Nuno Gomes

Efficacy and safety of postvitrectomy intravitreal triamcinolone therapy for diabetic macular edema.

Purpose After vitrectomy, diffusion and clearance rates of numerous drugs are increased, leading to a shorter intravitreal half-life. This raises doubts about the efficacy of intravitreal therapies, as retina specialists generally believe that a shorter half-life compromises the drugs’ therapeutic effect. We conducted a study to evaluate the functional and anatomical effect of intravitreal triamcinolone acetonide therapy (IVTA) in previously vitrectomized eyes with diabetic macular edema (DME). Methods In this retrospective, multicenter case series study including vitrectomized patients with DME who underwent IVTA injections, central macular thickness (CMT) measured with spectral-domain optical coherence tomography and best-corrected visual acuity (BCVA) in Early Treatment Diabetic Retinopathy Study letters were evaluated after each procedure. All relevant medical data were collected, including previous ophthalmologic treatments and comorbidities. Results Twenty vitrectomized eyes of 20 patients, mean age 58.1 years (range 40-72 years), were enrolled in the study. All patients presented DME and received at least one IVTA injection. Mean time between pars plana vitrectomy and IVTA was 12.9 ± 8.7 months. Mean pretreatment and posttreatment CMT was 438.8 ± 90.8 μm and 301.2 ± 76.2 μm, respectively, a difference that reached statistical significance (p<0.001). Mean gain in BCVA letter score was 7.83 ± 14.9 letters after treatment (p = 0.039). Mean intraocular pressure was significantly increased after IVTA (17.2 ± 1.9 mm Hg at baseline vs 21.2 ± 4.59 mm Hg after IVTA, p = 0.002). Conclusions A positive anatomical and functional effect was observed in our cohort. Our results suggest that, despite prior vitrectomy, triamcinolone remains a valid therapeutic approach for eyes with persistent DME. Further prospective randomized studies with larger patient samples are needed to validate this conclusion.

The Portuguese Experience with Ocriplasmin in Clinical Practice

Aim: Evaluate the real-life experience with ocriplasmin on vitreomacular traction (VMT) release and full-thickness macular hole (FTMH) closure in Portugal. Methods: Multicentric, retrospective study of 83 eyes of 78 patients who were treated with intravitreal ocriplasmin for VMT with and without FTMH. Primary outcomes were VMT release and FTMH closure. Secondary outcomes included visual acuity changes and structural features on spectral-domain ocular coherence tomography. Results: VMT resolved in 47 of the 83 eyes (56.6%) and 6 of the 12 FTMH were closed (50.0%). Mean best-corrected visual acuity (BCVA) improved from 65.1 at baseline to 70.8 ETDRS letters at the end of follow-up (p < 0.0001) with a mean follow-up of 138.8 days. Improvement in BCVA was significantly better in eyes with VMT release (p = 0.021). Approximately 73% of patients had normal ellipsoid zone integrity at the end of follow-up, 87% had no neurosensorial detachment and 40% had no intra- or subretinal fluid. Conclusion: VMT release and FTMH closure were achieved in more than half of the treated eyes and were correlated with significant BCVA improvements and favorable baseline characteristics. In fact, if a careful patient selection is carried out, VMT resolution with ocriplasmin can be optimized, tailoring the best approach to each patient.

Unveiling preclinical idiopathic macular hole formation using support vector machines

Macular holes are ruptures in the central part of the retina that if left untreated may lead to serious vision loss. Although there is a lot yet to know about this pathology, it is established that if one suffers from unilateral idiopathic macular hole (IMH), then there is an increased risk of developing the same condition in the fellow eye. The goal of this work is to use optical coherence tomography (OCT) scans and, resorting to automatic pattern recognition algorithms, develop a classifier that distinguishes eyes at risk of developing IMH from healthy controls. From the collected data we were able to estimate a set of parameters that allow for the classification of eyes into the group of eyes at risk or healthy controls with an accuracy of 95.1%, sensitivity of 96.9% and specificity of 93.1%.

