211 research outputs found
Ultra-wide-field fluorescein angiography in diabetic retinopathy: a narrative review
No full textAlessandro Rabiolo,1 Mariacristina Parravano,2 Lea Querques,1,2 Maria Vittoria Cicinelli,1 Adriano Carnevali,1,3 Riccardo Sacconi,1,4 Teresa Centoducati,1 Stela Vujosevic,5 Francesco Bandello,1 Giuseppe Querques1 1Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, 2G. B. Bietti Foundation – IRCCS, Rome, 3Department of Ophthalmology, University of “Magna Graecia,” Catanzaro, 4Department of Neurological and Movement Sciences, University of Verona, Verona, 5Department of Neuroscience, Ophthalmology Clinic, University of Padova, Padova, Italy Abstract: Fluorescein angiography (FA) is a useful examination in patients suffering from diabetic retinopathy (DR). Traditional angiograms explore 30°–50° of the retina at once; however, visualization of peripheral retina is fundamental in order to assess nonperfused areas, vascular leakage, microvascular abnormalities, and neovascularizations. In order to expand the field of view, wide-field and ultra-wide-field imaging has been developed allowing to image up to 200° of retinal surface in one single shot. The aim of this narrative review was to provide an overview of the role of the most recent technique of ultra-wide-field fluorescein angiography in DR. Keywords: ischemic index, targeted retinal photocoagulation, diabetic macular edema, diabetic macular ischemia, peripheral vessel leakage, capillary nonperfusio
Antiangiogenic therapy with anti-vascular endothelial growth factor modalities for diabetic macular oedema
No full textBackground Diabetic macular oedema (DMO) is a common complication of diabetic retinopathy. The retina at the macula thickens and this can cause gradual loss of central vision. Although grid or focal laser photocoagulation has been shown to reduce the risk of visual loss in DMO or clinically significant macular oedema (CSMO), vision is rarely improved. Antiangiogenic therapy with anti-vascular endothelial growth factor (anti-VEGF) modalities has recently been proposed for improving vision in people with DMO. Anti-VEGF drugs are delivered by an injection in the vitreous cavity of the eye. Objectives This review aims to assess the effectiveness of anti-VEGF therapy for preserving or improving vision in people with DMO. Search strategy We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE and Caribbean Literature on Health Sciences (LILACS). There were no language or date restrictions in the search for trials. The electronic databases were last searched on 16 April 2009. Selection criteria We included randomised controlled trials (RCTs) comparing any antiangiogenic drugs with an anti-VEGF mechanism of action compared to another treatment, sham treatment, or no treatment. Data collection and analysis Two authors independently extracted the data. The risk ratio (RR) of visual loss and visual gain of 3 or more lines was estimated at least six months after treatment. Main results We found four small studies that collected only short-term outcomes (24 to 36 weeks); three of which had more than two randomisation groups generating five types of comparisons overall. Only one comparison included more than one trial in the analysis. The short-term outcome was the mean change in LogMAR visual acuity. One study on 172 patients compared three doses of pegaptanib versus sham (about 5 injections on average) and another compared bevacizumab or bevacizumab plus triamcinolone with sham (multiple bevacizumab injections and a single triamcinolone injection in 101 patients, 115 eyes overall) in patients with CSMO that was refractory to photocoagulation. Bevacizumab or bevacizumab plus triamcinolone were also compared to photocoagulation in 129 patients with untreated CSMO(150 eyes, multiple injections needed in 24 patients). Although comparisons tended to favour antiangiogenic therapy, estimates did not reach statistical significance or, if they did, they were not robust to sensitivity analysis regarding missing data and potential bias related to single trial estimates. No difference could be demonstrated in one study on 26 patients comparing bevacizumab to triamcinolone (both administered with a single injection) and between bevacizumab and bevacizumab plus triamcinolone in two studies on 182 patients. All the studies in this review, except for the study on pegaptanib, were at risk of bias based on the assessment of six methodological quality items. There were no serious adverse effects in these short-term studies, except for one case of severe anterior uveitis in one eye treated with bevacizumab. No included study examined long-term adverse effects of antiangiogenic therapy. Authors' conclusions There is not sufficient high quality evidence from large RCTs supporting the use of either single or multiple anti-VEGF intravitreal injections to treat DMO. Results from ongoing studies on several compounds should assess not only treatment efficacy but also, if a benefit is found, the number of injections needed for maintenance and long-term safety
