Anat Loewenstein

Tel Aviv Sourasky Medical Center, Tell Afif, Tel Aviv, Israel

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Publications (257)630.6 Total impact

  • Roy Schwartz · Anat Loewenstein ·

    12/2015; 1(1). DOI:10.1186/s40942-015-0022-7
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    ABSTRACT: Dexamethasone intravitreal implant 0.7 mg (DEX 0.7) was approved for treatment of diabetic macular edema (DME) after demonstration of its efficacy and safety in the MEAD registration trials. We performed subgroup analysis of MEAD study results to evaluate the efficacy and safety of DEX 0.7 treatment in patients with previously treated DME. Three-year, randomized, sham-controlled phase 3 study in patients with DME, best-corrected visual acuity (BCVA) of 34–68 Early Treatment Diabetic Retinopathy Study letters (20/200–20/50 Snellen equivalent), and central retinal thickness (CRT) ≥300 μm measured by time-domain optical coherence tomography. Patients were randomized to 1 of 2 doses of DEX (0.7 mg or 0.35 mg), or to sham procedure, with retreatment no more than every 6 months. The primary endpoint was ≥15-letter gain in BCVA at study end. Average change in BCVA and CRT from baseline during the study (area-under-the-curve approach) and adverse events were also evaluated. The present subgroup analysis evaluated outcomes in patients randomized to DEX 0.7 (marketed dose) or sham based on prior treatment for DME at study entry. Baseline characteristics of previously treated DEX 0.7 (n = 247) and sham (n = 261) patients were similar. In the previously treated subgroup, mean number of treatments over 3 years was 4.1 for DEX 0.7 and 3.2 for sham, 21.5 % of DEX 0.7 patients versus 11.1 % of sham had ≥15-letter BCVA gain from baseline at study end (P = 0.002), mean average BCVA change from baseline was +3.2 letters with DEX 0.7 versus +1.5 letters with sham (P = 0.024), and mean average CRT change from baseline was −126.1 μm with DEX 0.7 versus −39.0 μm with sham (P < 0.001). Cataract-related adverse events were reported in 70.3 % of baseline phakic patients in the previously treated DEX 0.7 subgroup; vision gains were restored following cataract surgery. DEX 0.7 significantly improved visual and anatomic outcomes in patients with DME previously treated with laser, intravitreal anti-vascular endothelial growth factor, intravitreal triamcinolone acetonide, or a combination of these therapies. The safety profile of DEX 0.7 in previously treated patients was similar to its safety profile in the total study population. Trial registration NCT00168337 and NCT00168389, registered 12 September 2005
    BMC Ophthalmology 12/2015; 15(1). DOI:10.1186/s12886-015-0148-2 · 1.02 Impact Factor
  • Yit Yang · Clare Bailey · Anat Loewenstein · Pascale Massin ·
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    ABSTRACT: Purpose: To review the relationship between kinetics, efficacy, and safety of several corticosteroid formulations for the treatment of diabetic macular edema. Methods: Reports of corticosteroid use for the treatment of diabetic macular edema were identified by a literature search, which focused on the pharmacokinetics, efficacy, and safety of these agents in preclinical animal models and clinical trials. Results: Available corticosteroids for diabetic macular edema treatment include intravitreal triamcinolone acetonide, dexamethasone, and fluocinolone acetonide. Because of differences in solubility and bioavailability, various delivery mechanisms are used. Bioerodible delivery systems achieve higher maximum concentrations than nonbioerodible formulations. There is a relationship between visual gains and drug persistence in the intravitreal compartment. Safety effects were more complex; level of intravitreal triamcinolone acetonide exposure is related to development of elevated intraocular pressure and cataract; this does not seem to be the case for dexamethasone, where two different doses showed similar mean intraocular pressure and incidence of cataract surgery. With fluocinolone acetonide, rates of intraocular pressure elevations requiring surgery seem to be dose related; rates of cataract extraction were similar regardless of dose. Conclusion: Available corticosteroids for diabetic macular edema exhibit different pharmacokinetic profiles that impact efficacy and adverse events and should be taken into account when developing individualized treatment plans.This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially.
