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Wang L, Chen Z, Wang X. Clinical efficacy and acceptability of panretinal photocoagulation combined with conbercept for patients with proliferative diabetic retinopathy: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25611. [PMID: 33907112 PMCID: PMC8084045 DOI: 10.1097/md.0000000000025611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/04/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Although conbercept has been used for other diseases associated with new vascular formation, the effect of single-dose conbercept in combination with proliferative diabetic retinopathy (PDR) have not been established. We thus conducted this protocol for systematic review and meta-analysis to compare the efficacy and acceptability of panretinal photocoagulation (PRP) associated with intravitreal conbercept injections versus PRP alone in the treatment of patients with PDR. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols reporting guidelines and the recommendations of the Cochrane Collaboration were followed to conduct this study. Reviewers will search the PubMed, Cochrane Library, Web of Science, and EMBASE online databases using the key phrases "panretinal photocoagulation," "conbercept," and "proliferative diabetic retinopathy" for all cohort studies published up to May 2021. The studies on cohort study focusing on PRP + conbercept and PRP alone for PDR patients will be included in our meta-analysis. At least one of the following outcomes should have been measured: PRP completion rate, proportion of eyes with visual gain/loss, central macular thickness, and incidence of complication. Review Manager software (v 5.4; Cochrane Collaboration) is used for the meta-analysis. RESULTS It was hypothesized that intravitreal conbercept plus PRP was more effective than PRP alone. OSF REGISTRATION NUMBER 10.17605/OSF.IO/HCQ2S.
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Affiliation(s)
- Liangyu Wang
- Department of Ophthalmology, Qingdao Municipal Hospital (Group)
| | - Zhaoli Chen
- Department of Ophthalmology, Qingdao Municipal Hospital (Group)
| | - Xiaoxue Wang
- Department of Ophthalmology, Qingdao Aier Eye Hospital, Shandong, China
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Lin Y, Zheng X, Chen Q, Wu R. Clinical efficacy of anti-vascular endothelial growth factor versus panretinal photocoagulation for patients with proliferative diabetic retinopathy: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25682. [PMID: 33907139 PMCID: PMC8084044 DOI: 10.1097/md.0000000000025682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The argument on the optimal treatment for patients with proliferative diabetic retinopathy (PDR) remains to be resolved. Therefore, the primary objective of the present study was to evaluate the clinical efficacy of anti-vascular endothelial growth factor (anti-VEGF) therapy versus panretinal photocoagulation (PRP) for patients with PDR. METHODS Two independent investigators followed The Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines and the recommendations of the Cochrane Collaboration to conduct this meta-analysis. The electronic databases of EMBASE, PubMed, Cochrane Library, and Web of Science were searched from the inception to April 2021 using the following key terms: "proliferative diabetic retinopathy," "anti-vascular endothelial growth factor," and "panretinal photocoagulation," for all relevant studies. We identified literature that met the following inclusion criteria: patients with PDR; studies focusing on assessing anti-VEGF therapy and PRP; the following outcome measures must be shown: anatomical outcomes, including complete regression and recurrence of neovascularization, mean change in best corrected vision acuity from baseline to the end of follow-up period. The Cochrane risk of bias tool was used to evaluate the risk of bias of included randomized clinical trials by 2 independent reviewers. RESULTS This protocol will provide a reliable theoretical basis for the following research. TRIAL REGISTRATION NUMBER 10.17605/OSF.IO/UHYDR.
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Hu Y, Shen J, Peng Y. Clinical efficacy of intravitreal aflibercept injection versus vitrectomy with panretinal photocoagulation for patients with proliferative diabetic retinopathy: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25354. [PMID: 33832114 PMCID: PMC8036057 DOI: 10.1097/md.0000000000025354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND In the current literature, it is still controversial whether intravitreal aflibercept injection can provide better vision restoration compared with vitrectomy with panretinal photocoagulation (PRP) for proliferative diabetic retinopathy (PDR) patients. Given that there is no high-quality meta-analysis or review to incorporate existing evidence, the purpose of this study is to systematically review the level I evidence in the literature to ascertain whether intravitreal aflibercept injection can provide better vision restoration compared with vitrectomy with PRP for PDR patients. METHODS The systematic literature review is structured to adhere to PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses), which include requirements deemed essential for the transparent reporting of results. A systematic search will be performed in Web of Science, Embase, Scopus, Science Direct, Cochrane Library up to and inclusive of March 19, 2021. The method of data extraction will follow the approach outlined by the Cochrane Handbook for Systematic Reviews of Interventions. The primary outcome is change in best-corrected visual acuity. The secondary outcomes are change in area of neovascularization and change in area of retinal nonperfusion. Where disagreement occurs, this will be resolved through discussion. All outcomes are pooled on random-effect model. A P value of < .05 is considered to be statistically significant. RESULTS The results of our review will be reported strictly following the PRISMA criteria. CONCLUSIONS The hypothesis of the study was that visual acuity recovery would be faster with vitrectomy because the blood is mechanically cleared during surgery. REGISTRATION NUMBER 10.17605/OSF.IO/NCAXW.
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Ferreira MS, Wetter NU. Diode-side-pumped, intracavity Nd:YLF/KGW/LBO Raman laser at 573 nm for retinal photocoagulation. Opt Lett 2021; 46:508-511. [PMID: 33528396 DOI: 10.1364/ol.411895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/17/2020] [Indexed: 06/12/2023]
Abstract
Wavelengths in the yellow-orange range are of significant interest for retinal photocoagulation and are especially important in the case of diabetic retinopathy, which can cause blindness and affects 3.3% of all working-age adults. This work presents a highly-efficient, compact, and cost-efficient side-pumped, intracavity Raman configuration to achieve this objective. A side-pumped Nd:YLF/KGW/LBO frequency-doubled Raman laser producing 11.7 W of output power at 1147 nm with 21% of slope efficiency and 6 W of output power at 573.5 nm with 12% slope efficiency is demonstrated.
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Suzuki T, Matsumoto F, Sakamoto S, Nakagawa Y, Suzuki Y. Anti-VEGF Therapy and Retinal Photocoagulation to Prevent Recurrence of Central Retinal Vein Occlusion: Two Case Reports of Young Patients. Tokai J Exp Clin Med 2020; 45:249-253. [PMID: 33300598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/23/2020] [Indexed: 06/12/2023]
Abstract
Case 1: An 18-year-old man. On initial examination, he was diagnosed with central retinal vein occlusion (CRVO) due to optic papillitis. He had no previous systemic and ocular medical history. His best corrected visual acuity was 20/20 for the right eye, but macular edema accompanied by serous retinal detachment was observed about 2 months after the initial examination. Intravitreal anti-VEGF injection was performed, and the symptoms improved. Then, additional photocoagulation was applied to the retinal nonperfusion area, to maintain its normal state. Case 2: A 36-year-old man. He was diagnosed with neovascular glaucoma associated with CRVO in the right eye by his previous physician. Panretinal photocoagulation and intravitreal anti-VEGF injection were performed under maximum-tolerated medical therapy for the right eye. He had diabetes. On initial examination, his visual acuity was 20/100 and his intraocular pressure was 19mmHg. Macular edema and iris neovascularization recurred half a year later, so intravitreal anti-VEGF injection and additional photocoagulation were applied to nonperfusion area. After that, both macular edema and iris neovascularization have settled down. Conclusions: Intravitreal anti-VEGF injection is effective in young patients with CRVO. Also, photocoagulation to nonperfusion area in addition to the continuous treatment with intravitreal anti-VEGF injection seems effective for preventing recurrence.
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Affiliation(s)
- Takahiro Suzuki
- Department of Ophthalmology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan.
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Liu W, Li Y, Cao R, Bai Z, Liu W. A systematic review and meta-analysis to compare the efficacy of conbercept with ranibizumab in patients with macular edema secondary to retinal vein occlusion. Medicine (Baltimore) 2020; 99:e20222. [PMID: 32481293 PMCID: PMC7249991 DOI: 10.1097/md.0000000000020222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The objective of this review and meta-analysis is to investigate the efficacy of conbercept and ranibizumab, combined with or without laser photocoagulation, in patients with macular edema secondary to retinal vein occlusion (RVO-ME). METHODS Several databases have been used to identify relevant publications. After screening, a meta-analysis was conducted to compare conbercept and ranibizumab with the support of RevMan 5.3 (Cochrane Library Software, Oxford, UK). RESULTS In this study, 9 randomized controlled trials and 6 retrospective trials were included with a total of 1180 patients. No significant difference was found in best corrected visual acuity (BCVA) or central macular thickness (CMT) in the baseline parameters [BCVA (weighted mean difference (WMD): -0.01; 95% confidence interval CI: -0.03 to 0.01; P = .17), CMT (WMD: 20.14; 95% CI: -26.70 to 66.97; P = .40). No significant differences were found in the improvements of BCVA and adverse events (AEs) between the 2 groups after injection of loading dosage [the 1st month BCVA (WMD: -0.01; 95% CI: -0.04 to 0.02; P = .54),the 3rd month BCVA (WMD: -0.02; 95% CI: --0.05 to 0.01; P = .23), the 6th month BCVA (WMD: -0.02; 95% CI: -0.05 to 0.01; P = .27), AEs (odds ratio: 0.84; 95% CI: 0.38 to 1.84; P = .66)]. However, there were significant differences between conbercept and ranibizumab treatment in terms of CMT [1st month CMT (WMD: -11.70; 95% CI: -19.71 to -3.68; P < .01), 3rd month CMT (WMD: -10.08; 95% CI: -15.62 to -4.53; P < .01), 6th month CMT (WMD: -15.83; 95% CI: -22.88 to -8.78; P < .01)] and the number of injections (WMD, -0.36; 95% CI: -0.68 to -0.04; P = .03). CONCLUSION The current pooled evidence suggested that both therapies of intravitreal conbercept and intravitreal ranibizumab with or without laser photocoagulation are effective in vision function in RVO-ME patients, and confirmed that conbercept has advantages over ranibizumab in terms of CMT and the number of injections for treating RVO-ME. In addition, conbercept has the statistically same visual gains and safety as ranibizumab in RVO-ME patients. Longer-term follow-up surveys on the safety and effectiveness of these 2 treatment regimens are required.
