Cristina Calvo-Gonzalez

Intravitreal Ranibizumab for Myopic Choroidal Neovascularization: Factors Predictive of Visual Outcome and Need for Retreatment

PURPOSE To identify predictive factors for visual outcome and need for retreatment after treating myopic choroidal neovascularization (CNV) with ranibizumab. DESIGN A prospective interventional case series. METHODS Sixty-seven eyes of 67 patients with myopic CNV were treated with 3 intravitreal ranibizumab injections given monthly. Best-corrected visual acuity (BCVA) and optical coherence tomography-determined central macular thickness (CMT) were recorded monthly during follow-up. Fluorescein angiography changes and the number of injections needed were also assessed. RESULTS Mean follow-up was 15.9 months. Mean BCVA improved by 7.8 letters after the first injection, 12.5 letters after 3 injections, and 12 letters by end follow-up. In 53 eyes (79.1%), BCVA improved; 40.3% gained more than 15 letters. No differences were detected in visual outcome between treatment-naïve and previously treated patients. Myopic CNV area and greatest linear dimension had diminished at the study end. The mean reduction in CMT was 93.6 μm. The mean number of injections given was 4.2. A total of 53.7% of eyes received only 3 injections. Through regression analysis, baseline BCVA (P = .006) and myopic CNV location (P = .026) were significantly correlated with BCVA at the end of follow-up. Myopic CNV location (P = .023) and prior treatment (P = .047) were significantly linked to the number of injections given. No major complications arose. CONCLUSION An initial treatment regimen of 3 monthly ranibizumab injections seems effective and safe to treat myopic CNV. Baseline BCVA and myopic CNV location emerged as predictive factors for visual outcome. A need for retreatment was associated with myopic CNV location and prior treatment.

Retinal Nerve Fiber Layer Thickness Changes in Patients with Age-Related Macular Degeneration Treated with Intravitreal Ranibizumab

PURPOSE To assess the effects of intravitreal ranibizumab therapy on intraocular pressure (IOP) and retinal nerve fiber (RNFL) thickness. METHODS Forty-nine eyes of 49 patients with neovascular age-related macular degeneration (AMD) treated with intravitreal ranibizumab injections and 27 fellow eyes not requiring treatment were followed for 1 year. RNFL thickness, as measured by Fourier domain optical coherence tomography, and IOP were determined pre- and postinjection. RESULTS After 12 months, the mean number of injections received was 4.8 ± 1.6. The incidence of IOP elevations (>5 mm Hg over baseline) observed at the time of injection was 0.4%. Baseline RNFL thickness was 105.7 ± 12.2 μm in the treatment group compared with 101.8 ± 11.6 μm in the control group (P = 0.176). At the end of follow-up, significant RNFL thinning was noted in the treatment group (100.2 ± 11.0 μm, P < 0.001), whereas no differences were found in the control group (100.5 ± 10.8 μm, P = 0.477). CONCLUSIONS Intravitreal ranibizumab injections used to treat AMD caused a significant change in RNFL thickness after 12 months of follow-up.

Short-term anatomic effect of ranibizumab for polypoidal choroidal vasculopathy.

PURPOSE To assess the short-term anatomic effect of intravitreal ranibizumab for polypoidal choroidal vasculopathy. METHODS All patients had undergone a full ophthalmic examination. A monthly injection of ranibizumab was performed for 3 months. Indocyanine angiography (ICG) and optical coherence tomography (OCT) were performed 1 month after the third-month ranibizumab injection. RESULTS Polyps disappeared on ICG angiography in 9 out of 13 lesions (69.2%). Retinal thickness diminished significantly on OCT (p=0.02). In our series we noticed a significant reduction of the percentage of patients presenting with subretinal fluid (p=0.02) and pigment epithelium detachment between the initial and final visits (0.016). In addition, we noticed that BCVA increased significantly (p 0.02). CONCLUSIONS Monthly intravitreal injection of ranibizumab for 3 months has a short-term beneficial anatomic effect.

