Selezione Abstracts inerenti la Retina comparsi sulle riviste peer-reviewed del mese di Novembre 2011
a cura di Giulio Bamonte e Roberto dell'Omo
Ophthalmology. 2011 Nov;118(11):2203-11. Epub 2011 Sep 29.
Risk models for progression to advanced age-related macular degeneration using demographic, environmental, genetic, and ocular factors.
Seddon JM, Reynolds R, Yu Y, Daly MJ, Rosner B.
Source
Ophthalmic Epidemiology and Genetics Service, Tufts University School of Medicine and Tufts Medical Center, New England Eye Center, Boston, Massachusetts.
Abstract
PURPOSE:
To expand our predictive models for progression to advanced stages of age-related macular degeneration (AMD) based on demographic, environmental, genetic, and ocular factors, using longer follow-up, time varying analyses, calculation of absolute risks, adjustment for competing risks, and detailed baseline AMD and drusen status.
DESIGN:
Prospective, longitudinal study.
PARTICIPANTS:
We included 2937 individuals in the Age-Related Eye Disease Study, of which 819 subjects progressed to advanced AMD during 12 years of follow-up.
METHODS:
Cox proportional hazards regression analyses were performed to calculate hazard ratios for progression. Covariates included demographic and environmental factors, 6 variants in 5 genes, baseline macular drusen size, and presence and type of advanced AMD in 1 eye at baseline. To assess the ability of risk scores based on all covariates to discriminate between progressors and nonprogressors, an algorithm was developed and the area under the receiver operating characteristic curve (AUC) was calculated. To validate the overall model, the total sample was randomly subdivided into derivation and test samples. Another model was built based on the derivation sample and assessed for calibration and discrimination in the test sample. Sample sizes needed for testing new treatments in clinical trials were estimated based on models with and without genetic variables.
MAIN OUTCOME MEASURES:
Progression to advanced AMD, including geographic atrophy and neovascular disease.
RESULTS:
In multivariate models, age, smoking, body mass index, single nucleotide polymorphisms in the CFH, ARMS2/HTRA1, C3, C2, and CFB genes, as well as presence of advanced AMD in 1 eye and drusen size in both eyes were all independently associated with progression. The AUC for progression at 10 years in the model with genetic factors, drusen size, and environmental covariates was 0.915 in the total sample. In the test sample, based on a model estimated from the derivation sample, the AUC was 0.908. The sample sizes needed for clinical trials were estimated to be lower when genetic susceptibility was considered.
CONCLUSIONS:
Factors reflective of nature and nurture were incorporated into an expanded algorithm for risk prediction, which performed very well in both derivation and test samples. Risk scores and predicted progression rates will be useful for AMD surveillance and for designing clinical trials.
Ophthalmology. 2011 Nov;118(11):2212-7. Epub 2011 Sep 9.
Intraoperative Microscope-Mounted Spectral Domain Optical Coherence Tomography for Evaluation of Retinal Anatomy during Macular Surgery.
Ray R, Barañano DE, Fortun JA, Schwent BJ, Cribbs BE, Bergstrom CS, Hubbard GB 3rd, Srivastava SK.
Source
Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia.
Abstract
OBJECTIVE:
To evaluate the use of microscope mounted spectral domain optical coherence tomography (SD-OCT) to detect changes in retinal anatomy during macular surgery.
DESIGN:
Retrospective, observational case series.
PARTICIPANTS:
We included 25 eyes of 24 consecutive patients who underwent SD-OCT during macular surgery.
METHODS:
A retrospective review of operative techniques, outcomes, and imaging for all patients who underwent intraoperative microscope mounted SD-OCT during surgery for macular hole or epiretinal membrane (ERM) from April 2009 to April 2010 was performed. Qualitative and quantitative characteristics of intraoperative and postoperative changes in retinal anatomy were studied.
MAIN OUTCOME MEASURES:
Intraoperative change in macular hole dimensions and retinal thickness in patients with ERM owing to surgical manipulation measured using SD-OCT.
RESULTS:
Intraoperative SD-OCT from 13 eyes of 13 patients undergoing surgery for macular hole was reviewed. Two cases had images of suboptimal quality and were excluded. The remaining 11 eyes were subjected to quantitative analysis, which revealed stability of macular hole height and central hole diameter after internal limiting membrane (ILM) peeling, but an increase in the diameter of subretinal fluid under the macula in ten of 11 eyes (average 87% wider). Intraoperative imaging from 12 eyes of 11 patients undergoing surgery for ERM was analyzed. Quantitative analysis revealed an average increase of retinal thickness after ILM peel of <2%. Ten of 12 eyes developed a new subretinal hyporeflectance, which likely represents shallow detachment of the macula, after uncomplicated membrane peel.
