Showing papers in "Retina-the Journal of Retinal and Vitreous Diseases in 2006"
TL;DR: Ranibizumab represents a novel therapy that, for the first time, appears to have the potential to enable many AMD patients to obtain a meaningful and sustained gain of vision.
Abstract: Background Angiogenesis is a key aspect of the wet form of age-related neovascular (AMD), the leading cause of blindness in the elderly population. Substantial evidence indicated that vascular endothelial growth factor (VEGF)-A is a major mediator of angiogenesis and vascular leakage in wet AMD. VEGF-A is the prototype member of a gene family that includes also PlGF, VEGF-B, VEGF-C, VEGF-D and the orf virus-encoded VEGF-E. Several isoforms of VEGF-A can be generated due to alternative mRNA splicing. Various VEGF inhibitors have been clinically developed. Among these, ranibizumab is a high affinity recombinant Fab that neutralizes all isoforms of VEGF-A. The article briefly reviews the biology of VEGF and then focuses on the path that led to clinical development of ranibizumab. Results The safety and efficacy of ranibizumab in the treatment of neovascular AMD have been evaluated in two large phase III, multicenter, randomized, double-masked, controlled pivotal trials in different neovascular AMD patient populations. Combined, the trial results indicate that ranibizumab results not only in a slowing down of vision loss but also in a significant proportion of patients experiencing a clinically meaningful vision gain. The visual acuity benefit over control was observed regardless of CNV lesion type. Furthermore, the benefit was associated with a low rate of serious adverse events. Conclusions Ranibizumab represents a novel therapy that, for the first time, appears to have the potential to enable many AMD patients to obtain a meaningful and sustained gain of vision. On June 30 2006, ranibizumab was approved by the US Food and Drug Administration for the treatment of wet AMD.
781 citations
TL;DR: A retrospective study of patients with CNV secondary to AMD who were treated with intravitreal injection of bevacizumab during a 3-month period found no apparent short-term safety concerns and treated eyes had a significant decrease in macular thickness and improvement in visual acuity.
Abstract: Purpose:To describe the short-term anatomical and visual acuity responses after intravitreal injection of bevacizumab (Avastin, Genentech) in patients with choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD).Methods:We conducted a retrospective study of patients wi
647 citations
TL;DR: Intravitreal bevacizumab resulted in marked regression of neovascularization and rapid resolution of vitreous hemorrhage and the favorable short-term results suggest further study is needed in a larger group of patients.
Abstract: Purpose:To report the short-term anatomic and visual acuity response after intravitreal injection of bevacizumab (Avastin, Genentech) in patients with proliferative diabetic retinopathy complicated by vitreous hemorrhage.Methods:Two patients with vitreous hemorrhage due to proliferative diabetic ret
504 citations
TL;DR: Off-label intravitreal bevacizumab therapy for neovascular ARMD was well tolerated over 3 months with improvements in visual acuity and OCT central retinal thickness measurements.
Abstract: PURPOSE To evaluate the safety and efficacy of intravitreal bevacizumab (Avastin, Genentech Inc.) for the treatment of neovascular age-related macular degeneration (ARMD). METHODS A retrospective review was performed on consented patients with neovascular ARMD receiving intravitreal bevacizumab therapy. All patients received intravitreal bevacizumab at baseline with additional monthly injections given at the discretion of the treating physician. At each visit, a routine Snellen visual acuity assessment was performed followed by an ophthalmic examination and optical coherence tomography (OCT) imaging. RESULTS Fifty-three eyes of 50 patients received an intravitreal bevacizumab injection between May and August 2005. Including the month 3 visit, the average number of injections was 2.3 out of a maximum of 4 injections. No serious drug-related ocular or systemic adverse events were identified. Improvements in visual acuity and central retinal thickness measurements were evident by week 1 and continued through month 3. At month 3, the mean visual acuity improved from 20/160 to 20/125 (P < 0.001) and the mean central retinal thickness decreased by 99.6 microm (P < 0.001). CONCLUSION Off-label intravitreal bevacizumab therapy for neovascular ARMD was well tolerated over 3 months with improvements in visual acuity and OCT central retinal thickness measurements. While the long-term safety and efficacy of intravitreal bevacizumab remain unknown, these short-term results suggest that intravitreal bevacizumab may be the most cost effective therapy for the treatment of neovascular ARMD.