Ranibizumab in retinal angiomatous proliferation (RAP): influence of RAP stage on visual outcome

Purpose. To evaluate the influence of retinal angiomatous proliferation (RAP) stage on visual and anatomic outcome after ranibizumab (Lucentis®). Methods. This was a prospective study on consecutively diagnosed RAP eyes at the Hospital Clínico San Carlos, Madrid. Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) are performed monthly. Indocyanine green angiography (ICG) and fluorescein angiography (FA) are performed at baseline and every 3 months thereafter. A starting dose of a monthly ranibizumab injection in the first 3 months is followed by retreatment in case of intraretinal edema, subretinal fluid, or pigment epithelium detachment (PED) in OCT, increased leakage in FA, or a hot spot in ICG. Results. A total of 53 eyes from 49 patients were included. The mean change in BCVA at 12 months was +7.3, +0.83, and −2.1 letters in stages IIA (21 cases), Il B (18 cases), and III (14 cases), respectively. After adjusting the change in BCVA according to baseline BCVA, β coefficient was −6.012 letters (p=0.025) in stage IIB and −9.762 letters (p=0.003) in stage III vs stage IIA. Four cases had a retinal pigment epithelium tear after injection of ranibizumab. Conclusions. Patients in stage II without PED have a better visual and anatomic evolution than patients in stage II with PED and stage III.

Intravitreal bevacizumab (Avastin®) for radiation retinopathy neovascularization

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Retinal angiomatous proliferation reactivation 6 months after high-dose intravitreal acetonide triamcinolone and photodynamic therapy.

Purpose To describe the incidence of retinal angiomatous proliferation (RAP) reactivation after combined treatment with a high-dose intravitreal triamcinolone acetonide (IVTA) and photodynamic therapy (PDT) at 1-year follow-up. Methods All patients had undergone a full ophthalmic examination. High-dose IVTA (20 mg) was injected via pars plana. Four to 7 days later, PDT was delivered. Results Fourteen eyes of 13 patients were included. Eight lesions (57%) reopened and needed retreatment with combined therapy at 6 months follow-up. At 1-year follow up, the lesion was obliterated in nine cases (64.2%) and best-corrected visual acuity improved from 0.87 logMar (range, 0.7–1) to 0.79 logMar (range, 0.5–1). Conclusions Combined therapy using high-dose IVTA and PDT is beneficial in stabilizing RAP. However, a high incidence of RAP reactivation has been observed at 6 months, even with a high-dose IVTA injection.

Comparison of ocular hypotensive actions of fixed combinations of brimonidine/timolol and dorzolamide/timolol

Abstract Objective: To compare brimonidine/timolol fixed combination (BrTFC; Combigan with dorzolamide/timolol fixed combination (DTFC; Cosopt in terms of ability to lower intraocular pressure (IOP) in primary open-angle glaucoma (POAG). Methods: This was a prospective, randomized, double-masked, crossover study. After 6 weeks of therapy with timolol maleate 0.5% twice daily, patients were randomized to BrTFC twice daily or DTFC twice daily for 6 weeks, before being crossed over to the other treatment arm for a further 6 weeks. At all follow-up visits, IOP was measured at 09.00 (pre-instillation) 12.00 and 16.00. The primary outcome measure was change in mean diurnal IOP from baseline at 6 weeks. The secondary outcome was percentage of patients with IOP <18 mmHg at 6 weeks. Data were analyzed from all patients who completed the study. Results: Twenty-five patients were randomized and 20 completed the study. Mean diurnal IOP (mean ± standard deviation [SD]) was 20.28 ± 2.03 mmHg at timolol-treated baseline. After 6 weeks, mean diurnal IOP was 16.28 ± 2.07 mmHg following BrTFC and 17.23 ± 2.29 mmHg following DTFC (difference: 0.95 mmHg, 95% CI 0.10–1.80, p = 0.03). Mean IOP at 09.00 was 20.95 ± 2.31 mmHg at baseline. This was reduced to 15.85 ± 2.56 mmHg following BrTFC and 17.55 ± 2.67 mmHg following DTFC (difference: 1.70, 95% CI 0.80–2.60, p = 0.001). For the 12.00 and 16.00 timepoints, the mean changes from baseline in the two arms were comparable. Percentages of patients achieving a target IOP of <18 mmHg were 85% following BrTFC and 60% following DTFC (p = NS [not significant]). No treatment-related adverse events were reported with either therapy. Key limitations include the small size of the study population and the 6-week duration of treatment periods, which prevents drawing conclusions regarding long-term therapy. Conclusion: Reductions from baseline in mean diurnal IOP and morning IOP were greater with BrTFC than with DTFC.