Large choroidal excavation in retinitis pigmentosa: A case report
No full textPurpose: To report the morphological and clinical features of a case of retinitis pigmentosa with large choroidal excavation. Methods: The patient underwent a complete ophthalmologic examination including best-corrected visual acuity assessment, anterior segment and dilated fundus examination and spectral-domain optical coherence tomography. Results: A 41-year-old woman affected by retinitis pigmentosa with genetic confirmation with mutation in RDH12 gene had a best-corrected visual acuity of 20/50 in both eyes. Dilated fundus examination revealed waxy pallor of the optic disc, diffuse narrowing of the retinal arterioles and a generalized retinal pigment epithelium mottling with bony spicule associated with diffuse retinal atrophy. At the posterior pole, an extended bilateral chorioretinal atrophy was evident with a partial sparing of the macular area. On spectral-domain optical coherence tomography, a bilateral large choroidal excavation could be clearly detected and it was associated with a diffuse retinal thinning at the posterior pole and a partial sparing of the fovea. Conclusion: Large choroidal excavation has been rarely reported. Although the pathogenetic mechanisms leading to the formation of large choroidal excavation are still a matter of debate, a combination of primary degenerative-inflammatory factors could be retained responsible for the large choroidal excavation development
Prognostic relevance of optical coherence tomography angiography biomarkers in diabetic macular edema
No full textAbstract was not mandatory. The review article was devoted to describe optical coherence tomography angiography (OCTA) biomarkers with a prognostic significance in predicting the evolution of diabetic macular edema (DME). OCTA features are crucial to the early prediction of DME but also to evaluate the response to treatment, identifying potential poor responders
Reproducibility of Macular Thickness Measurements Using Cirrus SD-OCT in Neovascular Age-Related Macular Degeneration
No full textPURPOSE. To assess the test-retest variability of central and sectorial macular thickness measurements obtained by Cirrus HD-OCT (Carl Zeiss Meditec, Dublin, CA) in neovascular age-related macular degeneration (nAMD). METHODS. Macular thickness measurements of nine standard ETDRS subfields were obtained and analyzed. The repeatability of macular thickness measurements by Cirrus HD-OCT was assessed by examining the intrasession within subject standard deviation (Sw), coefficient of repeatability (CR), and coefficient of variation (CV), before and after eyes with retinal segmentation errors were excluded. RESULTS. Forty-nine nAMD eyes of 49 consecutive patients were included in the study. The CR for the central macular subfield was 42.4 mu m (10.5%) and ranged from 12.1 mu m (3.7%) for the outer nasal to 41.8 mu m (11.4%) for the inner nasal subfields. In a secondary analysis, eyes affected by erroneous detection of inner and outer retinal boundaries (6/49, 12.24%) were excluded. The revised coefficient of repeatability for the central macular subfield was 26.1 mu m (8.1%) and ranged from 10.3 mu m (3.8%) for the outer superior to 30.2 mu m (8.3%) for the inner nasal subfields. CONCLUSIONS. Overall, the test-retest variability of Cirrus HD-OCT is good for the central and sectorial macular subfields, with a low incidence of scan artifacts. (Invest Ophthalmol Vis Sci. 2010;51:4788 - 4791) DOI:10.1167/iovs.09-497
Interleukin-1beta tear concentration in glaucomatous and ocular hypertensive patients treated with preservative-free nonselective beta-blockers
No full textPURPOSE: To evaluate the ocular surface inflammatory response to the presence of preservatives in nonselective
beta-blocker eyedrops.
