[Show abstract][Hide abstract] ABSTRACT: Ranibizumab (Lucentis(R)) is a Fab-antibody fragment developed from Bevacizumab, a full-length anti-VEGF antibody. Both compounds are used for treating age-related macular degeneration (AMD). The influence of bevacizumab and ranibizumab on genes involved in signal transduction and cell signaling downstream of VEGF were compared in order to detect possible differences in their mode of action, which are not related to their Fab-antibody fragments.
[Show abstract][Hide abstract] ABSTRACT: Age-related macular degeneration (AMD) is still referred to as the leading cause of severe and irreversible visual loss world-wide. The disease has a profound effect on quality of life of affected individuals and represents a major socioeconomic challenge for societies due to the exponential increase in life expectancy and environmental risks. Advances in medical research have identified vascular endothelial growth factor (VEGF) as an important pathophysiological player in neovascular AMD and intraocular inhibition of VEGF as one of the most efficient therapies in medicine. The wide introduction of anti-VEGF therapy has led to an overwhelming improvement in the prognosis of patients affected by neovascular AMD, allowing recovery and maintenance of visual function in the vast majority of patients. However, the therapeutic benefit is accompanied by significant economic investments, unresolved medicolegal debates about the use of off-label substances and overwhelming problems in large population management. The burden of disease has turned into a burden of care with a dissociation of scientific advances and real-world clinical performance. Simultaneously, ground-breaking innovations in diagnostic technologies, such as optical coherence tomography, allows unprecedented high-resolution visualisation of disease morphology and provides a promising horizon for early disease detection and efficient therapeutic follow-up. However, definite conclusions from morphologic parameters are still lacking, and valid biomarkers have yet to be identified to provide a practical base for disease management. The European Society of Retina Specialists offers expert guidance for diagnostic and therapeutic management of neovascular AMD supporting healthcare givers and doctors in providing the best state-of-the-art care to their patients.
The British journal of ophthalmology. 09/2014; 98(9):1144-1167.
[Show abstract][Hide abstract] ABSTRACT: The purpose of this four year retrospective study was to compare the anatomical and functional outcomes of complicated retinal detachment (RD) surgery by pars plana vitrectomy (PPV) with and without retinotomy. The main outcome measures were primary anatomical success (defined as retinal re-attachment at the final follow-up after a single operation, with or without silicone in situ), final anatomical success, final best-corrected visual acuity (BCVA) and postoperative complications. Baseline characteristics did not differ between the groups, although there was a borderline significant trend for the retinotomy group to be associated with worse pre-surgical ocular pathology. With a mean follow-up of 18 (±7.8) months, primary anatomical success was achieved in 76.7% (33 of 43) of the retinotomy group eyes vs. 67.8% (40 of 59) of the eyes in the group without retinotomy. Final anatomical success rates for the retinotomy group and no retinotomy group were 100 and 93.2% respectively. The final BCVA was 1.57 LogMAR with retinotomy and 1.38 without retinotomy, an improvement in both groups. The incidence of postoperative complications was similar in the two groups, while the frequency of macular holes was higher in the retinotomy group. A similar degree of improvement in BCVA following both surgeries indicates their similar efficacy and justifies their performance even in complicated eyes in order to improve the patients' quality of life. With neither approach superior to the other, the choice of method should be left to the surgeon.
