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The British Journal of Ophthalmology Sep 2014Age-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... (Review)
Review
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.
Topics: Angiogenesis Inhibitors; Choroidal Neovascularization; Evidence-Based Medicine; Humans; Light Coagulation; Tomography, Optical Coherence; Vascular Endothelial Growth Factor A; Wet Macular Degeneration
PubMed: 25136079
DOI: 10.1136/bjophthalmol-2014-305702 -
JAMA Nov 2015Panretinal photocoagulation (PRP) is the standard treatment for reducing severe visual loss from proliferative diabetic retinopathy. However, PRP can damage the retina,... (Randomized Controlled Trial)
Randomized Controlled Trial
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.
Topics: Adult; Angiogenesis Inhibitors; Area Under Curve; Diabetic Retinopathy; Female; Humans; Intention to Treat Analysis; Intravitreal Injections; Light Coagulation; Macular Edema; Male; Middle Aged; Ranibizumab; Time Factors; Treatment Outcome; Visual Acuity; Vitrectomy
PubMed: 26565927
DOI: 10.1001/jama.2015.15217 -
Eye (London, England) Feb 2013Phototherapy can be translated to mean 'light or radiant energy-induced treatment.' Lasers have become the exclusive source of light or radiant energy for all... (Review)
Review
Phototherapy can be translated to mean 'light or radiant energy-induced treatment.' Lasers have become the exclusive source of light or radiant energy for all applications of phototherapy. Depending on the wavelength, intensity, and duration of exposure, tissues can either absorb the energy (photocoagulation, thermotherapy, and photodynamic therapy (PDT)) or undergo ionization (photodisruption). For phototherapy to be effective, the energy has to be absorbed by tissues or more specifically by naturally occurring pigment (xanthophyll, haemoglobin, and melanin) within them. In tissues or tumours that lack natural pigment, dyes (verteporphin, Visudyne) with narrow absorption spectrum can be injected intravenously that act as focal absorbent of laser energy after they have preferentially localized within the tumour. Ocular phototherapy has broad applications in treatment of ocular tumours. Laser photocoagulation, thermotherapy, and PDT can be delivered with low rates of complications and with ease in the outpatient setting. Review of the current literature suggests excellent results when these treatments are applied for benign tumours, particularly for vascular tumours such as circumscribed choroidal haemangioma. For primary malignant tumours, such as choroidal melanoma, thermotherapy, and PDT do not offer local tumour control rates that are equivalent or higher than those achieved with plaque or proton radiation therapy. However, for secondary malignant tumours (choroidal metastases), thermotherapy and PDT can be applied as a palliative treatment. Greater experience is necessary to fully comprehend risks, comparative benefits, and complication of ocular phototherapy of ocular tumours.
Topics: Eye Neoplasms; Humans; Laser Therapy; Lasers; Light Coagulation; Photochemotherapy; Phototherapy
PubMed: 23238445
DOI: 10.1038/eye.2012.258 -
The British Journal of Ophthalmology Mar 1986
Topics: Humans; Light Coagulation; Neovascularization, Pathologic; Retinal Vessels
PubMed: 2420353
DOI: 10.1136/bjo.70.3.161 -
Journal of Perioperative Practice May 2008The focus of this article is to discuss the care given to an elderly lady, Mrs Pitt, (a pseudonym) who is suffering from Diabetic Retinopathy (DR) and attending our Out... (Review)
Review
The focus of this article is to discuss the care given to an elderly lady, Mrs Pitt, (a pseudonym) who is suffering from Diabetic Retinopathy (DR) and attending our Out Patient Department (OPD). It will start with a brief description of diabetes and the associated complications, and then give a more in-depth description of DR and the relevant anatomy and physiology. It will then give details of Mrs Pitt's history and her current care and treatment. All information will be supported by current, relevant literature.
Topics: Aged; Anti-Inflammatory Agents; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Diabetic Retinopathy; Female; Fluorescein Angiography; Humans; Injections; Light Coagulation; Models, Nursing; Nurse's Role; Nursing Assessment; Operating Room Nursing; Patient Care Planning; Patient Education as Topic; Perioperative Care; Vision Screening; Visual Acuity
PubMed: 18578359
DOI: 10.1177/175045890801800504 -
Ophthalmology Sep 1986Choroidal neovascularization is now considered to be a most important feature in the pathogenesis and treatment of a number of chorioretinal disorders. Since the... (Review)
Review
Choroidal neovascularization is now considered to be a most important feature in the pathogenesis and treatment of a number of chorioretinal disorders. Since the recognition of its importance, choroidal neovascularization has been described in clinical and pathologic studies of a variety of different ophthalmologic conditions. We have summarized the diseases in which choroidal neovascularization occurs and have reviewed studies on the natural history, clinical findings, and therapy of choroidal neovascularization that provide the basis for the current management of this condition.