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Affiliation(s)
- Weishai Liu
- Department of Ophthalmology, The First hospital of Shanxi Medical University, Taiyuan City
| | - Yanjie Li
- Department of Ophthalmology, The First hospital of Shanxi Medical University, Taiyuan City
| | - Rongxia Cao
- Department of Ophthalmology, The First hospital of Shanxi Medical University, Taiyuan City
| | - Zichao Bai
- Department of Ophthalmology, The First hospital of Shanxi Medical University, Taiyuan City
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Magri F, Chytiris S, Molteni M, Croce L, Coperchini F, Rotondi M, Fonte R, Chiovato L. Laser photocoagulation therapy for thyroid nodules: long-term outcome and predictors of efficacy. J Endocrinol Invest 2020; 43:95-100. [PMID: 31321758 DOI: 10.1007/s40618-019-01085-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 07/11/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of the present study was to retrospectively evaluate the efficacy of interstitial laser photocoagulation (ILP) ablation of thyroid nodules during a 6-year follow-up period and to identify possible predictors of the final outcome. METHODS Forty-three outpatients (38 women) were assigned to ILP therapy. The study group included euthyroid patients with benign thyroid nodules. Thyroid size, nodule volume and features, and autoimmune test were collected at baseline. Patients underwent US control after the ILP procedure and 1 month, 6 months, 12 months later and then annually. RESULTS During the follow-up, two distinct groups of patients emerged: the responders (N = 33) and the non-responder (N = 10) ones to ILP. In the responder group, the nodule volume significantly decreased during the follow-up, but a trend toward a slight increase in nodule volume was recorded up to the end of follow-up. No significant decrease in nodule volume was observed in the non-responder group. Neither baseline clinical nor demographic features were significantly different between responders and non-responders groups. In the whole group of patients, the energy delivered per mL of nodule tissue was significantly correlated with the percent volume decrease at the end of follow-up. CONCLUSIONS Interstitial laser photocoagulation is a safe technique able to reduce byabout 50% the volume of benign thyroid nodules in the majority of treated patients. However, due to the great variability of results, an active follow-up is required. The only independent predictor of ILP outcome is the energy delivered per mL of nodule tissue.
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Affiliation(s)
- F Magri
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Department of Internal Medicine and Therapeutics, Istituti Clinici Scientifici Maugeri IRCCS, University of Pavia, Via S. Maugeri 4, 27100, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100, Pavia, Italy
| | - S Chytiris
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Department of Internal Medicine and Therapeutics, Istituti Clinici Scientifici Maugeri IRCCS, University of Pavia, Via S. Maugeri 4, 27100, Pavia, Italy
| | - M Molteni
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Department of Internal Medicine and Therapeutics, Istituti Clinici Scientifici Maugeri IRCCS, University of Pavia, Via S. Maugeri 4, 27100, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100, Pavia, Italy
| | - L Croce
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Department of Internal Medicine and Therapeutics, Istituti Clinici Scientifici Maugeri IRCCS, University of Pavia, Via S. Maugeri 4, 27100, Pavia, Italy
- PHD Course in Experimental Medicine, University of Pavia, 27100, Pavia, Italy
| | - F Coperchini
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Department of Internal Medicine and Therapeutics, Istituti Clinici Scientifici Maugeri IRCCS, University of Pavia, Via S. Maugeri 4, 27100, Pavia, Italy
| | - M Rotondi
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Department of Internal Medicine and Therapeutics, Istituti Clinici Scientifici Maugeri IRCCS, University of Pavia, Via S. Maugeri 4, 27100, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100, Pavia, Italy
| | - R Fonte
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Department of Internal Medicine and Therapeutics, Istituti Clinici Scientifici Maugeri IRCCS, University of Pavia, Via S. Maugeri 4, 27100, Pavia, Italy
| | - L Chiovato
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Department of Internal Medicine and Therapeutics, Istituti Clinici Scientifici Maugeri IRCCS, University of Pavia, Via S. Maugeri 4, 27100, Pavia, Italy.
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100, Pavia, Italy.
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Capodiferro S, Limongelli L, Tempesta A, Maiorano E, Favia G. Diode laser photocoagulation of sublingual varices in 706 patients on antithrombotic therapy without drug discontinuation. Ann Ital Chir 2020; 91:100-104. [PMID: 32180571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Several conditions such as age, gender, systemic diseases, smoking, consuming vitamin rich foods, denture wearing may play a role in aetiology of sublingual varices. However, few studies investigating these associations. Nevertheless, prevention of potential bleeding of sublingual varices especially in patients in antithrombotic therapy should led clinicians to treat them by diode laser, since it allows a minimally invasive treatment of photocoagulation. We report on a large sample of patients (706) showing single or multiple SVs on antithrombotic therapy, highlighting the possibility to treat lesions without drug discontinuation and without intra- and post -operative complications. KEY WORDS: Antithrombotic therapy, Bleeding, Diode laser photocoagulation, Sublingual varices.
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Mozetic V, Pacheco RL, Latorraca CDOC, Lee FCYO, Gomes JVB, Riera R. What do Cochrane systematic reviews say about interventions for age-related macular degeneration? SAO PAULO MED J 2019; 137:530-542. [PMID: 32159640 PMCID: PMC9754271 DOI: 10.1590/1516-3180.2019.010317092019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 09/17/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Age-related macular degeneration (AMD) is the third largest cause of blindness worldwide, accounting for 8.7% of all cases. A considerable number of preventive or therapeutic interventions have been used for AMD. OBJECTIVE This study presents a critical view of the interventions that have been assessed through Cochrane systematic reviews. DESIGN AND SETTING Review of systematic reviews, conducted in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP). METHODS Review of Cochrane systematic reviews about interventions for AMD. RESULTS The 18 systematic reviews included assessed the effects of surgical techniques, laser/photo/radiotherapy, intravitreal injections, systemic drugs and phytotherapy/vitamins/supplements. CONCLUSION The Cochrane systematic reviews found evidence that use of bevacizumab, ranibizumab, pegaptanib, laser photocoagulation, photodynamic therapy and multivitamin compounds may present some benefits for treating AMD. There was insufficient evidence for supporting the use of macular translocation, submacular surgery, steroid implantation, radiotherapy, intravitreal aflibercept, interferon alfa, statins or omega-3 fatty acids for treating AMD; or the use of multivitamin antioxidant vitamins or mineral supplementation for preventing AMD. Future randomized controlled trials are imperative to reduce the uncertainty in several clinical questions regarding AMD.
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Affiliation(s)
- Vania Mozetic
- MD. Ophthalmologist, Instituto Dante Pazzanese de Cardiologia, São Paulo (SP), Brazil.
| | - Rafael Leite Pacheco
- MD. Researcher, Centro Universitário São Camilo, and Master’s Student, Evidence-Based Health Program, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Carolina de Oliveira Cruz Latorraca
- MSc. Psychologist and Doctoral Student, Evidence-Based Health Program, Universidade Federal de São Paulo (UNIFESP), and Assistant Researcher, Cochrane Brazil, São Paulo (SP), Brazil.
| | - Fernanda Chin Yu Ogasawara Lee
- Undergraduate Medical Student, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - João Victor Borges Gomes
- Undergraduate Medical Student, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Rachel Riera
- MD, MSc, PhD. Rheumatologist and Adjunct Professor, Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), and Coordinator, Centre of Health Technology Assessment, Hospital Sírio-Libanês, São Paulo (SP), Brazil.
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Takayama K, Someya H, Yokoyama H, Takamura Y, Morioka M, Sameshima S, Ueda T, Kitano S, Tashiro M, Sugimoto M, Kondo M, Sakamoto T, Takeuchi M. Risk Factors of Neovascular Glaucoma After 25-gauge Vitrectomy for Proliferative Diabetic Retinopathy with Vitreous Hemorrhage: A Retrospective Multicenter Study. Sci Rep 2019; 9:14858. [PMID: 31619708 PMCID: PMC6795876 DOI: 10.1038/s41598-019-51411-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/25/2019] [Indexed: 11/08/2022] Open
Abstract
Neovascular glaucoma (NVG) is a terminal severe complication in eyes with proliferative diabetic retinopathy (PDR), and PDR eyes with vitreous hemorrhage (VH) which undergo vitrectomy may have higher risk of postoperative NVG. The incidence and the prognostic factor of postoperative NVG after 25-gauge vitrectomy with advanced surgical options remain unclear. We retrospectively reviewed medical records of 268 eyes of 268 consecutive PDR patients with VH who underwent 25-gauge vitrectomy and 12 months follow-up at seven centers. Preoperative ocular factors (visual acuity, tractional retinal detachment, panretinal photocoagulation [PRP]), demographics and clinical factors (sex, age, diabetic duration, HbA1c, hypertension, anticoagulant medication, and kidney function), surgical procedures, and postoperative complications were compared between patients who developed postoperative NVG (9.3%) and those who did not. NVG eyes was significantly younger (P = 0.026), had shorter diabetic duration (P = 0.022), higher HbA1c (P = 0.028), absence of PRP (P = 0.039) and higher frequency of postoperative VH (P = 0.0075) than non-NVG eyes. Logistic regression analysis identified postoperative VH (P = 0.014), shorter diabetic duration (P = 0.029), and no PRP (P = 0.028) as prognostic factors for postoperative NVG. This multicenter study indicates that younger age, uncontrolled diabetes, no PRP, and postoperative VH are risk factors of post-vitrectomy NVG.
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Affiliation(s)
- Kei Takayama
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, 3598513, Japan
| | - Hideaki Someya
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, 3598513, Japan
| | - Hiroshi Yokoyama
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, 6638501, Japan
| | - Yoshihiro Takamura
- Department of Ophthalmology, University of Fukui Faculty of Medical Sciences, Yoshida, 9101193, Japan
| | - Masakazu Morioka
- Department of Ophthalmology, University of Fukui Faculty of Medical Sciences, Yoshida, 9101193, Japan
| | - Seiji Sameshima
- Department of Ophthalmology, Kagoshima University, Kagoshima, 8900046, Japan
| | - Tetsuo Ueda
- Department of Ophthalmology, Nara Medical University, Kashihara, 6348522, Japan
| | - Shigehiko Kitano
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, 1628666, Japan
| | - Maki Tashiro
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, 1628666, Japan
| | | | - Mineo Kondo
- Department of Ophthalmology, Mie University, Tsu, 5148507, Japan
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University, Kagoshima, 8900046, Japan
| | - Masaru Takeuchi
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, 3598513, Japan.
