Selezione Abstracts inerenti la Retina comparsi sulle riviste peer-reviewed nel mese di Ottobre 2011
a cura di Giulio Bamonte e Roberto dell'Omo.
Retina.
2011 Oct;31(9):1749-52.
Evolving strategies in the management of submacular hemorrhage associated with choroidal neovascularization in the anti-vascular endothelial growth factor era.
Todorich B, Scott IU, Flynn HW Jr, Johnson MW.
Retina. 2011 Oct;31(9):1772-6.
Intraoperative endolaser retinopexy around the sclerotomy site for prevention of retinal detachment after pars plana vitrectomy.
Kim CS, Kim KN, Kim WJ, Kim JY.
Source
Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Korea.
Abstract
PURPOSE:
To investigate whether intraoperative endolaser retinopexy around the sclerotomy site during pars plana vitrectomy can prevent the postoperative complication of retinal detachment (RD).
METHODS:
Two hundred and seventy-eight patients who had undergone 20-gauge pars plana vitrectomy for various vitreoretinal disorders were investigated retrospectively. Patients who had rhegmatogenous RD and who underwent panretinal photocoagulation for diabetic retinopathy were excluded. In Group 1, 152 patients had not undergone laser retinopexy around the sclerotomy site, and in Group 2, 126 patients had undergone laser retinopexy around the sclerotomy site. The incidence rates of postoperative RD were compared.
RESULTS:
In Group 1, 7 cases (4.6%) of RD developed: 6 cases (3.9%) of sclerotomy-related retinal breaks, and 1 of a sclerotomy-unrelated retinal break. In Group 2, superior RD developed in 1 case (0.8%), but no sclerotomy-related retinal break was observed.
CONCLUSION:
Endolaser retinopexy around the sclerotomy site is relatively simple to perform, without inducing particular complications. It is expected to reduce the development of postoperative RD (4.6% vs. 0.8%; P = 0.08) and especially sclerotomy-related RD (3.9% vs. 0%; P = 0.03).
Retina. 2011 Oct;31(9):1777-82.
Macular holes after rhegmatogenous retinal detachment repair: surgical management and functional outcome.
Garcia-Arumi J, Boixadera A, Martinez-Castillo V, Zapata MA, Fonollosa A, Corcostegui B.
Source
Department of Ophthalmology, Instituto de Microcirugia Ocular, Barcelona, Spain. Questo indirizzo e-mail è protetto dallo spam bot. Abilita Javascript per vederlo.
Abstract
PURPOSE:
To review the surgical management and functional outcome of macular holes (MHs) developing after rhegmatogenous retinal detachment repair.
METHODS:
Retrospective, interventional, noncomparative case series. Twenty patients with MH developing after rhegmatogenous retinal detachment repair were included. Pars plana vitrectomy with internal limiting membrane peeling and gas tamponade was performed. Macular attachment status and number of best-corrected visual acuity lines of improvement after MH repair were evaluated.
RESULTS:
The fovea had been detached in all eyes at the time of rhegmatogenous retinal detachment repair. Six MHs developed after scleral buckling surgery and 14 MHs after vitrectomy with an encircling band. In 5 of the 20 patients, ≥ 2 operations had been required to achieve retinal reapplication. The mean time to MH diagnosis was 38 weeks. Preoperative best-corrected visual acuity was ≤ 20/100 in all but one case. Single-operation MH closure rate was 100%, with a mean of 4 Early Treatment Diabetic Retinopathy Study lines of visual improvement (P < 0.001). Mean postoperative Snellen best-corrected visual acuity was 20/70 (± 0.15) (P < 0.001).
CONCLUSION:
In this small retrospective study, standard surgical treatment for idiopathic MH was effective in achieving anatomical closure of these secondary MHs, but visual acuity gain was limited by the previous macula-involving rhegmatogenous retinal detachment status.
Retina. 2011 Oct;31(9):1877-84.