    Retina (Philadelphia, Pa.) 09/2015; DOI:10.1097/IAE.0000000000000726 · 3.24 Impact Factor
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    ABSTRACT: Adipose tissue-derived mesenchymal stem cells (ASCs) can be isolated from subcutaneous fat harvested by tissue resection or liposuction. The authors compared ASCs isolated by tissue resection or power-assisted liposuction (PAL) to determine whether either surgical procedure yielded ASCs with improved purity and competence that was preserved for several passages. For this experimental study, ASCs were isolated from fat harvested by tissue resection or PAL from six patients who underwent abdominoplasty. ASCs were counted to determine cell yields, and viabilities were assessed with an amine-reactive dye and by fluorescence-activated cell sorting (FACS). Cell phenotypes were determined by immunostaining and FACS, and doubling times were calculated. Senescence ratios of the cells were detected by gene profiling and by assaying β-galactosidase activity. Multipotency was evaluated by induced differentiation analyses. No significant differences were observed in cell numbers or viabilities of ASCs isolated following either surgical method of fat harvesting. Both populations of cultured ASCs expressed markers of mesenchymal stem cells and preserved this expression pattern through the third passage. PAL and tissue resection yielded ASCs with similar division rates, similar senescence ratios into the fourth passage, and similar capacities to differentiate into osteocytes or adipocytes. Fat harvested by PAL or tissue resection yielded uniform cultures of ASCs with high division rates, low senescence ratios, and multipotency preserved into passages 3 and 4. Because PAL is less invasive, it may be preferable for the isolation of ASCs. © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission:
    Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery 09/2015; 35(7). DOI:10.1093/asj/sjv055 · 1.84 Impact Factor
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    ABSTRACT: To assess the efficacy and safety of intraocular injections of bevacizumab in patients with macular edema (ME) following branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO). Retrospective, non-comparative case series. Patients ≥18 years of age with ME secondary to BRVO or CRVO who received a minimum of one intravitreal injection of bevacizumab with a follow-up >3 months were included. Primary endpoints were mean change in best corrected visual acuity (BCVA) from baseline to 12 and 24 months, and mean change in central macular thickness (CMT) after 3 injections. Secondary endpoints were mean change in BCVA and CMT from baseline to end of follow-up, number of injections, and ocular adverse events. Eighty-seven eyes with BRVO and 65 eyes with CRVO were included. Mean follow-up time was 24.4 and 26.1 months in the BRVO and CRVO groups, respectively. The mean change in BCVA was 0.25 LogMAR in the BRVO group and -0.118 LogMAR in the CRVO group. Visual acuity outcomes in the CRVO group were poorer, especially in patients with low baseline BCVA.
    Albrecht von Graæes Archiv für Ophthalmologie 08/2015; DOI:10.1007/s00417-015-3130-z · 1.91 Impact Factor
  • Ari Leshno · Adiel Barak · Anat Loewenstein · Amit Weinberg · Meira Neudorfer ·
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    ABSTRACT: To investigate the changes over time in optical density (OD) characteristics of subretinal fluid (SRF) in rhegmatogenous retinal detachment (RRD) and their clinical relevance. The study included patients with first-onset RRD and no history of intraocular illness who underwent optical coherence tomography (OCT) and whose OCT scans showed sufficient SRF for sampling (08/2013-09/2014). The highest quality B-scan (as graded by the OCT image acquisition software) containing SRF was analyzed. Optical density measurements were obtained using ImageJ. Optical density ratios (ODRs) were calculated as SRF OD divided by vitreous OD. Time from onset of RRD was determined by first signs of visual loss as described in the patient's anamnesis. Patients were divided into three groups by RRD duration: acute (≤1 week), subacute (between 1 week and 1 month), and chronic (>1 month). Thirty-five eyes (34 patients) met the inclusion criteria. The ODR measurement was significantly associated with RRD duration. The ODR had a significant (P < 0.0001) association with the 3-month postoperative visual acuity (VA). Vitreous OD did not differ significantly between the three groups. The increase over time in the ODR of the SRF in RRD might reflect a change in SRF composition and state of the retina. This, together with a significant association between preoperative ODR values and postoperative VA suggest its potential as a biological prognostic marker.