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Bressler SB, Beaulieu WT, Glassman AR, Gross JG, Melia M, Chen E, Pavlica MR, Jampol LM. PHOTOCOAGULATION VERSUS RANIBIZUMAB FOR PROLIFERATIVE DIABETIC RETINOPATHY: Should Baseline Characteristics Affect Choice of Treatment? Retina 2019; 39:1646-1654. [PMID: 30807516 PMCID: PMC6698425 DOI: 10.1097/iae.0000000000002377] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Among eyes with proliferative diabetic retinopathy, identify whether baseline characteristics impact the benefit of ranibizumab over panretinal photocoagulation (PRP) in DRCR.net Protocol S. METHODS Participants had proliferative diabetic retinopathy, visual acuity of 20/320 or better, and no previous PRP. Eyes were randomized to PRP or intravitreous 0.5-mg ranibizumab. RESULTS Ranibizumab was superior to PRP for change in visual acuity and development of vision-impairing central-involved diabetic macular edema over 2 years (P < 0.001). Among 25 characteristics, there were none in which participants assigned to PRP had superior outcomes relative to ranibizumab-assigned participants. The relative benefit of ranibizumab over PRP for change in visual acuity seemed greater in participants with higher mean arterial pressure (P = 0.03), without previous focal/grid laser (P = 0.03), with neovascularization of the disk and elsewhere on clinical examination (P = 0.04), and with more advanced proliferative diabetic retinopathy on photographs (P = 0.02). For development of vision-impairing central-involved diabetic macular edema, the relative benefit of ranibizumab over PRP seemed greater among nonwhite participants (P = 0.01) and those with higher mean arterial pressure (P = 0.01). CONCLUSION There were no characteristics identified in which outcomes were superior with PRP compared with ranibizumab. These exploratory analyses provide additional support that ranibizumab may be a reasonable alternative to PRP for proliferative diabetic retinopathy over a 2-year period.
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Affiliation(s)
- Susan B. Bressler
- Wilmer Eye Institute, Johns Hopkins University School of
Medicine, Baltimore, Maryland
| | | | | | | | | | - Eric Chen
- Retina Consultants of Houston, Houston, Texas
| | | | - Lee M. Jampol
- Feinberg School of Medicine, Northwestern University,
Chicago, Illinois
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Elwehidy AS, Bayoumi NHL, Badawi AE, Hagras SM, Abdelkader A. Intravitreal Ranibizumab With Panretinal Photocoagulation Followed by Trabeculectomy Versus Visco-Trabeculotomy in Management of Neovascular Glaucoma. Asia Pac J Ophthalmol (Phila) 2019; 8:308-313. [PMID: 31369406 PMCID: PMC6727917 DOI: 10.1097/apo.0000000000000248] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 01/09/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The aim of the current study was to compare visco-trabeculotomy (VT) with standard trabeculectomy with mitomycin C (Trab-MMC) in the treatment of quiescent neovascular glaucoma (NVG). METHODS The study was conducted on 51 eyes of 51 patients presenting with NVG and treated at an Ophthalmic Center in Egypt between March 2014 and April 2017. All study eyes were subjected to a standard protocol of intravitreal injection of ranibizumab followed by panretinal photocoagulation. Eyes were then randomized to either VT or Trab-MMC. Study eyes were followed up for at least 18 months. Success was defined as an intraocular pressure of ≤21 mm Hg and without vision-threatening complications. Complications were noted. RESULTS The mean ± SD (range, median) age of the study patients was 54.1 ± 6.4 (40-67, 54.5) and 52.4 ± 8.8 (38-66, 53) years in the VT (26 eyes) and Trab-MMC (25 eyes) groups, respectively (P = 0.45). The mean ± SD (range, median) intraocular pressure (IOP) of the study eyes was 45.19 ± 2.97 (39-52, 45.5) and 45.64 ± 3.56 (3-53, 45) mm Hg on maximal medical therapy in the VT and Trab-MMC groups, respectively (P = 0.61). At 18 months' follow-up, the mean ± SD (range, median) IOP of the study eyes was 18.19 ± 2.0 (16-23, 17) and 19.92 ± 2.6 (18-26, 19) mm Hg in the VT and Trab-MMC groups, respectively (P = 0.004). There was no difference in postoperative antiglaucoma medication between the 2 groups (P = 0.62). Complications included hyphema and Descemet split in the VT group and an IOP spike in the Trab-MMC group. Success rates were 84.6% and 80% in the VT and Trab-MMC groups, respectively (P = 0.726). CONCLUSIONS Both VT and Trab-MMC groups are effective in reducing the IOP in cases of NVG after control of neovascularization with anti-vascular endothelial growth factor and pan retinal photocoagulation.
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Affiliation(s)
| | | | | | | | - Amr Abdelkader
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Inan S, Polat O, Yıgıt S, Inan UU. PASCAL laser platform produces less pain responses compared to conventional laser system during the panretinal photocoagulation: a randomized clinical trial. Afr Health Sci 2018; 18:1010-1017. [PMID: 30766567 PMCID: PMC6354857 DOI: 10.4314/ahs.v18i4.22] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Most of patients experience pain during the panretinal photocoagulation(PRP). Laser photocoagulation delivery has advanced with the introduction of pattern-scanning laser systems (PASCAL). Shorter pulse duration and less choroidal penetration believed to reduce pain during the laser treatment. Objectives To compare the severity of expressed pain scores in patients with PDR who underwent PRP either with PASCAL laser or conventional laser. Methods A total of 28 patients with a diagnosis of PDR who were scheduled for bilateral PRP therapy were enrolled into the prospective study. Both eyes were treated within the same session and while one eye was treated with PASCAL the other was treated with conventional laser randomly. Pulse duration was adjusted to 100-ms in conventional laser and 30 ms in PASCAL. The severity of pain was graded using a verbal scale and a visual analog scale (VAS). Results Mean age was 61.36±9.10 years. Mean verbal and VAS scores were 1.32±0.47 and 2.86±1.21 in the PASCAL laser and 2.39±0.49 and 5.75±1.35 in the conventional laser group, respectively. Differences between expressed pain scores obtained by both two scales were statistically significant (p<0.001). Conclusion PASCAL laser significantly alleviates pain levels possibly due to the shorter laser pulse duration and lower intensity.
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Affiliation(s)
- Sibel Inan
- Department of Ophthalmology, Afyon Kocatepe University, Faculty of Medicine, Afyonkarahisar, Turkey
| | - Onur Polat
- Ophthalmology Clinic, Afyonkarahisar State Hospital, Afyonkarahisar, Turkey
| | - Safiye Yıgıt
- Ophthalmology Clinic, Gerede State Hospital, Bolu, Turkey
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Yan S, Chen Y, Chen R, Tian B, Li Z. Subthreshold micropulse laser photocoagulation therapy in a case of bilateral retinal astrocytic hamartomas with tuberous sclerosis complex: A case report. Medicine (Baltimore) 2018; 97:e13265. [PMID: 30557970 PMCID: PMC6320095 DOI: 10.1097/md.0000000000013265] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
RATIONALE Report a case of bilateral multiple retinal hamartomas (RAHs) in a patient with tuberous sclerosis complex (TSC) and introduced a new method (subthreshold micropulse laser photocoagulation) for the treatment of RAHs. PATIENT CONCERNS A 20-year-old man with TSC complained of decreased vision and metamorphosia in both eyes for 2 months. At presentation, visual acuity (VA) was 20/32 in the right eye and 20/40 in the left eye. Fundus photographs, optical coherence tomography, fundus fluorescein angiography (FFA), and indocyanine green angiography indicated multiple RAHs in both eyes. DIAGNOSES Bilateral retinal astrocytic hamartomas. INTERVENTIONS In the right eye, 577 nm photocoagulation was adopted to treat the RAHs with obvious fluorescein leakage in FFA. The paramacular RAHs were treated by subthreshold micropulse mode to minimize the damage to macula. Photocoagulation therapy was administrated in the left eye after 1 dose of intravitreal ranibizumab treatment. OUTCOMES After photocoagulation therapy (including subthreshold micropulse laser photocoagulation for the paramacular RAHs in both eyes), the VA improved to 20/25 OD and 20/32 OS with no recurrence of exudation. LESSONS About 577 nm photocoagulation for the peripheral RAHs in combination with subthreshold micropulse laser photocoagulation for RAHs in the macular zone is a good option for multiple RAHs in patients with TSC.
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Affiliation(s)
- Shenshen Yan
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University
| | - Yanyun Chen
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University
| | - Rui Chen
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University
| | - Bei Tian
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University
| | - Zheqing Li
- Department of Ophthalmology, Shijingshan Teaching Hospital of Capital Medical University, Beijing Shijingshan Hospital, Beijing, China
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Abstract
INTRODUCTION Asteroid hyalosis (AH) is characterized by mild vitreous-body liquefaction and a reduced likelihood of posterior vitreous detachment (PVD). Here, we report the clinical features of 2 cases of macular hole (MH) in eyes with AH. The extent of retinal vitreous adhesion at the time of vitreous surgery, the presence or absence of iatrogenic retinal breaks, and the postoperative course was examined in regard to the association with AH. CASE PRESENTATION Case 1 involved a 67-year-old female with decreased visual acuity in her left eye. Although preoperative optical coherence tomography examination revealed complete PVD with operculum around the fovea central region, vitreoretinal adhesion was quite strong starting at the midperiphery of the fundus, and an iatrogenic retinal break was formed at the inferior site during vitreous surgery. Endophotocoagulation was performed, and no onset of retinal detachment (RD) postsurgery was observed. Case 2 involved a 74-year-old male with metamorphopsia in his right eye. Preoperative perifoveal PVD was observed, yet vitreoretinal adhesion was strong starting at the midperiphery of the fundus and multiple iatrogenic retinal breaks had formed on the inferior, superior, and temporal sites. Moreover, RD occurred during surgery. Endophotocoagulation and gas tamponade was performed; however, postoperative RD requiring multiple reoperations occurred. CONCLUSION As with normal MH, MH with AH is thought to be caused by perifoveal PVD, yet as the vitreoretinal adhesion was found to be quite strong starting at the midperiphery of the fundus, we decided to keep the artificial PVD within a range where adhesion was loose.
