Alexandros A Rouvas

Publications (14)23.95 Total impact

• Article: Intravitreal ranibizumab versus thermal laser photocoagulation in the treatment of extrafoveal classic choroidal neovascularization secondary to age-related macular degeneration.

  Ioannis D Ladas, Irini P Chatziralli, Athanasios I Kotsolis, Maria Douvali, Ilias Georgalas, Panagiotis G Theodossiadis, Alexandros A Rouvas
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  ABSTRACT: To compare the efficacy of thermal laser photocoagulation versus intravitreal ranibizumab for the treatment of extrafoveal classic choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). We conducted a retrospective study on 24 eyes with extrafoveal classic CNV secondary to AMD, treated either with thermal laser photocoagulation (group 1) or with intravitreal ranibizumab (group 2). Visual acuity, number of injections/sessions and recurrence rate were assessed. The mean follow-up time was 23.6 ± 2.26 and 19.1 ± 9.74 months for group 1 and 2, respectively. Mean best corrected visual acuity (BCVA) of groups 1 and 2 was 0.59 ± 0.32 and 0.46 ± 0.30 logMAR, respectively (p = 0.343). At the end of the follow-up, mean BCVA of group 1 was 0.92 ± 0.35 and of group 2 0.16 ± 0.12 logMAR and differed statistically compared to baseline (p = 0.02 and p = 0.006, respectively). There was a statistically significant difference between the two groups as far as BCVA at the end of the follow-up was concerned (p < 0.0001). The patients in group 1 received on average 1.38 sessions of thermal laser photocoagulation, while patients in group 2 received on average 4 injections of ranibizumab. The recurrence rate in the laser group was 84.6%, while in the ranibizumab group it was 18.2% (p < 0.001). Specifically, the mean time of recurrence in the laser group was 11.5 months, whereas in the ranibizumab group it was 18 months (p = 0.048). Intravitreal ranibizumab showed promising results in BCVA improvement and decrease in macular thickness in patients with extrafoveal classic CNV due to AMD, with a small number of injections. Laser photocoagulation treatment presented worsening in BCVA and high recurrence rate in our study with long-term follow-up.
  Ophthalmologica 05/2012; 228(2):93-101. · 1.42 Impact Factor
• Article: Long-term results of intravitreal ranibizumab, intravitreal ranibizumab with photodynamic therapy, and intravitreal triamcinolone with photodynamic therapy for the treatment of retinal angiomatous proliferation.

  Alexandros A Rouvas, Irini P Chatziralli, Panagiotis G Theodossiadis, Marilita M Moschos, Athanasios I Kotsolis, Ioannis D Ladas
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  ABSTRACT: To compare intravitreal ranibizumab, intravitreal ranibizumab plus photodynamic therapy (PDT), and intravitreal triamcinolone plus PDT in retinal angiomatous proliferation, presenting the results of a 3-year follow-up. Thirty-seven eyes of 37 patients with retinal angiomatous proliferation were randomized to 1 of the 3 groups. Group 1 (n = 13) received 3 monthly injections of 0.5 mg ranibizumab, Group 2 (n = 13) received 1 session of PDT and 3 monthly injections of ranibizumab, and Group 3 (n = 11) received 1 session of PDT and 1 injection of 4 mg triamcinolone. Retreatment, with the same therapeutic scheme in each group, was considered in case of persistence or recurrence of subretinal/intraretinal fluid. Twelve patients in Groups 1 and 2 and 9 patients in Group 3 completed the 3-year follow-up. A total of 58% of patients in Group 1, 50% in Group 2, and 88.9% in Group 3 had the same or better visual acuity at the end of the follow-up (P = 0.081). Patients in Group 3 exhibited considerable improvement in visual acuity (P = 0.032) and statistically significant decrease in central retinal thickness (P < 0.0001) than the 2 other groups at the end of the follow-up. Also, the patients in Group 3 received on average the lowest number of injections (P < 0.0001). Of note, geographic atrophy mainly at the place of previous retinal angiomatous proliferation lesion was detected in 0% in Group 1, 25% in Group 2, and 55.6% in Group 3 (P = 0.203), while 33.3% of patients in Group 1 developed retinal scar. Treatment with ranibizumab or ranibizumab plus PDT resulted in stabilization of the disease, while treatment with IVT plus PDT achieved better results in terms of functional and anatomical features compared with the other groups.
  Retina (Philadelphia, Pa.) 03/2012; 32(6):1181-9. · 2.93 Impact Factor
• Article: Is topical diclofenac essential before and after uneventful phacoemulsification cataract surgery?