DESIGN: Prospective, crossover, single-masked, randomized
clinical study. METHODS: STUDY POPULATION: Twenty primary open angle glaucoma or ocular hypertensive patients were divided in two groups, one treated with preservative-free timolol 0.5% (group 1) and the other with preserved timolol 0.5% (group 2) eyedrops. After 60 days of therapy and 3 more weeks of washout, the two groups switched to the other therapy. PROCEDURE: At each visit,basal tear samples were collected from the inferior conjunctival fornix for the determination of interleukin (IL)-1 tear concentrations by an enzyme-linked immunosorbent assay. Intraocular pressure measurement, conjunctival
hyperemia, superficial punctate keratitis, and tear film breakup time were evaluated. MAIN OUTCOME MEASURE: IL-1 concentration in tears following the use of preserved eyedrops.
RESULTS: IL-1 tear concentrations increased significantly in both groups, compared with baseline values,during preserved timolol therapy. There were no statistically significant changes in hyperemia and superficial punctate keratitis throughout the study in either group.A statistically significant breakup time reduction was observed in both groups after 30 days and after 60 days of preserved therapy.
CONCLUSION: The use of preservatives in timolol 0.5% eyedrops leads to tear film instability and ocular surface inflammatory changes documented by a reduction of breakup time and an increase of IL-1 tear concentrations.Preservative-free beta-blockers are preferable for long-term hypotensive therapy to prevent ocular surface inflammation
DEXAMETHASONE IMPLANT FOR MACULAR EDEMA SECONDARY TO ISCHEMIC RETINAL VEIN OCCLUSIONS
No full textPurpose:To evaluate the effects of dexamethasone implant for the treatment of macular edema secondary to ischemic retinal vein occlusions (IRVO).Methods:Consecutive patients affected by macular edema related to IRVO were prospectively recruited. After a comprehensive ophthalmological examination, including visual acuity, fluorescein angiography, and optical coherence tomography, each patient received a first implant. Further re-treatments were performed on the basis of macular edema detection from the fourth month on. The primary outcome measure was the change in Early Treatment Diabetic Retinopathy Study letter score at the 12-month examination. Secondary outcome measures included changes in central foveal thickness and number of implants over the follow-up.Results:Fifteen patients with central IRVO and 14 patients with branch IRVO were recruited. The median ETDRS letter score at baseline was 10 (Snellen Equivalent 20/640) in the central IRVO subgroup, improving to 37 (Snellen Equivalent 20/200(2+)) at the 12-month examination. The median ETDRS letter score in the branch retinal vein occlusion subgroup changed from 48 (Snellen equivalent 20/125(3+)) at baseline to 62 (Snellen equivalent 20/63(2+)) at the 12-month examination. The baseline median central foveal thickness was 749 m in central IRVO, and 459 m in branch IRVO, improving to 363 m and 323 m, respectively, at the 12-month examination. Mean number of implants was 2.8 in the central IRVO and 2 in the branch IRVO.Conclusion:Dexamethasone implant can reduce macular edema in eyes affected by IRVO, leading to a slight improvement in visual acuity
Influence of macular choroidal thickness on visual function in highly myopic eyes
No full textPurpose: To explore the retinal and choroidal thicknesses (RT, CT), as measured using enhanced depth imaging (EDI) optical coherence tomography (OCT, Spectralis) in highly myopic eyes and its relationship with visual function. Materials and Methods: Prospective, case-control, noninterventional clinical study. CT was measured by EDI-OCT in highly myopic eyes (>= 6 dpt) without any macular diseases and age-matched control eyes. A complete ophthalmological examination, visual acuity assessment and MP1 microperimetry were obtained. Results: 38 myopic (15 M/23 F, mean age 51 +/- 8.9 years) and 21 control eyes (5 M/16 F, mean age 50 +/- 5.4 years) were included. The myopic mean refractive error was -13.3 +/- 4.9 dpt and axial length 29.2 +/- 2.2 mm. The mean best-corrected visual acuity (BCVA) was lower in highly myopic than in control eyes (77.3 +/- 9.25 vs. 84.8 +/- 0.6 letters, p = 0.0001, respectively) as was the mean retinal sensitivity (MRS; 16.32 +/- 2.6 vs. 19.9 +/- 0.2 dB, p < 0.0001). While RT was similar between groups (291.5 +/- 24.2 vs. 283.6 +/- 13.9 mu m, p = 0.06, respectively), subfoveal CT was thinner in highly myopic compared to control eyes (114.3 +/- 78.5 vs. 272.6 +/- 110.2 mu m, p < 0.0001). A significant relationship was found between subfoveal CT and MRS (R-2 = 0.22; p = 0.003) and BCVA (R-2 = 0.13; p = 0.027). Conclusions: Macular function is reduced in highly myopic eyes without any visible macular diseases compared to controls, and a significant proportion of the macular function variability seems to be related to a reduced CT
