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ABSTRACT: Ocular inflammatory disorders constitute a sight-threatening group of diseases that might be managed according to their severity. Their treatment guidelines experience constant changes with new agents that improve the results obtained with former drugs. Nowadays we can make use of a five step protocol in which topical, periocular and systemic corticosteroids remain as the main therapy for non-infectious uveitis. In addition, immunosuppresive drugs can be added in order to enhance the anti-inflammatory effects and to play the role of corticosteroid-sparing agents. These can be organized in four other steps: cyclosporine and methotrexate in a second one; azathioprine, mycophenolate and tacrolimus in a third step; biological anti-TNF drugs in fourth position; and a last one with cyclophosphamide and chlorambucil. In the present review we go through the main characteristics and complications of all these treatments and make a rational of this five-step treatment protocol for non-infectious posterior uveitis.
Inflammation & allergy drug targets. 02/2013; 12(1):38-45.
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Archives of ophthalmology 11/2012; 130(11):1475-6. · 3.86 Impact Factor
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Acta ophthalmologica 09/2012; · 2.44 Impact Factor
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Albrecht von Graæes Archiv für Ophthalmologie 04/2012; 250(7):955-6. · 2.17 Impact Factor
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ABSTRACT: BACKGROUND: The purpose of this study was to compare the efficacy of intravitreal ranibizumab in the treatment of macular edema due to branch retinal vein occlusions (BRVO) with and without serous macular neuroretinal detachment (SMD). METHODS: Forty-nine eyes of 49 patients with macular edema due to branch retinal vein occlusion (22 with SMD and 27 without SMD) were included in this prospective, parallel-group, comparative study. Intravitreal injection of ranibizumab was administered at baseline. Thereafter patients were followed monthly and further injections were performed in the presence of persistence or recurrence of macular thickening. Flattening of the macula was considered success. At the last visit, best-corrected visual acuity (BCVA), and spectral-domain optical coherence tomography (SD-OCT) quantitative parameters (central subfield thickness, cube volume, average cube thickness) were compared between groups. RESULTS: In patients with SMD, BCVA and all the SD-OCT quantitative parameters improved significantly after a mean number of 5.0 ranibizumab intravitreal injections through a median follow-up of 12.5 months (range, 7-34). In patients without SMD, all the variables analyzed improved significantly except for the cube volume, after a mean number of 4.3 ranibizumab intravitreal injections through a median follow-up of 10.4 months (range, 6.5-40.2). The numbers of injections were similar in both groups. The final BCVA was better in patients without SMD at baseline but without significant differences in the SD-OCT parameters between groups. CONCLUSIONS: The presence of SMD may be a baseline predictive factor for ranibizumab treatment outcomes in BRVO patients, with no influence in the number of treatments needed between patients with or without SMD at baseline. Further studies are needed in order to confirm the role of SMD as an independent predicitive factor in cases of BRVO.
Albrecht von Graæes Archiv für Ophthalmologie 04/2012; · 2.17 Impact Factor
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American journal of ophthalmology 02/2012; 153(2):389; author reply 389-90. · 3.83 Impact Factor
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ABSTRACT: Macular edema is the leading cause of visual impairment in patients with retinal vein occlusion. Limited improvements may be obtained with laser photocoagulation or intravitreal triamcinolone. However, according to the data provided by randomized clinical trials, intravitreal injections of ranibizumab (Lucentis; Genentech, South San Francisco, CA) constitute a new effective and safe option for the management of these vision-threatening diseases. The aim of the present review is to summarize the clinical evidence of ranibizumab for macular edema due to retinal vein occlusions.
Opthalmology and Eye Diseases 01/2012; 4:15-21.
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ABSTRACT: To report a case of Coats' disease managed with the dexamethasone intravitreal implant Ozurdex(®) (Allergan, Inc., Irvine, Calif., USA) combined with retinal photocoagulation.