495 citations
TL;DR: Initial treatment results of patients with macular edema secondary to CRVO did not reveal any short-term safety concerns and visual acuity improvement, defined as a halving of the visual angle, was seen in 14 of the 16 eyes.
Abstract: Purpose:To report the short term anatomic and visual acuity response after intravitreal injection of bevacizumab (Avastin, Genentech) in patients with macular edema due to central retinal vein occlusion (CRVO).Methods:The authors conducted a retrospective study of patients with macular edema due to
491 citations
TL;DR: Even in cases of diffuse diabetic macular edema not responding to previous treatments such as photocoagulation, intravitreal injection of triamcinolone, or vitrectomy, improvement of visual acuity and decrease of retinal thickness could be observed after intrav it real injection of bevacizumab.
Abstract: Purpose To evaluate the efficacy of bevacizumab (Avastin; Genentech, Inc., South San Francisco, CA) for the treatment of diabetic macular edema. Methods This prospective, consecutive, noncomparative case series included 51 consecutive patients (26 females and 25 males; mean age, 64 years) with diffuse diabetic macular edema. Inclusion criteria were determined independently of the size of edema, retinal thickness, visual acuity, age, metabolic control, type of diabetes, or previous treatments beyond a 6-month period. At each visit, patients underwent complete eye examination, including determination of best-corrected visual acuity, slit-lamp examination, intraocular pressure measurement, stereoscopic biomicroscopy of the macula, retinal thickness measurement by optical coherence tomography, fluorescein angiography, and fundus photography. After written informed consent was obtained, all patients were treated with a 0.05-mL injection containing 1.25 mg of bevacizumab. Results All patients completed 6 weeks of follow-up; 23 (45%) completed 12 weeks of follow-up. Sixteen patients (70%) had received at least two intravitreal injections. All patients had undergone previous treatments, such as focal laser therapy (35%), full-scatter panretinal laser therapy (37%), vitrectomy (12%), and intravitreal injection of triamcinolone (33%). The mean diameter of the foveal avascular zone was 503 micro m, with 49% with values of >500 micro m. At baseline, mean visual acuity +/- SD was 25.88 +/- 14.43 ETDRS letters (0.86 +/- 0.38 logMAR of Snellen letters). Mean central retinal thickness by optical coherence tomography +/- SD was 501 +/- 163 micro m (range, 252-1,031 micro m). Mean visual acuity +/- SD increased to 0.75 +/- 0.37 logMAR of Snellen letters at 6 weeks after injection (P = 0.001), with some regression to 0.84 +/- 0.41 logMAR of Snellen letters after 12 weeks. Changes in ETDRS letters were not significant throughout follow-up. Mean retinal thickness +/- SD decreased to 425 +/- 180 micro m at 2 weeks (P = 0.002), 416 +/- 180 micro m at 6 weeks (P = 0.001), and 377 +/- 117 micro m at 12 weeks (P = 0.001). Changes of retinal thickness and visual acuity correlated weakly (r = -0.480 and P = 0.03 at 6 weeks; r = -0.462 and P = 0.07 at 12 weeks). The increase of visual acuity after 6 weeks as measured by ETDRS charts could be predicted best by baseline visual acuity. No other factors investigated, such as age, thickness by optical coherence tomography, or previous treatments, were predictive for the increase in visual acuity. Conclusion Even in cases of diffuse diabetic macular edema not responding to previous treatments such as photocoagulation, intravitreal injection of triamcinolone, or vitrectomy, improvement of visual acuity and decrease of retinal thickness could be observed after intravitreal injection of bevacizumab. Although our follow-up period was too short to provide specific treatment recommendations, the short-term results encourage further prospective studies with different treatment groups and longer follow-up.
448 citations
TL;DR: Bvacizumab was found to be nontoxic to the retina of rabbits based on electrophysiologic studies, and full thickness retinal penetration may explain observed clinical effects of intravitreal bevacIZumab.