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Abstract
PURPOSE Neovascular glaucoma (NVG) is a severe secondary glaucoma with uncontrolled intraocular pressure that leads to serious eye pain and vision loss. Presently, the therapeutic strategies for NVG are diverse, but the therapeutic effects are still not ideal. We performed a network analysis to assess the effect of multiple therapeutic strategies on the treatment of NVG patients. METHODS We searched public electronic databases through April 2017 using the following keywords "neovascular glaucoma," "iris neovascularization," "hemorrhagic glaucoma," and "random" without language restrictions. The outcome considered in the present analysis was treatment success rate. A network meta-analysis and multilevel mixed-effects logistic regression were used to compare regimens. RESULTS We included 27 articles assessing a total of 1884 NVG patients in our analysis. According to the network analysis, interferon and mitomycin plus trabeculectomy (94.9%), glaucoma valve implantation (86.9%), and iris photocoagulation plus trabeculectomy (81.9%) were the most likely to improve treatment success rate in NVG patients. The multilevel logistic regression analysis showed that glaucoma valve, bevacizumab, interferon, cyclophotocoagulation, trabeculectomy, iris photocoagulation, ranibizumab, and mitomycin had advantages in terms of improving treatment success rate in NVG patients. However, the application of retinal photocoagulation and vitrectomy reduced patient treatment success rate. CONCLUSION The regimen including mitomycin, interferon, and trabeculectomy was the most likely to improve the treatment success rate in NVG patients. The application of glaucoma valve and bevacizumab were more beneficial for improving patient treatment success rate as a surgery and as an agent, respectively.
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Affiliation(s)
- Zixian Dong
- Department of Ophthalmology, the First Affiliated Hospital of Anhui Medical University
| | - Jianyang Gong
- Department of Ophthalmology, the First Affiliated Hospital of Anhui Medical University
| | - Rongfeng Liao
- Department of Ophthalmology, the First Affiliated Hospital of Anhui Medical University
| | - Shaojun Xu
- School of Public Health, Anhui Medical University, Hefei, China
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Zhong J, Jia J, Yu J, Zhang L, Xiang Y. Preoperative photocoagulation reduces corneal endothelial cell damage after vitrectomy in patients with proliferative diabetic retinopathy. Medicine (Baltimore) 2017; 96:e7971. [PMID: 28984756 PMCID: PMC5737992 DOI: 10.1097/md.0000000000007971] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Proliferative diabetic retinopathy (PDR) is a severe complication of diabetes and is a leading cause of visual decline and irreversible blindness. So we designed this study to investigate retrospectively the effect of preoperative photocoagulation on corneal endothelial cells after vitrectomy in patients with PDR.The study included 52 eyes of 46 patients with PDR complicated with vitreous hemorrhage, who underwent vitrectomy. Patients were apportioned to a photocoagulation group (26 eyes/23 patients) or nonphotocoagulation group (26/23 patients), according to their history of preoperative photocoagulation. A specular microscope was used to assess the corneal endothelial cell density and percentage of hexagonal cells (PHC) before surgery, and at 1 week, 1 month, and 3 months after surgery.The cell density was lower 3 months after surgery in the photocoagulation group, but at 1 month in the nonphotocoagulation group, all cases were significantly different from the preoperative value (P < .05 or P < .01). One week after surgery, the mean cell densities between the photocoagulation and nonphotocoagulation groups were not statistically different (P > .05). However, the mean cell densities at 1 and 3 months after surgery in the photocoagulation group were significantly higher than those in the nonphotocoagulation group (P < .05). The PHC values in the photocoagulation group at 1 week and in the nonphotocoagulation group at 1 week, 1 month, and 3 months were much lower than their respective preoperative values (P < .05 or P < .01). More importantly, at 1 and 3 months, the PHC had recovered to preoperative values in the photocoagulation group, but not in the nonphotocoagulation group. As for cell density and PHC, they were both significantly higher 1 and 3 months after surgery in the photocoagulation group than in the nonphotocoagulation group (P < .05).Photocoagulation before vitrectomy reduces subsequent corneal endothelial cell damage in PDR patients.
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Singh R, Rajaraman S, Balasubramanian M. A Novel Nanoparticle Mediated Selective Inner Retinal Photocoagulation for Diseases of the Inner Retina. IEEE Trans Nanobioscience 2017; 16:542-554. [PMID: 28829313 PMCID: PMC5926191 DOI: 10.1109/tnb.2017.2741490] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A novel nanoparticle mediated methodology for laser photocoagulation of the inner retina to achieve tissue selective treatment is presented. METHODS Transport of 527, 577, and 810 nm laser, heat deposition, and eventual thermal damage in vitreous, retina, RPE, choroid, and sclera were modeled using Bouguer-Beer-Lambert law of absorption and solved numerically using the finite volume method. Nanoparticles were designed using Mie theory of scattering. Performance of the new photocoagulation strategy using gold nanospheres and gold-silica nanoshells was compared with that of conventional methods without nanoparticles. For experimental validation, vitreous cavity of ex vivo porcine eyes was infused with gold nanospheres. After ~6 h of nanoparticle diffusion, the porcine retina was irradiated with a green laser and imaged simultaneously using a spectral domain optical coherence tomography (Spectralis SD-OCT, Heidelberg Engineering). RESULTS Our computational model predicted a significant spatial shift in the peak temperature from RPE to the inner retinal region when infused with nanoparticles. Arrhenius thermal damage in the mid-retinal location was achieved in ~14 ms for 527 nm laser thereby reducing the irradiation duration by ~30 ms compared with the treatment without nanoparticles. In ex vivo porcine eyes infused with gold nanospheres, SD-OCT retinal images revealed a lower thermal damage and expansion at RPE due to laser photocoagulation. CONCLUSION Nanoparticle infused laser photocoagulation strategy provided a selective inner retinal thermal damage with significant decrease in laser power and laser exposure time. SIGNIFICANCE The proposed treatment strategy shows possibilities for an efficient and highly selective inner retinal laser treatment.
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Matsumoto T, Itokawa T, Shiba T, Tomita M, Hine K, Mizukaki N, Yoda H, Hori Y. Decreased ocular blood flow after photocoagulation therapy in neonatal retinopathy of prematurity. Jpn J Ophthalmol 2017; 61:484-493. [PMID: 28932922 DOI: 10.1007/s10384-017-0536-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 07/31/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the relationships between optic nerve head blood flow, expressed as mean blur rate (MBR) measured by laser speckle flowgraphy (LSFG), and photocoagulation therapy in neonates with retinopathy of prematurity (ROP). STUDY DESIGN Case series study. METHODS We studied 5 ROP neonates either during sleep or under sedation both before and after photocoagulation, and evaluated 8 eyes in which the circulation could be measured three times consecutively. Correlations between the MBR-A (mean of all values), MBR-V (vessel mean) and MBR-T (tissue mean) and postmenstrual age were evaluated using Spearman's rank correlation coefficient. In addition, correlations between the relative MBR (-A, -V, -T) value and number of photocoagulation burns and the NV score were evaluated. Differences between post-treatment MBR in ROP subjects and normal neonates' MBR were estimated using analysis of covariance (ANCoVA), with adjustment for postmenstrual age. RESULTS The relative MBR (-A, -V, -T) values after photocoagulation were 69.6 ± 16.0%, 66.7 ± 17.0% and 74.3 ± 14.6%, respectively. Postmenstrual age was significantly correlated with post-treatment MBR-A (r = 0.83, p = 0.0101), MBR-V (r = 0.85, p = 0.007) and MBR-T (r = 0.76, p = 0.0282). The relative MBR-T value was significantly correlated with the number of photocoagulation burns (r = -0.75, p = 0.033) and NV score (r = -0.72, p = 0.0437). The ANCoVA results showed no significant difference between post-treatment MBR and normal neonates' MBR. CONCLUSIONS Photocoagulation improved the dilation of veins and tortuosity of arteries and reduced ocular blood flow in ROP subjects. Since the post-treatment MBR was not different from a normal neonate's MBR, it is suggested that the pre-treatment MBR was higher in severe ROP cases.
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Affiliation(s)
- Tadashi Matsumoto
- Department of Ophthalmology, School of Medicine, Toho University, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan.
| | - Takashi Itokawa
- Department of Ophthalmology, School of Medicine, Toho University, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Tomoaki Shiba
- Department of Ophthalmology, School of Medicine, Toho University, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Masahiko Tomita
- Department of Ophthalmology, School of Medicine, Toho University, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Kotaro Hine
- Department of Neonatology, School of Medicine, Toho University, Tokyo, Japan
| | - Norio Mizukaki
- Department of Neonatology, School of Medicine, Toho University, Tokyo, Japan
| | - Hitoshi Yoda
- Department of Neonatology, School of Medicine, Toho University, Tokyo, Japan
| | - Yuichi Hori
- Department of Ophthalmology, School of Medicine, Toho University, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
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Masis Solano M, Huang G, Lin SC. When Should We Give Up Filtration Surgery: Indications, Techniques and Results of Cyclodestruction. Dev Ophthalmol 2017; 59:179-190. [PMID: 28442697 DOI: 10.1159/000458496] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE Cyclodestructive procedures are traditionally used in cases of glaucoma that are refractory to medical and surgical therapy. The goal of this chapter is to describe the indications, contraindications, techniques, and pitfalls of cyclodestructive procedures, including transscleral cyclophotocoagulation (TCP), micropulse TCP (MP-TCP), endoscopic cyclophotocoagulation (ECP), and ultrasound cilioplasty. METHODS A literature search for cyclodestructive techniques was performed, and relevant studies were included for evaluation and review. RESULTS It is encouraging that TCP seems relatively efficacious even for patients who have been refractory to other treatments, depending on the energy setting, follow-up period, and definition of success. Repeated TCP is often required. TCP was more often used in eyes with limited visual potential caused by severe forms of glaucoma than in eyes with good visual potential. Serious complications were significant vision loss, inflammation, hypotony, and phthisis. ECP came later into clinical use for the treatment of refractory glaucoma. ECP is able to specifically target the ciliary epithelium under direct viewing as compared to TCP, which is an indirect cyclodestructive procedure. In the literature, it has been demonstrated that ECP has overall good success with relatively low complication rates when used for adult forms of glaucoma. A new technology using MP-TCP is a promising alternative to conventional cyclophotocoagulation. Early evidence shows that MP-TCP has clinical utility and a good safety profile. Ultrasound cilioplasty is a possible alternative to laser cyclodestruction that is already being commercialized and is currently under investigation. CONCLUSIONS Both TCP and ECP are effective cyclodestructive procedures and alternatives for the treatment of glaucoma refractory to medical and surgical therapy, though potential for serious complications exists. TCP, ECP, and ultrasound cilioplasty are being used increasingly as the primary surgery for various kinds and stages of glaucoma.
