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Outer retinal tubulation in diabetic macular edema following anti-VEGF treatment

Eye and Vision 2015年第1期2卷 71-75页

作者： Ali M Al-Halafi Department of Surgery Ophthalmology DivisionConsultant and Vitreoretinal Surgeon Security forces HospitalPO Box 3643Riyadh 11481Kingdom of Saudi Arabia

Background:To address the presence and features of outer retinal tubulation(ORT)found in diabetic macular edema(DME)treated with anti-vascular endothelial growth factor(anti-VEGF)and to differentiate between ORT and cystoid DME,which have different plans of ***:This was a retrospective review of a total of 514 patients investigated with spectral domain optical coherence tomography(OCT)in patients with diabetic macular edema treated with *** was seen in 12 eyes of 11 *** morphologic characteristics of ORT and its progress over time were examined using OCT *** retinal images were obtained by horizontal and vertical scans to analyze the possible presence of ORT and to explore their morphologic features and location in the retinal ***:ORT was seen in DME treated with *** was shown as round or ovoid hyporeflective spaces with hyperreflective borders on the B-scans,measuring 30 to 120μm high and 30 to 1775μm *** tubules generally remained stable over *** a retinal practice specializing in advanced diabetic retinopathy clinic,this ORT was seen in 12 eyes of 11 patients during a 12-month *** presented either after receiving 0.05 mL open-label intravitreal injections of 0.5 mg ranibizumab or 1.25 mg ***:ORT is found in DME treated with anti-VEGF that may show damage to the outer retina secondary to the severity and chronicity of the *** may be a result of underlying chronic and severe diabetic macular edema that may occur later possibly secondary to retinal layers rearrangement after several anti-VEGF *** is important to differentiate between ORT and cystoids *** presence of the ORT entity alone without the presence of DME does not require further anti-VEGF re-injections.

关键词： Outer retinal tubulation Diabetic macular edema Ranibizumab Bevacizumab

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Updates in uveitic macular edema

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World Journal of Ophthalmology 2014年第3期4卷 56-62页

作者： Samir S Shoughy Igor Kozak The Eye Center and The Eye Foundation for Research in Ophthalmology vitreoretinal and Uveitis division King Khaled Eye Specialist Hospital

Macular edema is one of the most common visionthreatening complications of uveitis noted in one third of patients with uveitis. The release of a number of inflammatory mediators induces retinal vascular hyperpermeability leading to uveitic macular edema(UME)which most commonly is of cystoid shape. Fluorescein angiography and non-invasive spectral-domain optical coherence tomography are standard procedures for diagnosis and follow-up of UME with some innovations such as scanning laser ophthalmoscope retro-mode imaging. Effective management of UME requires thorough understanding of the individual case. Proper control of intraocular inflammation is mandatory before targeting macular edema itself. Mainstay of treatment is immunosuppressive therapy with various drug delivery routes including topical, local subconjunctival, peribulbar and sub-Tenon's, intravitreal and systemic. Clinical trials with biologics are under way to study the efficacy of these agents in suppressing intraocular inflammation and resolution of UME. Visual prognosis in UME depends on numerous factors. Younger age and better visual acuity at baseline are associated with more favorable visual outcome in most

关键词： Intraocular inflammation Uveitic macular edema Fluorescein angiography Optical coherence tomography Corticosteroid therapy Drug delivery Clinical trials

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Clinical trials on corticosteroids for diabetic macular edema

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World Journal of Diabetes 2013年第6期4卷 295-302页

作者： Hassan A Al Dhibi J Fernando Arevalo vitreoretinal division King Khaled Eye Specialist HospitalRiyadh 11462Saudi Arabia Retina division Wilmer Eye InstituteJohns Hopkins University School of MedicineBaltimoreMD 21231United States