Abstract: Purpose:Intravitreal bevacizumab (Avastin; Genentech Inc., San Francisco, CA) is a new treatment for age-related macular degeneration. The aim of this study was to evaluate retinal penetration and toxicity of bevacizumab.Methods:Ten albino rabbits were injected intravitreally with 0.1 mL (2.5 mg) of
364 citations
332 citations
TL;DR: Histologic and ERG results in all groups showed no retinal toxicity of varying doses of bevacizumab when injected intravitreally in rabbits, however, some inflammatory cells were found in the vitreous at the 5–mg dose.
Abstract: Purpose:To evaluate the retinal toxicity of varying doses of bevacizumab when injected intravitreally in rabbits. Bevacizumab has been approved by the US Food and Drug Administration for the treatment of metastatic colorectal cancer.Materials and Methods:Twelve New Zealand albino rabbits were used f
316 citations
TL;DR: Intravitreal injection of bevacizumab achieved short-term reduction of fluorescein leakage from persistent active NV without loss of vision in patients with diabetic retinopathy.
Abstract: OBJECTIVE To evaluate the short-term fluorescein angiographic and visual acuity effects of a single intravitreal injection of bevacizumab (Avastin) for the management of persistent new vessels (NV) associated with diabetic retinopathy. METHODS A prospective, nonrandomized open-label study of diabetic patients with actively leaking NV refractory to laser treatment and best-corrected Early Treatment Diabetic Retinopathy Study visual acuity (BCVA) worse than 20/40. Standardized ophthalmic evaluation was performed at baseline and at weeks 1, 6, and 12 (+/-1) following intravitreal injection of 1.5 mg of bevacizumab. Main outcome measures include changes in total area of fluorescein leakage from active NV and BCVA. RESULTS Fifteen consecutive patients (men, 9 [60%]; women, 6 [40%]) were included and all completed the 12-week follow-up period of the study. The mean +/- SD age of participants was 60.08 +/- 7.75 years (median, 59.5; range, 49-73 years). At baseline, mean +/- standard error of the mean (SEM) NV leakage area was 27.79 +/- 6.29 mm2. The mean +/- SEM area of active leaking NV decreased significantly to 5.43 +/- 2.18 mm2 and 5.50 +/- 1.24 mm2 (P < 0.05, Tukey multiple comparisons post-test) at 1 and 12 weeks postinjection, respectively; at week 6 no leakage was observed. The mean +/- SEM logMAR (Snellen equivalent) BCVA improved significantly from 0.90 (20/160) +/- 0.11 at baseline to 0.76 (20/125(+2)) +/- 0.12, 0.77 (20/125(+2)) +/- 0.11, and 0.77 (20/125(+2)) +/- 0.12 at weeks 1, 6, and 12, respectively (P < 0.05, Tukey multiple comparisons post-test). No major adverse events were observed. CONCLUSIONS Intravitreal injection of bevacizumab achieved short-term reduction of fluorescein leakage from persistent active NV without loss of vision in patients with diabetic retinopathy. Further studies to investigate the role of anti-VEGF therapy with bevacizumab for the management of diabetic retinopathy refractory to laser treatment are warranted.
248 citations
TL;DR: BBG selectively stains the ILM, enabling peeling and surgery to be performed successfully and can facilitate the management of MH and ERM surgery without any adverse effects, as was shown in this short-term study.
Abstract: Purpose To report the use of the dye brilliant blue G (BBG) for staining of the internal limiting membrane (ILM) during macular hole (MH) and epiretinal membrane (ERM) surgery. Methods This study was designed as an interventional, noncomparative, prospective, clinical case series. Twenty eyes from 20 consecutive patients with MH or ERM underwent BBG-assisted ILM and ERM removal. In MH cases, a posterior vitreous detachment was created, followed by the injection of 0.25 mg/mL BBG solution into the vitreous cavity and immediate washout of the BBG. This technique improved visualization of the ILM, enabling peeling and surgery to be performed successfully. However, in ERM cases, staining of the ERM could not be confirmed at this concentration. Finally, the ILM including the ERM was removed in all cases. Preoperative and postoperative ophthalmic examinations were performed. Results Postoperatively, 17 patients (85%) had visual acuity improved by at least 2 Snellen lines. No adverse effects were observed postoperatively during the observation period (mean follow-up +/- SD, 7.3 +/- 1.0 months). Conclusions BBG selectively stains the ILM. This technique can facilitate the management of MH and ERM surgery without any adverse effects, as was shown in this short-term study.