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Abstract
OBJECTIVES Laser photocoagulation surgery is a routine treatment for threshold retinopathy of prematurity (ROP). However, little is known about which anaesthesia protocols provide efficient pain control while minimising exposure risk to vulnerable infants. In this study, therefore, we assessed the efficacy and tolerability of multiple anaesthesia techniques used on premature infants during laser therapy. DESIGN AND MAIN OUTCOME MEASURES Anaesthesia modalities consisted of topical eye drops anaesthesia, general anaesthesia and intravenous fentanyl sedation with mechanical ventilation. Laser treatment efficacy and detailed operative information were retrospectively and consecutively analysed. Cardiorespiratory stability was assessed and compared. The Neonatal Pain Agitation and Sedation Scale (N-PASS) was used to evaluate tolerability in infants that underwent intravenous fentanyl sedation. RESULTS 97 cases of prematurity were included in this study. In 94/97 (96.9%) cases, vascular proliferation regressed. In the topical anaesthesia groups, the ophthalmologist needed 12-16 min more to complete the treatment. During the 3 postoperative days, topical anaesthesia demonstrated the greatest instability; 4/31 (12.90%) infants in this group suffered from life threatening events requiring resuscitation. The only instability observed in general anaesthesia and fentanyl sedation was attributed to difficulty in extubating within 24 hours after surgery. During laser therapy, the N-PASS score increased to 1.8 in the fentanyl sedation group. CONCLUSIONS Topical anaesthesia was associated with more cardiorespiratory instability during ROP laser treatment. While general anaesthesia and fentanyl sedation had similar postoperative cardiorespiratory results, the latter demonstrated acceptable pain stress control. However, the difficulty of weaning off mechanical ventilation in some cases after surgery needs to be addressed in future studies.
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Affiliation(s)
- Jing-bo Jiang
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, China
- Department of Neonatology, Guangdong Women and Children's Hospital, Guangzhou, China
| | - Randy Strauss
- Virginia Tech Carilion Research Institute, Roanoke, Virginia, USA
| | - Xian-qiong Luo
- Department of Neonatology, Guangdong Women and Children's Hospital, Guangzhou, China
| | - Chuan Nie
- Department of Neonatology, Guangdong Women and Children's Hospital, Guangzhou, China
| | - Yan-li Wang
- Department of Neonatology, Guangdong Women and Children's Hospital, Guangzhou, China
| | - Jia-wen Zhang
- Department of Neonatology, Guangdong Women and Children's Hospital, Guangzhou, China
| | - Zhi-wei Zhang
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, China
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Gast TJ, Fu X, Gens JS, Glazier JA. A Computational Model of Peripheral Photocoagulation for the Prevention of Progressive Diabetic Capillary Occlusion. J Diabetes Res 2016; 2016:2508381. [PMID: 27847828 PMCID: PMC5099465 DOI: 10.1155/2016/2508381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 08/02/2016] [Accepted: 09/29/2016] [Indexed: 01/17/2023] Open
Abstract
We developed a computational model of the propagation of retinal ischemia in diabetic retinopathy and analyzed the consequences of various patterns and sizes of burns in peripheral retinal photocoagulation. The model addresses retinal ischemia as a phenomenon of adverse local feedback in which once a capillary is occluded there is an elevated probability of occlusion of adjacent capillaries resulting in enlarging areas of retinal ischemia as is commonly seen clinically. Retinal burns of different sizes and patterns, treated as local oxygen sources, are predicted to have different effects on the propagation of retinal ischemia. The patterns of retinal burns are optimized with regard to minimization of the sum of the photocoagulated retina and computer predicted ischemic retina. Our simulations show that certain patterns of retinal burns are effective at preventing the spatial spread of ischemia by creating oxygenated boundaries across which the ischemia does not propagate. This model makes no statement about current PRP treatment of avascular peripheral retina and notes that the usual spot sizes used in PRP will not prevent ischemic propagation in still vascularized retinal areas. The model seems to show that a properly patterned laser treatment of still vascularized peripheral retina may be able to prevent or at least constrain the propagation of diabetic retinal ischemia in those retinal areas with intact capillaries.
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Affiliation(s)
- Thomas J. Gast
- School of Optometry, Indiana University, Bloomington, IN 47405, USA
| | - Xiao Fu
- The Biocomplexity Institute, Indiana University, Bloomington, IN 47405, USA
- Physics Department, Indiana University, Bloomington, IN 47405, USA
| | - John Scott Gens
- The Biocomplexity Institute, Indiana University, Bloomington, IN 47405, USA
- Physics Department, Indiana University, Bloomington, IN 47405, USA
| | - James A. Glazier
- The Biocomplexity Institute, Indiana University, Bloomington, IN 47405, USA
- Physics Department, Indiana University, Bloomington, IN 47405, USA
- School of Informatics and Computing, Indiana University, Bloomington, IN 47408, USA
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Abstract
Age-related macular degeneration (AMD) is the leading cause of vision loss in the elderly. AMD is diagnosed based on characteristic retinal findings in individuals older than 50. Early detection and treatment are critical in increasing the likelihood of retaining good and functional vision.
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Affiliation(s)
- Sonia Mehta
- Vitreoretinal Diseases & Surgery Service, Wills Eye Hospital, Department of Ophthalmology, Thomas Jefferson University Hospital, 840 Walnut Street, Suite 1020, Philadelphia, PA 19107, USA.
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Affiliation(s)
- Jonathan M Gibson
- School of Life and Health Sciences, University of Aston, Birmingham B4 7ET, UK
| | - Samantha McGinnigle
- School of Life and Health Sciences, University of Aston, Birmingham B4 7ET, UK
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Gross JG, Glassman AR, Jampol LM, Inusah S, Aiello LP, Antoszyk AN, Baker CW, Berger BB, Bressler NM, Browning D, Elman MJ, Ferris FL, Friedman SM, Marcus DM, Melia M, Stockdale CR, Sun JK, Beck RW. Panretinal Photocoagulation vs Intravitreous Ranibizumab for Proliferative Diabetic Retinopathy: A Randomized Clinical Trial. JAMA 2015; 314:2137-2146. [PMID: 26565927 PMCID: PMC5567801 DOI: 10.1001/jama.2015.15217] [Citation(s) in RCA: 492] [Impact Index Per Article: 54.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
IMPORTANCE Panretinal photocoagulation (PRP) is the standard treatment for reducing severe visual loss from proliferative diabetic retinopathy. However, PRP can damage the retina, resulting in peripheral vision loss or worsening diabetic macular edema (DME). OBJECTIVE To evaluate the noninferiority of intravitreous ranibizumab compared with PRP for visual acuity outcomes in patients with proliferative diabetic retinopathy. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial conducted at 55 US sites among 305 adults with proliferative diabetic retinopathy enrolled between February and December 2012 (mean age, 52 years; 44% female; 52% white). Both eyes were enrolled for 89 participants (1 eye to each study group), with a total of 394 study eyes. The final 2-year visit was completed in January 2015. INTERVENTIONS Individual eyes were randomly assigned to receive PRP treatment, completed in 1 to 3 visits (n = 203 eyes), or ranibizumab, 0.5 mg, by intravitreous injection at baseline and as frequently as every 4 weeks based on a structured re-treatment protocol (n = 191 eyes). Eyes in both treatment groups could receive ranibizumab for DME. MAIN OUTCOMES AND MEASURES The primary outcome was mean visual acuity change at 2 years (5-letter noninferiority margin; intention-to-treat analysis). Secondary outcomes included visual acuity area under the curve, peripheral visual field loss, vitrectomy, DME development, and retinal neovascularization. RESULTS Mean visual acuity letter improvement at 2 years was +2.8 in the ranibizumab group vs +0.2 in the PRP group (difference, +2.2; 95% CI, -0.5 to +5.0; P < .001 for noninferiority). The mean treatment group difference in visual acuity area under the curve over 2 years was +4.2 (95% CI, +3.0 to +5.4; P < .001). Mean peripheral visual field sensitivity loss was worse (-23 dB vs -422 dB; difference, 372 dB; 95% CI, 213-531 dB; P < .001), vitrectomy was more frequent (15% vs 4%; difference, 9%; 95% CI, 4%-15%; P < .001), and DME development was more frequent (28% vs 9%; difference, 19%; 95% CI, 10%-28%; P < .001) in the PRP group vs the ranibizumab group, respectively. Eyes without active or regressed neovascularization at 2 years were not significantly different (35% in the ranibizumab group vs 30% in the PRP group; difference, 3%; 95% CI, -7% to 12%; P = .58). One eye in the ranibizumab group developed endophthalmitis. No significant differences between groups in rates of major cardiovascular events were identified. CONCLUSIONS AND RELEVANCE Among eyes with proliferative diabetic retinopathy, treatment with ranibizumab resulted in visual acuity that was noninferior to (not worse than) PRP treatment at 2 years. Although longer-term follow-up is needed, ranibizumab may be a reasonable treatment alternative, at least through 2 years, for patients with proliferative diabetic retinopathy. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01489189.
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Affiliation(s)
| | | | | | - Lee M Jampol
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Lloyd Paul Aiello
- Joslin Diabetes Center, Beetham Eye Institute, Department of Ophthalmology, Harvard University, Boston, Massachusetts
| | - Andrew N Antoszyk
- Charlotte Eye, Ear, Nose, and Throat Associates PA, Charlotte, North Carolina
| | | | | | - Neil M Bressler
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David Browning
- Charlotte Eye, Ear, Nose, and Throat Associates PA, Charlotte, North Carolina
| | | | - Frederick L Ferris
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | | | | | | | | | - Jennifer K Sun
- Joslin Diabetes Center, Beetham Eye Institute, Department of Ophthalmology, Harvard University, Boston, Massachusetts
| | - Roy W Beck
- Jaeb Center for Health Research, Tampa, Florida
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Affiliation(s)
- Timothy W Olsen
- Emory Eye Clinic, Department of Ophthalmology, Emory University, Atlanta, Georgia
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Wise J. Lucentis offers treatment alternative for diabetic retinopathy, trial finds. BMJ 2015; 351:h6145. [PMID: 26577167 DOI: 10.1136/bmj.h6145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Kaatsu training is an exercise method involving the application of pressure to the target muscle, and is being increasingly used in rehabilitation programs for heart disease patients in some hospitals. This method restricts blood flow to the muscles during exercise, and the resultant hypoxia effectively causes muscle hypertrophy and strengthening. However, no medical guidelines or risk factors for its use have been established.We report a case involving a 45-year-old man who suffered from 2 episodes of central retinal vein occlusion (CRVO), both occurring on the day following a Kaatsu training session.As a characteristic of the CRVO and its subsequent complications, the affected eye lost vision despite treatment. The patient had a history of hypertension and diabetes, and thus was at an increased risk of CRVO. Kaatsu training, which changes the heart rate and serum growth hormone levels, may have triggered the onset of CRVO.This case highlights that underlying medical conditions such as hypertension, diabetes, and the consequent inflammation, could be risk factors for vascular side effects resulting from Kaatsu training. Further studies are required before the medical and recreational use of Kaatsu training become widespread.