  Marilita M Moschos, Irini P Chatziralli, Panagiotis Pantazis, Alexandros A Rouvas, Theodoros N Sergentanis
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  ABSTRACT: The purpose of our study was to evaluate the effectiveness of preoperative and postoperative addition of topical diclofenac to chloramphenicol/dexamethasone in patients undergoing uneventful phacoemulsification cataract surgery. Patients were randomized to (1) chloramphenicol 0.5%-dexamethasone 0.1%, 1 drop 4 times a day (n=41), or (2) chloramphenicol 0.5%-dexamethasone 0.1%, 1 drop 4 times a day, plus diclofenac 0.1%, 1 drop 3 times a day (n=38). Patients in the second group also received diclofenac 0.1% for 3 days before surgery. Topical treatment was administered for 28 days after phacoemulsification. On postoperative days 1, 14, and 28, best corrected visual acuity, macular thickness, endothelial cell density, and central corneal thickness (CCT) were measured. The 2 groups did not have a statistically significant difference for CCT, endothelial cell density, macular thickness, and visual acuity at the 3 time points of the follow-up period. The addition of diclofenac did not seem to offer any additional benefit after uneventful phacoemulsification.
  Journal of ocular pharmacology and therapeutics: the official journal of the Association for Ocular Pharmacology and Therapeutics 03/2012; 28(4):335-9. · 1.46 Impact Factor
• Source

  Available from: irso.org

  Article: Ranibizumab for the treatment of exudative age-related macular degeneration associated with retinal pigment epithelial tear.

  Alexandros A Rouvas, Ioannis D Ladas, Ilias Georgalas, Ioannis Vergados, Dimitrios Papakonstantinou, Athanasios I Kotsolis
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  ABSTRACT: To evaluate the efficacy of intravitreal ranibizumab in eyes with exudative age-related macular degeneration associated with retinal pigment epithelial tear. In this retrospective case series, patients with active exudative age-related macular degeneration associated with retinal pigment epithelial tear were treated by repeated injections of intravitreal ranibizumab. The outcome measures were best-corrected visual acuity and the signs of lesion activity, as evaluated by optical coherence tomography, fluorescein angiography, and indocyanine green angiography. Twenty-one eyes of 20 patients were followed-up for a median of 12 months (range, 6-28 months). The median number of injections was 7 (range, 3-15). The best-corrected visual acuity improved in 6 eyes (28.57%), remained stable in 12 (57.14%), and decreased in 3 (14.28%). At the end of the follow-up time, 19 eyes (90.47%) had an inactive neovascular lesion in angiography, while 18 eyes (85.71%) had no signs of intraretinal or subretinal fluid. Intravitreal ranibizumab was effective in improving or stabilizing vision and resulting in a quiescent lesion in the majority of patients with exudative age-related macular degeneration associated with retinal pigment epithelial tear. The functional results were apparently better in eyes without foveal involvement by the retinal pigment epithelial tear.
  Retina (Philadelphia, Pa.) 03/2011; 31(6):1083-8. · 2.93 Impact Factor
• Article: Photodynamic therapy, ranibizumab, and ranibizumab with photodynamic therapy for the treatment of polypoidal choroidal vasculopathy.

