Gianluca Besozzi

Intravitreal bevacizumab for treatment‐naïve subfoveal occult choroidal neovascularization in age‐related macular degeneration

Purpose:  This study aimed to evaluate the efficacy of multiple injections of intravitreal bevacizumab for treatment‐naïve subfoveal occult choroidal neovascularization (CNV) in age‐related macular degeneration (AMD).

Effects of bevacizumab on neuronal viability of retinal ganglion cells in rats

The aim of this study was to investigate the effects of single and repeated intravitreal injections of bevacizumab on various retinal layers focusing more on retinal ganglion cells (RGCs) in healthy rats. Male Wistar rats were treated with intravitreal injection of bevacizimab (4 μL) within right eye. Left eyes were injected with the same volume of balanced salt solution (BSS) and used as control. Ten rats received a single intravitreal injection and ten rats had three injections, with seven days time interval. Histological and immunohistochemical evaluations and terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL) assay were performed in order to find out if some degree of apoptosis could occur on RGCs. Histological and immunohistochemical analyses showed that bevacizumab induces neuronal loss compared to control eyes, after multiple injections. RGCs apoptosis after multiple treatments was demonstrated to occur by TUNEL, Annexin V and Bax assays. The loss of ganglion cells following repeated injections was confirmed and quantified by the decrease in RGC specific protein Brn3a measured by western blotting in ten additional rats. The present results need to be considered when multiple intravitreal injection of bevacizumab are performed to treat retinal diseases.

Combined cataract extraction and intravitreal bevacizumab in eyes with choroidal neovascularization resulting from age-related macular degeneration

PURPOSE: To evaluate the safety and efficacy of phacoemulsification, intraocular lens (IOL) implantation, and a single intravitreal injection of bevacizumab in patients with coexisting visually significant cataract and subfoveal neovascularization due to age‐related macular degeneration. SETTING: Department of Ophthalmology, University of Bari, Bari, Italy. METHODS: Eyes with predominantly classic subfoveal neovascularization and cataract had phacoemulsification, IOL implantation, and a 1.25 mg intravitreal injection of bevacizumab. One month after combined surgery, corrected distance visual acuity (CDVA), anterior chamber reaction, and intraocular pressure were evaluated and central foveal thickness was measured by optical coherence tomography. RESULTS: Twenty eyes of 20 patients were evaluated. One month postoperatively, the mean CDVA improved significantly, from 20/100 (range 20/160 to 20/80) at baseline to 20/63 (range 20/125 to 20/50) (P<.0001). The mean central foveal thickness decreased significantly, from 353.75 μm ± 12.50 (SD) (range 334 to 375 μm) at baseline to 275.7 ± 17.3 μm (range 255 to 323 μm) at 1 month (P<.0001). Intraocular pressure did not change significantly, and anterior chamber reaction was absent. No ocular or systemic adverse events were observed. CONCLUSION: Combined phacoemulsification, IOL implantation, and intravitreal bevacizumab was a safe and efficacious treatment in patients with visually significant cataract and active subfoveal neovascularization.

Three-port lens-sparing vitrectomy for aggressive posterior retinopathy of prematurity : Early surgery before tractional retinal detachment appearance

Purpose Aggressive posterior retinopathy of prematurity (APROP) may suddenly develop into tractional retinal detachment (TRD), often resulting in poor vision if untreated. The aim of the current study is to examine the anatomic results and complications of lens-sparing vitrectomy (LSV) for stage 3 APROP, before TRD appearance. Methods A retrospective, noncomparative, consecutive case series of 13 eyes of 9 patients (mean gestational age 24.1±0.9 weeks [range: 23–25 weeks], mean birthweight of 725.8±107.9 grams [range: 598–897 grams]) with stage 3 APROP was carried out. The eyes did not respond to at least one session of retinal laser photocoagulation, showing signs of disease progression. All eyes underwent 20-gauge LSV before retinal detachment appearance. Results All eyes underwent 20-gauge three-port LSV and intraoperative additional laser photocoagulation. At the end of the surgery, five eyes were tamponaded with air; in eight eyes, a balanced salt solution was left in the vitreous cavity. After 13.5±5.3 months of follow-up (range: 4–22), the retina was completely attached in all eyes, without any signs of progression. The authors did not observe any intraoperative or postoperative complications. Conclusions Surgical approach to stage 3 APROP refractory to laser photocoagulation could be effective and safe in order to avoid the progression of the disease.

Cauterization for the prevention of leaking sclerotomies after 23-gauge transconjunctival pars plana vitrectomy: an easy way to obtain sclerotomy closure.

M icroincisional vitrectomy surgery is becoming increasingly popular based on several reported advantages of sutureless vitrectomy over the traditional techniques. However, potential disadvantages of this technique are an increased incidence of wound leaks, vitreous incarceration, hypotony, choroidal detachment, retinal detachment, endophthalmitis, and subconjunctival migration of gas and oil. Even with recent modifications of incision techniques, such as two-step or slit-shaped scleral tunnel incisions, it may be difficult to ensure perfect selfsealing of every entry site, especially in particular cases, such as myopia, thin sclera, and reoperation. In case of leaking sclerotomies, many authors place a single transconjunctival and transscleral absorbable suture. Chieh et al recently reported, in a retrospective case series of 118 eyes undergoing 23-gauge vitrectomy surgery, that 38% of eyes required suture closure of at least 1 sclerotomy port. The data from the Preferences and Trends (PAT) of the American Society of Retina Specialists (ASRS) survey support these numbers: 93% of the members of the ASRS who perform 23-gauge surgery suture at least 1 of the sclerotomies. Suture application leads to some undesirable effects, such as astigmatism and foreign body sensation, and sometimes it could be difficult to place because of chemosis or bleeding. To avoid these complications, alternative techniques to avoid entry site leakage were proposed: use of tissue glue, polyethylene glycol–based hydrogel bandage, or releasable suture technique. All of the mentioned techniques add cost and further procedures. We describe a new simple method to obtain a complete watertight sclerotomy closure. Description of Technique

Acute stroke after intravitreal bevacizumab to treat choroidal neovascularization due to angioid streaks in pseudoxanthoma elasticum

To report the occurrence of acute stroke after intravitreal bevacizumab administration to treat choroidal neovascularization due to angioid streaks in a patient affected by pseudoxanthoma elasticum. A 54-year-old man with pseudoxanthoma elasticum had vision loss because of choroidal neovascularization due to angioid streaks. He underwent two intravitreal bevacizumab injections. Three days after the second procedure the patient was afflicted by acute stroke. Intravitreal injection of bevacizumab to treat choroidal neovascularization due to angioid streaks in pseudoxanthoma elasticum could lead to severe systemic adverse events.