Stem cell therapy in stargardt disease: a systematic review

This article aimed to review current literature on the safety and efficacy of stem cell therapy in Stargardt disease. A comprehensive literature search was performed, and two animal and eleven human clinical trials were retrieved. These studies utilized different kinds of stem cells, including human or mouse embryonic stem cells, mesenchymal stem cells, bone marrow mononuclear fraction, and autologous bone marrow-derived stem cells. In addition, different injection techniques including subretinal, intravitreal, and suprachoroidal space injections have been evaluated. Although stem cell therapy holds promise in improving visual function in patients with Stargardt disease, further investigation is needed to determine the long-term benefits, safety, and efficacy in determining the best delivery method and selecting the most appropriate stem cell type.

Vitrectomy for posterior segment intraocular foreign bodies, visual and anatomical outcomes

To evaluate the visual and anatomic results and determine the prognostic factors after pars plana vitrectomy and posterior segment intraocular foreign body [IOFB] removal. This retrospective study reviews the patients' charts of 48 consecutive patients with posterior segment IOFB who underwent pars plana vitrectomy and IOFB removal over a 4-year period, recently. Association between visual outcome and various preoperative, operative, and postoperative variables was statistically analyzed. Data were analyzed with the paired t-test and the chi square test. Statistical significance was indicated by P < 0.05. The mean interval between the time of injury and IOFB removal was 24 +/- 43.1 days and 27 [53%] eyes underwent IOFB removal within 7 days of the injury. Nine [19.1%] patients achieved a visual acuity of 20/40 or better. An improvement of visual acuity of at least three lines occurred in 21 [44.6%] eyes and the vision remained unchanged in 15 [31.9%] eyes. Postoperative retinal detachment occurred in five [10.6%] eyes. Visual improvement was more likely to occur in eyes with lower levels of presenting visual acuity [P = 0.2]. Visual improvement was not associated with an entry site and IOFB location, lens injury, time to surgery, and pre- and post-operative retinal detachment. At the end of follow up, anatomical success was achieved in 97.9% of eyes. High anatomical success could be achieved after the removal of posterior segment IOFBs by vitrectomy, despite a delay in surgery. Poor visual outcome may be mainly due to the initial ocular injury

Retinoblastoma survival disparity: the expanding horizon in developing countries

The patients' survival for the most common intraocular tumor in children, retinoblastoma, has a wide spectrum among the world countries. This study was conducted to provide an overview of the retinoblastoma survival disparity worldwide by discussing the trends of patients' survival, as well as recent advances in the management of retinoblastoma. The design of this study was literature review and commentary. Selected articles from PubMed [except one] including both developing and developed countries regarding the patients' survival in retinoblastoma were considered and reviewed critically. An analysis of 47 articles was performed. In conclusion, in spite of an obvious contrast of retinoblastoma survival disparity in the world, the expanding horizons in developing countries are promising and continuing on all fronts and results are hope-inspiring

role of periocular carboplatin in treatment of advanced intraocular retinoblastoma

To evaluate the results of combined chemotherapy and periocular carboplatin injection to control advanced intraocular retinoblastoma [Rb]. In this prospective interventional case-series, we included 8 eyes of 8 patients with advanced intraocular Rb [group C or D in International Intraocular Retinoblastoma Classification, IIRC]. In these patients, periocular carboplatin was injected as a primary adjuvant therapy combined with chemotherapy [VEC regimen] or as a secondary treatment in patients who had recurrent disease or did not respond to primary chemotherapy and local modalities. All patients were examined under anesthesia [EUA] and fundus photography was done by Ret-cam before treatment. Fifteen miligrams of carboplatin was injected into subconjunctival or subtenon space in 3-4 weeks interval. Eight eyes of eight patients were enrolled. Five patients were male and three patients were female. Mean age of patients at the time of treatment was 34 months and the mean duration between initial presentation of Rb and beginning of treatment was 7.5 months. Mean injection of periocular carboplatin in each eye was 3.1 times. Past medical history in our patients before starting of this treatment included: External Beam Radiotherapy [EBRT] in 3 eyes, cryotherapy in 4 eyes, transpupillary thermotherapy [TTT] in 4 eyes and brachytherapy in 2 eyes. Four eyes were in group C and four eyes were in group D. In 3 patients carboplatin was injected as primary treatment and in five patients it was injected for tumor recurrence following initial treatment failure or relapse. Three patients had vitreous, one had sub-retinal and remaining four had both vitreous and sub-retinal seeding. The degree of seeding was low in two patients, moderate in two patients and severe in four patients. At the end of study, tumor was regressed in six eyes [75%], relapsed in one [12.5%] and recurred in another [12.5%]. In both eyes with relapsed and recurrent tumors, enucleation was done. Combined chemotherapy and periocular carboplatin injection as well as focal treatment may be an effective method to control advanced intraocular Rb

Plaque radiotherapy in recurrent or incomplete-excised conjunctival squamous cell carcinoma and melanoma

To assess the results of brachytherapy in patients with recurrent or incomplete excised conjunctival squamous cell carcinoma [SCC] and malignant melanoma. Three patients underwent brachytherapy of one eye and one patient underwent brachytherapy of both eyes with ruthenium-106 [RU-106] plaques, all of them had a history of incomplete resection or recurrence of the tumor after surgery. All patients were male with an average age at diagnosis of 54 years [range, 34-76 years].The shape and the size of plaques were determined based on location and size of the suspected area. The plaque was inserted to deliver a target dose of 80-100 Gy in the region of conjunctival malignancy. The diagnosis was squamous cell carcinoma in three eyes and conjunctival melanoma in two eyes. All patients had surgical history of one to three previous excisions with or without cryotherapy before brachytherapy. There were microscopic residual tumors after excision in 2 eyes and recurrent lesion was evident in 3 other eyes. A mean dose of 95 Gy was delivered to the tumor bed. Complete tumor regression without any evidence of recurrent lesion was obtained in all five eyes. The patients were followed for 32 months on average [range, 18-42 months]. No radiation related complication was detected, with an exception of a dry eye in the last follow up. Brachytherapy with RU-106 plaque is an alternative method for treatment of selected patients with recurrent or residual conjunctival SCC and melanoma

Two different doses of intravitreal bevacizumab for treatment of choroidal neovascularization associated with age-related macular degeneration

To compare the efficacy and safety of 1.25 mg versus 2.5 mg intravitreal bevacizumab [IVB] for treatment of choroidal neovascularization [CNV] associated with age-related macular degeneration [AMD]. In this randomized clinical trial, consecutive patients with active CNV associated with AMD received 1.25 mg or 2.5 mg IVB. Best corrected visual acuity [BCVA], foveal thickness and side effects of therapy were evaluated one and three months after intervention. Overall 86 subjects were enrolled and completed the scheduled follow-up. Forty seven and 39 patients received 1.25 and 2.5 mg IVB respectively. The study groups were balanced in terms of baseline characteristics such as age, BCVA and foveal thickness. Mean improvement in BCVA was 0.06 +/- 0.3 logMAR in the 1.25 mg group and 0.07 +/- 0.34 logMAR in the 2.5 mg group [P=0.9]. Mean decrease in foveal thickness was 49 +/- 36 micro m in the 1.25 mg group and 65 +/- 31micro m in the 2.5 mg group [P=0.6]. Three cases of vitreous reaction and one case of massive subretinal hemorrhage were observed in the 2.5 mg group. Double dose [2.5 mg] IVB does not seem to be more effective than regular dose [1.25 mg] injections for treatment of CNV due to AMD and may lead to more complications