739 research outputs found
Anti-complement intravitreal agents for geographic atrophy: A missed opportunity for European patients?
No full textAnti-VEGF therapies for age-related macular degeneration: a powerful tactical gear or a blunt weapon? The choice is ours
No full textPurpose: Blindness and vision loss are still frequent disabilities associated with a relevant impact on health care and quality of life, and a high economic burden. Supranational programs established by the World Health Organization (WHO), International Agency for the Prevention of Blindness (IAPB), and World Health Assembly (WHA) aim at reducing avoidable visual impairment. Age-related macular degeneration (AMD), diabetic retinopathy (DR), and other retinal diseases are well known causes of visual disability. Since more than a decade, intravitreal agents are available for the treatment of these diseases. The aim of this study is to review whether pharmacotherapy with anti-vascular endothelial growth factor (VEGF) drugs has led to a decrease in the prevalence of blindness with emphasis on AMD and different countries. A brief analysis of other factors correlated to changes in the rate of blindness is also presented. Methods: PubMed and Scopus web platforms were used to identify relevant studies on epidemiology of blindness and vision impairment, the influence of intravitreal therapies, and the existence of different vision care models. Additional data and material was searched in web internet accessed by the web browser Firefox. Results: Age-standardized prevalence of blindness secondary to AMD has started to decline as testified by a number of studies in different countries. This is due to the adoption of anti-VEGF therapy and its adequate management. The frequency of treatment and regimens applied are indirect signs of successful treatment. Local rules and regulations may represent an obstacle. Conclusions: This review shows that by implementing existing health care systems and dispensing adequate therapies in the field of retinal diseases, the prevalence of blindness due to these conditions can decline. [Figure not available: see fulltext.
Combined transconjunctival sutureless three-port vitrectomy and scleral fixation of intraocular lens
No full textPurpose: The aim of this article is to describe an innovative and minimally invasive surgical technique for posterior vitrectomy combined with secondary intraocular lens implantation, using a sutureless scleral fixation Carlevale intraocular lens (I71 FIL SSF Carlevale lens. Soleko IOL Division, Italy). Methods: The technique was conducted with only three transconjunctival sclerotomies and a corneal tunnel to perform intraocular lens explantation, posterior vitrectomy and Carlevale intraocular lens implantation. It is easier, quicker, and less invasive than the traditional technique with conjunctival peritomy, two scleral flaps and five sclerotomies. Results: Surgery was performed uneventfully on three eyes of three patients. Two of them presented a luxation of the intraocular lens into the vitreous chamber, while one patient presented an intraocular lens subluxation. No complications were observed after a 5 to 8 months of follow-up. The intraocular lenses were well positioned, no conjunctival erosion was noted, and the intraocular pressure remained normal at all stages. Conclusions: This is the first report of a combined procedure of IOL explantation, posterior vitrectomy and secondary IOL implantation using only three transconjunctival sclerotomies. This appears to be less invasive and it causes less discomfort to the patient. We suggest considering this technique in all those cases requiring a combined procedure in absence of a proper capsular support
From pro-re-nata to fixed-interval regimen: evolving real-world treatment paradigms in anti-VEGF therapy for neovascular AMD
