Current Issue : July - September Volume : 2012 Issue Number : 3 Articles : 7 Articles
We review articles describing intravitreal injection of anti-VEGF drug trials, while discussing the mechanisms of the action of anti-\r\nVEGF antibodies, and also evaluating their outcomes. Intraocular injections of anti-VEGF drug are considered to be an effective\r\ntreatment for macular edema after retinal vein occlusion, however, recurrent/persistent edema is common. The recent reports\r\nmay lead to a shift in treatment paradigm for DME, from laser photocoagulation, to newer approaches using anti-VEGF drugs.\r\nThere have been several well-publicized prospective, randomized studies that demonstrated the efficacy of intravitreal injection of\r\nanti-VEGF drugs for patients with AMD. Adjuvant bevacizumab for neovascular glaucoma may prevent further PAS formation,\r\nand it is likely to open up a therapeutic window for a panretinal photocoagulation and trabeculectomy. Intravitreal injection of\r\nbevacizumab (IVB) results in a substantial decrease in bleeding from the retinal vessels or new vessels during a standard vitrectomy.\r\nIVB has also been reported to be effective for inducing the regression of new vessels in proliferative diabetic retinopathy. The use\r\nof bevacizumab in stage 4 or 5 retinopahty of permaturity (ROP) is to reduce the plus sign to help reduce hemorrhage during the\r\nsubsequent vitrectomy. Some authors reported cases of resolution of stage 4 A ROP after bevacizumab injection....
Purpose. To describe the distribution of ocular variables, risk factors, and disease severity in newly diagnosed ocular hypertension\r\n(OH) or open-angle glaucoma (OAG). Methods. Eligible subjects underwent a complete history and examination. Adjusted odds\r\nratios (ORs) and 95% confidence intervals (CIs) obtained from multiple logistic regression models were used to compare OAG\r\nto OH and advanced to early/moderate OAG. Results. 405 subjects were enrolled: 292 (72.1%) with OAG and 113 (27.9%) with\r\nOH. 51.7% had early, 27.1% moderate, and 20.9% advanced OAG. The OR for OAG versus OH was 8.19 (P < 0.0001) for disc\r\nnotch, 5.36 (P < 0.0001) for abnormal visual field, 1.45 (P = 0.001) for worsening mean deviation, 1.91 (P < 0.0001) for increased\r\ncupping, 1.03 for increased age (P = 0.030), and 0.36 (P = 0.010) for smoking. Conclusions. Increased age was a risk for OAG,\r\nand smoking decreased the risk of OAG compared to OH. Almost half of the OAG subjects had moderate/advanced disease at\r\ndiagnosis....
Angiogenesis is the process by which new blood vessels form from existing vessel networks. In the past three decades, significant\r\nprogress has been made in our understanding of angiogenesis; progress driven in large part by the increasing realization that\r\nblood vessel growth can promote or facilitate disease. By the early 1990s, it had become clear that the recently discovered ââ?¬Å?vascular\r\nendothelial growth factorââ?¬Â (VEGF) was a powerful mediator of angiogenesis. As a result, several groups targeted this molecule\r\nas a potential mediator of retinal ischemia-induced neovascularization in disorders such as diabetic retinopathy and retinal vein\r\nocclusion. Around this time, it also became clear that increased intraocular VEGF production was not limited to ischemic retinal\r\ndiseases but was also a feature of choroidal vascular diseases such as neovascular age-related macular degeneration (AMD). Thus,\r\na new therapeutic era emerged, utilizing VEGF blockade for the management of chorioretinal diseases characterized by vascular\r\nhyperpermeability and/or neovascularization. In this review, we provide a guide for clinicians on the development of anti-VEGF\r\ntherapies for intraocular use....
Glaucoma after corneal transplantation is a leading cause of ocular morbidity after penetrating keratoplasty. The incidence\r\nreported is highly variable and a number of etiologic factors have been identified. A number of treatment options are available;\r\nsurgical intervention for IOP control is associated with a high incidence of graft failure. IOP elevation is less frequently seen\r\nfollowing deep anterior lamellar keratoplasty. Descemet�s striping-automated endothelial keratoplasty is also associated with\r\npostprocedure intraocular pressure elevation and secondary glaucoma and presents unique surgical challenges in patients with\r\npreexisting glaucoma surgeries. Glaucoma exists in up to three-quarters of patients who undergo keratoprosthesis surgery and\r\nthe management if often challenging. The aim of this paper is to highlight the incidence, etiology, and management of glaucoma\r\nfollowing different corneal transplant procedures. It also focuses on the challenges in the diagnosis of glaucoma and intraocular\r\npressure monitoring in this group of patients....
Diabetes is a systemic disease that causes a number of metabolic and physiologic abnormalities. One of the major microvascular\r\ncomplications of diabetes is diabetic retinopathy (DR), a leading cause of blindness in people over age 50. The mechanisms\r\nunderlying the development of DR are not fully understood; however, extensive studies have recently implicated chronic, lowgrade\r\ninflammation in the pathophysiology of DR. During inflammation leukocytes undergo sequential adhesive interactions with\r\nendothelial cells to migrate into the inflamed tissues, a process known as the ââ?¬Å?leukocyte recruitment cascadeââ?¬Â which is orchestrated\r\nby precise adhesion molecule expression on the cell surface of leukocytes and the endothelium. This paper summarizes the recent\r\nclinical and preclinical works on the roles of leukocyte adhesion molecules in DR....
Purpose. To evaluate the effects of photodynamic therapy (PDT) combined with intravitreal injection of ranibizumab (IVR) for\r\nexudative age-related macular degeneration (AMD). Methods. Retrospective case series. Thirty eight eyes of 38 patients with\r\nexudative AMD underwent combined therapy consisting first of IVR, followed by PDT within a week and the second IVR at 1\r\nmonth. All patients were followed up for more than 12 months. The best corrected visual acuity (BCVA) and central macular\r\nthickness (CMT) were examined. Results. The mean number of IVR and PDT sessions were 2.9 �± 1.3 and 1.1 �± 0.3, respectively.\r\nThe mean BCVA and CMT were significantly improved to 0.38 logMAR units (P < 0.01) and 240 �µm (P < 0.01) at 12 months,\r\nrespectively. Thirty-six of 38 eyes (94.8%) improved or maintained BCVA at 12 months. Conclusion. PDT combined with IVR for\r\nexudative AMD was effective at improving visual acuity and CMT with a low recurrence rate for 12 months....
This paper aims to evaluate the efficacy of intravitreal ultrasound (US) irradiation for green fluorescent protein (GFP) plasmid\r\ntransfer into the rabbit retina using a miniature US transducer. Intravitreal US irradiation was performed by a slight modification\r\nof the transconjunctival sutureless vitrectomy system utilizing a small probe. After vitrectomy, the US probe was inserted through\r\na scleral incision. A mixture of GFP plasmid (50 �µL) and bubble liposomes (BLs; 50 �µL) was injected into the vitreous cavity, and\r\nUS was generated to the retina using a SonoPore 4000. The control group was not exposed to US. After 72 h, the gene-transfer\r\nefficiency was quantified by counting the number of GFP-positive cells. The retinas that received plasmid, BL, and US showed\r\na significant increase in the number (average �± SEM) of GFP-positive cells (32 �± 4.9; n = 7; P < 0.01 ). No GFP-positive cells\r\nwere observed in the control eyes (n = 7). Intravitreal retinal US irradiation can transfer the GFP plasmid into the retina without\r\ncausing any apparent damage. This procedure could be used to transfer genes and drugs directly to the retina and therefore has\r\npotential therapeutic value....
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