TL;DR: Greater precision and safety in retinal photocoagulation might be achieved by delivering a multiplicity of spots in a pattern created by a scanner rather than as a series of individually placed lesions.
Abstract: The concept of retinal photocoagulation was introduced by Meyer-Schwickerath for the treatment of diabetic retinopathy in the 1950s and used with some success in the 1960s. The xenon arc photocoagulator utilized for this purpose was large, polychromatic, inefficient, and difficult to operate, prompting a search for a better method of treatment. Further progress was achieved when ruby,1 argon ion,2 and krypton ion3 lasers were coupled to a slit lamp with an articulating arm containing mirrors.4 A contact lens, aiming beam, and movable joystick were used to place the laser beam on the retina. These innovations allowed for creating single laser spots of variable size, power, and duration on the retina with a high degree of precision and ushered in the modern era of retinal laser photocoagulation in the 1970s. The techniques enabled by these devices, termed focal photocoagulation, grid photocoagulation, and panretinal photocoagulation, were refined and shown to be effective in the treatment of proliferative diabetic retinopathy and advanced forms of nonproliferative diabetic retinopathy associated with macular edema in large, prospective, multicenter, randomized trials—the DRS and ETDRS.5,6 These trials validated the efficacy and institutionalized the indications and parameters for treatment that have remained the gold standard since that time. Patients with high risk proliferative diabetic retinopathy who undergo panretinal photocoagulation typically receive between 1,200 and 1,500 laser spots in two to four sessions of 10 minutes to 20 minutes each over the course of 2 weeks to 4 weeks. Because the spots are delivered individually, treatments are time consuming and tedious for the patient and physician alike and can be painful, especially in the retinal periphery. Focal photocoagulation and grid photocoagulation for macular edema are less painful and time consuming, because the spots are applied more posteriorly and are fewer in number, but still are tedious and require a considerable degree of patient cooperation and physician skill to achieve a successful outcome and avoid complications. Until now, little has changed in the general design of the devices used for retinal photocoagulation aside from the substitution of fiber-optic cables for articulating arms and the use of air-cooled solid state lasers rather than water-cooled gas tubes. These innovations have had limited or no impact from the standpoint of the patient or physician on the technique of treatments and clinical outcomes. We reasoned that greater precision and safety in retinal photocoagulation might be achieved by delivering a multiplicity of spots in a pattern created by a scanner rather than as a series of individually placed lesions. We also wondered whether the pattern application time and patient discomfort could be further reduced by using shorter pulses than the conventional 100 milliseconds to 200 milliseconds recommended in the DRS and ETDRS.5,6 Prior efforts toward improvement in retinal photocoagulation systems were principally directed toward (1) fully automated systems with retinal stabilization based on eye tracking7–10 and (2) determination of the optimal dose in each spot using the tissue reflectance– based feedback systems.11 Automated systems required acquisition of an image of the retina before the treatment, planning and aligning all treatment locations with reference to the retinal image, and treating all of these locations automatically. Complex retinal tracking systems were also required in these approaches to ensure alignment between planned treatment locations defined on the acquired image and actual sites on the retina.7–10 The complexity of these fully automated systems hampered the introduction of
TL;DR: The intravitreal use of bevacizumab resulted in improvement of mf-ERG macular function responses and relatively stable G-ERG responses, and the macular electrophysiologic response suggests that Macular function improves with treatment.
Abstract: Purpose:To evaluate the short-term electrophysiologic effects of intravitreal bevacizumab in the treatment of exudative age-related macular degeneration (AMD).Methods:Nine subjects with AMD who received treatment with intravitreal bevacizumab for exudative AMD underwent pretreatment testing with mul
TL;DR: BBG, which has low potential for toxicity, high staining ability, and ease of handling, is a good candidate dye for ILM peeling, is demonstrated in primate eyes.