Intraocular pharmacokinetics after a single intravitreal injection of 1.5 mg versus 3.0 mg of bevacizumab in humans.
Source
Department of Ophthalmology, University of Bonn, Germany. Questo indirizzo e-mail è protetto dallo spam bot. Abilita Javascript per vederlo.
Abstract
PURPOSE:
To compare the concentration of unbound bevacizumab in the anterior chamber of patients with macular edema, who received a single intravitreal injection of two different dosages.
METHODS:
This was a comparative, interventional case series. Twenty-nine nonvitrectomized eyes of 29 patients with significant lens opacities and concurrent macular edema were included in the study. All patients were treated by a single dose of intravitreal injection of bevacizumab 1.5 mg (Group A, n = 13) or 3.0 mg (Group B, n = 16). Subsequent phacoemulsification and aspiration of an aqueous humor samples were performed at various intervals (1-60 days). The axial length of the globe was measured using the IOLMaster to calculate the total volume and corresponding globe size-corrected half-time. The concentration of unbound bevacizumab was measured by enzyme-linked immunosorbent assay and pharmacokinetic parameters including half-time of elimination.
RESULTS:
The mean peak concentration was observed in both groups on the first day after intravitreal bevacizumab injection. The mean concentration of unbound bevacizumab ranged in Group A from 17.5 μg/mL at baseline to 0.66 μg/mL at Day 57 and in Group B from 28.3 μg/mL at baseline to 0.00 μg/mL at 54 days. The axial lengths of all injected eyes were not significantly different between Group A (mean values, 23.026 mm, SD 1.21) and Group B (mean, 23.313 mm, SD 1.00; P = 0.31). Regression analysis determined elimination half-time values of 7.85 days (R2 = 0.75) in Group A and 11.67 days (R2 = 0.91) in Group B. Similar half-times were calculated for globe size-corrected concentrations with 8.21 days (R2 = 0.81) in Group A and 11.17 days (R2 = 0.88) in Group B.
CONCLUSION:
Single- and double-dose injections have similar pharmacokinetic characteristics in a first-order exponential decay function. The globe size-corrected concentration and half-time did not affect the calculated half-time in both groups. Doubled dosing induced a higher peak concentration at baseline, but the presumed extended biologic active concentration was no longer statistically significant after 6 weeks. The application of twice the dosage does not double the duration of its efficacy; it rather appears to extend the pharmacological duration by 1 half-time or approximately 8 days to 11 days.
Retina. 2011 Oct;31(9):1841-7.
Intravitreal bevacizumab therapy on an as-per-needed basis in subfoveal choroidal neovascularization secondary to pathological myopia: 2-year outcomes of a prospective case series.
Iacono P, Parodi MB, Papayannis A, Kontadakis S, Sheth S, Bandello F.
Source
Fondazione G. B. Bietti per l'Oftalmologia, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy. Questo indirizzo e-mail è protetto dallo spam bot. Abilita Javascript per vederlo.
Abstract
PURPOSE:
To evaluate the effects of intravitreal bevacizumab in the treatment of subfoveal choroidal neovascularization (CNV) related to pathological myopia.
METHODS:
Thirty eyes with treatment-naive CNV were included. Best-corrected visual acuity on Early Treatment Diabetic Retinopathy Study chart, optical coherence tomography (OCT), and fluorescein angiography assessment was performed at baseline and thereafter monthly for more than 24 months. Intravitreal bevacizumab on an as-per-needed basis was administered if either persistent intraretinal/subretinal fluid was detected on OCT or the presence of leakage was noted on fluorescein angiography. Primary outcome measures included the change in mean best-corrected visual acuity and the proportion of eyes improving by three lines or greater. Secondary outcome measures included the change in mean central macular thickness on OCT. The proportion of eyes with resolution of intraretinal/subretinal fluid on OCT and leakage on fluorescein angiography over the follow-up was also noted.