[Show abstract][Hide abstract] ABSTRACT: PurposeThe purpose was to evaluate the pain associated with intravitreal Ozurdex injections, and to compare it with that associated with intravitreal bevacizumab injections.Methods
The study included 57 eyes of 57 patients who received an intravitreal Ozurdex injection at our institution. Pain was measured by the visual analog scale (VAS). Additional parameters recorded included age, sex, indication for the injection, number of previous Ozurdex injections in the study eye, presence of diabetes mellitus, and lens status. Data were compared with a 2 : 1 sex- and age-matched control group of 114 patients who received intravitreal bevacizumab injections.ResultsIndications for injection included diabetic macular edema (40.4%) and macular edema secondary to central and branch retinal vein occlusion (28% and 31.6%, respectively). Pain scores on the VAS ranged from 0 to 90, with a mean of 20.8±20.3. There was no significant difference in pain between Ozurdex and bevacizumab injections. Pseudophakia was correlated with increased pain in Ozurdex injections.Conclusions
This is the first series evaluating the pain associated with intravitreal Ozurdex injections. Despite a larger needle gauge and tunneled injection technique, intravitreal injection of Ozurdex is not associated with increased pain compared with bevacizumab. This finding may be a potential advantage for Ozurdex, and may serve to improve patient compliance with future long-term treatment protocols.Eye advance online publication, 13 June 2014; doi:10.1038/eye.2014.129.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the onset and duration of improvement in best-corrected visual acuity (BCVA) in eyes treated with dexamethasone intravitreal implant 0.7 mg (DEX implant) for macular edema after branch or central retinal vein occlusion.
Post hoc analysis of data from 2 previously reported multicenter, 6-month, randomized sham-controlled clinical trials. Patients received a single DEX implant (n = 427) or sham procedure (n = 426) in the study eye. The primary endpoint was the percentage of eyes with ≥15-letter improvement in BCVA from baseline at postimplant Day 7.
The baseline mean BCVA was 20/80. At Day 7, 10.3% of DEX implant-treated eyes versus 4.0% of sham-treated eyes (P < 0.001) had ≥15-letter improvement in the BCVA, and 27.2% of DEX implant-treated eyes versus 10.6% of sham-treated eyes had ≥10-letter improvement (P < 0.001). The mean improvement at Day 7 was 5.3 letters (branch retinal vein occlusion, 5.1; and central retinal vein occlusion, 5.8) with DEX implant and 1.6 letters (branch retinal vein occlusion, 2.3; and central retinal vein occlusion, 0.1) with sham (P < 0.001). The mean time from initial observation of ≥15-letter BCVA gain to the last observation of ≥15-letter BCVA gain was 70 days.
Dexamethasone intravitreal implant treatment led to improvement in BCVA compared with sham procedure as early as postimplant Day 7. The duration of ≥3-line improvement was typically 2 to 3 months.
[Show abstract][Hide abstract] ABSTRACT: Purpose: Subthreshold laser treatment of diabetic macular edema (DME) may have less deleterious effects on the photoreceptors than regular continuous wave laser. This study aimed to assess whether subthreshold laser causes a long-term damage to the retinal structures, as demonstrated by spectral-domain optical coherence tomography (SD-OCT), and to evaluate the change in the axial diameter of retinal diabetic microaneurysms following treatment. Methods: A retrospective study of eyes that were diagnosed with non-foveal involving DME and underwent subthreshold laser treatment with the Lumenis Novus SRT system. SD-OCT scans of treated retinal areas, performed prior to treatment and approximately 4 months following treatment, were assessed for changes in the continuity of the photoreceptor (PR) layer, the thickness of the PR-retinal pigment epithelium layer, the retinal thickness at the treatment sites, and the diameter of the microaneurysms. Results: Thirty-one microaneurysms were included in this study. Following treatment, the continuity of the ellipsoid zone of the inner segments of the photoreceptors was confirmed in all but two cases. The thickness of the photoreceptor-retinal pigment epithelium layers was 72.32 ± 7.36 µm and 70.97 ± 7.27 µm prior to and following treatment, respectively (p=0.061). The retinal thickness at the treatment sites decreased from 398.65 ± 57.89 µm to 372.74 ± 60.4 µm (p<0.001). The mean measured diameter of the microaneurysms was 87.32 ± 27.45 µm and 6.68 ± 26.12 µm, respectively (p<0.001). Conclusions: In this study, subthreshold laser treatment for diabetic macular edema has been shown to be safe, as demonstrated by SD-OCT.
