6% of eyes with ≥5.5 disc areas of nonperfusion versus 4.0% of eyes with <5.5 disc areas of nonperfusion developed NVG (P = 0.0003); for BRVO at 36 months, 14.6% versus 2.4% developed NVD/NVE (P<0.0001). Similar results were noted for most other neovascular events. Nonperfusion was the only significant baseline factor for neovascularization in BRVO, with the risk of a neovascular event increasing with greater disc areas of nonperfusion, and the highest risk noted at ≥5.5 disc areas.
Conclusions: In the SCORE Study, triamcinolone treatment was not associated with lower incidences of neovascular events or nonperfusion status compared with observation or grid photocoagulation. Cumulative 36-month incidences for most neovascular events were significantly higher for nonperfused than perfused eyes. Greater baseline disc areas of nonperfusion increased the risk of neovascularization in BRVO but not CRVO eyes, possibly owing to obscuration of retinal capillary details caused by dense hemorrhage at baseline for CRVO eyes. Increased risk of neovascularization was noted below the historical threshold of 10 disc areas of nonperfusion for retinal vein occlusion.
Sustained-Release Intravitreal Liquid Drug Delivery Using Triamcinolone Acetonide for Cystoid Macular Edema in Retinal Vein Occlusion
Studio di Fase I che ha valutato il trattamento di occhi affetti da edema maculare cistoide secondario a occlusione venosa con una nuova formulazione di triamcinolone acetonide a lento rilascio. I risultati sembrano promettenti con un buone possibilita' di ripristino anatomico a 360 giorni. Gli effetti collaterali sono stati scarsi con un aumento della pressione endooculare in 3 pazienti, di cui in 2 dovuto a glaucoma neovascolare.
Ophthalmology Pages 1416-1422
Jennifer I. Lim, Anne E. Fung, Mark Wieland, Dean Hung, Vernon Wong
Purpose: To investigate side effects seen with this formulation and to search for evidence of effectiveness after a single intravitreal injection of IBI-20089 in eyes with cystoid macular edema (CME) secondary to retinal vein occlusion.
Design: Prospective, phase 1 clinical trial.
Participants: Ten patients with chronic CME resulting from retinal vein occlusion.
Methods: Patients received a single intravitreal injection of IBI-20089 using a sequential dose escalation schedule. Each cohort consisted of 5 patients who received the intravitreal injection of the sustained liquid drug delivery system containing either 6.9 mg (25 μl) triamcinolone acetonide (TA; cohort 1) or 13.8 mg (50 μl) TA (cohort 2). At each study visit, best-corrected visual acuity testing, slit-lamp biomicroscopy, IOP measurement, dilated ophthalmoscopy, fundus photography and optical coherence tomography (OCT) were performed. Patients also underwent laboratory testing and physical examinations to monitor for any systemic adverse events.
Main Outcome Measures: Optical coherence tomography central subfield thickness, ocular and systemic adverse events.
Results: In cohort 1, mean baseline OCT central subfield thickness (CST) was 477 μm and decreased to 369 μm at day 1 (P<0.06), 387 μm at day 30 (P = 0.18), and 251 μm at day 360 (P = 0.46). In cohort 2, mean baseline OCT CST was 518 μm and decreased to 404 μm at day 1 (P = 0.134), 289 μm at day 30 (P = 0.003), 207 μm at day180 (P = 0.004), and 278 μm at day 360 (P = 0.009). Related adverse events included elevation of IOP in 3 patients, in 2 because of neovascular glaucoma (not related to study drug) and in 1 who required a glaucoma tube shunt.
Conclusions: A single intravitreal injection of IBI-20089 resulted in a controlled and sustained delivery of a TA. Side effects included elevated IOP in 3 eyes, 2 of which had neovascular glaucoma.