RESULTS:
Mean best-corrected visual acuity improved from 54.8 ± 14.8 (Early Treatment Diabetic Retinopathy Study letters ± SD) to 59.03 ± 17.0 at 3 months, subsequently stabilizing to 58.63 ± 18.52 at 12 months and 59.25 ± 20 at 24 months. A statistically significant difference was detected only at the 1-month examination. Best-corrected visual acuity at 24 months showed a 3-line improvement in 36.6% of cases and at least a 1-line increment in 43.3% of cases. Mean central macular thickness showed no significant reduction from baseline (216.8 ± 86 µm) up to the end of 24 months (205 ± 77.8 µm). At the last visit, a complete CNV closure was obtained in 93% of cases while intraretinal/subretinal fluid was detected on OCT in 13% of cases. The mean number of intravitreal bevacizumab injections was 4.73 (range, 1-10) at the end of 12 months and 5.9 (range, 1-13) at the end of the 24 months.
CONCLUSION:
Intravitreal bevacizumab injection for myopic subfoveal CNV administered on an as-per-needed basis over 24 months of follow-up achieved stabilization of vision with >90% CNV closure rate.
Ophthalmology. 2011 Oct;118(10):1916-26. Epub 2011 Aug 15.
Randomized comparison of systemic anti-inflammatory therapy versus fluocinolone acetonide implant for intermediate, posterior, and panuveitis: the multicenter uveitis steroid treatment trial.
Multicenter Uveitis Steroid Treatment (MUST) Trial Research Group, Kempen JH, Altaweel MM, Holbrook JT, Jabs DA, Louis TA, Sugar EA, Thorne JE.
Source
Ocular Inflammation Service, The University of Pennsylvania, Philadelphia, Philadelphia, PA 19104, USA.
Abstract
OBJECTIVE:
To compare the relative effectiveness of systemic corticosteroids plus immunosuppression when indicated (systemic therapy) versus fluocinolone acetonide implant (implant therapy) for noninfectious intermediate, posterior, or panuveitis (uveitis).
DESIGN:
Randomized controlled parallel superiority trial.
PARTICIPANTS:
Patients with active or recently active uveitis.
METHODS:
Participants were randomized (allocation ratio 1:1) to systemic or implant therapy at 23 centers (3 countries). Implant-assigned participants with bilateral uveitis were assigned to have each eye that warranted study treatment implanted. Treatment-outcome associations were analyzed by assigned treatment for all eyes with uveitis.
MAIN OUTCOME MEASURES:
Masked examiners measured the primary outcome: change in best-corrected visual acuity from baseline. Secondary outcomes included patient-reported quality of life, ophthalmologist-graded uveitis activity, and local and systemic complications of uveitis or therapy. Reading Center graders and glaucoma specialists assessing ocular complications were masked. Participants, ophthalmologists, and coordinators were unmasked.
RESULTS:
On evaluation of changes from baseline to 24 months among 255 patients randomized to implant and systemic therapy (479 eyes with uveitis), the implant and systemic therapy groups had an improvement in visual acuity of +6.0 and +3.2 letters (P = 0.16, 95% confidence interval on difference in improvement between groups, -1.2 to +6.7 letters, positive values favoring implant), an improvement in vision-related quality of life of +11.4 and +6.8 units (P = 0.043), a change in EuroQol-EQ5D health utility of +0.02 and -0.02 (P = 0.060), and residual active uveitis in 12% and 29% (P=0.001), respectively. Over the 24 month period, implant-assigned eyes had a higher risk of cataract surgery (80%, hazard ratio [HR] = 3.3, P < 0.0001), treatment for elevated intraocular pressure (61%, HR=4.2, P < 0.0001), and glaucoma (17%, HR=4.2, P = 0.0008). Patients assigned to systemic therapy had more prescription-requiring infections than patients assigned to implant therapy (0.60 vs 0.36/person-year, P=0.034), without notable long-term consequences; systemic adverse outcomes otherwise were unusual in both groups, with minimal differences between groups.
