Showing papers by "Anat Loewenstein published in 2010"
TL;DR: In this paper, the safety and efficacy of dexamethasone intravitreal implant (DEX implant; OZURDEX, Allergan, Inc., Irvine, CA) compared with sham in eyes with vision loss due to macular edema (ME) associated with BRVO or central retinal vein occlusion (CRVO).
955 citations
TL;DR: First-line treatment of postsurgical CME should include topical nonsteroidal anti-inflammatory drugs and corticosteroids and Oral carbonic anhydrase inhibitors can be considered complementary.
Abstract: Cystoid macular edema (CME) is a primary cause of reduced vision following both cataract and successful vitreoretinal surgery. The incidence of clinical CME following modern cataract surgery is 0.1-2.35%. Preexisting conditions such as diabetes mellitus and uveitis as well as intraoperative complications can raise the risk of developing CME postoperatively. The etiology of CME is not completely understood. Prolapsed or incarcerated vitreous and postoperative inflammatory processes have been proposed as causative agents. Pseudophakic CME is characterized by poor postoperative visual acuity. Fluorescein angiography is indispensable in the workup of CME, showing the classical perifoveal petaloid staining pattern and late leakage of the optic disk. Optical coherence tomography is a useful diagnostic tool, which displays cystic spaces in the outer nuclear layer. The most important differential diagnoses include age-related macular degeneration and other causes of CME such as diabetic macular edema. Most cases of pseudophakic CME resolve spontaneously. The value of prophylactic treatment is doubtful. First-line treatment of postsurgical CME should include topical nonsteroidal anti-inflammatory drugs and corticosteroids. Oral carbonic anhydrase inhibitors can be considered complementary. In cases of resistant CME, periocular or intraocular corticosteroids present an option. Antiangiogenic agents, though experimental, should be considered for nonresponsive persistent CME. Surgical options should be reserved for special indications.
144 citations
TL;DR: Early vitrectomy even in nontractional DME results in significant macular thinning and may lead to rapid improvement in vision with long-term stabilization, but a randomized trial pitting vit rectomy against the methods currently employed has not yet been performed.
Abstract: Diabetic macular edema (DME), defined as a retinal thickening involving or approaching the center of the macula, represents the most common cause of vision loss in patients affected by diabetes mellitus. In the last few years, many diagnostic tools have been proven useful in the detection and the monitoring of the features characterizing DME. On the other hand, several therapeutic approaches can now be proposed on the basis of the DME-specific characteristics. The aim of the present chapter is to thoroughly delineate the clinical and morpho functional characteristics of DME and its current treatment perspectives. The pathogenesis and the course of DME require a complex approach with multidisciplinary intervention both at the systemic and local levels.
105 citations
TL;DR: This work has shown that extended-release intravitreal drug delivery systems can achieve sustained therapeutic levels with the goal of providing a prolonged clinical benefit in posterior eye disease.
Abstract: Drug delivery into the posterior segment of the eye is complicated by the existence of the blood-ocular barrier. Strategies for delivering drugs to the posterior segment include systemic administration, modification of the barrier, and local drug delivery (including transcorneal, transscleral, and intravitreal). Recently, new topical treatments have emerged for the treatment of posterior eye disease. Iontophoretic, juxtascleral, and intravitreal routes can be used to achieve therapeutic levels in the posterior segment. Extended-release intravitreal drug delivery systems can achieve sustained therapeutic levels with the goal of providing a prolonged clinical benefit.
98 citations
TL;DR: Acute endophthalmitis following anti-VEGF injection appears within days and can result in severe loss of vision if not treated promptly and in the authors' series the clinical and prognostic characteristics were considerably different between culture positive endophTHB cases and culture negative cases.