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Affiliation(s)
- Yoko Ozawa
- From the Laboratory of Retinal Cell Biology (YO); Department of Ophthalmology, Keio University, School of Medicine, Shinjuku-ku (YO, TK, HS, KT), and Kyorin Eye Center, Kyorin University School of Medicine, Mitaka-shi, Tokyo Japan (TK)
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Abstract
Diabetic retinopathy is a common microvascular complication of diabetes mellitus. It affects a substantial proportion of US adults over age 40. The condition is a leading cause of visual loss. Much attention has been given to expanding the role of current treatments along with investigating various novel therapies and drug delivery methods. In the treatment of diabetic macular edema (DME), intravitreal pharmacotherapies, especially anti-vascular endothelial growth factor (anti-VEGF) agents, have gained popularity. Currently, anti-VEGF agents are often used as first-line agents in center-involved DME, with recent data suggesting that among these agents, aflibercept leads to better visual outcomes in patients with worse baseline visual acuities. While photocoagulation remains the standard treatment for proliferative diabetic retinopathy (PDR), recent FDA approvals of ranibizumab and aflibercept in the management of diabetic retinopathy associated with DME may suggest a potential for pharmacologic treatments of PDR as well. Novel therapies, including small interfering RNAs, chemokines, kallikrein-kinin inhibitors, and various anti-angiogenic agents, are currently being evaluated for the management of diabetic retinopathy and DME. In addition to these strategies, novel drug delivery methods such as sustained-release implants and refillable reservoir implants are either under active evaluation or have recently gained FDA approval. This review provides an update on the novel developments in the treatment of diabetic retinopathy.
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Affiliation(s)
| | - Stephen G. Schwartz
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136, USA
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Feuerstein M, Reis W. Preselectable intensity distribution in large-area laser coagulation by electronically controlled beam deflection. Dev Ophthalmol 2015; 14:69-73. [PMID: 3653486 DOI: 10.1159/000414366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Meyer-Schwickerath G, Fried M. Treatment of diabetic retinopathy with photocoagulation. How many coagulations have to be performed in the individual case? Dev Ophthalmol 2015; 2:265-73. [PMID: 6167472 DOI: 10.1159/000395332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Abstract
A 52-yr-old male was referred for progressive visual loss in the left eye. The decimal best-corrected visual acuity (BCVA) was 0.01. Fundus examination revealed diffuse retinal pigment epithelial degeneration, focal yellow-white, infiltrative subretinal lesion with fuzzy border and a live nematode within the retina. Diffuse unilateral subacute neuroretinitis (DUSN) was diagnosed and the direct laser photocoagulation was performed to destroy the live nematode. During eight months after treatment, BCVA gradually improved to 0.2 along with the gradual restoration of outer retinal layers on SD-OCT. We report on the first case of DUSN in Korea. DUSN should be included in the differential diagnosis of unexplained unilateral visual loss in otherwise healthy subjects.
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Affiliation(s)
- Hae Min Kang
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Catholic Kwandong University College of Medicine, International St.Mary's Hospital, Incheon, Korea
| | - Christopher Seungkyu Lee
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
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Kandilarov N, Dimitrova V. HEMORRHOIDAL DISEASE - CONTEMPORARY ASPECTS OF THE PATHOGENESIS, CLINICAL COURSE, DIAGNOSIS AND TREATMENT. Khirurgiia (Mosk) 2015; 81:38-56. [PMID: 26506639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The hemorrhoidal disease affects mainly individuals in their active age, as the reported incidence is much lower than the actual number, due to the nature of the complaints and the "subjective feeling of discomfort" when contacting a healthcare professional. Although in a large part of the cases the disease is successfully treated by non-surgical methods, the persisting symptoms greatly lower patients' quality of life, and the development of complications is related to a high morbidity rate. The defining, diagnosis and determining of the stages of the disease do not pose any difficulties to the modern medical practice, which - however - is not the case with the selection of the optimal and most efficient treatment method. There are a great number of treatment procedures, including surgical, for the treatment of the hemorrhoidal disease. Although there are certain recommended schemes and algorithms for therapeutic behavior, the selection of the method, ensuring individualized and optimal therapy, depends on the judgment of the surgeon.
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Lima Gómez V, Razo Blanco-Hernández DM, García Rubio YZ, Sánchez Montoya PA. Retinal thickness after focal photocoagulation for diabetic macular edema with and without temporal perifoveal thickening. Rev Invest Clin 2015; 67:25-32. [PMID: 25857581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Visual improvement after focal photocoagulation in diabetic macular edema is more common in eyes without temporal perifoveal thickening. This feature is related to a lower macular volume before treatment; the higher proportion of visual improvement could be associated with a shorter need of volume reduction. OBJECTIVE To compare macular volume before and after focal photocoagulation in eyes with diabetic macular edema, with and without temporal perifoveal thickening. METHODS Non-experimental, retrospective, longitudinal, comparative study in diabetics with macular edema treated with focal photocoagulation. Macular volume measured with optical coherence tomography, and best corrected visual acuity were compared between eyes with (group 1) and without temporal perifoveal thickening (group 2, independent samples Student's t test). The comparison was also performed after stratifying the groups by baseline visual acuity. RESULTS One hundred and twenty eyes, 65 eyes from group 1 (54.2%) and 55 from group 2 (45.8%). Mean volume before and after treatment and mean absolute and percentage changes were lower in group 2 (p < 0.001) regardless of visual acuity. Macular volume decreased significantly in eyes of group 1; only eyes in group 2 with visual acuity < 0.5 before treatment increased their visual function (p < 0.001). CONCLUSIONS Eyes without temporal perifoveal thickening had visual improvement, although their volume did not change statistically. The significant volume reduction in eyes with temporal perifoveal thickening was not associated to visual improvement. The anatomical change was not enough to explain the functional improvement.
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Abstract
Diabetes mellitus is a chronic disease which has multiple effects on different end-organs, including the retina. In this paper, we discuss updates on diabetic macular edema (DME) and the management options. The underlying pathology of DME is the leakage of exudates from retinal microaneurysms, which trigger subsequent inflammatory reactions. Both clinical and imaging techniques are useful in diagnosing, classifying, and gauging the severity of DME. We performed a comprehensive literature search using the keywords "diabetes," "macula edema," "epidemiology," "pathogenesis," "optical coherence tomography," "intravitreal injections," "systemic treatment," "hypertension," "hyperlipidemia," "anemia," and "renal disease" and collated a total of 47 relevant articles published in English language. The main modalities of treatment currently in use comprise laser photocoagulation, intravitreal pharmacological and selected systemic pharmacological options. In addition, we mention some novel therapies that show promise in treating DME. We also review systemic factors associated with exacerbation or improvement in DME.
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Affiliation(s)
- Christopher Mathew
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597
| | | | - Srinivasan Sanjay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597
- Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828
- *Srinivasan Sanjay:
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Kamath SB, George D, Parakandy SG. Worm in the eye. JAMA Ophthalmol 2014; 133:139. [PMID: 25541914 DOI: 10.1001/jamaophthalmol.2014.597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Martinez‐Zapata MJ, Martí‐Carvajal AJ, Solà I, Pijoán JI, Buil‐Calvo JA, Cordero JA, Evans JR. Anti-vascular endothelial growth factor for proliferative diabetic retinopathy. Cochrane Database Syst Rev 2014; 2014:CD008721. [PMID: 25418485 PMCID: PMC6995643 DOI: 10.1002/14651858.cd008721.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Proliferative diabetic retinopathy (PDR) is a complication of diabetic retinopathy that can cause blindness. Although panretinal photocoagulation (PRP) is the treatment of choice for PDR, it has secondary effects that can affect vision. An alternative treatment such as anti-vascular endothelial growth factor (anti-VEGF), which produces an inhibition of vascular proliferation, could improve the vision of people with PDR. OBJECTIVES To assess the effectiveness and safety of anti-VEGFs for PDR. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2014, Issue 3), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to April 2014), EMBASE (January 1980 to April 2014), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 28 April 2014. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing anti-VEGFs to another active treatment, sham treatment or no treatment for people with PDR. We also included studies that assessed the combination of anti-VEGFs with other treatments. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies for inclusion, extracted data and assessed risk of bias for all included trials. We calculated the risk ratio (RR) or the mean difference (MD), and 95% confidence intervals (CI). MAIN RESULTS We included 18 RCTs with 1005 participants (1131 eyes) of whom 57% were men. The median number of participants per RCT was 40 (range 15 to 261). The studies took place in Asia (three studies), Europe (two studies), the Middle East (seven studies), North America (three studies) and South America (three studies). Eight RCTs recruited people eligible for PRP, nine RCTs enrolled people with diabetes requiring vitrectomy and one RCT recruited people undergoing cataract surgery. The median follow-up was six months (range one to 12 months). Seven studies were at high risk of bias and the remainder were unclear risk of bias in one or more domains.Very low quality evidence from one study of 61 people showed that people treated with bevacizumab and PRP were less likely to lose 3 or more lines of visual acuity at 12 months compared with people treated with PRP alone (RR 0.19, 95% CI 0.05 to 0.81). People treated with anti-VEGF had an increased chance of gaining 3 or more lines of visual acuity but the effect was imprecise and compatible with no effect or being less likely to gain vision (RR 6.78, 95% CI 0.37 to 125.95). No other study reported these two outcomes. On average, people treated with anti-VEGF (bevacizumab, pegaptanib or ranibizumab) had better visual acuity at 12 months compared with people not receiving anti-VEGF (MD -0.07 logMAR, 95% CI -0.12 to -0.02; 5 RCTs, 373 participants, low quality evidence). There was some evidence to suggest a regression of PDR with smaller leakage on fluorescein angiography but it was difficult to estimate a pooled result from the two trials reporting this outcome. People receiving anti-VEGF were less likely to have vitreous or pre-retinal haemorrhage at 12 months (RR 0.32, 95% CI 0.16 to 0.65; 3 RCTs, 342 participants, low quality evidence). No study reported on fluorescein leakage or quality of life.All of the nine trials of anti-VEGF before or during vitrectomy investigated bevacizumab; most studies investigated bevacizumab before vitrectomy, one study investigated bevacizumab during surgery.People treated with bevacizumab and vitrectomy were less likely to lose 3 or more lines of visual acuity at 12 months compared with people given vitrectomy alone but the effect was imprecise and compatible with no effect or being more likely to lose vision (RR 0.49, 95% CI 0.08 to 3.14; 3 RCTs, 94 participants, low quality evidence). People treated with bevacizumab were more likely to gain 3 or more lines of visual acuity (RR 1.62, 95% CI 1.20 to 2.17; 3 RCTs, 94 participants, low quality evidence). On average, people treated with bevacizumab had better visual acuity at 12 months compared with people not receiving bevacizumab but there was uncertainty in the estimate (the CIs included 0; i.e. were compatible with no effect, and there was considerable inconsistency between studies; MD -0.24 logMAR, 95% CI -0.50 to 0.01; 6 RCTs, 335 participants, I(2) = 67%; low quality evidence). People receiving bevacizumab were less likely to have vitreous or pre-retinal haemorrhage at 12 months (RR 0.30, 95% CI 0.18 to 0.52; 7 RCTs, 393 participants, low quality evidence). No study reported on quality of life.Reasons for downgrading the quality of the evidence included risk of bias in included studies, imprecision of the estimates, inconsistency of effect estimates and indirectness (few studies reported at 12 months).Adverse effects were rarely reported and there was no evidence for any increased risk with anti-VEGF but given the relatively few studies that reported these, and the low event rate, the power of the analysis to detect any differences was low. AUTHORS' CONCLUSIONS There was very low or low quality evidence from RCTs for the efficacy and safety of anti-VEGF agents when used to treat PDR over and above current standard treatments. However, the results suggest that anti-VEGFs can reduce the risk of intraocular bleeding in people with PDR. Further carefully designed clinical trials should be able to improve this evidence.