  Alexandros A Rouvas, Thanos D Papakostas, Amalia Ntouraki, Maria Douvali, Ioannis Vergados, Ioannis D Ladas
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  ABSTRACT: The purpose of this study was to compare photodynamic therapy (PDT), ranibizumab, and ranibizumab with PDT in polypoidal choroidal vasculopathy. In this retrospective comparative study, 30 eyes of 30 patients with polypoidal choroidal vasculopathy were assigned to 1 of the 3 groups. The patients in Group 1 (n = 11) received 1 session of PDT. The patients in Group 2 (n = 10) received 3 monthly intravitreal injections of 0.5 mg ranibizumab, and the patients in Group 3 (n = 9) received 1 session of PDT and 3 injections of 0.5 mg ranibizumab. Retreatment, with the same therapeutic scheme in each group, was considered in case of leaking polyps on the indocyanine green angiography in Groups 1 and 3 and persistence or recurrence of subretinal fluid, intraretinal fluid, and/or hemorrhages in Group 2. All the patients completed 12 months of follow-up. The visual acuity in the patients of Group 1 improved by 0.25 logarithm of the minimum angle of resolution units (P < 0.001), whereas the differences in the visual acuity in the other 2 groups were not statistically significant (0.04 logarithm of the minimum angle of resolution, P = 0.8118 in Group 2 and 0.18 logarithm of the minimum angle of resolution, P > 0.05 in Group 3). Of the patients in Group 1, 45.45% gained more than 3 lines (P = 0.0056), whereas no patient in Groups 2 and 3 experienced such a difference. No patient in Group 1 and 11.1% (n = 1) in Group 3 had angiographically evident polyps at 12 months, whereas 90% (n = 9) of the patients in Group 2 had persistent leakage. No extensive submacular hemorrhage or other complications were noted during the follow-up period. Photodynamic therapy resulted in a significantly better outcome at the end of the follow-up, whereas the patients who received ranibizumab or PDT and ranibizumab experienced a stabilization of the disease.
  Retina (Philadelphia, Pa.) 03/2011; 31(3):464-74. · 2.93 Impact Factor
• Article: Intravitreal ranibizumab treatment of macular choroidal neovascularization secondary to angioid streaks: one-year results of a prospective study.

  Ioannis D Ladas, Athanasios I Kotsolis, Dimitrios S Ladas, Maria Niskopoulou, Ilias Georgalas, Dimitrios Papakonstantinou, Alexandros A Rouvas
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  ABSTRACT: The purpose of this study was to evaluate the efficacy of intravitreal ranibizumab in eyes with macular choroidal neovascularization secondary to angioid streaks. A prospective interventional case series was conducted on eyes with macular choroidal neovascularization, secondary to angioid streaks, treated by repeated injections of intravitreal ranibizumab (0.5 mg) and completing a follow-up time of 1 year. The outcome measures were best-corrected visual acuity, greatest lesion height as evaluated by optical coherence tomography, and lesion size as assessed by fluorescein angiography. Over a 16-month period, we treated 15 consecutive eyes. The average number of injections was 7.1 +/- 0.5. Mean best-corrected visual acuity was improved from 20/100 to 20/50 (P = 0.006). Best-corrected visual acuity either improved or stabilized in 14 eyes (93.3%). At baseline, 3 of the 15 eyes (20%) had a best-corrected visual acuity of >or=20/50 compared with 10 eyes (66.7%) at the end of the first year. Fourteen eyes (93.3%) presented reduction in greatest lesion height and stabilization or reduction in lesion size. The mean greatest lesion height was decreased from 377.3 +/- 139.7 microm to 270.2 +/- 88.6 microm (P < 0.001). Intravitreal ranibizumab is highly effective in improving or stabilizing vision and lesion morphology in patients with macular choroidal neovascularization secondary to angioid streaks.
  Retina (Philadelphia, Pa.) 09/2010; 30(8):1185-9. · 2.93 Impact Factor
• Article: Safety of repeat intravitreal injections of bevacizumab versus ranibizumab: our experience after 2,000 injections.

