ABSTRACT
PURPOSE: Analyze clinical features, management and outcomes of patients with sterile endophthalmitis associated with intravitreal antivascular endothelial growth factor. METHODS: Observational retrospective case series of patients with sterile endophthalmitis following anti-VEGF intravitreal injections. Clinical data of patients treated with intravitreal anti-VEGFs during one year have been revised. Those who have presented an episode of sterile endophthalmitis are analyzed and their causality and management are studied. RESULTS: Seven patients have had a sterile endophthalmitis onset within 4days after intravitreal injection (aflibercept n=5 and ranibizumab n=2). These patients have some active neovascular condition: age related macular degeneration (n=4), myopic choroidal neovascularization (n=1) or macular edema: diabetic macular edema (n=1), branch retinal vein occlusion (n=1). Shared signs and symptoms included painless vision loss, anterior chamber and vitreous cell and lack of hypopyon. In all patients, visual acuity returned to within one line of baseline acuity. CONCLUSION: Differentiating cases of sterile from infectious endophthalmitis may be challenging. It is crucial to differentiate both entities as a good diagnosis determines the visual prognosis. We should be aware of minimal inflammation after repeated intravitreal injections in order to establish the adequate treatment.
Subject(s)
Angiogenesis Inhibitors/adverse effects , Endophthalmitis/chemically induced , Ranibizumab/adverse effects , Recombinant Fusion Proteins/adverse effects , Adult , Aged , Aged, 80 and over , Angiogenesis Inhibitors/administration & dosage , Endophthalmitis/diagnosis , Endophthalmitis/therapy , Female , Humans , Intravitreal Injections , Male , Middle Aged , Ranibizumab/administration & dosage , Receptors, Vascular Endothelial Growth Factor/administration & dosage , Recombinant Fusion Proteins/administration & dosage , Retrospective Studies , Treatment OutcomeABSTRACT
OBJECTIVE: To analyse the disease burden in patients with diabetic macular oedema (DMO) or with retinal vein occlusion macular oedema (RVOMO) from a societal perspective. METHODS: Observational, cross-sectional, multicentre study conducted on patients >18 years old diagnosed with uni- or bilateral DMO or unilateral RVOMO. Data on the use of health resources from diagnosis was collected, and the impact of disease on work life was assessed. Costs were annualised (euros, January 2014). Differences were contrasted using Chi-squared test (or Fisher Exact test), Mann Whitney-U test or Kruskal-Wallis test (Dunn contrast). RESULTS: A total of 448 patients were included (DMO 255; RVOMO 193). There were significant differences in costs of diagnosis: RVOMO 1856, bilateral DMO 1661, and unilateral DMO 1401 (P<.001) and the aggregate medical costs: RVOMO 4639, bilateral DMO 6275 and unilateral DMO 6269 (P<.001). Cost by permanent time off work was higher in bilateral DMO 11712, than in unilateral DMO 4284, and than in RVOMO 1052 (P<.05). Linear regression analysis showed that variables associated with direct health costs were: Diagnosis (bilateral DMO was associated with higher cost), as well as number of days in hospital, number of visits, time of observation, and number of days of time off work. CONCLUSIONS: Patients with bilateral DMO are associated with a higher direct health cost, as well as a higher indirect cost by impact of the disease on work life.
Subject(s)
Diabetic Retinopathy/economics , Health Care Costs/statistics & numerical data , Health Expenditures/statistics & numerical data , Macular Edema/economics , Retinal Vein Occlusion/economics , Absenteeism , Adult , Aged , Aged, 80 and over , Costs and Cost Analysis , Cross-Sectional Studies , Diabetic Retinopathy/etiology , Diagnostic Techniques, Ophthalmological/economics , Female , Health Resources/economics , Health Resources/statistics & numerical data , Hospitalization/economics , Hospitalization/statistics & numerical data , Humans , Macular Edema/etiology , Male , Middle Aged , Office Visits/economics , Office Visits/statistics & numerical data , Quality of Life , Retinal Vein Occlusion/complications , Spain/epidemiologyABSTRACT
Retinal vein occlusion (RVO) is the second most common cause of retinal vascular disease after diabetic retinopathy. Despite the existence of several possible treatment options, none was entirely satisfactory and many patients suffered irreversible visual loss. As a result of the BRAVO, CRUISE and GENEVA trials, ranibizumab and the intravitreal biodegradable implants of dexamethasone has recently been approved by the US Food and Drug Administration and the European Medicines Agency for the treatment of RVO secondary edema. In this paper we begin by describing the current treatment options for RVO associated macular edema and continue with the description of the treatment regimen with ranibizumab.
Subject(s)
Angiogenesis Inhibitors/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Macular Edema/drug therapy , Retinal Vein Occlusion/complications , Translational Research, Biomedical/methods , Angiogenesis Inhibitors/administration & dosage , Antibodies, Monoclonal, Humanized/administration & dosage , Bevacizumab , Clinical Protocols , Clinical Trials, Phase III as Topic , Dexamethasone/administration & dosage , Dexamethasone/therapeutic use , Drug Implants , Fluorescein Angiography , Humans , Intravitreal Injections , Laser Coagulation , Macular Edema/etiology , Macular Edema/surgery , Multicenter Studies as Topic , Radiography , Randomized Controlled Trials as Topic , Ranibizumab , Retinal Vein Occlusion/classification , Retinal Vein Occlusion/diagnostic imaging , Retinal Vein Occlusion/surgery , Tomography, Optical CoherenceABSTRACT
PURPOSE: A guidelines for the management of retinal vein occlusion is presented. This is necessary because at this moment several therapeutic alternatives have been developed although their role is not yet sufficiently defined. METHODS: Review of the literature for evidence published up to date. Relevant literature was identified and the level of evidence graded. Evidence was then assessed for consistency, applicability and clinical impact. The information was contrasted with those guides published in other countries. RESULTS: Taking into account the different options of treatment that are currently used, several modes of action are suggested. The role of the various complementary examinations are discussed and it is recommended that criteria for the treatment are based on clinical, angiographic, and tomographic findings. CONCLUSIONS: Although there is no overall consensus, these guidelines promote a good standard of clinical practise and provide an update of the management of retinal vein occlusion.