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Affiliation(s)
- Maria José Martinez‐Zapata
- CIBER Epidemiología y Salud Pública (CIBERESP)Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau)Sant Antoni M. Claret 171Casa de ConvalescènciaBarcelonaCataloniaSpain08041
| | | | - Ivan Solà
- CIBER Epidemiología y Salud Pública (CIBERESP)Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau)Sant Antoni M. Claret 171Casa de ConvalescènciaBarcelonaCataloniaSpain08041
| | - José I Pijoán
- Hospital Universitario CrucesPlaza de Cruces s/nBarakaldoPais VascoSpain48903
- CIBER Epidemiología y Salud Pública (CIBERESP)BioCruces Health Research InstituteBarakaldoSpain
| | - José A Buil‐Calvo
- Hospital de la Santa Creu i Sant PauOftalmologySant Antoni Mª Claret 171BarcelonaCatalonianSpain08041
| | - Josep A Cordero
- Universitat Ramon LlullBlanquerna School of Health ScienceBarcelonaSpain
| | - Jennifer R Evans
- London School of Hygiene & Tropical MedicineCochrane Eyes and Vision Group, ICEHKeppel StreetLondonUKWC1E 7HT
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Abstract
Age-related macular degeneration (AMD) is a multifactorial degeneration of photoreceptors and retinal pigment epithelium. The societal impact is significant, with more than 2 million individuals in the United States alone affected by advanced stages of AMD. Recent progress in our understanding of this complex disease and parallel developments in therapeutics and imaging have translated into new management paradigms in recent years. However, there are many unanswered questions, and diagnostic and prognostic precision and treatment outcomes can still be improved. In this article, we discuss the clinical features of AMD, provide correlations with modern imaging and histopathology, and present an overview of treatment strategies.
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Affiliation(s)
- Yoshihiro Yonekawa
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts 02114
| | - Ivana K Kim
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts 02114
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Schmidt-Erfurth U, Chong V, Loewenstein A, Larsen M, Souied E, Schlingemann R, Eldem B, Monés J, Richard G, Bandello F. Guidelines for the management of neovascular age-related macular degeneration by the European Society of Retina Specialists (EURETINA). Br J Ophthalmol 2014; 98:1144-67. [PMID: 25136079 PMCID: PMC4145443 DOI: 10.1136/bjophthalmol-2014-305702] [Citation(s) in RCA: 400] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 06/23/2014] [Indexed: 02/06/2023]
Abstract
UNLABELLED Age-related macular degeneration (AMD) is still referred to as the leading cause of severe and irreversible visual loss world-wide. The disease has a profound effect on quality of life of affected individuals and represents a major socioeconomic challenge for societies due to the exponential increase in life expectancy and environmental risks. Advances in medical research have identified vascular endothelial growth factor (VEGF) as an important pathophysiological player in neovascular AMD and intraocular inhibition of VEGF as one of the most efficient therapies in medicine. The wide introduction of anti-VEGF therapy has led to an overwhelming improvement in the prognosis of patients affected by neovascular AMD, allowing recovery and maintenance of visual function in the vast majority of patients. However, the therapeutic benefit is accompanied by significant economic investments, unresolved medicolegal debates about the use of off-label substances and overwhelming problems in large population management. The burden of disease has turned into a burden of care with a dissociation of scientific advances and real-world clinical performance. Simultaneously, ground-breaking innovations in diagnostic technologies, such as optical coherence tomography, allows unprecedented high-resolution visualisation of disease morphology and provides a promising horizon for early disease detection and efficient therapeutic follow-up. However, definite conclusions from morphologic parameters are still lacking, and valid biomarkers have yet to be identified to provide a practical base for disease management. The European Society of Retina Specialists offers expert guidance for diagnostic and therapeutic management of neovascular AMD supporting healthcare givers and doctors in providing the best state-of-the-art care to their patients. TRIAL REGISTRATION NUMBER NCT01318941.
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Affiliation(s)
| | - Victor Chong
- Oxford Eye Hospital, Oxford University Hospitals, Oxford, UK
| | - Anat Loewenstein
- Department of Ophthalmology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Michael Larsen
- Department of Ophthalmology, Glostrup Hospital and University of Copenhagen, Copenhagen, Denmark
| | - Eric Souied
- Hôpital Intercommunal de Créteil, Paris, France
| | - Reinier Schlingemann
- Medical Retina Unit and Ocular Angiogenesis Group, Department Of Ophthalmology, Academic Medical Center, Amsterdam, The Netherlands
| | - Bora Eldem
- Department of Ophthalmology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Jordi Monés
- Centro Médico TEKNON, Director Institut de la Màcula i de la Retina, Barcelona, Spain
| | - Gisbert Richard
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute; Scientific Institute San Raffaele, Milano, Italy
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Speilburg AM, Klemencic SA. Ruptured retinal arterial macroaneurysm: diagnosis and management. J Optom 2014; 7:131-137. [PMID: 25000868 PMCID: PMC4087178 DOI: 10.1016/j.optom.2013.08.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 08/02/2013] [Accepted: 08/02/2013] [Indexed: 06/03/2023]
Abstract
Retinal arterial macroaneurysm is an acquired, focal dilation of a retinal artery, typically occurring within the first three bifurcations of the central retinal artery. The clinical presentation of a retinal arterial macroaneurysm is highly variable, making initial diagnosis difficult and differentials many. Identification of retinal arterial macroaneurysms is crucial to appropriately co-manage with the primary care physician for hypertension control. Prognosis is generally good and observation is often an adequate treatment. However, in cases of macular threat or involvement, some treatment options are available and referral to a retinal specialist is indicated.
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Affiliation(s)
- Ashley M Speilburg
- Illinois College of Optometry/Illinois Eye Institute, 3241 S. Michigan Avenue, Chicago, IL 60616, United States.
| | - Stephanie A Klemencic
- Illinois College of Optometry/Illinois Eye Institute, 3241 S. Michigan Avenue, Chicago, IL 60616, United States
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Tereshchenko AV, Belyĭ IA, Isaev SV, Trifanenkova IG, Tereshenkova MS. [Studying the regression pattern of stage II and III retinopathy of prematurity by means of morphometric analysis of retinal vessels in different terms after laser retinal photocoagulation]. Vestn Oftalmol 2014; 130:49-56. [PMID: 25306724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Dynamic evaluation of the diameters of central fundus vessels, 2nd order and peripheral vessels as well as the tortuosity index of central zone arteries in stage II and III retinopathy of prematurity (ROP), which showed regression after laser treatment, was performed. Obtained data can be used for estimation of the optimal follow-up period ensuring early detection of high probability for ROP progression after laser coagulation and decrease of the number of diagnostic examinations for patients whose pathologic process is resolving.
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Forlini M, Adabache-Guel T, Bratu A, Rossini P, Mingaine MS, Cavallini GM, Forlini C. Endoscopic cyclophotocoagulation in refractory glaucoma after osteo-odonto-keratoprosthesis in Stevens-Johnson syndrome: a case report. Retin Cases Brief Rep 2014; 8:193-196. [PMID: 25372436 DOI: 10.1097/icb.0000000000000040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To report successful treatment of refractive glaucoma in a patient submitted to osteo-odonto-keratoprosthesis surgery for Stevens-Johnson syndrome. METHODS An interventional case report. RESULTS The patient is a 62-year-old Indian man with known Stevens-Johnson syndrome since 1972 secondary to tetracycline therapy, with bilateral dry eye and corneal blindness. He underwent symblepharon release surgery with mucous membrane graft in both eyes. Osteo-odonto-keratoprosthesis surgery was later performed on the left eye. He was submitted to 2 Ahmed valve implants to control secondary glaucoma but visual fields continued to worsen; hence, he underwent endoscopic 140° cyclophotocoagulation with a good control of IOP. CONCLUSION Endoscopic cyclophotocoagulation as alternative treatment provides good results in refractory glaucoma after osteo-odonto-keratoprosthesis surgery.