  Ioannis D Ladas, Dimitrios A Karagiannis, Alexandros A Rouvas, Athanasios I Kotsolis, Andromachi Liotsou, Ioannis Vergados
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  ABSTRACT: To compare the safety of repeat intravitreal injections of bevacizumab versus ranibizumab performed on a large series of patients during the past 2 years period of time. Four hundred fifty patients receiving 2,000 injections (1,275 bevacizumab and 725 ranibizumab) were studied retrospectively. Injections performed in a usual examination room under the standard sterile conditions. Follow-up varied from 3 to 24 months. Serious ocular adverse events were uncommon. Only one patient developed retinal detachment (0.05%). Most common procedure-related ocular adverse event was injection-site redness (64.75%). Postoperative subconjuctival hemorrhage occurred after 200 (10%) injections. Patients receiving aspirin treatment were more prone to have subconjuctival hemorrhage (P = 0.0002). Most common drug-related ocular adverse event was uveitis (1.90%), which was treated successfully and lasted no >12 days. There was no statistically significant difference between the patients treated with bevacizumab or ranibizumab regarding the noted adverse events (P > 0.5%). Multiple intravitreal injections of bevacizumab or ranibizumab were both well tolerated and safe. Performing injections on a usual examination room proved safe. Injection-site redness, subconjuctival hemorrhage, and uveitis were the most common ocular adverse events. Aspirin treatment was a risk factor for the development of subconjuctival hemorrhage.
  Retina (Philadelphia, Pa.) 04/2009; 29(3):313-8. · 2.93 Impact Factor
• Source

  Available from: Dimitrios A Karagiannis

  Article: Photodynamic therapy of choroidal neovascularization with enlargement of the spot size to include the feeding complex.

  Ilias Georgalas, Alexandros A Rouvas, Dimitrios A Karagiannis, Athanasios I Kotsolis, Ioannis D Ladas
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  ABSTRACT: This is a case report of a 83-year-old man with choroidal neovascularization (CNV), due to age-related macular degeneration (AMD) in his right eye. Digital fluorescein (FA) and indocyanine green angiography (ICG) were performed, which disclosed predominantly classic subfoveal CNV and a dilated and tortuous feeding complex. The visual acuity was 20/800. Anti-vascular endothelial growth factor (anti-VEGF) treatment was suggested, however, the patient was not keen to receive an intraocular injection. Modified photodynamic therapy (PDT) with spot size enlarged, to include not only the CNV lesion but the feeding complex as well, was performed. Ten days after one session of PDT, ICG showed absence of leakage from the CNV and complete occlusion of the feeding complex. The visual acuity gradually improved to 20/100 and remained stable during the following 23 months. No evidence of CNV leakage was seen in the FA and ICG during the follow up period. Adjustment of the PDT spot size to include the detectable by ICG feeding complex might be an additional option in order to close the subfoveal CNV and might be considered as an alternative to intravitreal injection of anti-VEGF in selected cases where anti-VEGF treatment is not available.
  Clinical ophthalmology (Auckland, N.Z.) 02/2009; 3:13-6.
• Source

  Available from: PubMed Central

  Article: Quantitative determination of glycosaminoglycans in tears of diabetic patients.

  Marilita M Moschos, Alexandros A Rouvas, Spyridon Papadimitriou, Athanasios Kotsolis, Nikolaos Sitaras, Michael Apostolopoulos
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  ABSTRACT: To determine the amount of glycosaminoglycans (GAGs) in tears of patients with diabetic retinopathy (DR) and to compare it with normal subjects. 38 patients with DR and 24 normal volunteers were included. Thirty subjects suffered from background diabetic retinopathy (BDR) and 8 from proliferate diabetic retinopathy (PDR). For the GAGs assay, the uronic carbazole reaction was used. The mean concentration of GAGs was significantly higher in patients with DR than in normal subjects. The GAGs concentration in patients with BDR or PDR was significantly higher than in normal subjects. The measurement of GAGs in tears of diabetic patients could be a tool in order to assess the stability or not of the disease.
  Clinical ophthalmology (Auckland, N.Z.) 10/2008; 2(3):581-4.
• Article: Enlargement of the hypofluorescent post photodynamic therapy treatment spot after a combination of photodynamic therapy with an intravitreal injection of bevacizumab for retinal angiomatous proliferation.