    Investigative ophthalmology & visual science 08/2015; 56(9):5432-5438. DOI:10.1167/iovs.15-16952 · 3.40 Impact Factor
  • Elad Moisseiev · Joseph Moisseiev · Anat Loewenstein ·
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    ABSTRACT: Optic disc pit (ODP) is a rare congenital anomaly of the optic disc, which can be complicated by a maculopathy associated with progressive visual loss. Optic disc pits are usually unilateral and sporadic in occurrence, and the development of maculopathy is unpredictable with no known triggers. Optic disc pit maculopathy (ODP-M) is characterized by intraretinal and subretinal fluid at the macula, causing visual deterioration. The source of this fluid is still unclear, and several competing theories have suggested it may be vitreous fluid, cerebrospinal fluid, leakage from blood vessels at the base of the pit or leakage from the choroid. The mechanism of pathogenesis of ODP-M has not been fully elucidated, but vitreous liquefaction and traction and pressure gradients within the eye have been implicated to be involved. There are no clear guidelines on the management of patients with ODP-M, and numerous techniques have been described, including laser photocoagulation, intravitreal gas injection, macular buckling and pars plana vitrectomy with many different modifications. The majority of reports describe small series, and as there are no comparative studies there is no consensus regarding the optimal treatment for ODP-M. This review discusses the literature on the possible sources of fluid and mechanisms of pathogenesis in ODP-M, as well as the wide array of treatment modalities and their results. Based on these, a set of recommended key concepts for the timing and choice of treatment for these challenging are presented.
    08/2015; 1(1):13. DOI:10.1186/s40942-015-0013-8
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    Pravin U Dugel · Francesco Bandello · Anat Loewenstein ·
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    ABSTRACT: Diabetic macular edema (DME) resembles a chronic, low-grade inflammatory reaction, and is characterized by blood-retinal barrier (BRB) breakdown and retinal capillary leakage. Corticosteroids are of therapeutic benefit because of their anti-inflammatory, antiangiogenic, and BRB-stabilizing properties. Delivery modes include periocular and intravitreal (via pars plana) injection. To offset the short intravitreal half-life of corticosteroid solutions (~3 hours) and the need for frequent intravitreal injections, sustained-release intravitreal corticosteroid implants have been developed. Dexamethasone intravitreal implant provides retinal drug delivery for ≤6 months and recently has been approved for use in the treatment of DME. Pooled findings (n=1,048) from two large-scale, randomized Phase III trials indicated that dexamethasone intravitreal implant (0.35 mg and 0.7 mg) administered at ≥6-month intervals produced sustained improvements in best-corrected visual acuity (BCVA) and macular edema. Significantly more patients showed a ≥15-letter gain in BCVA at 3 years with dexamethasone intravitreal implant 0.35 mg and 0.7 mg than with sham injection (18.4% and 22.2% vs 12.0%). Anatomical assessments showed rapid and sustained reductions in macular edema and slowing of retinopathy progression. Phase II study findings suggest that dexamethasone intravitreal implant is effective in focal, cystoid, and diffuse DME, in vitrectomized eyes, and in combination with laser therapy. Ocular complications of dexamethasone intravitreal implant in Phase III trials included cataract-related events (66.0% in phakic patients), intraocular pressure elevation ≥25 mmHg (29.7%), conjunctival hemorrhage (23.5%), vitreous hemorrhage (10.0%), macular fibrosis (8.3%), conjunctival hyperemia (7.2%), eye pain (6.1%), vitreous detachment (5.8%), and dry eye (5.8%); injection-related complications (eg, retinal tear/detachment, vitreous loss, endophthalmitis) were infrequent (<2%). Dexamethasone intravitreal implant offers a viable treatment option for DME, especially in cases that are persistent or treatment (anti-vascular endothelial growth factor/laser) refractory.
    Clinical ophthalmology (Auckland, N.Z.) 07/2015; 9:1321-35. DOI:10.2147/OPTH.S79948
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    ABSTRACT: To validate and evaluate the accuracy of an algorithm for the identification of nonmetallic intraocular foreign body composition based on computed tomography and magnetic resonance imaging. An algorithm for the identification of 10 nonmetallic materials based on computed tomography and magnetic resonance imaging has been previously determined in an ex vivo porcine model. Materials were classified into 4 groups (plastic, glass, stone, and wood). The algorithm was tested by 40 ophthalmologists, which completed a questionnaire including 10 sets of computed tomography and magnetic resonance images of eyes with intraocular foreign bodies and were asked to use the algorithm to identify their compositions. Rates of exact material identification and group identification were measured. Exact material identification was achieved in 42.75% of the cases, and correct group identification in 65%. Using the algorithm, 6 of the materials were exactly identified by over 50% of the participants, and 7 were correctly classified according to their groups by over 75% of the materials. The algorithm was validated and was found to enable correct identification of nonmetallic intraocular foreign body composition in the majority of cases. This is the first study to report and validate a clinical tool allowing intraocular foreign body composition based on their appearance in computed tomography and magnetic resonance imaging, which was previously impossible.