No full textObjective: To evaluate the impact of evolving treatment paradigms for neovascular age-related macular degeneration (nAMD) by comparing outcomes between two patient cohorts treated with different anti-vascular endothelial growth factor (anti-VEGF) regimens over a decade apart. Methods: This retrospective cohort study included 200 treatment-naive nAMD patients divided into two cohorts. Cohort 1 (2009–2010) was treated with a pro re nata (PRN) regimen, involving three initial monthly injections followed by as-needed treatments based on monthly monitoring. Cohort 2 (2019–2021) received a fixed-interval regimen, consisting of three initial monthly injections followed by bimonthly maintenance doses. Primary outcomes included changes in best corrected visual acuity (BCVA) and central retinal thickness (CRT) at 12 months. Secondary outcomes included the number of injections, follow-up visits, and adherence to treatment schedules. Results: Cohort 2 demonstrated significantly greater improvement in BCVA (+5.5 vs −2.0 ETDRS letters, p < 0.001) and CRT reduction (−101.7 vs −26.5 μm, p < 0.001) compared to Cohort 1. Patients in Cohort 2 received more injections (7.7 vs 4.8, p < 0.001) but required fewer monitoring visits (3.2 vs 5.1, p < 0.001). Adherence to treatment schedules was markedly higher in Cohort 2 (78% vs 0%, p < 0.001). Conclusions: The transition from a PRN to a fixed-interval anti-VEGF regimen significantly improved visual and anatomical outcomes in nAMD patients. Fixed-interval regimens not only enhanced treatment efficacy but also optimized resource utilization, suggesting a superior approach for managing nAMD in a real-world clinical setting
Initial clinical experience using a diode red laser (670 nm) in the treatment of retinal disease
No full textAim To investigate the clinical use of a 670-nm diode red laser in the treatment of a number of retinal conditions. Methods In all, 17 eyes of 17 patients were treated for conditions such as proliferative diabetic retinopathy, retinal neovascularization in central retinal vein occlusion, rhegmatogenous retinal lesions and retinal breaks, and prophylactic peripheral retinopexy prior to silicone oil removal after three port pars plana vitrectomy. Results Regression of neovascularization was observed in all the eyes treated for vascular proliferation at the 3-month follow-up visit. Adhesive pigmented scars were observed in the remaining eyes 1 month after treatment. No major complications were recorded. Conclusions In this pilot study, the 670-nm diode laser appears to be a promising modality for laser photocoagulation of the retina
Optical Coherence Tomography Findings in Rhegmatogenous Retinal Detachment: A Systematic Review
No full textRhegmatogenous retinal detachment is a sight-threatening condition that may lead to blindness if left untreated. Surgical treatments may vary and are tailored to a single patient. Anatomical and functional results may vary, due to factors that are currently under study. Optical coherence tomography (OCT) allows a detailed visualization of the retinal structure. Some studies have been performed using OCT on eyes with retinal detachment. We performed a review on the subject. Several data have been obtained using different OCT applications. Some alterations may represent potential biomarkers since they are associated with visual and anatomical prognoses. Increased knowledge on the subject may be helpful to choose among different surgical strategies and endotamponades. More research on the topic is needed
Early vascular changes induced by transpupillary thermotherapy of choroidal neovascularization
No full textObjective: To study early direct effects of transpupillary thermotherapy (TTT) on choroidal neovascularization (CNV) and choroid. Design: Retrospective, noncomparative interventional case series. Participants: Sixty-four eyes with subfoveal CNV. Intervention: TTT was delivered using a diode laser at 810 nm through a contact lens. Exposure time was 60 seconds with a power/diameter ratio of 247 mW/mm. The end point was an invisible treatment with no color change at the retina level. Main Outcome Measures: Fluorescein and indocyanine green angiographic findings within 1 hour, and at 1, 2, and 4 weeks after TTT. Results: Fluorescein angiography (FA) and indocyanine green angiography (ICGA) performed within 1 hour after TTT showed increased leakage of CNV and choroidal vessels. Follow-up at 1 and 2 weeks demonstrated a hypofluorescent area corresponding to the laser spot and absence of angiographic leakage seen on FA and ICGA. At 4 weeks after TIT FA showed mottled hypofluorescence-hyperfluorescence of the TTT-treated area and absence of angiographic leakage. Conclusions: TTT induces a characteristic dynamic sequence of vascular changes. Treatment with TTT can lead to absence of angiographic (FA and ICGA) leakage for 4 weeks. Determination of the long-term efficacy and visual implications awaits the results of clinical trials. Ophthalmology 2002;109:1098-1104 (C) 2002 by the American Academy of Ophthalmology
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