Abstract: Purpose: To investigate the effects of intravitreal brilliant blue G (BBG) on the morphology and functions of the retina and its possible use for staining and peeling of the internal limiting membrane (ILM). Methods: Rat eyes (n = 78) underwent gas compression vitrectomy. BBG solution was then injected into the vitreous cavity. The eyes were enucleated at 2 weeks and 2 months. Light as well as electron microscopy, terminal nick-end labeling staining, and electroretinography (ERG) were used to investigate retinal damage and function. To test the clinical potential of BBG, ILM staining was evaluated in primate eyes after pars plana vitrectomy followed by ILM peeling. Results: In the rat eyes, no pathologic changes were observed with light microscopy. Electron microscopy revealed that high doses of BBG induced vacuolization in the inner retinal cells, but apoptosis was not detected. There was no reduction in the amplitude of the ERG waves. In the primate eyes, the ILM was clearly visualized after the intravitreous injection of BBG and was peeled off easily from the retina. Conclusions: These results demonstrate that BBG, which has low potential for toxicity, high staining ability, and ease of handling, is a good candidate dye for ILM peeling.
TL;DR: Fluid retention associated with glitazone use should be considered when assessing treatment options for patients with DME, especially those with concomitant peripheral edema.
Abstract: PURPOSE To describe diabetic macular edema (DME) in patients who developed fluid retention as a consequence of glitazone use. METHODS A chart review identified 30 patients who used pioglitazone or rosiglitazone and had both lower extremity edema and macular edema. Clinical reports, photographs, and fluorescein angiograms were reviewed. Patients followed for >3 months were analyzed separately. RESULTS Seventeen patients took oral pioglitazone, 11 took rosiglitazone, and 2 took both drugs at different times. Eleven patients were observed for >3 months after cessation of glitazones. Mean weight gain during drug administration in this group was 30 lb, and mean weight loss after drug discontinuation was 19 lb. Rapid reduction in macular edema off drug occurred in only 4 of 11 patients, but 8 of 11 had reduced edema over 2 years. Mean visual acuity in this group at the initial visit was 20/60, and at the final visit, it was 20/85. Four eyes of three patients had resolution of diffuse macular edema with improved vision after cessation of glitazones without laser treatment. CONCLUSIONS Fluid retention occurs in 5% to 15% of patients taking glitazones. In some of these patients, glitazone use appears to be a cause of macular edema, and drug cessation appears to result in rapid resolution of both peripheral and macular edema. Fluid retention associated with glitazone use should be considered when assessing treatment options for patients with DME, especially those with concomitant peripheral edema.
TL;DR: Benzyl alcohol at concentrations modestly higher than what is present in commercial Kenalog is toxic to the rabbit eye, and decanting the supernatant or using other means to remove the benzyl alcohol may be considered.
Abstract: PURPOSE To test the toxicity of intravitreal injections of benzyl alcohol. METHODS Nine New Zealand rabbits were injected with either a control or a test article at elevating concentrations. The test article was benzyl alcohol calculated to give final injected concentrations of 0.0073%, 0.022%, 0.073%, 0.222%, and 0.733% benzyl alcohol. The 0.022% concentration corresponds to the concentration of benzyl alcohol in human eyes when 0.1 mL of commercial Kenalog (Bristol-Myers Squibb, Princeton, NJ) is used. Baseline examination of the rabbits was performed along with postinjection examinations on days 1, 3, 7, and 14. The eyes were enucleated and examined by light and electron microscopic examinations. RESULTS Eyes injected with benzyl alcohol concentrations of 0.073%, 0.222%, and 0.733% displayed changes in the outer retina including loss of, and shortening of, outer segments and photoreceptors. CONCLUSIONS Benzyl alcohol at concentrations modestly higher than what is present in commercial Kenalog is toxic to the rabbit eye. This has been shown in other organ systems. If commercial preserved Kenalog is to be used clinically, decanting the supernatant or using other means to remove the benzyl alcohol may be considered, especially if a volume of >0.1 mL of solution is used. We hypothesize that the noninfectious inflammation seen clinically after Kenalog injection is due to the presence of a toxic preservative at unsafe concentrations.