Serological inflammatory factors as biomarkers for anatomic response in diabetic macular edema treated with anti-VEGF

PURPOSE To study the relationship between systemic pro-inflammatory factors and macular structural response to intravitreal bevacizumab for diabetic macular edema (DME). METHODS Prospective study including 30 cases with DME, treated with bevacizumab and a minimum follow-up of 6 months. All cases underwent baseline laboratory testing for cardiovascular risk (high sensitivity C-reactive protein (hsCRP), homocystein), dyslipidemia, renal dysfunction and glucose control. Serum levels of VEGF, soluble ICAM-1, MCP-1 and TNF-α were assessed by enzyme-linked immunosorbent assay kits. Significant associations between systemic factors and quantitative and qualitative spectral-domain optical coherence macular features were analyzed. RESULTS A mean of 4.82 ± 0.56 intravitreal injections was performed, resulting in significant improvement of central foveal thickness (CFT) (p < 0.001). A significant association with third month CFT decrease <10% was found for hsCRP (3.33 ± 2.01 vs 1.39 ± 1.15 mg/l, p = 0.007) and ICAM1 (975.54 ± 265.49 vs 727.07 ± 336.09 pg/ml, p = 0.012). ROC curve analysis indicated hsCRP and ICAM1 as significant biomarkers for 3rd month reduced anatomic response (area under the curve (AUC) = 0.807, p = 0.009 for hsCRP; AUC = 0.788, p = 0.014 for ICAM1). ROC curve analysis revealed hsCRP as a significant biomarker for 6th month CFT decrease <10% (AUC = 0.903, p < 0.001, cutoff value = 1.81 mg/l). A significant association with 6th month CFT decrease ≥25% was found for serum MCP1 (244.69 ± 49.34 pg/ml vs 319.24 ± 94.88 pg/ml, p = 0.017) and serum VEGF (90.84 ± 37.33 vs 58.28 ± 25.19 pg/ml, p = 0.027). The combined model of serum VEGF and LDL-cholesterol was found to be predictive of 6th month hard exudate severity (p = 0.001, r2 = 0.463). CONCLUSIONS Increased levels of hsCRP and ICAM1 were found to be significant biomarkers for early reduced anatomic response to anti-VEGF treatment. Cases with higher serum levels of such factors had increased CFT values, despite treatment, suggesting inner blood-retinal barrier breakdown that is not adequately responsive to anti-VEGF monotherapy.

Modeling Agents Working on ETL Processes

All data warehousing systems architects know that is quite difficult to build a “perfect” ETL system without having primarily a model well founded on real operational requisites. Thus ETL modeling is crucial to the success of populating a data warehouse, independently from their natural complexity. Modeling will also reduce implementation costs once it allows for revealing eventual operational errors originated by misinterpreted requisites. In this demo we demonstrate the viability of modeling an ETL system, using a standard workflow language and an ETL pattern approach implemented based on a cooperative community of opportunistic agents. The demo shows how we modeled, configured and executed an ETL system prototype in YAWL, and how we used agents to implement a self-organizing general purpose ETL system.

Acknowledgements to the Referees

www.karger.com/ore Abcouwer, Steven Ajtony, Csilla Aragona, Pasquale Arévalo, J. Fernando Arias, Lluis Augustin, Albert J. Aveleira, Célia A. Balaskas, Konstantinos Barsam, Allon Bi, Hongsheng Bowl, Wadim Bringmann, Andreas Chatziralli, Irini Chowers, Itay Christoforidis, John Costa, Esmeralda Cruchaga, Carlos Davis, Benjamin De Groef, Lies Digiuni, Maurizio Donate-Lopez, Juan Duran, Juan Fernandes, Rosa Fonollosa, Alex Georgiou, Anne Harrison, Ian He, Mingguang Heeren, Tjebo Hjortdal, Jesper Hussain, Ali Jaksic, Vesna Kalogeropoulos, Christos Kanonidou, Evgenia Kondo, Hiroyuki Kroupis, Christos Kühlewein, Laura Kusaka, Shunji Lai, Chi-Chun Lengyel, Imre Martin, Gottfried Martins, João Mathew, Raeba Medeiros, Marco D. Mesquida, Marina Murta, Joaquim Nakahara, Tsutomu Ni Dhubhghaill, Sorcha Noda, Kousuke Panos, Georgios Paques, Michel Parisi, Vincenzo Picaud, Serge A. Pinazo-Duran, Maria Dolores Porciatti, Vittorio Quadrado, Maria João Radach, Ralph Rezende, Flavio Rotenstreich, Ygal Rozema, Jos J. Santiago, Ana Raquel Sappington, Rebecca M. Saxena, Sandeep Schlottmann, Patricio Schmetterer, Leopold Sheha, Hosam Shieh, Chi-Chang Silva, Rufino Stahl, Andreas Stalmans, Peter Stieger, Knut Strong, Stacey Suzuma, Kiyoshi Terasaki, Hiroko Tian, Kailin Toth, Marta Tsubota, Kazuo Vujosevic, Stela Watson, Peter Xu, Heping Yanagi, Yasuo Yang, Sung Jae Zarogiannis, Sotirios