CONCLUSIONS:
In each treatment group, mean visual acuity improved over 24 months, with neither approach superior to a degree detectable with the study's power. Therefore, the specific advantages and disadvantages identified should dictate selection between the alternative treatments in consideration of individual patients' particular circumstances. Systemic therapy with aggressive use of corticosteroid-sparing immunosuppression was well tolerated, suggesting that this approach is reasonably safe for local and systemic inflammatory disorders.
FINANCIAL DISCLOSURE(S):
Proprietary or commercial disclosure may be found after the references.
Ophthalmology. 2011 Oct;118(10):2028-34. Epub 2011 Jun 25.
Outcomes and risk factors associated with endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents.
Shah CP, Garg SJ, Vander JF, Brown GC, Kaiser RS, Haller JA; Post-Injection Endophthalmitis (PIE) Study Team.
Collaborators (16)
Baskin DE, Wolfe JD, Baker P, Chiang A, Milder E, Benson W, Federman J, Fischer D, Ho AC, Hsu J, Lucier A, Maguire JI, Arch McNamara J, Regillo CD, Sarin L, Sivalingam A.
Source
Ophthalmic Consultants of Boston, Boston, Massachusetts, USA.
Abstract
OBJECTIVE:
To describe outcomes of and risk factors for endophthalmitis after intravitreal anti-vascular endothelial growth factor (VEGF) injection.
DESIGN:
Single-center, consecutive, case series and retrospective case-control study.
PARTICIPANTS:
Between January 1, 2009, and May 31, 2010, 16 vitreoretinal surgeons administered a total of 27 736 injections. During this period, 23 cases of presumed infectious endophthalmitis occurred. Each surgeon used his own preferred injection technique.
INTERVENTION:
Vitreous or aqueous tap, or both, with intravitreal antibiotic injection and subsequent topical antibiotic and steroid drops.
MAIN OUTCOME MEASURES:
Visual acuity, bladed lid speculum use, conjunctival displacement, hemisphere of injection, bevacizumab versus ranibizumab, and infectious organism.
RESULTS:
Seven of 23 cases had positive culture results; 3 grew coagulase-negative Staphylococcus. All cases had pain and vitritis on average 3.4 days (range, 1-6 days) after injection, with no difference between culture-positive and culture-negative groups. Eighteen (78%) of 23 cases had a hypopyon. Fifteen of 23 cases returned to baseline vision (±2 lines) within 3 months. Neither lid speculum use (0.10% vs. 0.066% in the no-use group; P = 0.27), conjunctival displacement (0.11% vs. 0.076% in the no-displacement group; P = 0.43), hemisphere of injection (0.11% superior vs. 0.079% inferior; P = 0.56), or bevacizumab versus ranibizumab (0.11% vs. 0.066%; P = 0.21) affected risk. Analysis of only culture-positive results yielded similar results. There was no statistically significant difference between the proportion of culture-negative cases after bevacizumab injection (83%) versus ranibizumab injection (55%; P = 0.13).
CONCLUSIONS:
Most patients in whom presumed infectious endophthalmitis develop after anti-VEGF injection regained baseline vision after treatment. Bladed lid speculum use, conjunctival displacement, hemisphere of injection, and type of anti-VEGF agent did not affect risk. No difference in culture-negative endophthalmitis rates was detected after bevacizumab versus ranibizumab injection. Neither the presence of pain, vitritis, decreased vision, hypopyon, nor the interval between injection and development of symptoms differentiate culture-positive from culture-negative cases. Because a subgroup of patients had poor outcomes, a low threshold for vitreous tap with intravitreal antibiotic injection may be warranted.
FINANCIAL DISCLOSURE(S):
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Ophthalmology. 2011 Oct;118(10):2070-5. Epub 2011 Aug 25.
Clinical presentation of familial exudative vitreoretinopathy.
Ranchod TM, Ho LY, Drenser KA, Capone A Jr, Trese MT.