[Show abstract][Hide abstract] ABSTRACT: Abstract Objective or Purpose: Macular edema (ME) is secondary to various disease processes. It is most commonly seen following venous occlusive disease, diabetic retinopathy, posterior segment inflammatory disease, and vitreomacular traction syndromes. Treatment varies, depending upon the underlying etiology, and has led to varying degrees of success. Advances in vitreoretinal surgical techniques over the years have expanded the list of indications for vitreoretinal surgical treatment. The purpose of this review is to outline the current use of vitreoretinal surgery and highlight the ever-growing indications for surgery in macular edema. Design: This is a comprehensive review, using Medline, of all literature published on vitreoretinal surgery for macular edema secondary to various conditions. Results: Over 450 abstracts were reviewed, and the articles pertinent to our discussion were selected. The search words were "macular edema" and "pars plana vitrectomy" or "surgery." Conclusions: The pathology of the vitreous body is associated with ME in several different conditions, and vitreoretinal surgical techniques can be effective in the management of ME in the majority of them. The ever-expanding new surgical techniques, as well as the new pharmacologic agents used during surgery, show great promise for the future.
Seminars in ophthalmology 01/2014; · 1.09 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The 12th Euretina Congress
Milan, Italy, 6–9 September 2012
The congress provided a chance for retina specialists all over the world to listen and learn from international world-leading experts in retina sharing their experience and knowledge. Main sessions, free paper presentation sessions, instructional courses and wetlabs took place throughout the 4-day meeting. In addition, joint symposia with both ESCRS and WCPOS added an exciting dimension to the program.
[Show abstract][Hide abstract] ABSTRACT: Purpose
To report the long-term outcomes of triamcinolone acetonide–assisted anterior vitrectomy during complicated cataract surgery with vitreous loss.
Tel Aviv Medical Center, Tel Aviv, Israel.
Consecutive patients who had triamcinolone acetonide–assisted anterior vitrectomy for complicated cataract surgery with vitreous loss between January 2010 and January 2012 were studied. The main outcome measures were the results of the ocular examination and spectral-domain optical coherence tomography of the macula at the last follow-up visit 12 months or more postoperatively. The ocular examination included corrected distance visual acuity (CDVA), intraocular pressure (IOP), and anterior segment and fundus biomicroscopy.
The study included 15 patients (15 eyes) with a mean age of 71 years (range 50 to 92 years). The mean follow-up was 21 months (range 12 to 29 months). At the last follow-up, the mean CDVA was statistically significantly better than preoperatively (0.24 logMAR ± 0.31 [SD] versus 0.89 ± 0.81 logMAR) (P=.0033); all patients had improved CDVA over the preoperative values. Except for 1 patient with a macular scar, all the patients had a CDVA between 20/40 and 20/20. At last follow-up, 1 patient required 2 IOP-lowering medications that had been used preoperatively as well. The mean IOP was 15.3 ± 2.4 mm Hg. There were no cases of residual vitreous strands in the anterior chamber, inflammatory reactions, triamcinolone acetonide crystals, retinal breaks, retinal detachment, or pseudophakic cystoid macular edema.
Triamcinolone acetonide-assisted anterior vitrectomy during complicated cataract surgery with vitreous loss was safe and effective.
No author has a financial or proprietary interest in any material or method mentioned.
Journal of Cataract and Refractive Surgery 01/2014; 40(5):722–727. · 2.75 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To report on the efficacy of macular and optic nerve spectral-domain optical coherence tomography (SD-OCT) in differentiating between long-standing central retinal artery occlusion (CRAO) and nonarteritic anterior ischemic optic neuropathy (NAION).
SD-OCT scans of the macula and optic nerve in 24 patients with unilateral optic atrophy secondary to CRAO (12 patients) and NAION (12 patients) were compared both qualitatively and quantitatively for differentiating features.
