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Abstract Objective: The primary objective of the study is to evaluate, in a population in the state of Bahia, Brazil, the impact of ranibizumab in best-corrected visual acuity of patients with macular disease and macular edema. Methods: This study did a retrospective and observational assessment visual acuity of the group of patients followed at the Professor Edgard Santos University Hospital and Oftalmodiagnose Eye Hospital in 2011 and 2012 in a real life context. Results: The impact on sample patientes post-treatment demonstrated favorable outcome with an increase in visual acuity of 32%, which means improvement of more than one line in the snellem chart. Conclusion: Improvement in visual acuity of this group was observed from baseline to the end of follow up in a real-life context.
Resumo Objetivo: O objetivo principal do estudo é avaliar, em uma população no estado da Bahia, o impacto do ranibizumab na acuidade visual melhor corrigida de pacientes com doença macular e edema macular. Métodos: Para isso, fizemos uma avaliação retrospectiva e observacional da acuidade visual do grupo de pacientes seguidos no Hospital Universitário Professor Edgard Santos e Oftalmodiagnose Hospital de Olhos em 2011 e 2012 em um contexto de vida real. Resultados: O estudo demonstrou desfecho favorável com aumento da acuidade visual de 32%, o que significa melhora de mais de uma linha no quadro snellem. Conclusão: A melhora da acuidade visual desse grupo foi observada desde o início até o final do seguimento em um contexto da vida real.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Acuidade Visual/efeitos dos fármacos , Edema Macular/tratamento farmacológico , Inibidores da Angiogênese/uso terapêutico , Ranibizumab/uso terapêutico , Degeneração Macular/tratamento farmacológico , Estudos Retrospectivos , Estudo ObservacionalRESUMO
Atrophic age-related macular degeneration (AMD) does not show obvious loss of visual function in the early stage,so it is not easy to be taken seriously.In the advanced stage,most of the patients suffered from macular area retinal map atrophy,which affected night vision and central vision.Drugs currently used in clinical or clinical trials to treat atrophic AMD include drugs for improving choroidal perfusion,reducing the accumulation of harmful substances,preventing oxidative stress injury,inhibiting inflammatory reactions,as well as neuroprotectants and lipid metabolism drugs.Stem cell transplantation for atrophic AMD is currently the most promising treatment.In theory,it is feasible to replace atrophic AMD with retinal photoreceptor cells and RPE cells derived from human stem cell differentiation.However,there are still many problems to be solved,such as how to improve the efficiency of directional differentiation of seed cells and how to ensure the safe and effective RPE cell transplantation and survival after transplantation.At present,several studies have found that multiple locus mutations are associated with atrophic AMD,so gene therapy also plays an important role in the development of the disease.
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Vascular endothelial growth factor (VEGF),platelet derived growth factor (PDGF) and complements play key roles in the pathogenesis of age-related macular degeneration (AMD).Pegaptanib,the first therapeutic aptamer against VEGF165,has been approved by the Food and Drug Administration (FDA) of US for the treatment of exudative AMD.Another two aptamers El0030 and ARC1905,each target PDGF-B and complement C5 respectively,are undergoing clinical trials.Recent trends to treat AMD are combined therapies targeting multiple key molecules in the pathogenesis of AMD;aptamers against multiple targets may become the preferred drug for AMD.