Abstract: Purpose The purpose of this study was to describe the clinical characteristics and management of patients with bacterial endophthalmitis after an intravitreal antivascular endothelial growth factor injection. Methods This is a retrospective chart review of all patients admitted with suspected endophthalmitis from 2006 to 2008. Results Endophthalmitis was verified by positive Gram stain and culture in nine eyes. The mean preinjection visual acuity of the 9 eyes was 0.02 +/- 0.021 diopters (decimal visual acuity scale) and dropped to 0.01667 +/- 0.02449 diopters in the eyes with endophthalmitis. All nine patients presented with reduced visual acuity, of whom seven also had ocular pain. Initial treatment was administered without delay and consisted of vitreous tap and intravitreal antibiotics injection in five cases and pars plana vitrectomy with intravitreal antibiotics injection in the other four cases. Vitreous tap failed in one case. Seven patients underwent a second procedure and two underwent a third procedure. The mean posttreatment visual acuity in all 9 eyes improved significantly (0.19 +/- 0.24, P = 0.0071). Five patients had major complications (e.g., retinal detachment, phacolytic glaucoma, and recurrent endophthalmitis). Conclusion Acute endophthalmitis following anti-VEGF injection appears within days and can result in severe loss of vision if not treated promptly. In our series the clinical and prognostic characteristics were considerably different between culture positive endophthalmitis cases and culture negative cases.
57 citations
TL;DR: The various pathogenetic mechanisms and their contribution to the edema process are described in detail in this chapter.
Abstract: Macular edema represents a common final pathway for many disease processes. Related ocular disorders include diabetic retinopathy, vascular occlusions, post surgical situations and inherited disorders. The pathophysiology includes breakdown of the blood ocular barrier, release of various cytokines and significant inflammations. These mechanisms may be complicated by ischemic processes. The various pathogenetic mechanisms and their contribution to the edema process are described in detail in this chapter.
44 citations
TL;DR: The electrophysiological tests and the morphologic data indicate that the repeated intravitreal injections of ranibizumab or bevacIZumab have no cumulative long-term toxic effect on the retina in rabbits.
Abstract: Purpose:Repeated intravitreal injections of ranibizumab or bevacizumab are a common treatment for several retinal diseases. The aim of the present study was to evaluate the long-term retinal toxicity of repeated injections of ranibizumab and bevacizumab in rabbits.Methods:Albino rabbits were injecte
32 citations
TL;DR: Formation of a full-thickness macular hole subsequent to an injection of bevacizumab for the treatment of neovascular AMD may be caused by focal tractional forces on the retinal surface due to either vitreous incarceration at the injection site or contraction of the choroidal neov vascularization membrane.
Abstract: This report describes formation of a full-thickness macular hole subsequent to an injection of bevacizumab for the treatment of neovascular AMD. This complication may be caused by focal tractional forces on the retinal surface due to either vitreous incarceration at the injection site or contraction of the choroidal neovascularization membrane. Alternatively, it may be due to a toxic effect of bevacizumab on a previously compromised retina.
26 citations
TL;DR: Trypan blue exerts transient physiological effects on the distal retina of the rabbit, but in concentrations of 0.15% it can induce permanent toxic effects, therefore, caution should be used when using this dye in vitreoretinal surgery.
Abstract: PURPOSE To determine whether intravitreal injection of trypan blue is toxic to the retina of the albino rabbit. METHODS Sixteen albino rabbits were studied for the effects of intravitreal trypan blue (eight with 0.06% solution and eight with 0.15% solution). Saline was injected into the fellow control eye of all rabbits. The electroretinogram and visual evoked potentials were recorded from each rabbit at different time intervals after injection. The rabbits were killed at the termination of the follow-up period, and their retinas were prepared for histologic examination under light microscopy. RESULTS In all rabbits, short-term follow-up showed significant reduction of ERG responses in the experimental eye, with the b-wave more affected than the a-wave. Partial to complete recovery was observed during follow-up. After 4 weeks, negligible ERG deficit was observed in the rabbits treated with 0.06% trypan blue, whereas significant ERG deficit was measured in rabbits tested by the 0.15% trypan blue. No differences in flash VEP responses between experimental and control rabbit eyes were found. Light microscopy showed no significant histologic effects in the retinas exposed to the 0.06% solution. Marked disorganization of all retinal layers was observed in areas close to the site of injection in the rabbits injected with the 0.15% solution. CONCLUSIONS Trypan blue exerts transient physiological effects on the distal retina of the rabbit, but in concentrations of 0.15% it can induce permanent toxic effects. Therefore, caution should be used when using this dye in vitreoretinal surgery.