In patients with long-standing CRAO, there was a significantly greater (P < .001) thinning of the macula relative to the fellow uninvolved eye (-59.7 ± 31.8 μm) compared to patients with longstanding NAION (-19.9 ± 8.4 μm) even though both conditions caused a similar (P = .726) degree of peripapillary retinal nerve fiber layer loss (-42.4 ± 18.5 μm and -44.1 ± 12.4 μm, respectively).
SD-OCT macular scans can be used as an adjunctive tool for differentiating between longstanding CRAO and NAION. [Ophthalmic Surg Lasers Imaging Retina. 2014;45:38-44.].
[Show abstract][Hide abstract] ABSTRACT: Purpose: Previous reports have demonstrated that the serum levels of vascular endothelial growth factor (VEGF) are reduced after intravitreal injections of bevacizumab. This study aimed to determine the serum levels of ischemia-modified albumin (IMA), a marker of ischemia, and VEGF following intravitreal injections of bevacizumab.
Methods: This was a prospective study. Blood samples were drawn prior to injection and at 1, 7, and 30 days after injection.
Results: A total of 11 patients participated in this study. Mean serum IMA levels were lower than baseline during follow-up, with statistically significant differences compared to baseline levels at day 1 and day 30 (preinjection: 49.82 ± 15.28 ng/mL; 44.57 ± 12.01 ng/mL, p = 0.007, and 43.71 ± 13.82 ng/mL, p = 0.001, respectively). Mean serum VEGF levels were lower than baseline throughout the follow-up period (from 307.45 ± 273.45 pg/mL at baseline to 159.55 ± 120.68 pg/mL at day 30). Mean serum VEGF levels were significantly lower compared to baseline levels at day 1 and day 7 (147.09 ± 106.08 pg/mL, p = 0.014; 72.91 ± 50 pg/mL, p = 0.011, respectively).
Conclusions: In this study, mean serum IMA and VEGF levels were lower following intravitreal bevacizumab injections.
European journal of ophthalmology 12/2013; · 0.91 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Topical bevacizumab is a potential treatment modality for corneal neovascularization, and several recent studies have demonstrated its efficacy. No previous study of the pharmacokinetics of topical bevacizumab has been performed in human eyes. The purpose of this study is to investigate the pharmacokinetics of topical administration of bevacizumab in human eyes, and also to compare the pharmacokinetics of intravitreal bevacizumab injections with previously reported data.
Twenty-two (22 eyes) were included in this study, and divided into four groups: eight patients received topical bevacizumab and aqueous samples were obtained 1 hour later during cataract extraction surgery (group 1), eight patients received topical bevacizumab and vitreous samples were obtained 1 day later during pars-plana vitrectomy (PPV) (group 2), three patients received intravitreal bevacizumab and vitreous samples were obtained during PPV (group 3). Vitreous samples from three patients who received no bevacizumab served as controls (group 4). All samples underwent enzyme-linked immunosorbent assay to detect bevacizumab.
No bevacizumab was detected in the aqueous or vitreous of any topically treated eyes. The mean vitreal half-life for intravitreally injected bevacizumab was 4.9 days in four non-vitrectomized eyes and 0.66 days in one previously vitrectomized eye.
Topically administered bevacizumab does not penetrate the cornea into the anterior chamber and vitreous cavity, indicating that topical use for treating corneal neovascularization has minimal risk of intraocular penetration and adverse events related to intraocular vascular endothelial growth factor inhibition. The half-life following intravitreal bevacizumab injection measured in this study is comparable to that of previous reports, and includes the first demonstration of a significantly reduced half-life following intravitreal injection in a previously vitrectomized eye.