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Exudative or wet age-related macular degeneration (AMD) is characterized by the progressive growth of choroidal neovascularization (CNV).Anti-vascular endothelial growth factor (VEGF) drugs have been used in the control of the development of CNV and vision improvement,but there are still defects like frequent injections,drug resistance and so on.Radiotherapy can deactivate local inflammatory cell populations,and make CNV unstable in the absence ofpericytes and VEGF stimulation,which induce apoptosis of the vascular endothelial cells.Therefore,radiotherapy is considered as a potential adjuvant treatment of anti-VEGF therapy.The current clinical approaches include epimacular brachytherapy (EMBT) and long-range stereotactic radiotherapy (SRT).SRT may be a preferred adjuvant treatment for patients receiving anti-VEGF therapy.Knowing the progress of radiotherapy for the treatment of exudative AMD may help us to fully understand the pathogenesis of wAMD in China
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Replacement of diseased retinal pigment epithelium (RPE) cells with healthy RPE cells by transplantation is one option to treat several retinal degenerative diseases including age-related macular degeneration,which are caused by RPE loss and dysfunction.A cellular scaffold as a carrier for transplanted cells,may hold immense promise for facilitating cell migration and promoting the integration of RPE ceils into the host environment.Scaffolds can be prepared from a variety of natural and synthetic materials.Strategies,such as surface modification and structure adjustment,can improve the biomimetic properties of the scaffolds,optimize cell attachment and cellular function following transplantation and lay a foundation of clinical application in the future.
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Based on the pathogenic mechanisms of age-related macular degeneration (AMD),tremendous preclinical and clinical trials have demonstrated that cell transplantation which aim to replace impaired retinal pigment epithelium (RPE) with healthy RPE cells is a promising approach to treat AMD.So far,choices of cell sources mainly are autologous RPE,iris pigment epithelium,fetal RPE,human embryonic stem cell-derived RPE and human induced pluripotent stem cell-derived RPE,and some of them are undergoing clinical researches.Grafting manners in cell-based therapies are various including RPE sheet or RPE-choroid complex transplantation,RPE cell suspension injection,and RPE sheet transplantation with scaffolds.This review is limited to cell-based therapies for RPE that damaged first in the progress of AMD and focus on recent advances in cell sources,transplantation methods,preclinical and clinical trials,and the obstacles that must be overcome.
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Age-related macular degeneration (AMD) has become one of the leading causes of irreversible blindness worldwide.With the advancement of stem cell technology,tissue engineering and biomaterials,cell-based therapy has been inspiring for many degenerative diseases.For its unique advantages,AMD has become one of the most promising fields for cell-based therapy,which involve retinal pigment epithelium(RPE)cells,induced differentiation of neural retina cells and related cytokine regulations.RPE cells can be derived from human embryonic stem cells (hESC) or Induced pluripotent stem cells (iPS).Recently hESC-derived RPE cells have been applied to patients with dry AMD with initial success in clinical trials.In terms of tissue engineering,studies are focused on factors affecting the long-term survival of transplanted cells,including tissue scaffolds,soluble hybrid materials and scaffold anchoring.This article briefly reviews the RPE differentiation,neural retina differentiation and related cytokines of cell-based therapy and scaffolds,materials,and cell-scaffolds interactions of tissue engineering in AMD treatment.
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The diagnosis and treatment of age-related macular degeneration (AMD) is an international hotspot of eye research.Successful clinical applications of anti-VEGF drugs promoted both basic research and clinical practice of AMD.A number of countries and professional societies have established clinical guidelines for AMD management,including the epidemiology,risk factors,diagnosis,classification,and treatment process.These AMD guidelines are mostly based on recently published results of clinical trials,provided good model of evidence based medicine.It is urgent and necessary to have our own guideline which is suitable for Chinese patients.Reviewing and learning existed guidelines will help us to improve the clinical practice of AMD in China.