    Retina (Philadelphia, Pa.) 05/2015; Publish Ahead of Print(9). DOI:10.1097/IAE.0000000000000556 · 3.24 Impact Factor
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    ABSTRACT: PurposeTo evaluate the safety and efficacy of 1.5% dexamethasone nanoparticle (DexNP) drops in eyes with non-infectious uveitic macular oedema and vitritis.Methods In a prospective pilot study, DexNP drops were administered four times a day for 4 weeks followed by drops tapering over a period of another 4 weeks. Follow-up time was 12 weeks.ResultsFive eyes with macular oedema and three eyes with vitritis were included in the study. Best corrected visual acuity (BCVA) significantly improved from a median of 0.2 logMAR to a median of 0.15 logMAR at 4 weeks' time (p < 0.05). Median BCVA was 0.175 logMAR and 0.2 logMAR, at week 8 and 12, respectively (p > 0.05). Macular oedema significantly improved at all time-points as compared to baseline (p < 0.05) and resolved in all eyes during follow-up. One eye had macular oedema relapse at week 12. Vitritis improved in all eyes and resolved completely in two eyes. One eye had intraocular pressure (IOP) elevation which was well controlled with topical antihypertensive treatment, and one eye had cataract progression.Conclusion This short pilot study demonstrates favourable effect of 1.5% DexNP eye drops on eyes with non-infectious uveitic macular oedema and vitritis. Further comparative long-term studies are warranted to assess this effect.
    Acta ophthalmologica 05/2015; 93(5). DOI:10.1111/aos.12744 · 2.84 Impact Factor
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    E Moisseiev · D Loberman · E Zunz · A Kesler · A Loewenstein · J Mandelblum ·
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    ABSTRACT: PurposeTo compare the efficacy in pupil dilation and degree of discomfort between topical instillation of mydriatic drops and gel.Methods The study included 60 patients with no previous ocular history of trauma and surgery. One eye was dilated with two drops (tropicamide 0.5% and phenylephrine 10%), and the other with one drop of gel (tropicamide 0.5%+phenylephrine 5%). Pupil size was measured by a Colvard pupillometer at baseline and 5, 15, 30, and 45 min following instillation. Pain upon instillation was measured by visual analog scale (VAS).ResultsThere was no difference in pupil size at baseline. Use of the gel achieved greater mydriasis than drops (P=0.01), and was also associated with lower pain scores (P=0.003). In diabetic patients, pupil size was smaller at baseline and following instillation of drops and gel. Use of the gel achieved an even greater degree of pupil dilation in this subset of patients than drops (P=0.019).Conclusions Gel formulation achieved significantly greater pupil dilation than drops, despite a lower concentration of phenylephrine, and was also associated with significantly lower patient discomfort. This study is the first report of improved mydriatic efficacy in diabetic patients.Eye advance online publication, 10 April 2015; doi:10.1038/eye.2015.47.
    Eye (London, England) 04/2015; 29(6). DOI:10.1038/eye.2015.47 · 2.08 Impact Factor
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    ABSTRACT: To investigate the effect of oral Rifampin in patients with chronic central serous chorioretinoapthy (CSCR). This was a prospective pilot study of patients with chronic CSCR with persistent subretinal fluid (SRF) for at least 3 months, who were treated with oral Rifampin 300 mg twice per day for 3 months and had 6 months of follow-up. All patients underwent a complete ocular examination and a spectral domain optical coherence tomography (SD-OCT) scan monthly from baseline until month 4, and then at month 6. Fluorescein angiography (FA) was performed at baseline and at the end of the study. Fourteen eyes of 12 patients were included in the study, nine men and three women. Mean age was 58.5 years (range 32-80). Mean duration of SRF prior to study entry was 28.4 months. Forty-two percent of eyes were treated previously for CSR with thermal laser, PDT, or intravitreal bevacizumab. Mean best corrected visual acuity (BCVA) at presentation was 20/60 and improved to a mean of 20/50 at month 3 (P > 0.05). Retinal thickness was reduced by 25.3 %, 21.2 %, and 21 % on months 1, 2, 3, respectively (P < 0.05). Mean choroidal thickness at presentation was 476 μ (SD 188 μ) decreasing to 427 μ (SD 125 μ) after 3 months of treatment (P > 0.05). SRF was reduced in nine eyes (64 %) and completely resolved in six eyes (42.8 %) at month 3 following 3 months of treatment, and four out of these six eyes remained fluid free at month 6. Two patients stopped the treatment after 2 months due to adverse events. Oral Rifampin may be a therapeutic option in patients with longstanding chronic CSCR.