Diabetic macular edema(DME)is a common cause of visual impairment in diabetic *** is caused by an increase in the permeability of the perifoveal capillaries and a disruption of the blood *** pathogenesis of DME is *** therapeutic modalities have been proposed for the treatment of *** treatments have emerged as an alternative therapy for persistent DME or refractory to conventional laser photocoagulation and other modalities,due to anti-inflammatory,anti-vascular endothelial growth factor and anti-proliferative *** studies have demonstrated the beneficial therapeutic effect of corticosteroids with improvement to both retinal thickness and visual acuity in short-term on the treatment of *** and intravitreal injections have been used to deliver steroids for DME with frequent injections due to the chronic and recurrent nature of the ***-related side effects include elevated intraocular pressure,cataract,and injection related complications such as endophthalmitis,vitreous hemorrhage,and retinal detachment particularly with intravitreal steroid *** order to reduce the risks,complications and frequent dosing of intravitreal steroids,intravitreal implants have been developed recently to provide sustained release of corticosteroids and reduce repeated intravitreal injections for the management of DME.

关键词： Corticosteroids Diabetic macular edema Intravitreal triamcinolone acetonide injection Intravitreal steroid sustained-release implants Peribulbar steroid injections Subtenon’ s steroid Injections

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Diabetic macular edema:Current management 2013

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World Journal of Diabetes 2013年第6期4卷 231-233页

作者： J Fernando Arevalo Retina division Wilmer Eye InstituteJohns Hopkins University School of MedicineBaltimoreMD 21287United States the vitreoretinal division The King Khaled Eye Specialist HospitalRiyadh 11462Saudi Arabia

Diabetic retinopathy(DR)is the leading cause of vision loss of working-age adults,and diabetic macular edema(DME)is the most frequent cause of vision loss related to *** Wisconsin Epidemiologic Study of Diabetic Retinopathy found the 14-year incidence of DME in type 1 diabetics to be 26%.Similarly the Diabetes Control and Complications Trial reported that 27% of type 1 diabetic patients develop DME within9 years of *** most common type of diabetes,type 2,is strongly associated with obesity and a sedentary *** even higher incidence of macular edema has been reported in older patients with type *** the last 5 years,the use of intravitreal corticosteroids and intravitreal anti-vascular endothelial growth factor(VEGF)agents have come into clinical practice for the management of DME and several recent randomized clinical trials have shown improved effectiveness of ranibizumab compared to focal/grid *** this theme issue,we discuss the classification of DR and the treatment options currently available for the treatment of DME including corticosteroids,anti-VEGF agents,combined therapy,enzymatic vitrectomy(vitreolysis),and new therapies.

关键词： Diabetic macular edema Diabetic retinopathy Diabetic macular edema Enzymatic vitrectomy (vitreolysis) Focal/grid laser Intravitreal anti-vascular endothelial growth factor Intravitreal corticosteroids New therapies

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Perfluorocarbon in vitreoretinal surgery and preoperative bevacizumab in diabetic tractional retinal detachment

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World Journal of Diabetes 2014年第5期5卷 724-729页

作者： J Fernando Arevalo Martin A Serrano Juan D Arias From the Retina division Wilmer Eye Institute Johns Hopkins University School of Medicine Baltimore MD 21287 United States the vitreoretinal division King Khaled Eye Specialist Hospital Riyadh 11462 Saudi Arabia division of Ophthalmology Faculty of Medicine and Health Sciences University of Stellenbosch Stellenbosch 7600 South Africa the Retina and Vitreous Service Clinica Oftalmologica Centro Caracas Caracas 1010 Venezuela