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Objective To summarize the clinical results and safety of photodynamic therapy (PDT) through 4 years after single and multi-treatments of patients with subfoveal choroidal neovascularization (CNV) caused by age-related macular degeneration (AMD). Methods Clinical data of 73 AMD cases (95 eyes) diagnosed through fluorescein angiography (FFA), indocyanine green angiography (ICGA) and optic coherence tomography (OCT), treated with PDT were reviewed and analyzed in this hospital from June 2000 to June 2004. The changes of best corrected visual acuity (BCVA), fundus pictures, FFA, ICGA and OCT were compared before and after PDT. Follow-up time varied from 3 months to 4 years (mean, 2 years). Results The mean age of 73 patients was 67.8 years old. The BCVA was from (CF/10 cm) to 1.0. At the final follow up, the BCVA was improved (increase≥2 lines) in 39 eyes (41.1%), stabilized (?1 line) in 51 eyes (53.7%) and decreased 2 lines in 5 eyes (5.3%). Fundus hemorrhage and exudation reduced after PDT. FFA and ICGA showed CNV complete closure in 58 eyes (61.05%), partial closure in 6 eyes (6.32%), CNV incomplete closure in 22 eyes (23.16%) and recurrence in 9 eyes (9.47%). After once PDT of 12 eyes with early-stage AMD, the BCVA improved (from 0.6 to 1.5), CNV completely closed, and the OCT showed disappearance of macular edema and neursensory retinal detachment. No CNV recurred in our four years follow-up observation and the BCVA of the patients remained stable. The mean number of PDT treatment was 1.8 per eye in 95 cases. No serious local or systemic complications were encountered. Conclusions Single or multiple sessions of PDT can acheive long-term safety and efficacy. For early-stage AMD patients with minimally classic CNV, PDT can completely make CNV closed and reduce the risk of visual loss.
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Objective To investigate the therapeutic efficacy of transpupillary thermal therapy (TTT) for age-related macular degeneration (AMD) accompanied with subfoveal choroidal neovascularization (CNV). Methods Fifty-one eyes of 47 patients whose illness had been diagnosed as AMD by fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were treated with diode 810 laser. There are 42 eyes of 39 patients had occult CNV and 9 eyes of 8 patients had classic CNV, and the average visual acuity in their fist diagnosis was 0.12. According to the focus size, the diameters of beam spot varied from 0.8, 1.2, 2.0, and 3.0 mm; and the power was 120, 160, 260 and 360mW correspondingly, with the duration of 60 seconds. The follow-up examination was performed once a month after the treatment, and repetitious treatment would be taken once to thrice if necessary. The follow-up period was 3~33 months with the mean of 10 months. Visual acuity, haemorrhage in ocular fundus, absorption of exudation, and the closure of CNV were examined in the follow-up examination. Results No immediate decrement of visual acuity or any other discomforts were found in all of the treated eyes soon after the treatment. The average visual acuity of 51 eyes was 0.16 in the last diagnosis, which remained no change in 68.62%; increased in 23.53% and decreased in 7.84% compared with that in the first diagnosis. The results of FFA and ICCG demonstrated that at the 3rd months after the treatment, the closure rate was 42.86% in occult CNV and 22.22% in classic CNV; and at the 6th month, the closure rate was 73.81% in occult CNV and 66.67% in classic CNV. The results of ophthalmoscopy showed that at the 3rd month after the treatment, partial or complete absorption of hemorrhage and/or exudates with various thickness of organized scarring tissue was found in 42 eyes with occult CNV; decrement of hemorrhage and exudates was observed in 7 out of 9 eyes with classic CNV; and new hemorrhage occurred in 1 eye. At the 6~(th) month, in 27 eyes with occult CNV, new hemorrhage occurred in 3 including 2 eyes with occult CNV, new hemorrhage occurred in 3 including 2 eyes with faster absorption and remaining unchanged for 12 months; in 5 eyes with classic CNV, new hemorrhage occurred in 2, which was absorbed after treated again and remained stable in the 16-month followed-up. In 19 eyes with occult CNV which had been followed up for more than 6 months, hemorrhage disappeared in 5 and new hemorrhage occurred in 5. In the followed-up over 6 months, new hemorrhage occurred in 8 eyes with the recurrent rate of 15.6%. Conclusion TTT is effective for AMD with either classic or occult CNV. In the long-term followed-up, CNV recurs in 15.6% of the treated eyes which may be improved after the further treatment.