    Albrecht von Graæes Archiv für Ophthalmologie 03/2015; DOI:10.1007/s00417-015-2989-z · 1.91 Impact Factor
  • Dinah Zur · Anat Loewenstein · Adiel Barak ·
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    ABSTRACT: To evaluate clinical feasibility, safety, and efficacy of epiretinal strontium-90 brachytherapy in subfoveal choroidal neovascularization (CNV) due to age-related macular degeneration (AMD) in eyes unresponsive to repeated anti-VEGF injections. A retrospective, single-center study on patients treated with strontium-90 brachytherapy for CNV secondary to neovascular AMD. Patients underwent pars plana vitrectomy with a single 24 Gy dose brachytherapy. They were re-treated with anti-VEGF injections on an as-needed basis if subretinal or intraretinal fluid was detected on optical coherence tomography imaging. Twenty-two patients were treated, and 20 completed 12 months of follow-up. Ten patients maintained stable vision, eight gained vision, and two lost more than three Snellen lines. The mean best corrected visual acuity change from baseline was -8 ± 5.7 letters. A mean of 5.5 ± 4.4 anti-VEGF injections were administered throughout 12 months. Epimacular brachytherapy is feasible in clinical practice. While some patients benefit from the treatment and need significantly fewer as-needed injections, others appear not to react to irradiation treatment after 1 year of follow-up. Larger numbers of patients are needed to evaluate therapeutic efficacy and to determine which patients can benefit from combined radiation and anti-VEGF therapy. [Ophthalmic Surg Lasers Imaging Retina. 2015;46:338-343.]. Copyright 2015, SLACK Incorporated.
    Ophthalmic Surgery Lasers and Imaging Retina 03/2015; 46(3):338-43. DOI:10.3928/23258160-20150323-07 · 1.06 Impact Factor
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    ABSTRACT: To evaluate the safety and efficacy of switching from bevacizumab to ranibizumab in patients with neovascular age-related macular degeneration. Retrospective study of patients with neovascular age-related macular degeneration initially treated with bevacizumab and switched to ranibizumab. Visual acuity and central retinal thickness (CRT) were retrieved at four time points: before the last three bevacizumab injections, at the switch, after the first three ranibizumab injections, and at the end of follow-up. One hundred and fourteen eyes of 110 patients were included. Switching from bevacizumab to ranibizumab did not achieve a significant change in visual acuity, and a significant reduction in CRT was achieved after the first three injections but was not maintained by the end of follow-up. Eyes that lost ≥0.1 logMAR before the switch were more likely to improve in visual acuity (P = 0.013), and eyes with ≥10% increase in CRT before the switch were more likely to improve anatomically (P = 0.0003). In 47.3% of the eyes, the CRT was reduced by ≥10% after the first 3 ranibizumab injections, and the reduction was maintained with additional injections. Switching to ranibizumab should be considered in patients with visual acuity decrease or CRT increase, despite monthly bevacizumab injections. The response should be evaluated after the first three injections to guide future treatment.
    Retina 02/2015; 35(7). DOI:10.1097/IAE.0000000000000500 · 3.24 Impact Factor
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    ABSTRACT: To evaluate the effect of pupil dilation on biometric measurements and intraocular lens power calculation using the IOLMaster (Carl Zeiss Meditec, Jena, Germany). Prospective observational case series. In this prospective study, two consecutive optical biometry measurements, before and after pupil dilation, were performed using the IOLMaster on 318 eyes, in 214 patients, at the cataract pre-surgery clinic. The parameters compared were axial length (AL), corneal power (mean K), cylinder and the corresponding intraocular lens (IOL) power which was calculated using the SRK/T formula. This study found no statistically significant difference in pre- and post-dilation measurements in AL (0.005, P = 0.476), K (0.001, P = 0.933) or calculated IOL power (0.011, P = 0.609). A statistically significant difference was shown in cylinder measurements pre- and post-dilation (0.102, P < 0.001). This study demonstrates there is no clinically significant effect of pupil dilation on the IOLMaster measurements of axial length, corneal power and corresponding theoretical IOL power calculated using the SRK/T formula. Copyright © 2015 Elsevier Inc. All rights reserved.