Source
Associated Retinal Consultants, Royal Oak, MI 48073, USA.
Abstract
OBJECTIVE:
To describe the clinical characteristics, staging and presentation of patients with familial exudative vitreoretinopathy (FEVR) in our clinical practice over the last 25 years.
DESIGN:
Case series, retrospective review.
PARTICIPANTS:
We included 273 eyes of 145 patients.
METHODS:
Data collected from charts included gender, gestational age at birth, birthweight, age at presentation, referring diagnosis, family history, prior ocular surgery, and clinical presentation in each eye. Eyes with invasive posterior segment procedures before initial presentation were excluded.
MAIN OUTCOME MEASURES:
Demographics on presentation and clinical staging.
RESULTS:
Patients were slightly male predominant (57%) with a mean birthweight of 2.80 kg (range, 740 g-4.76 kg), mean gestational age of 37.8 weeks (range, 25-42), and mean age at presentation of almost 6 years (range, <1 month-49 years). A positive family history of FEVR was obtained in 18% of patients. A positive family history for ocular disease consistent with but not diagnosed as FEVR was obtained in an additional 19%. Stage 1 FEVR was identified in 45 eyes, stage 2 in 33 eyes, stage 3 in 42 eyes, stage 4 in 89 eyes, and stage 5 in 44 eyes. Radial retinal folds were seen in 77 eyes, 64 of which were temporal or inferotemporal in location.
CONCLUSIONS:
The FEVR patient population is remarkable for the wide range of age at presentation, gestational age, and birthweight. Although a positive family history on presentation may support the diagnosis of FEVR, a negative family history is of little help. The majority of retinal folds extended radially in the temporal quadrants, but radial folds were seen in almost all quadrants. Fellow eyes demonstrated a wide variation in symmetry. The presentation of FEVR may mimic the presentation of other pediatric and adult vitreoretinal disorders, and careful examination is often crucial in making the diagnosis of FEVR.
FINANCIAL DISCLOSURE(S):
The authors have no proprietary or commercial interest in any of the materials discussed in this article.
Am J Ophthalmol. 2011 Oct;152(4):509-14.
How the comparison of age-related macular degeneration treatments trial results will impact clinical care.
Davis J, Olsen TW, Stewart M, Sternberg P Jr.
Source
Bascom Palmer Eye Institute, Miami, Florida, USA.
Abstract
PURPOSE:
To provide a perspective on the impact of the Comparison of Age-related Macular Degeneration Treatments Trial (CATT) on future clinical practices.
DESIGN:
Interpretation of trial outcomes relative to clinical use of neovascular age-related macular degeneration (AMD) treatments, assessment of the influence of study design and execution on results, and review of unanalyzed safety data in the online supplement.
METHODS:
Expert opinion.
RESULTS:
The CATT study supports the selection of either ranibizumab or bevacizumab for treatment of AMD based on factors other than efficacy, such as cost, because monthly administration of bevacizumab was noninferior to the reference treatment of monthly ranibizumab in improving visual acuity at 1 year. Visual acuity results for bevacizumab as needed were inconclusive for noninferiority relative to monthly administration of either drug. The secondary outcome of decrease in thickness at the foveal center as measured by time-domain optical coherence tomography significantly favored the monthly ranibizumab group vs the bevacizumab-as-needed group but is more difficult to interpret as it did not correlate with visual acuity and is less appropriate for a noninferiority design. Bevacizumab groups had a statistically higher observed risk of serious adverse events; however, scrutiny of the online supplements shows similar numbers of cardiac and neurologic events in bevacizumab and ranibizumab users. Information regarding fellow eye treatment with anti-VEGF agents was not given.
CONCLUSIONS:
CATT provides the first level I evidence for bevacizumab in a large number of patients with neovascular AMD. The trial supports use of either drug as primary therapy and suggests that modification of monthly dosing regimens is feasible. A difference in cardiovascular safety between the 2 drugs was not apparent on inspection of the supplementary safety data.