CONCLUSIONS:
Use of intraoperative SD-OCT has provided new insight into the changes to retinal anatomy during macular surgery and may prove to be a useful tool for vitreoretinal surgery. Further study is warranted to determine whether intraoperative changes such as the creation of shallow retinal detachments during uncomplicated macular surgery affects visual recovery.
FINANCIAL DISCLOSURE(S):
Proprietary or commercial disclosure may be found after the references.
Ophthalmology. 2011 Nov;118(11):2218-26. Epub 2011 Jul 2.
The effect of adjunctive intravitreal bevacizumab for preventing postvitrectomy hemorrhage in proliferative diabetic retinopathy.
Ahn J, Woo SJ, Chung H, Park KH.
Source
Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea.
Abstract
OBJECTIVE:
To assess the effects of preoperative and intraoperative intravitreal bevacizumab (IVB) injection on the incidence of postoperative vitreous hemorrhage (VH) after vitrectomy for proliferative diabetic retinopathy (PDR).
DESIGN:
Prospective, randomized, clinical trial.
PARTICIPANTS:
One hundred seven eyes of 91 patients undergoing pars plana vitrectomy (PPV) for the management of PDR-related complications were enrolled.
METHODS:
One hundred seven cases were assigned randomly to either group 1 (intravitreal 1.25 mg/0.05 ml bevacizumab injection 1 to 14 days before PPV), group 2 (intravitreal 1.25 mg/0.05 ml bevacizumab injection at the end of PPV), or group 3 (no IVB injection).
MAIN OUTCOME MEASURES:
The primary outcome was the incidence of early (≤4 weeks) and late (>4 weeks) recurrent VH. Secondary outcome measures were the initial time of vitreous clearing (ITVC) and best-corrected visual acuity (BCVA) at 6 months after surgery.
RESULTS:
The incidences of early recurrent VH were 22.2%, 10.8%, and 32.4% in groups 1, 2, and 3, respectively (P = 0.087). A subgroup pairwise analysis showed significantly decreased early VH incidence in group 2 compared with that of group 3 (P = 0.026). The incidences of late recurrent VH were 11.1%, 16.2%, and 14.7% in groups 1, 2, and 3, respectively (P = 0.813). The ITVC in groups 1, 2, and 3 were 26.4±42.5 days, 10.3±8.2 days, and 25.2±26.1 days, respectively. The ITVC was significantly shorter in group 2 compared with that in groups 1 and 3 (P = 0.045 and P = 0.015, respectively). The BCVA at 6 months after surgery did not differ significantly among the 3 groups (P = 0.418).
CONCLUSIONS:
This study found no substantial evidence to support the adjunctive use of preoperative IVB to reduce postoperative recurrence of VH in vitrectomy for PDR. For select cases in which adjunctive IVB use is considered, intraoperative administration seems to be the better option for reducing postoperative VH.
FINANCIAL DISCLOSURE(S):
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Ophthalmology. 2011 Nov;118(11):2227-37.
Retinal prostheses: current clinical results and future needs.
Weiland JD, Cho AK, Humayun MS.
Source
Doheny Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California.
Abstract
Degenerative diseases such as age-related macular degeneration (AMD) and retinitis pigmentosa (RP) primarily affect the photoreceptors, ultimately resulting in significant loss of vision. Retinal prostheses aim to elicit neural activity in the remaining retinal cells by detecting and converting light into electrical stimuli that can then be delivered to the retina. The concept of visual prostheses has existed for more than 50 years and recent progress shows promise, yet much remains to be understood about how the visual system will respond to artificial input after years of blindness that necessitate this type of prosthesis. This review focuses on 3 major areas: the histopathologic features of human retina affected by AMD and RP, current results from clinical trials, and challenges to overcome for continued improvement of retinal prostheses. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosures may be found after the references.
Am J Ophthalmol. 2011 Nov;152(5):784-92.e2. Epub 2011 Jul 13.
A randomized pilot study of low-fluence photodynamic therapy versus intravitreal ranibizumab for chronic central serous chorioretinopathy.
Bae SH, Heo JW, Kim C, Kim TW, Lee JY, Song SJ, Park TK, Moon SW, Chung H.
