1,721,013 research outputs found
XEN gel stent for the treatment of open-angle glaucoma: real-world effectiveness and safety
No full textThe term glaucoma refers to a broad group of diseases causing characteristic optic nerve damage. Elevated intraocular pressure (IOP) does not define glaucoma but has been strongly associated with the development and progression of glaucomatous damage and is currently the only modifiable risk factor. Among new surgical procedure to reduce IOP, the XEN gel stent implantation offers sub-conjunctival filtration by the implantation of a flexible 6mm tube. In the present work we have prospectively collected data on XEN implantations performed at our site with the aim to assess the efficacy and safety of the procedure. In this research we found that a post-operative IOP below or equal to 9 mmHg, which is the theoretical pressure drop of the implant, is also predictive of long-term efficacy of the procedure. We reported and analysed two relevant complications regarding the XEN implantation. Choroidal detachment has been associated with higher patient's age and with an increased number of IOP-lowering drugs. We also reported cases where the implant appeared damaged during the follow-up and we described the clinical course. Then, comparing XEN with trabeculectomy, we found that the two procedures are comparable when the IOP success criterion is in the mid-teens but is favourable to trabeculectomy when a very low IOP target is needed
The Use of Topical Corticosteroids for Treatment of Dry Eye Syndrome
No full textDry eye disease (DED) is a multifactorial disease that results in symptoms of discomfort, visual disturbance, and damage to the ocular surface. Because chronic inflammation plays an important role in DED, treatment with topical corticosteroids has been demonstrated to ameliorate the signs and symptoms of the disease. Although these agents have proven short-term efficacy, their long-term use may cause intraocular pressure elevation and cataract progression. A carefully review of the different studies shows that differences between corticosteroids may exist regarding the incidence of side effects and evidence of efficacy in DED patients
Chorioretinal folds: a proposed diagnostic algorithm
No full textPurpose: To create a diagnostic algorithm for the management of chorioretinal folds. Methods: We reviewed the existing literature about chorioretinal folds focusing our attention on three specific conditions and created a diagnostic algorithm in order to otpimize the choice and the number of investigations. Results: Chorioretinal folds are visible striations of the fundus usually arranged in parallel lines and disposed horizontally. They may be either unilateral or bilateral, symptomatic or asymptomatic and are often associated with different possible ocular and extra ocular pathologies, including systemic diseases like autoimmune disorders and intracranial hypertension. They are named idiopathic when no apparent cause for their development is detectable. However, with improved diagnostic testing, the patients with idiopathic choroidal folds are likely to represent only a smaller portion of the total. Conclusions: Since choroidal folds be the sole sign of an underlying disease possibly requiring a multidisciplinary approach, an appropriate work-up varying according to the specific clinical features of each case is needed to define the etiology and the treatment. A diagnosting algorithm may be useful in order to optimize the diagnostic approach and management
COLOR DOPPLER IMAGING (CDI) IN PAZIENTE CON GLAUCOMA PRIMARIO A BASSA PRESSIONE SOTTOPOSTA A TERAPIA MEDICA E AGOPUNTURA
No full textSubthreshold laser grid photocoagulation for the treatment of diabetic macular edema
No full textAbstract Purpose : o evaluate the efficacy and safety of subthreshold laser grid photocoagulation (SLGP) in patients affected by diabetic macular edema (DME). Methods : or the past decades, laser photocoagulation has been the mainstay of treatment for patients with DME; however, although effective in preserving vision, this form of therapy is of limited effect in restoring lost vision. Recently, anti vascular endothelial growth factor agents and corticosteroids have been approved for the treatment of DME but there are still some questions regarding safety, dose frequency and costs for both the patients and the national health system. Retrospective analysis of the I-maculaweb database selecting patients with DME treated with SLGP. The patients for this study were selected according to the following characteristics: not being able to receive either anti-VEGF agents, due to medical reasons, or corticosteroids being phakic or cortisone responders or among those who did not show any improvement after anti-VEGF injections. 21 eyes of 14 caucasian patients were treated with SLGP using 10 ms, 100 μm single spot, 50% end point management. Initial energy was 100 mW, increases of 25 mW were utilised as needed.Patients were retreated after a minimum time of 3 months when either the central retinal thickness (CRT) didn’t show any sign of decrease or best corrected visual acuity (BCVA) didn’t increase more than 5 letter. Mean number of SLGP was 1.4±0.75.Glycosilated Haemoglobin levels were monitored before the treatment and did not differ significantly during the follow-up. Results : ean age was 68 years±16.85. Mean CRT at baseline and last follow-up visit was 327.49μ ±27.40 and 312.07 μ ±32.06 respectively (p=0.0045; paired t test). Mean number of ETDRS letter score at baseline and last follow-up visit was 67.43±9.93 and 71.38±10.95 (p=0,0075; paired t test) respectively. Mean follow-up was 11.52 months ±9.02.No visual and systemic adverse events were experienced after the SLGP. Conclusions : LGP might be a safe and useful option in those patients who cannot receive either anti-vegf agents or corticosteroids. This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016