Combined Pegaptanib sodium (Macugen) and photodynamic therapy in predominantly classic juxtafoveal choroidal neovascularisation in age related macular degeneration

Aims: This prospective, open label, non-comparative, observational case series evaluates 6-month results of Pegaptanib Sodium (Macugen®) and Photodynamic Therapy (PDT) in predominantly classic juxtafoveal choroidal neovascularisation (CNV) in age-related macular degeneration (AMD) in seven eyes of seven patients. Results: Best corrected visual acuity (BCVA) diminished with a mean of five letters. Initial area of CNV increased significantly from 1.4 mm2 to 2.7 mm2. There was a significant increase in the greatest linear dimension (GLD) from 1280.3 μm to 2065.7 μm at the 24-week follow-up. Conclusion: Predominantly classic juxtafoveal CNVs are highly aggressive lesions that demonstrate poor response despite combined therapy using PDT and Macugen.

Intravitreal pegabtanib sodium in choroidal neovascularization secondary to angioid streaks.

An 18-year-old male was seen in February 2000 after noting ‘tiny mobile flies’ in his field of vision OS. On examination, the right eye was normal. Visual acuity was 20 ⁄ 20 OD and 20 ⁄ 25 OS. The left retina exhibited mild perimacular haemorrhages compatible with a superotemporal BRVO. The patient admitted to regular ingestion of anabolic steroids for almost 1 year prior to his assessment. His diet consisted of a high protein intake, supplemented with essential amino acids. He drank distilled water and had been taking oral furosemide (40 mg) twice per week, and oral decadurobolin and stanozolol, two anabolic-androgenic steroids, (5 mg) three times per week. Fluorescein angiography confirmed the diagnosis of BRVO. The side-effects of anabolic steroids include behavioural and clinical alterations. There is a high rate of hepatotoxicity among anabolic steroid users, leading to cirrhosis and cardiovascular disorders (Dhar et al. 2005). The aetiology of the type of venous obstruction these two bodybuilders experienced appears to include three factors: increased blood viscosity; a disorder of the vascular wall of the blood vessels, and arterial hypertension, which compresses the common arteriovenous sheath at the site of an arteriovenous crossing. Among the longterm cardiovascular effects of steroids is an increased cardiac debit (caused by a higher metabolism), which often leads to arterial hypertension. Another consequence is an alteration in the metabolism of lipoproteins, giving rise to hypercholesterolaemia and hypertriglyceridaemia. In addition, the habitual use of diuretics and distilled drinking water in an attempt to improve the appearance of the muscle mass can increase blood viscosity (Ring et al. 1976; McGrath et al. 1978; Dodson et al. 1982). Both patients fared well, regaining perfect VA within several months of stopping their drug ingestion, similarly to other cases (Jampol & Fleishman 1981).

Ocular inflammatory signs observed in a cohort of Spanish patients with Behcet disease and ocular inflammation

Purpose To study the clinical characteristics of a cohort of Spanish patients diagnosed with Behçet disease and who also presented ocular inflammation. Methods Thirty cases of Behçet disease were studied retrospectively. The authors studied age distribution, distribution by sex, clinical course, laterality, type of uveitis, secondary glaucoma, corneal involvement, hypopyon, iris-lens synechiae, secondary cataract, cystoid macular edema (CME), and papillitis (optic neuritis). Results Fourteen of the patients were men and 16 were women (ratio 0.875:1). The mean age of the patients was 35.24 years (±10.917; 21–61 years). In 23 patients, the disease course was recurrent. In 9 patients, the disease manifested unilaterally. In 5 patients showing unilateral onset, the contralateral eye became affected. In 2 of the 30 patients, uveitis exclusively affected the anterior segment. In 8 patients, uveitis was solely posterior. There was one case of intermediate uveitis. The remaining 19 patients showed panuveitis. Three had focal chorioretinitis. One had diffuse chorioretinitis. Fifteen showed signs of diffuse vasculitis. Eight patients showed focal vasculitis. Conclusions Women were slightly more affected than men, although the authors found no significant correlation between sex and the clinical variables examined. Apart from one unexpected case of intermediate uveitis, the observations are similar to those reported for other patient series.