    American Journal of Ophthalmology 01/2015; 159(5). DOI:10.1016/j.ajo.2015.01.025 · 3.87 Impact Factor

  • 01/2015; DOI:10.1159/000369514
  • Elad Moisseiev · Anat Loewenstein ·
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    ABSTRACT: Purpose: To describe a new method for training residents in ophthalmology in performing laser retinopexy around retinal breaks, and its practicality. Methods: The simulator consists of a model eye that can be adjusted to fit any laser instrument, with a retinal break created in it. The retinal breaks are made of paper strips and can simulate tears and holes. The simulator is used with a three-mirror lens and real laser instrument. Results: The simulator creates conditions simulating near-real laser retinopexy and has been used successfully in training 3 novice residents who have never performed this procedure before. Conclusions: This simulator is simple, reusable and inexpensive. We believe it may be a valuable instructional tool in training residents in performing laser retinopexy, shorten their learning curve and improve their efficiency it in.
    Ophthalmologica 11/2014; 233(1). DOI:10.1159/000368248 · 1.68 Impact Factor
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    ABSTRACT: Background Ranibizumab (Lucentis®) 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. Methods Human umbilical vein cell lines (EA.hy926) and retinal pigment epithelial cells (ARP-19) were exposed to oxidative stress. The cells were treated with therapeutic concentrations of bevacizumab (0.25 mg/mL) and ranibizumab (125 mg/mL) for 24 hours prior to all experiments, and their effects on gene expressions were determined by RT- PCR. Results After exposure to bevacizumab, more genes in the endothelial cells were up-regulated (KDR, NFATc2) and down-regulated (Pla2g12a, Rac2, HgdC, PRKCG) compared to non-treated controls. After exposure to ranibizumab, fewer genes were up-regulated (PTGS2) and down-regulated (NOS3) compared to controls. In comparison between drugs, more genes were up-regulated (NFATc2 and KDR) and more were down-regulated (Pla2g12a, Pla2g1b, Ppp3r2, Rac2) by bevacizumab than by ranibizumab. In RPE cells, NOS3 and PGF were up-regulated and Pla2g12b was down-regulated after exposure to ranibizumab, while PIK3CG was up-regulated and FIGF was down-regulated after exposure to bevacizumab, but the differences in gene expression were minor between drugs (PIK3CGand PGF were down-regulated more by ranibizumab than by bevacizumab). Conclusions The different gene expressions after exposure to ranibizumab and bevacizumab in endothelial and RPE cells may indicate a somewhat different biological activity of the two compounds.
    BMC Research Notes 09/2014; 7(1):617. DOI:10.1186/1756-0500-7-617
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    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. Trial registration number NCT01318941.
    British Journal of Ophthalmology 09/2014; 98(9):1144-1167. DOI:10.1136/bjophthalmol-2014-305702 · 2.98 Impact Factor
  • Tal Frenkel · Elad Moisseiev · Meira Neudorfer · Anat Loewenstein · Adiel Barak ·
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    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.
    Albrecht von Graæes Archiv für Ophthalmologie 08/2014; 253(6). DOI:10.1007/s00417-014-2778-0 · 1.91 Impact Factor

Publication Stats

3k Citations
630.60 Total Impact Points


  • 1995-2015
    • Tel Aviv Sourasky Medical Center
      • Department of Ophthalmology
      Tell Afif, Tel Aviv, Israel
    • Boston Children's Hospital
      • Division of Genetics
      Boston, Massachusetts, United States
    • Technion - Israel Institute of Technology
      • Ruth and Bruce Rappaport Faculty of Medicine
      H̱efa, Haifa, Israel
  • 1990-2015
    • Tel Aviv University
      • • Department of Ophthalmology
      • • Sackler Faculty of Medicine
      Tell Afif, Tel Aviv, Israel
  • 2012
    • Wills Eye Institute
      Philadelphia, Pennsylvania, United States
  • 2010
    • Meir Medical Center
      Kafr Saba, Central District, Israel
    • University of California, Irvine
      • Department of Ophthalmology
      Irvine, CA, United States
  • 1997-1998
    • Johns Hopkins University
      Baltimore, Maryland, United States
    • Johns Hopkins Medicine
      • Wilmer Eye Institute
      Baltimore, Maryland, United States