These guidelines were developed jointly by the American Society of Health-System Pharmacists (ASHP), the Infectious Diseases Society of America (IDSA), the Surgical Infection Society (SIS), and the Society for Healthcare Epidemiology of America (SHEA). This work represents an update to the

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Clinical practice guidelines for antimicrobial prophylaxis in surgery

Background Retinopathy of prematurity is a leading cause of childhood blindness worldwide. Peripheral retinal ablation with conventional (confluent) laser therapy is destructive, causes complications, and does not prevent all vision loss, especially in cases of retinopathy of prematurity affecting zone I of the eye. Case series in which patients were treated with vascular endothelial growth factor inhibitors suggest that these agents may be useful in treating retinopathy of prematurity. Methods We conducted a prospective, controlled, randomized, stratified, multicenter trial to assess intravitreal bevacizumab monotherapy for zone I or zone II posterior stage 3+ (i.e., stage 3 with plus disease) retinopathy of prematurity. Infants were randomly assigned to receive intravitreal bevacizumab (0.625 mg in 0.025 ml of solution) or conventional laser therapy, bilaterally. The primary ocular outcome was recurrence of retinopathy of prematurity in one or both eyes requiring retreatment before 54 weeks' postmenstru...

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Efficacy of Intravitreal Bevacizumab for Stage 3+ Retinopathy of Prematurity

Antiangiogenesis Strategies Revisited: From Starving Tumors to Alleviating Hypoxia

/pdf/clinical-practice-guidelines-for-antimicrobial-prophylaxis-yxd0y9e4ks.pdf

Clinical practice guidelines for antimicrobial prophylaxis in surgery.

Optical coherence tomography angiography.

Purpose To report the use of commercially available preservative-free intravitreal triamcinolone acetonide for the treatment of macular oedema due to retinal vascular diseases. Design Retrospective interventional case series. Methods Charts of eyes that received 4 mg preservative-free intravitreal triamcinolone acetonide for the treatment of persistent macular oedema due to retinal vascular diseases were reviewed. Patients were included if they had a follow-up of at least 3 months. Visual acuity, intraocular pressure, presence of an anterior chamber reaction, and mean macular thickness on optical coherence tomography (OCT) were recorded. Results A total of 10 eyes of 10 patients were identified. Visual acuity improved by a mean of 1.1 Snellen lines at 1 month and 1.3 lines at 3 months. Macular thickness on OCT decreased by a mean of 183.5 μm at 1 month (P<0.0001). Intraocular pressure increased from a mean of 13.5 mmHg at baseline to 15.3 at 1 month, and 14.5 at 3 months. Only the 1-month change in intraocular pressure was statistically significant (P=0.0274). There were no cases of endophthalmitis, anterior chamber reaction, or retinal detachment. Conclusion In this small retrospective, noncomparative series, commercially available preservative-free intravitreal triamcinolone acetonide had no adverse outcomes. Macular oedema was noted to decrease following treatment.

Intravitreal preservative-free triamcinolone acetonide for the treatment of macular oedema

PURPOSE To correlate fundus autofluorescence (FAF) patterns in choroidal melanocytic lesions with changes present on the surface of such lesions, including lipofuscin, hyperpigmentation, drusen, and fibrous metaplasia. METHODS Retrospective chart review for 23 consecutive patients with choroidal nevi and melanoma who underwent FAF photography. The correlation between increased FAF patterns and foci of lipofuscin, hyperpigmentation, drusen, or fibrous metaplasia was defined as complete correlation, partial correlation, or no correlation. RESULTS Lipofuscin was present in 13 tumors, hyperpigmentation was present in 9 tumors, drusen were present in 6 tumors, and fibrous metaplasia was present in 4 tumors. Complete correlation between increased FAF and lipofuscin was found in 8 tumors (61.5%); partial correlation, in 3 tumors (23.1%); and no correlation, in 2 tumors (15.4%). Complete correlation between hyperpigmentation and increased FAF was found in 5 tumors (55.6%); partial correlation, in 3 tumors (33.3%); and no correlation, in 1 tumor (11.1%). Partial correlation was found between drusen and increased FAF in 4 tumors. Partial correlation was found between fibrous metaplasia and increased FAF in three tumors. CONCLUSION Choroidal melanocytic lesions with overlying lipofuscin and hyperpigmentation are associated with increased FAF in approximately 90% of cases.

Fundus autofluorescence in choroidal melanocytic lesions.

While angiogenesis is one of the factors associated with the development of CNV due to age-related macular degeneration (AMD), inflammation and oxidative stress also appear to play a role. Treatment of CNV with intravitreal anti-vascular endothelial growth factor monotherapy is currently the standard of care. However, not all patients respond to monotherapy, and combination therapy may target the CNV through multiple mechanisms, thus reducing treatment frequency or improving visual outcome. Photodynamic therapy (with regular or reduced fluence), as well as intravitreal steroids are used in combination with anti-VEGF therapy. This paper reviews the many clinical trials that have been performed utilizing several combinations of double and triple therapy. While combination therapy is biologically justifiable, further study is required to determine correct combinations and dosage.

Review of combination therapies for neovascular age-related macular degeneration.

The prevalence of Age-related macular degeneration (AMD) is increasing as the population of elderly in the United States grows. Currently the pathogenesis is not fully understood, however oxidative injury is felt to play a significant role. The Age-Related Eye Disease Study (AREDS) established that a supplemental combination of dietary antioxidants of zinc, β-carotene, vitamin C and vitamin E slowed progression of AMD. Recently lutein, zeaxanthin, B vitamins, and omega-3 fatty acids have also been reported to decrease AMD progression, while vitamin E and β-carotene where found to increase the risk of late AMD. AREDS2 is currently underway, further examining the effects of omega-3 fatty acids, carotenoids, and the original AREDS formulation. While awaiting the results of AREDS2, it is important to understand the evidence currently available, so that physicians can safely advise patients today. This review examines the most current literature available exploring nutritional supplementation in age-related macular degeneration.

Nutritional supplementation and age-related macular degeneration.

To describe the use of disposable 31-gauge needles for intraocular injections. Description of the technique and photographs of the needles. Patients feel the injection less and a smaller postinjection bleb is noted. Consideration should be given to the use of disposable 31-gauge needles or syringes for intraocular injections.

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Sophie J. Bakri

Papers

Intravitreal preservative-free triamcinolone acetonide for the treatment of macular oedema

Fundus autofluorescence in choroidal melanocytic lesions.

Review of combination therapies for neovascular age-related macular degeneration.

Nutritional supplementation and age-related macular degeneration.

The use of 31-gauge needles and syringes for intraocular injections.