  Alexandros A Rouvas, Thanos D Papakostas, Ioannis D Ladas, Ioannis Vergados
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  ABSTRACT: To report a case of enlargement of the post photodynamic therapy treatment (PDT) spot in a patient with retinal angiomatous proliferation (RAP) that was treated with PDT combined with an intravitreal injection of bevacizumab. 74-year-old woman with RAP due to age-related macular degeneration was treated with one verteporfin PDT session, sequenced by a single intravitreal injection of bevacizumab (1.25 mg) after 30 minutes. The patient's visual acuity (VA) at baseline was 20/200 and is now at the 10-month follow-up visit 20/400, while the RAP has disappeared according to the indocyanine angiography (ICG) findings. The post PDT hypofluorescent treatment spot has enlarged from 1,450 microm at the day of the treatment, to 5,360 microm at the 6-week visit. The patient is now at the 10-month follow-up visit and the hypofluorescence is still persisting. The simultaneous combination of PDT with bevacizumab in patients with RAP may enhance the photochemical stress in normal choroid with prolonged and magnified hypofluorescence in ICG, due to ischemia in normal choriocapillaries.
  Albrecht von Graæes Archiv für Ophthalmologie 03/2008; 246(2):315-8. · 2.17 Impact Factor
• Article: Quantitative determination of glycosaminoglycans in tears of diabetic patients

  Marilita M Moschos, Alexandros A Rouvas, Papadimitriou Spyridon, Kotsolis Athanasios, Sitaras Nikolaos, Apostolopoulos Michael
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  ABSTRACT: Marilita M Moschos1, Alexandros A Rouvas1, Spyridon Papadimitriou1, Athanasios Kotsolis1, Nikolaos Sitaras2, Michael Apostolopoulos11Department of Ophthalmology; 2Department of Pharmacology, University of Athens, GreecePurpose: To determine the amount of glycosaminoglycans (GAGs) in tears of patients with diabetic retinopathy (DR) and to compare it with normal subjects.Methods: 38 patients with DR and 24 normal volunteers were included. Thirty subjects suffered from background diabetic retinopathy (BDR) and 8 from proliferate diabetic retinopathy (PDR). For the GAGs assay, the uronic carbazole reaction was used.Results: The mean concentration of GAGs was significantly higher in patients with DR than in normal subjects. The GAGs concentration in patients with BDR or PDR was significantly higher than in normal subjects.Conclusion: The measurement of GAGs in tears of diabetic patients could be a tool in order to assess the stability or not of the disease.Keywords: glycosaminoglycans, tears, diabetic retinopathy
  Clinical Ophthalmology. 01/2008;
• Article: Photodynamic therapy of choroidal neovascularization with enlargement of the spot size to include the feeding complex

  Georgalas Ilias, Alexandros A Rouvas, Dimitrios A Karagiannis, Athanasios I Kotsolis, Ioannis D Ladas
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  ABSTRACT: Ilias Georgalas, Alexandros A Rouvas, Dimitrios A Karagiannis, Athanasios I Kotsolis, Ioannis D LadasDepartment of Ophthalmology, Medical School of Athens University, Athens, GreeceAbstract: This is a case report of a 83-year-old man with choroidal neovascularization (CNV), due to age-related macular degeneration (AMD) in his right eye. Digital fluorescein (FA) and indocyanine green angiography (ICG) were performed, which disclosed predominantly classic subfoveal CNV and a dilated and tortuous feeding complex. The visual acuity was 20/800. Anti-vascular endothelial growth factor (anti-VEGF) treatment was suggested, however, the patient was not keen to receive an intraocular injection. Modified photodynamic therapy (PDT) with spot size enlarged, to include not only the CNV lesion but the feeding complex as well, was performed. Ten days after one session of PDT, ICG showed absence of leakage from the CNV and complete occlusion of the feeding complex. The visual acuity gradually improved to 20/100 and remained stable during the following 23 months. No evidence of CNV leakage was seen in the FA and ICG during the follow up period. Adjustment of the PDT spot size to include the detectable by ICG feeding complex might be an additional option in order to close the subfoveal CNV and might be considered as an alternative to intravitreal injection of anti-VEGF in selected cases where anti-VEGF treatment is not available.Keywords: age-related macular degeneration, choroidal neovascularization, photodynamic treatment, feeder vessel
  Clinical Ophthalmology. 01/2008;
• Article: Intravitreal bevacizumab combined with photodynamic therapy for the treatment of occult choroidal neovascularization associated with serous pigment epithelium detachment in age-related macular degeneration.