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Objective To compare the clinical results of photodynamic therapy(PDT) and transpupillary thermotherapy (TTT) for patients with choroidal neovascularization caused by exudative age-related macular degeneration. Methods Seventy cases (82 eyes) with exudative AMD were divided into PDT and TTT groups. Thirty-five cases (42 eyes) were treated with PDT. Nineteen eyes had occult or predominantly occult CNV. Twenty-three eyes had classic or predominantly classic CNV. Thirty-five cases (40 eyes) were treated with TTT. Twenty-five eyes had occult or predominantly occult CNV. Fifteen eyes had classic or predominantly classic CNV. Visual acuity, FFA, ICGA and OCT were evaluated before and after treatment. All cases were subfoveal or juxtafoveal CNV. The follow-up was (3-6 months.) Results Visual acuity in 3 eyes (15.8%) of PDT group and 1 eye (4.0%) in TTT group increased at least 2 lines. The difference was no significant(P=0.1778), FFA showed cessation or reduction of fluorescein leakage from CNV in 15 eyes(78.9%) in PDT group and 13 eyes(52.0%) in TTT group. The difference was not significant (P=0.0657). Three months after treatment, The visual acuity of 2 eyes(10.5%) in PDT group and 2 eyes (8.0%) in TTT group increased at least 2 lines. The difference was not significant (P=0.7728). FFA showed cessation or reduction of fluorescein leakage from CNV in 8 eyes(42.1%) in PDT group and 21 eyes(84.0%) in TTT group. The difference was significant (P=0.0037). Conclusion For classic CNV, the short-term effect of PDT is better than TTT concerning visual acuity. The effect of PDT is apparently better than TTT in cessation or reduction of fluorescein leakage one month after treatment. But there was no significant difference between PDT and TTT in cessation or reduction of fluorescein leakage three month after treatment. For occult CNV, there is no significant short-term difference between PDT and TTT concerning visual acuity. There was no significant difference between PDT and TTT in cessatin or reduction of fluorescein leakage one month after treatment. But three month after treatment TTT is apparently better than PDT in cessation or reduction of fluorescein leakage. We need more cases and longer follow -up to evaluate these two kinds of treatments in treating exudative age-related macular degeneration.
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Objective To evaluate the visual function before and after photodynamic therapy(PDT) in patients with subfoveal choroidal neovascularization (CNV) caused by age-related macular degeneration (AMD). Methods Twenty-five consecutive patients (34 eyes) treated with PDT (verteporfin) for subfoveal CNV in age-related macular degeneration diagnosed by fluorescein angiography (FFA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT). Visual function including best corrected visual acuity, contrast sensitivity frequency, binocular function, confusion, stereo-vision, color vision, metamorphopsis and central scotoma were examed before photodynamic therapy and 1 week, 1 month, 3 month after photodynamic therapy. The follow-up time varied from 3 months to 2 years (mean 7.6 months). Results The changes of visual function at the 3rd month after photodynamic therapy revealed improving in 13 eyes (38.24%), without any change in 17 eyes (50.00%), and decreasing in 6 eyes (17.65%). Visual acuity with logMRA improved after photodynamic therapy, but without statistic difference. All spatial contrast sensitivity improved. Contrast sensitivity for spatial frequencies 5 cycles per degree (cpd) was better after photodynamic therapy with significant difference (P=0.045).Binocular function, fusion function, stereo function and color vision were slightly improved without statistic difference. Conclusion Damage of visual function in macular degeneration is many-sided. The treatment of PDT for exudative AMD can improve part visual function.
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Objective To evaluate short term effects of a single photodynamic therapy (PDT) treatment with visudyne (CIBA Vision Corp.) for choroidal neovascularization (CNV) in age ralated macular degeneration (AMD). Methods Thirty cases (35 eyes) diagnosed as AMD patients with classic CNV were treated with PDT. The data of visual acuity testing, fluorescein angiography (FFA), indocyanine green angiography (ICGA) and optic coherence tomography (OCT) were used to evaluate the effects of a single treatment of PDT before and 1 week, 1 ,3 month after treatment. Results The visual acuity of 34 eyes were stable or improved in 3 months follow up;and the visual acuity of 1 eye was decreased. Decrease or dispearance of fluorescein leakage from CNV was noted in 19 eyes. No serious complication occurred. Conclusion Single treatment of PDT for CNV in AMD can achieve short term decrease or cessation of fluorescein leakage from CNV without loss of visual acuity.