Il possibile ruolo biologico del TGF-Beta nella rara associazione fra cataratta e malattia di Dupuytren
No full textEuropean Glaucoma Society - Terminology and guidelines for glaucoma, 6th Edition
No full text: We practice medicine in times of exponentially increasing medical knowledge. In 1950, it was estimated that the doubling time was 50 years; by 1980, it was 7 years and by 2010, 3.5 years. In 2020, it was projected to be just 73 days! To continue to practice evidence-based medicine and to provide the best possible care for our patients, clinicians need to adapt their strategies to keep their knowledge up to date. There will always be a role for critical appraisal of individual studies in the field of a clinician's practice, but with such an increase in the volume of published research, it becomes impossible to appraise all relevant material. For this reason, sources of distilled knowledge, such as the EGS Guidelines, become essential references for best practice medicine. Rigorous methods for evidence synthesis, such as the systematic reviews overseen by Cochrane, provide a comprehensive summary of the current state of knowledge for important clinical questions. However, for many clinical uncertainties, there is little or no high-quality evidence, let alone an evidence synthesis. Where evidence is lacking, practice guidance needs to be built from expert opinion and consensus, while acknowledging the limitations of such an approach. Expert opinion, derived from sound medical knowledge and years of practice experience, also has an important role in understanding the relevance of lines of evidence and the nuances of implementing them in practice. Thus, the expert commentary around the evidence base given in these Guidelines is essential for proper implementation of published evidence. Importantly, the EGS Guidelines also include 'Choosing wisely' elements indicating actions which should be avoided due to insufficient evidence and/or unsubstantiated belief. Guidelines need regular updating to take account of new knowledge and aspects of clinical care that have not been given sufficient emphasis in the past. This 6th Edition of the EGS Guidelines includes an updated 'evidence based' section with new clinical questions and evidence-based answers. The section 'What matters to patients' has also been updated, recognising that, because Guidelines are typically written by clinicians for clinicians, there have been gaps in understanding the patient perspective. The updated section now has direct input from the Expert by Experience patient advisors in the EGS Patient Involvement Project and includes eight Tips for Doctors in their communication with patients. The Guidelines team, led by Drs Pazos, Traverso and Viswanathan, is to be congratulated for the 6th Edition of the Guidelines, updating and enhancing the previous edition, while maintaining the highly success format which gives a framework for glaucoma care, based on evidence synthesis and consensus expert opinion, and presented as a 'How to' manual for patient diagnosis and management. David (Ted) Garway-Heath Glaucoma UK Professor of Ophthalmology, UC
Assessing Descemet's Stripping Automated Endothelial Keratoplasty in complex cases followed up with Optical Coherence Tomography
No full textAbstract Purpose : to assess the predictive value of early Anterior Segment Optical Coherence Tomography (AS-OCT) findings on graft adherence after Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) performed in complex eyes. Methods : hirty-seven consecutive DSAEK in complex eyes, performed by a single surgeon (C.E.T.), were analyzed. The main inclusion criterion was a history of one or more surgical procedures, i.e. trabeculectomy, glaucoma drainage device (GDD, Baerveldt®) implantation, penetrating keratoplasty (PK), aphakia with anterior chamber intraocular lens (AC-IOL) implantation, AC-IOL + GDD, PK + GDD, PK + AC-IOL + GDD, respectively. Complexity included severe corneal edema. Uncomplicated cataract extraction with posterior chamber IOL implantation was not a selection criterion. Graft adherence/detachment was assessed using AS-OCT on day 1 (early AS-OCT) and week 1 postoperatively and again at 1, 3 and 6 months. Grading was: complete attachment, one sector peripheral detachment (1S.P.D.), more than one sector peripheral detachment (>1S.P.D.). Results :f the 37 consecutive complex eyes analyzed, thirty eyes (81%) had severe corneal edema preoperatively. At day 1, 7 grafts (19%) were completely attached in the AS-OCT scan and 30 (81%) showed some degree of peripheral detachment. Nineteen (63%) of the partially detached cases presented 1S.P.D. and 11 (37%) had >1S.P.D. At 6 months, completely attached grafts were stable. Seventeen eyes with 1S.P.D. (90%) showed improved graft adhesion; 2 (10%) were unchanged. Of the 11 cases with >1S.P.D.: 8 (72%) were stable, 2 (18%) detached completely while and 1 (9%) improved. Conclusions :S-OCT is a non-invasive imaging technique and therefore suited to monitor DSAEK graft adhesion in complex eyes. Findings at day 1 yielded a good predictive value of graft adherence at 6 months. Therefore, early AS-OCT scans do, indeed, facilitate decision-making with regards to further surgical procedures in complex eyes. This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016
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