  Ioannis D Ladas, Athanasios I Kotsolis, Thanos D Papakostas, Alexandros A Rouvas, Dimitrios A Karagiannis, Ioannis Vergados
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  ABSTRACT: To evaluate the efficacy of intravitreal injection of bevacizumab combined with photodynamic therapy (PDT) for the treatment of occult choroidal neovascularization (CNV) associated with serous pigment epithelium detachment (s-PED) due to age-related macular degeneration (AMD). In this retrospective study, six patients (six eyes) with subfoveal occult CNV associated with s-PED due to AMD were treated with intravitreal bevacizumab combined with PDT. All patients were treated at baseline with PDT followed by intravitreal bevacizumab 1.25 mg 1 hour later. Afterwards, according to the findings of optical coherence tomography and fluorescein angiography, repeat bevacizumab injections were given, if necessary, monthly for three doses followed by further doses every 3 months. PDT was repeated every 3 months according to the same criteria. Follow-up time was 9 months. All patients completed their treatment during the first 3 months from baseline. Best-corrected visual acuity (BCVA) improved or remained stable related to the baseline values in all patients at the end of the follow-up time. Mean BCVA improved from 20/67 to 20/42. S-PED and subretinal fluid decreased or disappeared. The mean central 1-mm retinal thickness was reduced from baseline value for the 9-month follow-up period by 128 microm. Intravitreal bevacizumab combined with PDT seems to be a promising treatment with good functional and anatomical results for occult CNV associated with s-PED due to AMD.
  Retina 10/2007; 27(7):891-6. · 2.81 Impact Factor
• Article: Efficacy of photodynamic therapy in the management of occult choroidal neovascularization associated with serous pigment epithelium detachment.

  Ioannis D Ladas, Athanasios I Kotsolis, Alexandros A Rouvas, Dimitrios Brouzas, Marilita M Moschos
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  ABSTRACT: To evaluate the efficacy of photodynamic therapy (PDT) in the treatment of subfoveal occult choroidal neovascularization (CNV) associated with serous pigment epithelium detachment (PED) in eyes with age-related macular degeneration. Hundred and fifty-three patients (161 eyes) with subfoveal occult CNV due to age-related macular degeneration, were divided into two groups. The first group (70 patients, 75 eyes) included eyes with occult CNV associated with serous PED of at least 1 disc diameter in size and the second (83 patients, 86 eyes) eyes with late leakage of undetermined source. All the patients were treated with PDT. The follow-up time ranged from 12 to 48 months. At the last examination, in the first group, the visual acuity (VA) improved or remained stable in 17 (22.7%) and decreased in 58 (77.3%). In the second group, the VA improved or remained stable in 37 (43%) and decreased in 49 (57%). The difference in the change (decrease) in the VA between the two groups was statistically very significant (p = 0.0075). Retinal pigment epithelium tear occurred in 15 eyes (20%) of the first group. Our study showed that the visual prognosis of eyes treated with PDT due to subfoveal occult CNV associated with serous PED is not favorable. We believe that the distinction between the two forms of occult CNV is essential, as they carry a different prognosis.
  Ophthalmologica 02/2007; 221(5):313-9. · 1.42 Impact Factor