A 46-year-old female with 20/200 visual acuity was diagnosed with Coats' disease with secondary retinal vasoproliferative tumor. An initial approach was performed with an intravitreal injection of the sustained-release dexamethasone implant Ozurdex. After reattachment of the retina, the telangiectatic vessels were treated with laser photocoagulation.
The patient's visual acuity improved to 20/25 after the intravitreal Ozurdex. No further recurrences of exudation were evident through the 12-month follow-up.
Ozurdex may be an effective initial therapeutic approach for Coats' disease with immediate anatomical response and visual improvement.
Case reports in ophthalmology. 01/2012; 3(1):123-7.
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ABSTRACT: The purpose of this study was to determine the efficacy of an intraoperative intravitreal pegaptanib injection during phacoemulsification in preventing the development of pseudophakic cystoid macular edema (CME) following cataract surgery.
This prospective, controlled pilot study was carried out at the Department of Ophthalmology, Nuevo Hospital Universitario y Politécnico La Fe, Valencia (Spain). Five hundred patients with cataract and healthy retina were included in the study. Patients were assigned in a 1:1 ratio to receive an intraoperative intravitreal pegaptanib injection (n=250) or not (control group, n=250) associated with standardized phacoemulsification surgery and postoperative treatment. Any surgical complication was considered as an exclusion criterion. The main outcome measure was the incidence of CME at 4 weeks postsurgery, defined as a central foveal thickness greater than 350 μm as measured by spectral-domain optical coherence tomography with associated cystoid changes.
The incidence of CME by the fourth postoperative week was 0.4% (n=1) in the pegaptanib group and 4.4% (n=11) in the control group (P=0.009).
Prophylactic use of intravitreal pegaptanib immediately after phacoemulsification was effective in preventing CME by the fourth postoperative week. The inclusion of intravitreal pegaptanib injection in the prophylaxis of pseudophakic CME will be considered for complicated cases in forthcoming studies.
Journal of ocular pharmacology and therapeutics: the official journal of the Association for Ocular Pharmacology and Therapeutics 09/2011; 28(1):65-8. · 1.46 Impact Factor
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ABSTRACT: Vogt-Koyanagi-Harada (VKH) prognosis depends on early recognition and treatment; chronic disease may be developed when either delayed or inadequate treatment is performed, whereas other cases despite correct treatment are refractory to different drugs and also become chronic. We report a case of refractory VKH controlled with rituximab treatment.
A 41-year-old female with painful visual loss and headache was examined. (VA 0.4 in RE and hand movements (HM) in LE). Retinal examination demonstrated multiple serous retinal detachments in both eyes. High-dose oral steroids were started, followed by progressive tapering of prednisone. New acute anterior and posterior relapses were achieved, and other immunommodulators were progressively added-new high-dose steroid treatment, adalimumab, cyclosporine, and methotrexate-but patient had new anterior and posterior recurrences associated with tinnitus and headache. Thus, an infusion of 1 g of rituximab was administered after 15 months follow-up; the VA was 0.2 in RE and counting fingers in LE. Three additional doses of 1 g each were administered 1, 6, and 16 months later. We have achieved a final VA after 34 months follow-up of 0.2 in RE and HM in LE, with definitive control of inflammation, without acute relapses since rituximab was administered.
After searching PubMed/Medline, this is the first report of VKH disease treated with rituximab. Additional studies are warranted to confirm the efficacy of this new approach for inflammatory control in refractory cases of VKH disease.
Journal of ophthalmic inflammation and infection. 07/2011; 1(4):177-80.
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ABSTRACT: The aim of this study was to compare the efficacy of spectral-domain optical coherence tomography (SD-OCT) and fluorescein angiography (FA) in the guidance of macular laser photocoagulation for diabetic macular edema.
This was a prospective interventional clinical comparative pilot study. Forty eyes from 24 consecutive patients with diabetic macular edema were allocated to receive laser photocoagulation guided by SD-OCT or FA. Best-corrected visual acuity (BCVA), central macular thickness, and retinal volume were assessed at baseline and two months after treatment.