AIM: To describe the en bloc perfluorodissection(EBPD) technique and to demonstrate the applicabilityof using preoperative intravitreal bevacizumab duringsmall-gauge vitreoretinal surgery(23-gauge transconjunctival sutureless vitrectomy) in eyes with advancedproliferative diabetic retinopathy(PDR) with tractionalretinal detachment(TRD).METHODS: This is a prospective, interventional caseseries. Participants included 114(eyes) with advancedproliferative diabetic retinopathy and TRD. EBPD wasperformed in 114 eyes(consecutive patients) during23-gauge vitrectomy with the utilization of preoperativebevacizumab(1.25 mg/-0.05 mL). Patients mean age was 45 years(range, 21-85 years). Surgical time had a mean of 55 min(Range, 25-85 min). Mean follow up of this group of patients was 24 mo(range, 12-32 mo). Main outcome measures included best-corrected visual acuity(BCVA), retinal reattachment, and ***: Anatomic success occurred in 100%(114/-114) of eyes. Significant visual improvement [≥ 2 Early Treatment Diabetic Retinopathy Study(ETDRS) lines] was obtained in 69.2%(79/-114), in 26 eyes(22.8%) BCVA remained stable, and in 8 eyes(7%) BCVA decreased(≥ 2 ETDRS lines). Final BCVA was 20/-50 or better in 24% of eyes, between 20/-60 and 20/-400 in 46% of eyes, and worse than 20/-400 in 30% of eyes. Complications included cataract in 32(28%) eyes, iatrogenic retinal breaks in 9(7.8%) eyes, vitreous hemorrhage requiring another procedure in 7(6.1%) eyes, and phthisis bulbi in 1(0.9%) ***: This study demonstrates the usefulne-ss of using preoperative intravitreal bevacizumab and EBPD during smallgauge vitreoretinal surgery in eyes with TRD in PDR.

关键词： Avastin Intravitreal bevacizumab Intravitreal injections Proliferative diabetic retinopathy Tractional retinal detachment Perfluorodissection Minimally invasive vitreoretinal surgery Vitrectomy

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维替泊芬光动力治疗诱导脉络膜新生血管凋亡

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世界核心医学期刊文摘(眼科学分册) 2006年第12期 45-46页

作者： Petermeier K. Tatar O. Inhoffen W. S. Grisanti 喻平平 Department of Ophthalmology I Division of Vitreoretinal Surgery Eberhard-Karls University of Tuebingen Schleichstrasse 12-16 72076 Tuebingen GermanyProf.

Aim: To evaluate the impact of verteporfin photodynamic therapy (PDT) on the induction of apoptosis in choroidal neovascular membranes (CNV) secondary to age related macular degeneration. Methods: Retrospective review of 22 surgically excised CNV. 12 of these patients had been treated with PDT 3-146 days previously. Apoptotic cells were detected with the TUNEL technique and compared to the expression of CD34 (endothelial cells, EC), CD105 (activated endothelial cells), Ki-67 (proliferation marker), and cytokeratin18 (retinal pigment epithelial cells, RPE). Results: CNV excised 3 days after PDT were characterised both by collapsed and patent vessels. The EC displayed a statistical significant positive TUNEL reaction when compared to the remaining treated CNV (p< 0.001) and untreated CNV (P=0.002). The proliferative activity was reduced. CNV excised 1-5 months after PDT displayed a patent vascularisation and high proliferative activity. All membranes either treated or untreated disclosed only sporadic TUNEL positive cells within the stroma and the RPE. Conclusions: Verteporfin PDT leads to selective and effective damage of EC within CNV. Both patent and occluded vessels were lined by apoptotic EC. This finding and the increased expression of proliferation marker at later time points suggest that revascularisation after PDT is caused by angiogenesis rather than recanalisation.

关键词：维替泊芬 CNV 微替泊芬脉络膜新生血管光动力凋亡

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玻璃体切除术中20G Tano钳断裂

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世界核心医学期刊文摘(眼科学分册) 2006年第4期 14-14页

作者： Bartz-Schmidt K.U. El-Araj I. Gelisken F. 陈立军 Dr.Department of Ophthalmology I Division of Vitreoretinal Surgery Eberhard-Karls University of Tuebingen Tuebingen Germany

PURPOSE: To report three cases with breakage of a 20-gauge kryptonite forceps during vitreoretinal surgery. DESIGN: Interventional case report. METHODS: Pars plana vitrectomy that included a membrane peeling was performed in three patients through standard ports with 20-gauge vitrectomy systems. The peeling procedure was attempted with the end-gripping kryptonite forceps. RESULTS: Intraoperatively, the branch/tip broke and dropped onto the posterior pole. Removal of the broken part was uncomplicated, and the subsequent clinical course was unremarkable. In one case, the handle and branch/tip part were exchanged inadvertently. In the other two cases, neither an exchange nor a maladaptation of the parts was noted. CONCLUSION: An exchange of the hand piece and gripping end may increase the risk of breakage and retinal damage. The delicate gripping tips, however, may break because of inadequate maintenance and/or aging of the material. Intraoperative visual and functional examination is recommended before intraocular use.