11 citations
TL;DR: This comprehensive review outlines the current use of steroids and highlights the ever-growing indications for steroids in ME secondary to various ocular conditions as well as the recent breakthrough results of the efficacy of this treatment.
Abstract: Macular edema (ME) is a condition which is usually secondary to an underlying disease process. It is most commonly seen following venous occlusive disease, diabetic retinopathy and posterior segment inflammatory disease. The treatment of ME varies, depending upon the underlying etiology, and has led to varying degrees of success. Traditionally, the main treatment options have included topical and systemic steroids, due to their known antiangiogenic, antiedematous, antiinflammatory and antiproliferative effects. This comprehensive review outlines the current use of steroids and highlights the ever-growing indications for steroids in ME secondary to various ocular conditions as well as the recent breakthrough results of the efficacy of this treatment.
6 citations
TL;DR: TGDC-01 may estimate intraocular pressure with a fair agreement to the Goldmann tonometer, although caution should be used for patients who require precise IOP measurements, which may be suitable for IOP screening.
Abstract: PURPOSE This study aimed to compare intraocular pressure (IOP) measurements obtained by the transpalpebral tonometer TGDc-01 and by the Goldmann applanation tonometer (GAT). METHODS IOP was measured by the conventional GAT and the TGDc-01 tonometer. Central corneal thickness (CCT) was measured for all eyes. RESULTS Sixty-seven consecutive patients (123 eyes) participated. The mean difference between the 2 techniques (TGDc-01-GAT) was -0.93 mmHg, SD=2.74 (p=0.0002, paired t-test), and 70% of the measurements were within +/-2 mmHg. The correlation coefficient was 0.67 (p 580 microm, the mean IOP difference was -2.29 mmHg (p=0.0003); r=0.57 (p=0.003). CONCLUSIONS TGDc-01 may estimate IOP with a fair agreement to the Goldmann tonometer, although caution should be used for patients who require precise IOP measurements. TGDc-01 measured higher IOPs than Goldman tonometry for thinner corneas, a trend that was reversed for thicker corneas. This tonometer is a portable device, easy to use, does not require anesthetic drops, and may be suitable for IOP screening.
Journal Article•
TL;DR: A 40-year-old man with decreasing visual acuity in his left eye over 1 year, diagnosed elsewhere as vein occlusion and treated unsuccessfully by systemic steroids was reported, and a retrospective diagnosis of idiopathic macular telangiectasia (IMT) was made.
Abstract: A 40-year-old man with decreasing visual acuity in his left eye over 1 year, diagnosed elsewhere as vein occlusion and treated unsuccessfully by systemic steroids was reported. Retrospective analysis of available previous imaging studies was undertaken, and a retrospective diagnosis of idiopathic macular telangiectasia (IMT) was made. Examination revealed subfoveal neovascularization and retinochoroidal anastomosis (RCA) in his left eye with macular edema and exudates surrounding it. The right eye was normal. Current fluorescein angiography (FA) confirmed the presence of choroidal neovascularization and RCA, and optical coherence tomography (OCT) demonstrated cystoid macular edema and subfoveal neovascularization.The patient was diagnosed with unilateral idiopathic macular telangiectasia complicated by subretinal neovascularization. The presences of a choroidal neovascularization process and an RCA have not, to our knowledge, been reported in this type of IMT.
TL;DR: Cat-scratch disease should be considered in the differential diagnosis of BRAO, especially in young patients, and the use of systemic antibiotics in cat scratch neuroretinitis should probably be reserved for the more severe forms of the disease.