Source
Department of Ophthalmology, College of Medicine, Seoul National University, Seoul, Korea.
Abstract
PURPOSE:
To report 6-month outcomes of a prospective, randomized study comparing the efficacy and safety between low-fluence photodynamic therapy (PDT) and intravitreal injections of ranibizumab in the treatment of chronic central serous chorioretinopathy.
DESIGN:
Prospective, randomized, single-center pilot study.
METHODS:
Sixteen eyes with chronic central serous chorioretinopathy were randomized to receive either low-fluence PDT or intravitreal injections of ranibizumab: 8 eyes in the low-fluence PDT group and 8 in the ranibizumab group. Rescue treatment was considered if subretinal fluid was sustained after completion of primary treatment: low-fluence PDT for the ranibizumab group and ranibizumab injection for the low-fluence PDT group. Main outcome measures were excess foveal thickness, resolution of subretinal fluid, choroidal perfusion on indocyanine green angiography, and best-corrected visual acuity.
RESULTS:
At 3 months, the mean excess foveal thickness was reduced from 74.1 ± 56.0 μm to -35.4 ± 44.5 μm in the low-fluence PDT group (P = .017) and from 26.3 ± 50.6 μm to -23.1 ± 56.5 μm in the ranibizumab group (P = .058). After a single session of PDT, 6 eyes (75%) in the low-fluence PDT group achieved complete resolution of subretinal fluid and reduction of choroidal hyperpermeability, whereas 2 (25%) eyes in the ranibizumab group achieved this after consecutive ranibizumab injections. Four eyes (50%) in the ranibizumab group underwent additional low-fluence PDT and accomplished complete resolution. At 3 months, significant improvement of best-corrected visual acuity was not demonstrated in the low-fluence PDT group (P = .075), whereas it was observed in the ranibizumab group (P = .012). However, the tendency toward improvement of best-corrected visual acuity was not maintained.
CONCLUSIONS:
In terms of anatomic outcomes, the effect of ranibizumab injections was not promising compared with that of low-fluence PDT.
Am J Ophthalmol. 2011 Nov;152(5):793-8. Epub 2011 Jul 26.
Cataract surgery in ranibizumab-treated patients with neovascular age-related macular degeneration from the phase 3 ANCHOR and MARINA trials.
Rosenfeld PJ, Shapiro H, Ehrlich JS, Wong P; MARINA and ANCHOR Study Groups.
Source
Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida 33136, USA. Questo indirizzo e-mail è protetto dallo spam bot. Abilita Javascript per vederlo.
Abstract
PURPOSE:
To investigate whether cataract surgery was beneficial in patients with neovascular age-related macular degeneration (AMD) receiving monthly ranibizumab injections in the ANCHOR (Anti-VEGF Antibody for the Treatment of Predominantly Classic Choroidal Neovascularization in AMD) and MARINA (Minimally Classic/Occult Trial of the Anti-VEGF Antibody Ranibizumab in the Treatment of Neovascular AMD) phase 3 trials.
DESIGN:
Retrospective analysis.
METHODS:
Patients were identified who underwent cataract surgery during the 2 pivotal trials. For this analysis, the best-corrected visual acuity (VA) just prior to cataract surgery was referred to as the redefined baseline VA. For the period after cataract surgery, endpoints included change in VA, time to first postsurgery injection, and total number of injections. Monthly follow-up visits after surgery were defined at 30-day intervals ± 15 days.
RESULTS:
Three subgroups were identified: study eyes of ranibizumab-treated patients (758 eyes [23 undergoing surgery]), fellow eyes of ranibizumab-treated patients (758 eyes [28 undergoing surgery]), and eyes of non-ranibizumab patients (762 [16 undergoing surgery]). Three months postsurgery, the VA of ranibizumab-treated eyes improved by a mean of 10.4 (± 3.4) letters compared to the redefined baseline (n = 20; 95% confidence interval +3.3 letters to +17.5 letters). The mean VA change from redefined baseline VA was not significantly different between the 3 groups at any of the evaluated time points postsurgery (P > .44 for all comparisons between each pair of the 3 groups at 1, 2, 3, and 4 months following surgery).
CONCLUSIONS:
In the phase 3 trials, cataract surgery appeared to be safe and beneficial for all eyes with AMD, including ranibizumab-treated eyes with neovascular AMD. An average VA improvement of more than 2 lines was typically observed.
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