Topics: Aged; Choroid; Fluorescein Angiography; Humans; Light Coagulation; Neovascularization, Pathologic; Ophthalmoscopy; Recurrence; Retinal Detachment; Retinal Diseases; Uveal Diseases
PubMed: 2433662
DOI: 10.1016/s0161-6420(86)33609-1 -
Experimental Eye Research Jan 2016In response to injury, reparative processes are triggered to restore the damaged tissue; however, such processes are not always successful in rebuilding the original... (Review)
Review
In response to injury, reparative processes are triggered to restore the damaged tissue; however, such processes are not always successful in rebuilding the original state. The formation of fibrous connective tissue is known as fibrosis, a hallmark of the reparative process. For fibrosis to be successful, delicately balanced cellular events involving cell proliferation, cell migration, and extracellular matrix (ECM) remodeling must occur in a highly orchestrated manner. While successful repair may result in a fibrous scar, this often restores structural stability and functionality to the injured tissue. However, depending on the functionality of the injured tissue, a fibrotic scar can have a devastating effect. For example, in the retina, fibrotic scarring may compromise vision and ultimately lead to blindness. In this review, we discuss some of the retinal fibrotic complications and highlight mechanisms underlying the development of retinal fibrosis in diabetic retinopathy.
Topics: Angiogenesis Inhibitors; Diabetic Retinopathy; Ependymoglial Cells; Fibrosis; Humans; Inflammation; Intercellular Signaling Peptides and Proteins; Light Coagulation; Neuroglia
PubMed: 26675403
DOI: 10.1016/j.exer.2015.04.004 -
The Medical Journal of Malaysia Mar 2010Since its discovery in the 1940s, retinal photocoagulation has evolved immensely. Although the first photocoagulators utilised incandescent light, it was the invention... (Review)
Review
Since its discovery in the 1940s, retinal photocoagulation has evolved immensely. Although the first photocoagulators utilised incandescent light, it was the invention of laser that instigated the widespread use of photocoagulation for treatment of retinal diseases. Laser permits choice of electromagnetic wavelength in addition to temporal delivery methods such as continuous and micropulse modes. These variables are crucial for accurate targeting of retinal tissue and prevention of detrimental side effects such as central blind spots. Laser photocoagulation is the mainstay of treatment for proliferative diabetic retinopathy amongst many other retinal conditions. Considering the escalating prevalence of diabetes mellitus, it is important for physicians to grasp the basic principles and be aware of new developments in retinal laser therapy.
Topics: Humans; Laser Coagulation; Retinal Diseases
PubMed: 21265262
DOI: No ID Found -
BMJ (Clinical Research Ed.) Nov 1993
Review
Topics: Blood Flow Velocity; Blood Glucose; Diabetic Retinopathy; Humans; Light Coagulation; Vision Disorders; Vitrectomy
PubMed: 8251848
DOI: 10.1136/bmj.307.6913.1195 -
International Ophthalmology Clinics 2015Acute retinal necrosis is a viral syndrome characterized by a panuveitis with necrotizing retinitis that may be complicated by retinal detachment, vaso-occlusion, optic... (Review)
Review
Acute retinal necrosis is a viral syndrome characterized by a panuveitis with necrotizing retinitis that may be complicated by retinal detachment, vaso-occlusion, optic neuropathy, and other causes of decreased visual acuity. Polymerase chain reaction testing provides a rapid and sensitive method of identifying the viral etiology of acute retinal necrosis, which is most commonly caused by herpes simplex virus type 1, herpes simplex virus type 2, and varicella zoster virus. Prompt diagnosis and treatment is paramount to prevent further vision loss. We review the management of acute retinal necrosis including systemic, local intravitreal, and combination antiviral medications. We also discuss the appropriate and inappropriate use of corticosteroids, laser retinopexy, surgical therapy, and other adjunctive measures.
Topics: Adrenal Cortex Hormones; Antiviral Agents; Disease Management; Drug Therapy, Combination; Fibrinolytic Agents; Humans; Intravitreal Injections; Light Coagulation; Retinal Necrosis Syndrome, Acute; Vitrectomy
PubMed: 26035758
DOI: 10.1097/IIO.0000000000000077