TL;DR: It is suggested that bevacizumab, at concentrations at or above the dose normally used in clinical practice, is not toxic to human retinal pigment epithelial, rat neurosensory retinal, or human microvascular endothelial cells in vitro.
Abstract: Purpose To evaluate the short-term in vitro safety of bevacizumab (Avastin) in human retinal pigment epithelial (ARPE-19), rat neurosensory retinal (R28), and human microvascular endothelial (HMVECad) cells. Methods ARPE-19 and R28 cells were treated with 0.125 mg/mL, 0.25 mg/mL, 0.50 mg/mL, and 1 mg/mL of bevacizumab for 2, 6, and 24 hours. HMVECad cells were treated with 5 ng/mL of vascular endothelial growth factor (VEGF) and 0.125 mg/mL, 0.25 mg/mL, 0.50 mg/mL, and 1 mg/mL of either bevacizumab for 2, 6, and 24 hours or a nonspecific human purified immunoglobulin (IgG) for 24 hours. Cell viability was measured using trypan blue dye exclusion assay. Results The cell viabilities of ARPE-19 cells, R28 cells, and HMVECad cells treated with bevacizumab were not significantly different (P > 0.05) from that of untreated controls. There was no significant difference (P > 0.05) between viabilities of HMVECad cells treated with bevacizumab and IgG. Conclusion This study suggests that bevacizumab, at concentrations at or above the dose normally used in clinical practice, is not toxic to human retinal pigment epithelial, rat neurosensory retinal, or human microvascular endothelial cells in vitro. This report is consistent with the recent report of lack of toxicity of intravitreal bevacizumab in rabbits as well as the lack of apparent toxicity in clinical use.
TL;DR: Structural improvement was seen but with limited visual improvement after ILM peeling, in this prospective, comparative study of PPV with and without ILm peeling for diffuse clinically significant macular edema.
Abstract: PURPOSE: A prospective, comparative, nonrandomized study to evaluate the efficacy of pars plana vitrectomy (PPV) with and without inner limiting membrane (ILM) peeling for persistent diffuse clinically significant macular edema. METHODS: Eighteen patients with persistent diffuse clinically significant macular edema despite laser photocoagulation were recruited for the study. Clinical assessment included determination of best-corrected visual acuity, fundus fluorescein angiography, optical coherence tomography, and perifoveal cone function testing. Eight patients underwent PPV with elevation and removal of the posterior hyaloid alone, and 10 patients underwent vitrectomy and ILM peeling. The follow-up was 12 months. RESULTS: Patients with ILM peeling had improvement in foveal thickness (P = 0.07) and significant improvement in the macular volume (P = 0.039) 12 months after surgery but did not have significant improvement in Early Treatment Diabetic Retinopathy Study vision or perifoveal cone function. There was no significant difference in outcome parameters between the no peeling group and the ILM peeling group. CONCLUSIONS: In this prospective, comparative study of PPV with and without ILM peeling for diffuse clinically significant macular edema, structural improvement was seen but with limited visual improvement after ILM peeling
TL;DR: A single dose of intravitreal bevacizumab is likely to provide complete intravItreal VEGF blockade for a minimum of 4 weeks, with an intrav itreal beVacIZumab half-life of ≈3 days.
Abstract: Background:Vitreous levels of unbound bevacizumab (Avastin) and unbound vascular endothelial growth factor (VEGF) were determined in two patients. Patient 1 underwent repair of an 8-day-old rhegmatogenous retinal detachment 4 weeks after a single intravitreal bevacizumab injection, and Patient 2 und
TL;DR: Combined treatment of PDT with verteporfin and intravitreal bevacizumab may be useful in treating neovascular AMD by reducing retreatment rates and improving visual acuity.