Albrecht von Graæes Archiv für Ophthalmologie 10/2013; · 1.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Abstract Purpose/Aim of the study: To study changes in retinal blood flow velocity in patients with early and neovascular age-related macular degeneration (AMD). We used the Retinal Function Imager (RFI, Optical Imaging Ltd., Rehovot, Israel), a noninvasive diagnostic approach for measuring blood flow velocity. Materials and Methods: Sixty eyes of 43 AMD patients and 53 eyes of 35 healthy individuals over the age of 50 were recruited for this study. All patients were scanned by the RFI with analysis of blood flow velocity of secondary and tertiary branches of arteries and veins. Differences among groups were assessed by mixed linear models. Results: The average velocity in AMD patients was significantly lower compared to controls in arteries (3.6 ± 1.4 versus 4.3 ± 1.0 mm/sec, p = 0.009) but not in veins (2.6 ± 0.9 versus 3.1 ± 0.6 mm/sec, p = 0.08). When comparing the velocity between low- and high-grade AMD eyes, venous velocity was slower in the high grade AMD eyes only in the "narrow" group of vessels. Conclusions: Decreased blood flow velocity in retinal arteries in patients with AMD was found. Despite the fact that AMD is essentially a choroidal disease, retinal vessels show a functional abnormality, which may suggest that the vascular abnormality in this disease is more generalized.
Current eye research 10/2013; · 1.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose: To review the current practice of retreatment with Ozurdex injections in patients with macular edema (ME) secondary to retinal vein occlusion (RVO), and to recommend simple guidelines for Ozurdex reinjection in management of RVO.
Methods: This was a multicenter retrospective study of patients who received more than 2 Ozurdex injections for the treatment of ME in RVO. Recorded parameters included percent of patients with a 15-letter gain, visual acuity (VA) improvement from baseline, change in central macular thickness (CMT), time to reinjection, and occurrence of any complications.
Results: A total of 128 patients were included, 58 (45.3%) with central RVO (CRVO) and 70 (54.7%) with branch RVO (BRVO). Mean interval for Ozurdex reinjection was 5.9 months following the first injection and 8.7 months following the second. A >15-letter gain in VA was observed in 34 (48.8%) patients with CRVO and 16 (28%) patients with BRVO. Mean overall VA improvement at month 6 did not show significance (p>0.05); however, a significantly better mean VA improvement was seen in treatment-naïve eyes (p<0.03). The CMT was significantly reduced compared to baseline. The mean CMT decreased by 214.6 µm in eyes with BRVO (n = 53) and by 355.1 µm in eyes with CRVO (n = 63) (p = 0.002). Complication rates were very low.
Conclusions: Repeated injections of Ozurdex are effective and have a favorable safety profile. In current practice, the retreatment interval with Ozurdex injections might be too long, precluding the full therapeutic potential of this treatment modality. A strategy for managing RVO patients treated with Ozurdex on an as-needed basis is provided.
European journal of ophthalmology 10/2013; · 0.91 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: PURPOSE:: To describe a method for measuring the diameters of large retinal blood vessels by means of spectral domain optical coherence tomography. METHODS:: Prospective cohort study of 29 healthy subjects (58 eyes) who underwent a spectral domain optical coherence tomography examination. Two cubes of horizontal scans were placed at the superior and inferior borders of the disk to include the large temporal retinal vessels. Vessels diameters were measured, and an artery-to-vein ratio was calculated at 10 measurement points (480-1440 μm superiorly and inferiorly from the optic disk border). RESULTS:: The mean age of the study subjects was 41.45 ± 15.53 years. Patients had no ocular or systemic pathologies. The mean diameter of the retinal artery was 135.73 ± 15.64 μm and of the vein 151.32 ± 15.22 μm at the measurement point of 480 μm, with a gradual decrease to 123.01 ± 13.43 μm and 137.69 ± 13.84 μm, respectively, at 1440 μm. The artery-to-vein ratio was ∼0.9 at all points of measurement. CONCLUSION:: This is a new noninvasive method for retinal blood vessels diameter measurement using the spectral domain optical coherence tomography imaging modality. This method may aid in evaluation of retinal and systemic vascular diseases.