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Affiliation(s)
- Matteo Forlini
- *Institute of Ophthalmology, University of Modena, Modena, Italy; †Department of Retina, Asociación para Evitar la Ceguera en México IAP, México City, México; ‡Department of Ophthalmology, Surgical Vitreoretinal Unit, "Santa Maria delle Croci" Hospital, Ravenna, Italy; and §Meru District Hospital, Meru Town, Kenya
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Yang J, Liu Q, Li X, Zhou L, Sun P, Wang X. Clinical evaluation of traumatic ciliochoroidal detachment with surgical treatment. Eye Sci 2013; 28:124-139. [PMID: 24579552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE To determine the clinical features of traumatic ciliochoroidal detachment (CCD), and to evaluate the surgical outcomes. METHODS We retrospectively reviewed the records of 37 consecutive patients with traumatic CCD who underwent surgical procedures, including ciliary body suturing, transscleral cyclophotocoagulation, and cyclocryopexy. A complete ocular examination was performed at pre-surgery and at periodical post-surgery follow-ups. We compared visual acuity (VA), intraocular pressure (IOP), and morphologic changes with UBM among the different surgical procedures at the pre-surgery and periodical follow-ups. RESULTS The mean IOP was 6.62 mmHg, and the median VA was 20/200 at baseline. The mean final IOP was 11.03 mmHg, and the final median VA improved to 20/50. IOPs were significantly different in post-surgery compared with those at baseline (P = 0.000) among the ciliary body suturing, cyclophotocoagulation, and cyclocryopexy groups. However, no significant differences were noted at each follow-up among the 3 groups (P > 0.05). The post-surgical morphological figures consisted of complete reattachment, partial reattachment, and the complete detachment. Cyclocryopexy (71.4%), suturing (68.4%), and cyclophotocoagulation (63.6%) produced similar surgical outcomes of the complete reattachment based on UBM images. CONCLUSION Prompt treatment and periodic follow-ups are necessary after traumatic CCD, based on accurate dimensions and configuration by UBM. The appropriate choice of surgical procedures is pivotal for an optimal outcome.
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Affiliation(s)
- Jiangang Yang
- Department of Ophthalmology, First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, China.
| | - Qianying Liu
- Department of Ophthalmology, Second Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an 710004, China
| | - Xiaoyan Li
- Department of Ophthalmology, First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, China
| | - Lingxiao Zhou
- Department of Ophthalmology, First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, China
| | - Pengrui Sun
- Department of Ophthalmology, First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, China
| | - XiaoHua Wang
- Department of Ophthalmology, Second Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an 710004, China
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González Rubio-Medina E, Pedroza-Seres M. [Clinical course of pars planitis in patients treated with selective photocoagulation]. ACTA ACUST UNITED AC 2013; 88:298-301. [PMID: 23886360 DOI: 10.1016/j.oftal.2012.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 09/06/2012] [Accepted: 09/28/2012] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Pars planitis is an intermediate uveitis with bilateral and asymmetric presentation. The etiology is unknown and pathogenesis is unclear. Treatment follows the algorithm of Foster, which includes selective photocoagulation. The mechanism of action of photocoagulation is still unknown. MATERIAL AND METHODS An observational, longitudinal, ambispective cohort study was performed with the objective of evaluating the course of inflammation in patients with pars planitis treated with a selective argon laser. RESULTS The study included 29 patients (10 female and 19 male) diagnosed with pars planitis and were treated with selective laser. The mean age of onset was 11.77 years. Eighteen (62.1%) patients were not immunosuppressed at the time of receiving the selective laser, and 11 (37.9%) were taking immunosuppressants. Indications for selective laser were; following the algorithm, 19 (65.55%), vitreous hemorrhage 7 (24.1%), vitrectomy 2 (6.98%), and neovascularization 1 (3.4%). The mean time for inflammation reduction was 5.9 months, and 17 patients (58.6%) had no relapse. Visual acuity showed improvement post-laser (OD P=.025 and OI P=.022). There was also an improvement in vitreous cells. CONCLUSION Selective laser was effective in 58.6%% of patients.
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Affiliation(s)
- E González Rubio-Medina
- Servicio de Uveítis e Inmunología Ocular, Instituto de Oftalmología, Fundación Conde de Valenciana, México D.F, México
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Ward MA. Elective laparoscopic fetal laser photocoagulation in twin-twin transfusion syndrome: a case report. AANA J 2013; 81:222-224. [PMID: 23923674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Twin-twin transfusion syndrome (TTTS) is a complication of multiple gestation in which arteriovenous vascular communications occur in a shared placenta. Due to these communications, there is an imbalance of blood flow between the developing fetuses. This results in 1 twin becoming the donor and the other becoming the recipient. In severe cases, the recipient may experience polycythemia, polyhydramnios, and hydrops fetalis, while in the donor oligohydramnios and severe anemia may develop. It has been reported that fetal mortality can reach as high as 60% to 80% if TTTS develops before 26 weeks' gestation and goes untreated. Therapeutic options available include decompression amniocentesis, amniotic septostomy, interruption of the placental vessel communications, and selective fetal reduction. Selective fetoscopic laser photocoagulation of abnormal vascular communications has shown to result in increasing survival rates and has become a definitive treatment option for severe TTTS. The case report presented involves a 32-year-old, gravida 5, para 2 patient at 19 weeks' estimated gestational age with a monochorionic diamniotic twin gestation with TTS diagnosed using ultrasonography presenting for an elective laparoscopic fetal laser photocoagulation.
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Li QP, Wang ZH, Zhang S, Chen Y, Chen J, Huang JJ, Wang ZZ, Ke Y, Feng ZC. [Bedside diode laser photocoagulation for 103 cases with serious retinopathy of prematurity in NICU]. Zhonghua Er Ke Za Zhi 2013; 51:12-15. [PMID: 23527925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of the bedside diode laser photocoagulation for severe retinopathy of prematurity in neonatal intensive care unit (NICU). METHOD Data of 103 patients with prethreshold or threshold retinopathy of prematurity (ROP), treated with diode laser photoablation after vecuronium-induced anesthesia and mechanical ventilation from March 2009 to July 2011 in NICU of Bayi Children's Hospital. RESULT Totally 199 eyes in 103 patients received laser therapy with at least 5 months follow up. Among these eyes, zone I disease was found in 76 eyes (38.2%) of 39 infants, zone II disease was found in 123 eyes (61.8%)of 64 infants and additional disease was found in 180 eyes of 91 infants. After treatment 191 (96.0%) of 199 eyes had favorable outcomes and 8 developed to partial retinal detachment. The rate of favorable outcomes in zone I diseases and zone 2 diseases were 89.5% and 100% respectively. The laser therapy was undertaken in all patients safely and the use of ventilator was stopped quickly [after a mean of (6.7 ± 1.3) h]. CONCLUSION Bedside laser photocoagulation in NICU is a safe and effective treatment mode for severe ROP and should be used widely.
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Affiliation(s)
- Qiu-ping Li
- Bayi Children's Hospital Affiliated to the Beijing Military Region General Hospital, Beijing, China
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Steigerwalt RD, Pascarella A, Arrico L, Librando A, Plateroti R, Plateroti AM, Plateroti P, Nebbioso M. Idiopathic juxtafoveal retinal telangiectasis and retinal macroaneurysm treated with indocyanine green dye-enhanced photocoagulation. Panminerva Med 2012; 54:93-96. [PMID: 23241941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This case report presents the use of indocyanine green dye-enhanced photocoagulation (ICG-DEP) for the treatment of idiopathic juxtafoveal retinal telangiectasis and a retinal macroaneurysm. A 35-year-old male with 20/20 vision had been followed for 5 years for a retinal macroaneurysm with retinal telangiectasis outside the macular area. He then presented with a recently decreased vision in his right. He had macular edema with a new area of idiopathic juxtafoveal retinal telangiectasis. After 4 focal argon laser treatments, angiographic closure of the lesions was not obtained and the retinal edema remained. After 3 sessions of ICG-DEP, the lesions were closed and the edema absorbed. The 810 nm infrared laser with ICG-DEP should be considered for the treatment of idiopathic juxtafoveal retinal telangiectasis and retinal macroaneurysms. In this case the procedure appears to be safe and well tolerated. It may allow for more direct energy absorption than that of the argon laser to these types of retinal lesions with better tissue closure.
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Kawaji T. [Retinal laser photocoagulation for familial transthyretin-related ocular amyloidosis]. Nippon Ganka Gakkai Zasshi 2012; 116:1046-1051. [PMID: 23316653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Ocular manifestations associated with transthyretin-related familial amyloidotic polyneuropathy (FAP), such as vitreous opacity and glaucoma, reportedly continue and worsen, even after liver transplantation, which should halt the progression of the neurological complications. We used panretinal laser photocoagulation, which damages the retinal pigment epithelium, the main synthetic source of amyloidogenic transthyretin in ocular tissues, to treat one eye each of two FAP patients as a pilot study. Panretinal laser photocoagulation prevented the progression of amyloid depositions in the vitreous and on the retinal surface in both cases during a 3 years follow-up. No serious complications occurred. Panretinal laser photocoagulation may be a safe and novel treatment option to mitigate ocular manifestations in FAP patients.
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Affiliation(s)
- Takahiro Kawaji
- Department of Ophthalmology, Faculty of Life Science, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
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Miyazaki H, Ohshiro T, Watanabe H, Kakizaki H, Makiguchi T, Kim M, Negishi A, Yokoo S. Ultrasound-guided intralesional laser treatment of venous malformation in the oral cavity. Int J Oral Maxillofac Surg 2012; 42:281-7. [PMID: 22835683 DOI: 10.1016/j.ijom.2012.06.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 04/20/2012] [Accepted: 06/15/2012] [Indexed: 11/18/2022]
Abstract
An ultrasound-guided intralesional photocoagulation (ILP) technique using a laser is described for treatment of deep venous malformations in the oral cavity. ILP is basically a blind operation and has a risk of unintended destruction of surrounding normal tissue, therefore the authors now routinely use guidance by ultrasonography using a mini-probe to improve the safety and reliability of ILP. This approach enables safe fibre insertion, appropriate laser irradiation, and intraoperative assessment of coagulation. The use of this technique is described in 8 patients. The authors conclude that ultrasound-guided ILP with a laser is a promising technique for less-invasive treatment of a vascular malformation in the oral cavity.
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Affiliation(s)
- H Miyazaki
- Department of Stomatology and Oral Surgery, Gunma University Graduate School of Medicine, Gunma, Japan.
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