Abstract: Purpose:We describe two cases of branch retinal artery occlusion (BRAO) as the presenting sign of cat-scratch diseaseMethods and Patients:Case 1 (25-year-old man) presented with decreased vision, visual field changes, a swollen disk, and BRAO Case 2 (27-year-old woman) presented with decreased vis
TL;DR: This is the first report of sterile intraocular inflammation recurring after repeated intravitreal injections of bevacizumab, and awareness of the possible association between beVacizuab administration and sterile endophthalmitis may be warranted.
Abstract: PURPOSE To report on two patients with sterile endophthalmitis recurring twice after intravitreal bevacizumab injection METHODS Two cases of sterile intraocular inflammation recurring after repeated intravitreal injections of bevacizumab are described, followed by a review of the literature RESULTS Two patients presented with painful eyes and decreased vision associated with endophthalmitis several days after intravitreal bevacizumab injection In both patients, vitreous specimens were sterile The intraocular inflammation recurred after additional intravitreal injection of bevacizumab that was performed during subsequent follow-up CONCLUSION This is the first report of sterile intraocular inflammation recurring after repeated intravitreal injections of bevacizumab Awareness of the possible association between bevacizumab administration and sterile endophthalmitis may be warranted
TL;DR: Based on the evolving data, as well as on clinical experience, it is believed that the two drugs, while harboring different biological characteristics and potential clinical differences, still share many similar characteristics in their efficacy and safety.
Abstract: Age-related macular degeneration (AMD) is a leading cause of severe visual loss in the elderly. A long path of clinical trials with various treatment modalities has led to novel contemporary treatments, including bevacizumab (Avastin®; Genentech, CA, USA) and ranibizumab (Lucentis®; Genentech). These drugs have revolutionized the approach to neovascular AMD, and today they are one of the major treatments for the disease. While both these drugs are reported to be effective, with somewhat stronger clinical evidence for ranibizumab, debate continues as to which is most effective in the treatment of AMD. Large-scale studies currently underway are expected to shed light on the subject. Based on the evolving data, as well as on our clinical experience, we believe that the two drugs, while harboring different biological characteristics and potential clinical differences, still share many similar characteristics in their efficacy and safety. The similarities and differences in efficacy and safety will be demonstr...
Journal Article•
Journal Article•
TL;DR: In a national study conducted among the Israeli society of retinal specialists (personal communication), it was found that most of these specialists would recommend intravitreal anti-VEGF drug injection immediately upon the diagnosis of macular edema in non-ischemic CRVO with visual acuity of 6/15 or less.
Abstract: Central retinal vein occlusion (CRVO) is one of the common causes of visual loss. The main reasons for decreased vision are development of macular edema, macular ischemia and neovascular glaucoma. The introduction of anti-vascular endothelial growth factor (VEGF) drugs for CRVO in 2005 demonstrated marked improvement in visual acuity, macular edema and ocular neovascularization. However, the absence of clear guidelines for the treatment of CRVO presents a genuine therapeutic challenge. In a national study conducted among the Israeli society of retinal specialists (personal communication), it was found that most of these specialists would recommend intravitreal anti-VEGF drug injection immediately upon the diagnosis of macular edema in non-ischemic CRVO with visual acuity of 6/15 or less. Only 21% would recommend this treatment in ischemic CRVO with visual acuity of 6/60 or less, if no macular edema exists. After the edema resolves, 94% would follow-up the patients by imaging with optical coherent tomography every 4-6 weeks, and recommend further treatment accordingly. Large prospective controlled studies are warranted in order to address the important issues of when to start anti-VEGF treatment for CRVO, when to withhold treatment, and recommended treatment intervals.
Journal Article•
01 Jan 2010
TL;DR: Tienda online donde Comprar Macular Edema, A Practical Approach (Developments In Ophthalmology, Vol. 47) al precio 131,26 € de Coscas, Gabriel.
Abstract: Tienda online donde Comprar Macular Edema. A Practical Approach (Developments In Ophthalmology, Vol. 47) al precio 131,26 € de Coscas, Gabriel | J. Cunha-Vaz | Anat Loewenstein | Gisele Soubrane, tienda de Libros de Medicina, Libros de Oftalmologia y Optica - Oftalmologia clinica