4 research outputs found
Strategy for the Management of Uncomplicated Retinal Detachments
No full textObjective: To study success and failure in the treatment of uncomplicated rhegmatogenous retinal detachments (RRDs). Design: Nonrandomized, multicenter retrospective study. Participants: One hundred seventy-six surgeons from 48 countries spanning 5 continents provided information on the primary procedures for 7678 cases of RRDs including 4179 patients with uncomplicated RRDs. Methods: Reported data included specific clinical findings, the method of repair, and the outcome after intervention. Main Outcome Measures: Final failure of retinal detachment repair (level 1 failure rate), remaining silicone oil at the study's conclusion (level 2 failure rate), and need for additional procedures to repair the detachment (level 3 failure rate). Results: Four thousand one hundred seventy-nine uncomplicated cases of RRD were included. Combining phakic, pseudophakic, and aphakic groups, those treated with scleral buckle alone (n = 1341) had a significantly lower final failure rate than those treated with vitrectomy, with or without a supplemental buckle (n = 2723; P = 0.04). In phakic patients, final failure rate was lower in the scleral buckle group compared with those who had vitrectomy, with or without a supplemental buckle (P = 0.028). In pseudophakic patients, the failure rate of the initial procedure was lower in the vitrectomy group compared with the scleral buckle group (P = 3×10-8). There was no statistically significant difference in failure rate between segmental (n = 721) and encircling (n = 351) buckles (P = 0.5). Those who underwent vitrectomy with a supplemental scleral buckle (n = 488) had an increased failure rate compared with those who underwent vitrectomy alone (n = 2235; P = 0.048). Pneumatic retinopexy was found to be comparable with scleral buckle when a retinal hole was present (P = 0.65), but not in cases with a flap tear (P = 0.034). Conclusions: In the treatment of uncomplicated phakic retinal detachments, repair using scleral buckle may be a good option. There was no significant difference between segmental versus 360-degree buckle. For pseudophakic uncomplicated retinal detachments, the surgeon should balance the risks and benefits of vitrectomy versus scleral buckle and keep in mind that the single-surgery reattachment rate may be higher with vitrectomy. However, if a vitrectomy is to be performed, these data suggest that a supplemental buckle is not helpful. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. © 2013 American Academy of Ophthalmology
A model of the interaction of DR5026 with a bacterial membrane.
No full text<p>The final state of MD simulation after 55 ns shows <b>DR5026</b> molecules penetrated into the phospholipid bilayer. The nitrogen atoms from the iminosugar modules of <b>DR5026</b> are highlighted as blue spheres. Phosphorus atoms of the phospholipid bilayer (PB) are depicted as yellow/red spheres. For clarity, almost all atoms of the PB are hidden.</p
Three-year randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with diabetic macular edema.
No full textPurpose: To evaluate the safety and efficacy of dexamethasone intravitreal implant (Ozurdex, DEX implant)
0.7 and 0.35 mg in the treatment of patients with diabetic macular edema (DME).
Design: Two randomized, multicenter, masked, sham-controlled, phase III clinical trials with identical protocols
were conducted. Data were pooled for analysis.
Participants: Patients (n 1⁄4 1048) with DME, best-corrected visual acuity (BCVA) of 20/50 to 20/200 Snellen
equivalent, and central retinal thickness (CRT) of 300 mm by optical coherence tomography.
Methods: Patientswere randomized in a 1:1:1 ratio to study treatmentwithDEX implant 0.7mg,DEX implant 0.35
mg, or shamprocedure andfollowedfor 3 years (or 39months for patients treatedatmonth36) at40 scheduledvisits.
Patients who met retreatment eligibility criteria could be retreated no more often than every 6 months.
Main Outcome Measures: The predefined primary efficacy endpoint for the United States Food and Drug
Administration was achievement of 15-letter improvement in BCVA from baseline at study end. Safety measures
included adverse events and intraocular pressure (IOP).
Results: Mean number of treatments received over 3 years was 4.1, 4.4, and 3.3 with DEX implant 0.7 mg, DEX
implant 0.35 mg, and sham, respectively. The percentage of patients with 15-letter improvement in BCVA from
baseline at study end was greater with DEX implant 0.7 mg (22.2%) and DEX implant 0.35 mg (18.4%) than sham
(12.0%; P 0.018). Mean average reduction in CRT from baseline was greater with DEX implant 0.7 mg (111.6
mm) and DEX implant 0.35 mg (107.9 mm) than sham (41.9 mm; P < 0.001). Rates of cataract-related adverse
events in phakic eyes were 67.9%, 64.1%, and 20.4% in the DEX implant 0.7 mg, DEX implant 0.35 mg, and sham
groups, respectively. Increases in IOP were usually controlled with medication or no therapy; only 2 patients (0.6%)
in the DEX implant 0.7 mg group and 1 (0.3%) in the DEX implant 0.35 mg group required trabeculectomy.
Conclusions: The DEX implant 0.7 mg and 0.35 mg met the primary efficacy endpoint for improvement in
BCVA. The safety profile was acceptable and consistent with previous reports. Ophthalmology 2014;121:1904-
1914 a 2014 by the American Academy of Ophthalmolog