Subjects treated using FA-guided laser improved BCVA from the logarithm of the minimum angle of resolution (logMAR) 0.52 ± 0.2 to 0.37 ± 0.2 (P < 0.001), and decreased mean central macular thickness from 397.25 ± 139.1 to 333.50 ± 105.7 μm (P < 0.001) and retinal volume from 12.61 ± 1.6 to 10.94 ± 1.4 mm(3) (P < 0.001). Subjects treated using SD-OCT guided laser had improved BCVA from 0.48 ± 0.2 to 0.33 ± 0.2 logMAR (P < 0.001), and decreased mean central macular thickness from 425.90 ± 149.6 to 353.4 ± 140 μm (P < 0.001) and retinal volume from 12.38 ± 2.1 to 11.53 ± 1.1 mm(3) (P < 0.001). No significant differences between the groups were found in two-month BCVA (P = 0.505), two-month central macular thickness (P = 0.660), or two-month retinal volume (P = 0.582).
The short-term results of this pilot study suggest that SD-OCT is a safe and effective technique and could be considered as a valid alternative to FA in the guidance of macular laser photocoagulation treatment for diabetic macular edema.
Clinical Ophthalmology 01/2011; 5:613-7.
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ABSTRACT: Introduction: An entirely new type of staphyloma has been recently described as dome-shaped macula (DSM). It is characterized by an abnormal convex macular contour within the concavity of a posterior staphyloma. We found DSM associated with serous macular detachment (SMD) and tilted disc in two consecutive cases. Case Reports: Case 1: A 37-year-old female presented to our department because of sudden onset blurred vision in her right eye (OD). The best-corrected visual acuity (BCVA) was 0.5 in both eyes. Funduscopy evidenced bilateral tilted disc associated with posterior staphyloma. Optical coherence tomography (OCT) demonstrated a DSM with SMD in her OD. After 15 months of follow-up, BCVA of her OD remained stable with chronic SMD. Case 2: A 32-year-old female presented to our department because of blurred vision in her OD. The BCVA was 0.4 in the OD and 1.0 in the left eye (OS). Bilateral tilted disc and posterior staphyloma were evidenced in the funduscopy. OCT demonstrated a bilateral DSM with SMD in her OD. After 45 months of follow-up, two further episodes of transient SMD were observed in her OD and seven in her OS. The final BCVA was 0.63 in the OD and 0.8 in the OS. Discussion: SMD associated with tilted disc constitutes a potential cause of subretinal fluid accumulation in myopic patients. OCT is essential for the detection of both SMD and DSM.
Case reports in ophthalmology. 01/2011; 2(1):111-5.
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ABSTRACT: To evaluate the efficacy of intravitreal injections of ranibizumab in adult-onset foveomacular vitelliform dystrophy (AOFVD).
Six female patients were misdiagnosed in the office as occult choroidal neovascularization due to AMD, and scheduled for 3-monthly intravitreal injections of ranibizumab. One month after the third injection, all patients underwent further examinations consisting of visual acuity, optical coherence tomography, Indocyanine Green angiography, electrophysiological tests (electroretinogram and electrooculogram), and an exhaustive familial history of macular diseases. Cases were followed-up every 6 weeks since the formal diagnose of AOFVD was evidenced.
The mean BCVA improved from 0.36 ± 0.1 at baseline to 0.56 ± 0.1 (p = 0.038). No significant change was evidence in the SD-OCT thickness analysis. Metamorphopsia disappeared completely in all cases after the first injection. No familial history was evidenced.
Ranibizumab intravitreal injections are effective in the short-term BCVA improvement in patients with AOFVD.
Albrecht von Graæes Archiv für Ophthalmologie 10/2010; 249(3):455-8. · 2.17 Impact Factor
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Albrecht von Graæes Archiv für Ophthalmologie 07/2010; 248(7):1047-8. · 2.17 Impact Factor