关键词：玻璃体切除术 Tano 显微钳

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白内障术后眼内炎的微生物变化趋势

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世界核心医学期刊文摘(眼科学分册) 2006年第1期 22-22页

作者： Recchia F.M. Busbee B.G. Pearlman R.B. 王大江 division of vitreoretinal Diseases and Surgery Vanderbilt Eye Institute8018 MedicalCenter East Nashville TN 37232 United States Dr

Objective: To analyze the microbiologic spectrum and in vitro susceptibility profiles over the last 11 years of organisms isolated from the vitreous of patients with endophthalmitis following cataract surgery. Methods: Records of 497 consecutive patients treated at 1 institution for clinically suspected endophthalmitis following cataract surgery from July 1989 through June 2000 were reviewed. Results of microbiologic culture and in vitro antibiotic susceptibility testing from the periods 1989 to 1994 and 1995 to 2000 were compared. Results: Between the 2 periods, there was a significant increase in the incidence of gram-positive bacteria (92% -97% of bacterial isolates). There was a significant increase in resistance among all bacterial isolates to ciprofloxacin (23% -37% ; P=.02). There was increased resistance among coagulase-negative staphylococci to both ciprofloxacin (20% -38% ) and cefazolin (19% -40% ). Resistance to bacitracin, trimethoprim-su-lfamethoxazole, and vancomycin remained unchanged. Vancomycin retained in vitro efficacy against more than 99% of gram-positive bacteria. Ceftazidime was effective against 100% of gram-negative bacteria tested. Conclusions: The spectrum of pathogens causing postcataract endophthalmitis is changing, and resistance to antibiotics used for its prophylaxis has grown. These findings may affect the empirical treatment of postcataract endophthalmitis, as well as the use and choice of antibiotics in patients undergoing cataract surgery.

关键词：白内障术后眼内炎耐药性抗药性微生物

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光动力疗法治疗Vogt-小柳-原田病中心凹下脉络膜新生血管形成

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世界核心医学期刊文摘(眼科学分册) 2006年第12期 41-41页

作者： Nowilaty S.R. Bouhaimed M. 刘瑛 vitreoretinal division Department of Ophthalmology King Khaled Eye Specialist Hospital PO Box 7191 Riyadh 11462 Saudi ArabiaDr.

Aim: To assess the effects of photodynamic therapy (PDT)with verteporfin in the treatment of subfoveal choroidal neovascularisation (CNV) secondary to Vogt-Koyanagi- Harada disease (VKH). Methods: Six eyes of six patients with VKH who developed subfoveal CNV underwent standard PDT. Repeated treatments were performed at 3 month intervals for persistent leakage. Charts and angiographic data were analysed retrospectively. Results: Age of patients ranged between 17 years and 27 years. Five CNV lesions were recent and classic (greatest lesion diameter was 1100-3100 μm). One CNV was chronic and partially scarred. Mean visual acuity (VA) at presentation was 20/200. Five patients had more than 1 year of follow up. In five eyes there was active inflammation and CNV. Of these eyes, the first three required one PDT each. The final CNV scar was smaller/stable with improvement of VA in two eyes. The third developed a larger CNV scar with loss of two lines of VA. Submacular fibrosis developed in all three. In the fourth eye, mild CNV leakage persisted after one PDT but hazy media precluded a second PDT. At 18 months the CNV scar and VA were stable. The fifth case, with mild inflammation, required three PDT. The CNV leakage became minimal, the lesion became smaller, and VA improved significantly. The sixth eye with CNV had no inflammation and needed two PDT sessions to halt the CNV leakage. The final lesion was smaller and vision was stable. There were no PDT related complications in our series. Conclusion: Photodynamic therapy with verteporfin appears to be a safe and viable treatment option for subfoveal CNV secondary to VKH. It offers a chance for stabilisation or even improvement of vision. Further study is warranted.

关键词：中心凹光动力疗法 Vogt 原田病小柳脉络膜新生血管

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