Abstract: Purpose: To examine the 7-month results for patients treated with combined photodynamic therapy (PDT) with verteporfin and intravitreal bevacizumab for choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). Methods: This is a retrospective series of 24 eyes with juxtafoveal or subfoveal CNV secondary to AMD. Patients were treated with PDT with verteporfin and 1.25 mg of intravitreal bevacizumab. All patients were naive to treatment and had either treatment within a 14-day interval. Main outcome measures were visual acuity stabilization (defined as no change or a gain in visual acuity) and retreatment rate. Results: At the 7-month follow-up, 20 (83%) of 24 patients had stabilization of visual acuity. Sixteen eyes (67%) had improvement in visual acuity. Mean improvement in visual acuity (n = 24) was 2.04 Snellen lines. Fifteen eyes (63%) required only a single combined treatment for CNV resolution. There were no complications, including endophthalmitis, uveitis, and ocular hypertension. Conclusion: The results of this study suggest that combined treatment of PDT with verteporfin and intravitreal bevacizumab may be useful in treating neovascular AMD by reducing retreatment rates and improving visual acuity. Further investigation with large, controlled trials is warranted to outline the appropriate treatment paradigm for combination therapy.
TL;DR: Intravitreal bevacizumab has the potential for improvement in vision in both naive and previously treated eyes for at least 6 months, and the benefit is more pronounced in eyes without prior pegaptanib and/or PDT.
Abstract: PURPOSE: To study the visual and anatomic outcome of intravitreal bevacizumab injection in the treatment of exudative age-related macular degeneration (AMD). METHODS: Retrospective review of patients who received one or more intravitreal bevacizumab injections for exudative AMD. Outcome measures include standardized visual acuity, optical coherence tomography (OCT), macular thickness and volume, intraocular pressure, and blood pressure at 24 or more weeks follow-up. RESULTS: Fifty eyes of 48 patients were identified. Patients were observed for a median length of follow-up of 34 weeks (range, 24-50 weeks). Thirty-six eyes (72%) had prior treatment with pegaptanib (Macugen) and/or photodynamic therapy (PDT) and 14 eyes (28%) were treatment-naive. Mean visual acuity increased by 6.5 letters (P < 0.01) at 4 weeks and 5.3 letters (P < 0.01) at 24 weeks after initial bevacizumab injection. At 24 weeks, naive eyes had a mean increase of 14.2 letters (P < 0.001) and previously treated eyes had a mean increase of 2.8 letters (P = 0.06). Overall, mean OCT macular thickness and volume decreased by 73 micro m (P < 0.001) and 1.0 mm3 (P < 0.001) respectively at last follow-up. At last follow-up, all eyes received an average of 3.5 injections and experienced an average of 1.08 recurrences. There was no incidence of severe vision loss or adverse effect. CONCLUSION: Intravitreal bevacizumab has the potential for improvement in vision in both naive and previously treated eyes for at least 6 months. The benefit is more pronounced in eyes without prior pegaptanib and/or PDT.
TL;DR: Macular hole surgery with peeling of the ILM is a very safe procedure that leads to very good and stable functional and anatomical results and best-corrected visual acuity improved in 59 (92%) of 64 patients, remained unchanged in 2, and deteriorated in 3.
Abstract: PURPOSE To report on long-term results of macular hole surgery with peeling of the internal limiting membrane (ILM) in a prospective nonrandomized study. METHODS Sixty-four consecutive patients with a follow-up of at least 36 months were included. Only idiopathic macular holes were included in the study. All patients had undergone standard pars plana vitrectomy with removal of the ILM and intraocular gas tamponade with a 15% hexafluoroethane (C2F6) gas-air mixture followed by a face-down position for at least 5 days. During each follow-up visit, complete clinical examination including determination of best-corrected visual acuity, Goldmann perimetry, and optical coherence tomography was performed. RESULTS Fifty-two patients were female and 12 were male, and the patients' mean age was 72 years (range, 53-82 years) at the last visit. We observed stage 2 holes in 5 patients, stage 3 holes in 47, and stage 4 holes in 12. The median postoperative follow-up was 62 months (mean, 56 months; range, 36-75 months). Sixty-two patients (97%) were pseudophakic at the last examination: 3 patients (5%) were already pseudophakic at the time of macular hole surgery; a combined procedure was performed on 9 patients (14%); and 50 patients (78%) underwent cataract surgery later. The median follow-up for patients after cataract extraction was 61 months (mean, 56 months; range, 36-75 months). Anatomical closure was achieved in 61 (95%) of 64 patients as confirmed clinically and by optical coherence tomography. No late reopening of a macular hole or formation of epiretinal membranes was observed after successful hole closure. Best-corrected visual acuity improved in 59 (92%) of 64 patients, remained unchanged in 2, and deteriorated in 3. Best-corrected visual acuity improved from a median of 20/100 preoperatively to a median of 20/32 postoperatively (P < 0.001). There was a median gain of 5 lines (range, -6 to 12). The development of visual acuity did not depend on the duration of symptoms, the number of surgeries, or the stage of the macular hole. CONCLUSIONS Macular hole surgery with peeling of the ILM is a very safe procedure, even in the long term. It leads to very good and stable functional and anatomical results.