Vision-related quality of life in patients treated for myopic choroidal neovascularization : A post hoc analysis of the OLIMPIC study
No full textPurpose: To investigate vision-related quality of life in patients referred to the Italian Retina Services for intravitreal ranibizumab treatment for choroidal neovascularization due to pathologic myopia. Design: Post hoc analysis of a multicenter, interventional phase IIIb study (OLIMPIC). Methods: Patients with either previously untreated (naïve) or treated choroidal neovascularization due to pathologic myopia were enrolled. Vision-related quality of life was measured using the Italian version of the Impact of Vision Impairment Questionnaire with scores from 0 (no impact) to 5 (severe impact). Burden of illness data were collected regarding income, and personal and public resource use. Results: In the 200 included subjects, mean best-corrected visual acuity in the better eye was 68.3 Early Treatment Diabetic Retinopathy Study letters (standard deviation: 15.2) compared with 42.5 Early Treatment Diabetic Retinopathy Study letters (standard deviation: 23.3) in the worse eye. The proportion of better eyes affected by choroidal neovascularization was 147/200 (73.5%). In multivariable analyses, lower better eye, but not worse eye, best-corrected visual acuity was associated with lower vision-related quality of life (per 10 fewer letters, beta: + 0.17, p < 0.001). An annual income below 20,000 euros was also associated with lower vision-related quality of life (beta: + 0.38; standard error: 0.13, p = 0.004). Moreover, in univariate analyses, increasing income level was linearly associated with better presenting best-corrected visual acuity in the better eye (p < 0.003), with a difference of 15 Early Treatment Diabetic Retinopathy Study letters for patient income <20,000 euros compared with >70,000 euros. Conclusion: Italian patients with myopic choroidal neovascularization and a low income presented with lower better-eye best-corrected visual acuity and lower vision-related quality of life compared with those with a higher income. Future research should investigate disease awareness and candidacy issues that may influence the quality of life of patients
DEXAMETHASONE IMPLANT FOR MACULAR EDEMA SECONDARY TO CENTRAL RETINAL VEIN OCCLUSION IN PATIENTS YOUNGER THAN 50 YEARS
No full textPurpose:To evaluate the effects of dexamethasone implant for macular edema secondary to central retinal vein occlusion in patients younger than 50 years.Methods:Patients with no previous treatment, macular edema with central foveal thickness >250 m and best-corrected visual acuity between 1.30 LogMAR and 0.30 LogMAR were prospectively recruited for a 12-month follow-up study. After baseline dexamethasone implant, re-treatment was performed starting from the fourth month if a best-corrected visual acuity deterioration with central foveal thickness >250 m occurred after an initial improvement. The primary outcome was the change in the best-corrected visual acuity. Secondary outcomes included the proportion of eyes gaining at least 3 Early Treatment Diabetic Retinopathy Study lines, the change in the central foveal thickness, and the number of treatments.Results:Mean best-corrected visual acuity changed significantly from 0.60 0.38 LogMAR at baseline to 0.43 +/- 0.48 at the 12-month examination (P = 0.03). Eight of 16 eyes (50%) gained 3 Early Treatment Diabetic Retinopathy Study lines. Mean central foveal thickness improved significantly from 705 +/- 202 m at baseline to 408 +/- 196 m at 12-month visit (P < 0.001). The patients received a mean of 1.8 +/- 0.9 implants with 8/16 eyes and 3/16 receiving 1 and 2 implants, respectively.Conclusion:This present investigation indicates that dexamethasone implant can provide a 3-line improvement in half of the patients younger than 50 years and affected by macular edema secondary to central retinal vein occlusion
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