The Predisposing Pathology and Clinical Characteristics in the Scottish Retinal Detachment Study
Interessante e vasto studio epidemiologico sulle caratteristiche di presentazione in casi di Distacco Retinico Regmatogeno Primario. Nella maggior pare dei casi (86%) la causa responsabile di un RRD e' una rottura a ferro di cavallo a seguito di una distacco posteriore di vitreo. Nella maggior parte dei casi si reperta piu'di una rottura. Traumi precedenti, interventi per cataratta, familiarita' e presenza di degenerazione a lattice sono importanti fattori di rischio.
Ophthalmlogy Pages 1429-1434
Danny Mitry, Jaswinder Singh, David Yorston, M.A. Rehman Siddiqui, Alan Wright, Brian W. Fleck, Harry Campbell, David G. Charteris
Purpose: To describe the predisposing pathology and clinical features of all incident cases of rhegmatogenous retinal detachment (RRD) recruited in Scotland during a 2-year period.
Design: Prospective surveillance study of incident cases of RRD.
Participants: All incident cases of RRD recruited as part of the Scottish Retinal Detachment Study.
Methods: During a 2-year period, we coordinated a comprehensive system in which every case of primary RRD presenting to 1 of 6 vitreoretinal surgical sites in Scotland was examined and approached for study inclusion.
Main Outcome Measures: Rhegmatogenous retinal detachment incidence, predisposing features, and clinical characteristics.
Results: A total of 1202 cases were recruited. Detailed clinical information was available on 1130 (94%) of cases. By causative break, the proportions of RRD were horseshoe tear (HST) associated with posterior vitreous detachment (PVD) in 86.2%, giant retinal tear (GRT) and PVD in 1.3%, non-PVD round hole (RH) in 4.9%, retinal dialysis in 5.9%, and retinoschisis RRD in 1.6%. One in 10 cases reported significant ocular trauma. One in 5 cases were pseudophakic. Round hole RRD more frequently presented with multiple retinal breaks compared with HST RRD (67.8% vs. 48.7%; P = 0.003). In PVD-associated RRD, 56.1% (95% confidence interval [CI], 53.8–58.3) of breaks were identified in the superotemporal retina. In non-PVD RRD, 54.6% (95% CI, 47.9–61.1) of breaks were inferotemporal, followed by superotemporal in 34.9% (95% CI, 28.7–41.5). Lattice degeneration was present in 18.7% of affected eyes and more common in RH RRD (35.7%) than in HST RRD (19.3%) (P = 0.003). Seven percent reported an affected first-degree relative, and these cases were significantly more myopic than nonfamilial cases.
Conclusions: More than 85% of RRD cases are associated with PVD and related tractional tears. Non-PVD RH RRD occurred in younger and more myopic individuals. The majority of cases are caused by more than 1 retinal break, and the macula is affected in more than 50% at presentation. Ocular trauma, previous cataract surgery, family history, and lattice degeneration are important predisposing features.
Intraocular Foreign Bodies in China: Clinical Characteristics, Prognostic Factors, and Visual Outcomes in 1421 Eyes
Altro vasto studio epidemiologico, riguardante le caratteristiche dei traumi oculari complicati dalla presenza di una corpo estraneo endobulbare. I traumi oculari con ritenzione di CE rappresentano il 28% dei casi. Una endoftalmite si sviluppa nel 165 circa. Fattori protettivi per lo sviluppo di una infezione sono un pronto intervento entro le 24 ore e la capacita' della ferita di autochiudersi.Tra i fattori prognoostici negativi ferite piu'grandi del CE.
Ophthalmology Pages 66-73.e1
Ying Zhang, MaoNian Zhang, CaiHui Jiang, Huai Yu Qiu
Purpose: To investigate epidemiologic and clinical characteristics, prognostic factors, and visual outcomes of posttraumatic intraocular foreign body (IOFB).
Design: Retrospective, consecutive case series.
Methods: Information from 1421 eyes (1299 inpatients) with IOFB selected from all open-globe injury cases (4968 eyes of 4865 inpatients) in 15 tertiary hospitals in China over a 5-year period were collected from a standardized preformulated database of eye injuries. Factors affecting retinal lesions or detachment, development of endophthalmitis, and visual outcome were analyzed statistically.