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Objective To evaluated the effect of transpupillary thermotherapy (TTT) on age related macular degeneration (AMD). Methods Sixty two cases (62 eyes) of exudative AMD were managed with TTT. Before treatment, 58 cases underwent fundus fluorescein angiography(FFA),42 cases underwent simultaneous indocyanine green angiography (ICGA), and 56 cases underwent optic coherence tomography (OCT).TTT was delivered using a 810 nm diode laser with variable spot sizes 0.5 3.0 mm and power range 60 40 mW,60 seconds duration. Sixty two cases were followed up for 1 10 months with 4 8 months average. Results The visual acuities of last visit were compared with those before the treatment. The visual acuity was unchanged in 43 cases (69.3%), improved in 15 cases (24.2%), and declined in 4 cases (6.5%). OCT was re done in 51 cases and compared with OCT images before TTT treatment. The height of macular edema was unchanged in 29 cases (56.9%), decreased in 18 cases (35.3%), and increased in 4 cases (7.8%). The amelioration of visual acuity was compatible with that of macular configuration in the majority of cases (74.5%). Only in 13 cases (25.5%) the amelioration of visual acuity lagged behind that of macular configuration. The re treatment was performed in 18 cases (29.1%), probably due to insufficiency of laser power. No side effect was found. Conclusion TTT makes most of the cases of exudative AMD retaining or improving their visual acuity. The employment is secured. Further exploration is needed in order to obtain the parameters of the laser treatment.
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Purpose To evaluate short term visual acuity effects of a single photodynamic therapy(PDT) treatment with Visudyne (CIBA Vision Corp, Duluth, Ga) for choroidal neovascularization (CNV) in age related macular degeneration (AMD). Methods Definitely diagnostic AMD patients with classic CNV were treated with PDT (5 cases, 7 eyes). The data of visual acuity testing, ophthalmic examination, color photographs, optic coherence tomography, fluorescein angiograms and indocyanine green angiogram before photodynamic therapy and 1 week ,1 month after it were used to evaluate the effects of a single treatment of PDT with Visudyne. Results The visual acuity of all the treated eyes at the follow up examination at 1 month after PDT were not reduced. Distinct reduction of fluorescein leakage from CNV was noted in all patients by 1 week after PDT. Fluorescein leakage from a portion of the CNV reappeared by 1 month after treatment in 2 eyes. Conclusion PDT with Visudyne achieved short term cessation of fluorescein leakage from CNV without loss of vision or growth of classic CNV in some patients with AMD.
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Objective To investigate the method and the effects of the surgical treatment of massive subretinal hemorrhage and vitreous hemorrhage associated with age related macular degeneration. Methods A retrospective study of 14 consecutive patients underwent a complete pars plana vitrectomy. Retinotomy was carried out for removing subretinal hemorrhage by using balanced salt solution. Complete air fluid exchange and gas or silicone oil tamponade were performed in all patients. The follow up period was within 3～7 months. Results Atrophy of eyeball in 2 eyes (14.3%) postoperatively. Improvement of corrected final visual acuity and anatomical retinal reattachment were achieved in 12 (85.7%) of the 14 eyes postoperatively. Seven days after operation, muddy sand hemorrhage in anterior chamber occurred in 4 (28.6%) of the eyes and paracenteses of anterior chamber were performed for these eyes. Conclusion Surgical intervention should be applied in the eyes with the massive subretinal hemorrhage associated with age related macular degeneration in order to avoid the affected eyes becoming atrophic due to the subsequent complication of vitreous hemorrhage, anterior chamber muddy sand hemorrhage,ghost cell glaucoma or retinal detachment.