Photodynamic therapy with and without adjunctive intravitreal triamcinolone acetonide: a retrospective comparative study

Intravitreal Dexamethasone in Patients with Wet Age-Related Macular Degeneration Resistant to Anti-VEGF: A Prospective Pilot Study

Purpose

To evaluate the efficacy and safety of a single intravitreal dexamethasone implant (DXI) combined with intravitreal antivascular endothelial growth factor (anti-VEGF) therapy, in patients with neovascular age-related macular degeneration (wet-AMD) resistant to conventional treatment.

Methods

In this randomized, controlled pilot study, 16 eyes of 15 patients, unresponsive to anti-VEGF therapy, were enrolled and randomly assigned to two groups: DXI + anti-VEGF (treatment group: 11 eyes) and monthly anti-VEGF alone (control group: 5 eyes). Patients were treated at baseline and followed for 6 months. Best corrected visual acuity (BCVA), optical coherence tomography (OCT) parameters, and fluorescein angiography (FA) were evaluated.

Results

Eight eyes (72.7%) in the treatment group and 2 eyes in the control group (40%) showed complete retinal fluid resorption (p=0.049). BCVA showed no significant change from baseline in both the treatment group and the control group (p=0.40 and p=0.29, respectively). Both median central foveal thickness (CFT) and median macular volume showed a greater reduction from baseline in the treatment group.

Conclusion

In patients showing an incomplete response to anti-VEGF therapy, DXI combined with intravitreal anti-VEGF seems to improve retinal fluid resorption without functional advantage. This trial is registered with ACTRN12618001102268.

Pharmacogenetics and age-related macular degeneration

Pharmacogenetics seeks to explain interpatient variability in response to medications by investigating genotype-phenotype correlations. There is a small but growing body of data regarding the pharmacogenetics of both nonexudative and exudative age-related macular degeneration. Most reported data concern polymorphisms in the complement factor H and age-related maculopathy susceptibility 2 genes. At this time, the data are not consistent and no definite conclusions may be drawn. As clinical trials data continue to accumulate, these relationships may become more apparent.

Photodynamic sensitivity of esophageal cancer KYSE-70 cells is attenuated by all-trans retinoic acid-induced differentiation

AIM: To investigate the impact of all-trans retinoic acid (ATRA)-induced cell differentiation on photodynamic sensitivity of human esophageal cancer cell line KYSE-70.

METHODS: Both well and poorly differentiated KYSE-450 cell lines were used in this study. KYSE-70 differentiation was induced with 1 µmol/L ATRA and evidenced by cell morphology and proliferation. Phototoxicity after photodynamic therapy (PDT, 450 nm) was detected by MTT assay. Apoptosis was measured by flow cytometry, and morphology of apoptotic cells was visualized after Hoechst 33342 staining.

RESULTS: Cells after ATRA treatment exhibited increased size, reduced cytoplasmic and nuclear density, and nuclear enlargement. Cell growth was inhibited compared to control cells. After PDT treatment, the survival of well differentiated KYSE-450 cells and ATRA-treated KYSE-70 cells were reduced compared to poorly differentiated KYSE-70 cells. Cell viability differed significantly between ATRA-treated and non-treated KYSE-70 cells after PDT treatment (54.28% ± 3.64% vs 36.23% ± 7.43%, P < 0.001). The percentage of apoptotic cells in ATRA-induced KYSE-70 cells was less than that in non-treated KYSE-70 cells (18.1% vs 33.3%, P < 0.05).

CONCLUSION: ATRA-induced cell differentiation decreases photodynamic sensitivity of esophageal cancer KYSE-70 cells possibly by inducing resistance to apoptosis.

The role of anti-inflammatory agents in age-related macular degeneration (AMD) treatment

Although age-related macular degeneration (AMD) is not a classic inflammatory disease like uveitis, inflammation has been found to have an important role in disease pathogenesis and progression. Innate immunity and autoimmune components, such as complement factors, chemokines, cytokines, macrophages, and ocular microglia, are believed to be heavily involved in AMD development. Targeting these specific inflammatory molecules has recently been explored in an attempt to better understand and treat AMD. Although antivascular endothelial growth factor therapy is the first line of defence against neovascular AMD, anti-inflammatory agents such as corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), immunosuppressive agents (eg, methotrexate and rapamycin), and biologics (eg, infliximab, daclizumab, and complement inhibitors) may provide an adjunct or alternative mechanism to suppress the inflammatory processes driving AMD progression. Further investigation is required to evaluate the long-term safety and efficacy of these drugs for both neovascular and non-neovascular AMD.