Results: IOFBs represented 28.60% of all open-globe injuries. Of the 1421 eyes, endophthalmitis developed in 232 (16.76%), and independent protective factors included primary repair within 24 hours (odds ratio [OR], 0.59; P = .006) and self-sealing wounds (OR, 0.69; P = .013). At discharge or follow-up, the enucleation rate was 7.53%, best-corrected visual acuity (VA) improved in 54.33%, and 4.85% had no light perception. Wound length of at least 3 mm and IOFB located in the posterior segment increased the risk of retinal lesion or detachment, and both (OR, 1.66; P < .001; OR, 4.04; P < .001) were significant negative predictors for visual outcome, along with wound larger than IOFB in largest length (OR, 2.38; P = .002) and endophthalmitis (OR, 2.01; P = .0003). Better initial VA (OR, 0.76; P < .001) was a protective factor for final VA.
Conclusions: For IOFBs, primary wound closure by repair within 24 hours or self-sealing independently reduces the risk of endophthalmitis. Worse presenting VA, larger wounds, IOFB in posterior segment, wound larger than IOFB in largest length, and endophthalmitis predict worse visual outcome.
Natural History of Lamellar Macular Holes in Highly Myopic Eyes
Raramente i fori maculari lamellari progrediscono a foro maculare a tutto spessore. In questo studio su occhi miopi (>8D) solo 1/24 occhi, affetti da foro maculare lamellare e' progredito a FM a tutto spessore in un periodo di un anno.
Am J Ophthalmol Pages 96-99.e1
Yuichiro Tanaka, Noriaki Shimada, Muka Moriyama, Kengo Hayashi, Takeshi Yoshida, Takashi Tokoro, Kyoko Ohno-Matsui
Purpose: To determine the natural course of lamellar macular holes (MHs) in highly myopic eyes.
Design: Prospective and observational case series.
Methods: Twenty-four eyes of 21 consecutive patients with a lamellar MH and high myopia (myopic refractive error >8 diopters or axial length ≥26.5 mm) were followed for ≥12 months. The changes of the optical coherence tomography (OCT) findings and the best-corrected visual acuity (BCVA) were analyzed. The progression of the lamellar MH to a full-thickness MH and the change of the BCVA were analyzed.
Results: At the initial examination, an epiretinal membrane was identified by OCT in 17 of the 24 eyes (70.8%) and 7 eyes (29.2%) had macular retinoschisis. Twenty-three of 24 eyes (95.8%) did not show any changes of the lamellar MH in the OCT images during a mean follow-up of 19.2 ± 10.2 months. However, the remaining eye progressed to a full-thickness MH and pars plana vitrectomy was required to close the MH. Except for this 1 eye, the BCVA was maintained (within 0.2 logMAR change) during the follow-up period of at least 1 year.
Conclusions: A lamellar MH in highly myopic eyes is a relatively stable condition.
Cystoid Macular Degeneration in Exudative Age-Related Macular Degeneration
LA degenerzione cistoide maculare e' una ben nota entita' che puo' conseguire all'ARMD essudativa post trattamento dopo la formazione di una cicatrice fibroatrofica e non va considerata come un segnale di attivita' della CNV.
Am J Ophthalmol Pages 100-107.e2
Giuseppe Querques, Florence Coscas, Raimondo Forte, Nathalie Massamba, Margaret Sterkers, Eric H. Souied
Purpose: To investigate the prevalence and clinical significance of cystoid macular degeneration in eyes that underwent intravitreal ranibizumab injections for exudative age-related macular degeneration.
Design: Retrospective, interventional case series.
Methods: We reviewed the charts of 56 consecutive patients (19 male, 37 female; mean age ± standard deviation, 80.81 ± 4.8 years) with exudative age-related macular degeneration who received the last intravitreal ranibizumab injection at least 6 months before and were judged to have a fibroatrophic scar without signs of progression by fluorescein angiography or spectral-domain optical coherence tomography. Main outcome measures were the estimated prevalence and clinical significance of cystoid macular degeneration.