Am J Ophthalmol. 2011 Oct;152(4):686-94. Epub 2011 Jul 22.
Changes in aqueous concentrations of various cytokines after intravitreal triamcinolone versus bevacizumab for diabetic macular edema.
Sohn HJ, Han DH, Kim IT, Oh IK, Kim KH, Lee DY, Nam DH.
Source
Department of Ophthalmology, Hongik Hospital, Seoul, Korea.
Abstract
PURPOSE:
To investigate the changes in aqueous inflammatory and angiogenic cytokine levels after intravitreal injection of triamcinolone or bevacizumab for reducing foveal thickness in diabetic macular edema (DME).
DESIGN:
Prospective, interventional case series.
METHODS:
Twenty-two eyes of 11 patients with bilateral DME and 6 eyes of 6 patients undergoing cataract surgery participated in this study. In each DME patient, 1 eye received an intravitreal injection of 4 mg triamcinolone acetonide and the other eye received 1.25 mg bevacizumab. Aqueous humor samples were obtained before and 4 weeks after the intravitreal injection in the DME group and before the surgery in the control group. Aqueous concentrations of interleukin (IL)-6, IL-8, interferon-induced protein (IP)-10, monocyte chemotactic protein (MCP)-1, platelet-derived growth factor (PDGF)-AA, and vascular endothelial growth factor (VEGF) were measured by multiplex bead assay.
RESULTS:
Before the administration of the drugs, aqueous levels of IL-8, IP-10, MCP-1, and VEGF were significantly higher in the DME group than in the control group. After intravitreal injection, foveal thickness was more decreased in the triamcinolone acetonide (IVTA) group compared with the bevacizumab (IVBe) group. IL-6, IP-10, MCP-1, PDGF-AA, and VEGF were significantly decreased in the IVTA group, but only VEGF in the IVBe group. Aqueous levels of VEGF were more decreased in the IVBe group than in the IVTA group.
CONCLUSIONS:
These findings suggest that the pathogenesis of DME is not only related to VEGF dependency, but also to other mechanisms suppressed by corticosteroids. We suppose that these cytokines would have an important role in both the pathogenesis of DME and the underlying mechanism of intravitreal injections.
Br J Ophthalmol. 2011 Oct;95(10):1415-8. Epub 2011 Jan 26.
Spectral domain optical coherence tomography for higher precision in the evaluation of vitreoretinal adhesions in exudative age-related macular degeneration.
Krebs I, Glittenberg C, Zeiler F, Binder S.
Source
Department of Ophthalmology, Rudolf Foundation Clinic, Vienna, Austria. Questo indirizzo e-mail è protetto dallo spam bot. Abilita Javascript per vederlo.
Abstract
AIM:
The role of changes at the vitreoretinal interface and vitreomacular traction forces in pathogenesis, and the course of exudative age-related macular degeneration (AMD) need further exploration. This study examines the localisation of adhesion and the direction of traction lines in eyes with exudative AMD.
METHODS:
The cubes 512×128 of Cirrus optical coherence tomography (OCT) and volume scans of Spectralis OCT were reviewed in a consecutive series of patients presenting between December 2008 and March 2009 with vitreomacular adhesion in exudative AMD.
RESULTS:
30 eyes of 25 patients with exudative AMD and vitreomacular adhesion were studied. 50% had type III lesions, 46.7% occult and 3.3% predominantly classic lesions. The localisation of the adhesion corresponded in 100% with the area of the neovascularisation (CNV), in 73.3% traction directed towards the CNV and in 83.3% towards the optic disc could be noted. Spectral domain OCT and 3D visualisation enabled clearer localisation of vitreomacular adhesion and definition of resulting traction lines.
CONCLUSION:
There is a high prevalence of type III lesions within eyes with vitreomacular adhesions, and complete correspondence between the location of the adhesion and the CNV. There is also a high incidence of vitreopapillary adhesion in these cases, suggesting a possible role in pathogenesis.
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