TL;DR: The present study shows the efficacy of topical dorzolamide for treating foveal cystic-appearing lesions in patients with XLRS.
Abstract: Purpose: To determine the value of a topical carbonic anhydrase inhibitor for the treatment of foveal lesions in patients with X-linked retinoschisis (XLRS). Methods: Eight patients with XLRS and foveal cystic-appearing spaces by fundus examination and by optical coherence tomography (OCT) were treated with a topical form of carbonic anhydrase inhibitor. Changes in “foveal thickness” and “foveal zone thickness” were measured by OCT, and changes of best-corrected visual acuity were measured by Early Treatment Diabetic Retinopathy Study (ETDRS) charts. Results: Seven of eight patients treated with 2% dorzolamide had a noticeable reduction in foveal thickness as well as cystic-appearing spaces by OCT. This reduction was found in both eyes in four of these patients and in one eye in one patient after 1 month of treatment. After an additional 1 month to 2 months of the same treatment regimen, two additional patients also had a noticeable reduction in foveal thickness as well as cystic-appearing spaces. Of these seven patients who had an improvement shown by OCT with treatment, five also had improvement of their visual acuity by ≥7 letters in at least one eye on ETDRS charts. Conclusion: The present study shows the efficacy of topical dorzolamide for treating foveal cystic-appearing lesions in patients with XLRS.
TL;DR: The anti-VEGF activity of bevacizumab may degrade minimally over time, with storage, and this results suggests that it may be able to be frozen for up to 6 months after refrigeration or freezing.
Abstract: Purpose To determine the change in anti-vascular endothelial growth factor (VEGF) activity of bevacizumab (Avastin, Genentech, Inc., San Francisco, CA) after refrigeration or freezing. Methods Samples of bevacizumab were drawn up from new vials into plastic tuberculin syringes and refrigerated at 4 degrees C for 1 week, 3 weeks, 1 month, 3 months, and 6 months. The vials and syringes were stored at 4 degrees C, and the syringes were capped with a needle. One syringe was frozen at -10 degrees C. The bevacizumab concentration was measured, via its binding to VEGF-165. Results The percentage of degradation of bevacizumab in the previously pierced vials stored at 4 degrees C compared with that in the unpierced vial was 9.6% at 3 months and 12.7% at 6 months. The bevacizumab drawn into the syringe and stored at 4 degrees C was degraded by 1.6% at 1 week, 0% at 3 weeks, 8.8% at 3 months, and 15.9% at 6 months. The bevacizumab frozen in a syringe at -10 degrees C was degraded by 12.0% at 6 months. Conclusion The anti-VEGF activity of bevacizumab may degrade minimally over time, with storage.
TL;DR: A posterior localization of the disease carries a worse prognosis after laser photocoagulation, and surgical intervention can effectively reattach the retina in a significant number of zone I ROP-related retinal detachments.
Abstract: Purpose:To study the clinical characteristics and treatment outcomes after laser and surgical treatment in a series of infants with zone I retinopathy of prematurity (ROP).Methods:Preterm infants less than 1,500 g at birth diagnosed with zone I ROP were studied. Fifty-seven consecutive eyes in 29 in