Results: Twenty-two eyes showed various combinations of degenerative pseudocysts, whereas 34 eyes did not show any pseudocysts. The 95% confidence interval for the prevalence estimate was 36.98% to 41.02%. Degenerative pseudocysts appeared square-shaped, did not change their overall appearance over time, and were located just below the internal limiting membrane in 11 eyes (50%), in the inner nuclear layer in 16 eyes (72.7%), in the outer nuclear layer in 8 eyes (36.3%), and in all the retinal layers in 6 eyes (27.2%). Best-corrected visual acuity improved in eyes with and without degenerative pseudocysts and decreased significantly in eyes with degenerative pseudocysts (P = .03). Mean central macular thickness decreased significantly (P < .001) to 324.1 μm and to 328.2 μm in eyes with and without degenerative pseudocysts, respectively.
Conclusions: Cystoid macular degeneration represents a well-distinguished clinical entity that may be detected in exudative age-related macular degeneration eyes showing a posttreatment fibroatrophic scar and should not be considered as a manifestation of choroidal neovascularization activity.
The incidence of visual impairment due to retinopathy of prematurity (ROP) and concomitant disabilities in the Netherlands: a 30 year overview
Interessante studio retrospettivo sulla ROP. Rispetto al passato si registra una netta diminuzione dei casi di cecita'dovuti a ROP.
Br J Ophthalmol 2011;95:937-941 Published Online First: 10 February 2011
A J van Sorge, J U M Termote, M J de Vries, F N Boonstra, C Stellingwerf, N E Schalij-Delfos
Abstract
Aim: To determine the incidence of visual impairment (VI) caused by retinopathy of prematurity (ROP) and concomitant disabilities in preterm neonates born between 2000 and 2009 in the Netherlands.
Methods: Data were retrieved from the Dutch institutes for the visually impaired. They were compared with similar Dutch studies conducted in 1975–1987, 1986–1994 and 1994–2000.
Results: Records of 42 infants with VI due to ROP were included. A gradual decrease of gestational age and birthweight but an increase of duration of artificial ventilation, supplemental oxygen administration, bronchopulmonary dysplasia, developmental delay and behavioural abnormalities was found. Compared with the previous study (1994–2000), significantly fewer children were visually impaired due to ROP (1.84 per 100,000 live births/year vs 3.93 per 100,000 live births/year, p=0.000), the incidence of complete blindness decreased from 27.5% to 7.1% (p<0.05) and more children were treated (66.7% vs 56.9%, NS). The incidence of concomitant disabilities was high and did not differ greatly from the previous study.
Conclusion: This was a retrospective study showing a significant decrease in VI due to ROP in the Netherlands. Changes in neonatal care practices did not result in a decrease in the incidence of concomitant disabilities. More children were treated for ROP, but 33% were not treated.
Evolution of reticular pseudodrusen
Br J Ophthalmol 2011;95:979-985 Published Online First: 25 November 2010
John Sarks, Jennifer Arnold, I-Van Ho, Shirley Sarks, Murray Killingsworth
Abstract
Aims: To report observations relating to the clinical recognition and possible basis of reticular pseudodrusen (RPD).
Methods: This retrospective study reports the evolution of RPD in 166 patients who had follow-up of over 1 year using multiple imaging techniques. Mean age when first seen was 73.3 years and the mean period of observation was 4.9 years (range 1–18 years). Associated macular changes were recorded.
Results: RPD were first identified in the upper fundus as a reticular network, which then became less obvious, developing a diffuse yellowish appearance. RPD also faded around choroidal neovascularisation (CNV). RPD therefore could be transient but the pattern often remained visible outside the macula or nasal to the discs. Manifestations of age-related macular degeneration (AMD) were present in nearly all eyes and there was a particularly high association with CNV (52.1%). In one clinicopathological case abnormal material was found in the subretinal space.
Conclusions: The prevalence of RPD may be underestimated because their recognition depends upon the imaging method used, the area of fundus examined and the confusion with typical drusen. The pathology of one eye suggests that RPD may correspond to material in the subretinal space.
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