Alternative ultraviolet A lamp for corneal collagen crosslinking.

In this paper, we describe an original, affordable, and available device for performing collagen crosslinking. This is carried out in a safe and reproducible way by means of a simple modification to an affordable ultraviolet A lamp and by preparing riboflavin 0.1% solution inhouse.

Intravitreal pegaptanib for refractory macular edema secondary to retinal vein occlusion.

PURPOSE: To assess the efficacy of intravitreal Pegaptanib sodium (Macugen(®)) injection in the management of refractory macular edema secondary to branch retinal vein occlusion. METHODS: This is a prospective, nonrandomized, interventional case series. Five eyes of five patients with macular edema refractory to either bevacizumab or triamcinolone were treated with intravitreal injection of Pegaptanib sodium. RESULTS: After three months follow-up, both visual acuity and macular edema, measured by optical coherence tomography and fluorescence angiography, dramatically improved. CONCLUSION: Pegaptanib sodium is a safe and efficacy treatment for macular edema secondary to branch retinal vein occlusion.

Prophylaxis of macular edema with intravitreal ranibizumab in patients with diabetic retinopathy after cataract surgery: a pilot study.

The purpose of this study was to evaluate the effectiveness of intravitreal ranibizumab (Lucentis, Genentech, South San Francisco, Calif, USA) combined with cataract surgery for the prevention of clinically significant macular edema (CSME) in patients with diabetic retinopathy (DR). This prospective interventional case series included fifty-four eyes of 54 patients with a previous diagnosis of nonproliferative diabetic retinopathy (NPDR) without macular edema preoperatively. Subjects were assigned in a 1 : 1 ratio to receive an intraoperative intravitreal ranibizumab injection (n = 27) or not (control group, n = 27) associated with standardised phacoemulsification surgery. The main outcome measure was the incidence of CSME one and three months after surgery. One month after surgery the incidence of CSME in the control group was 25.92% and 3.70% in the treatment group and at three months was 22.22% and 3.70%, respectively. Short-term results suggest that intravitreal ranibizumab immediately after phacoemulsification prevents CS ME in patients with NPDR.

Acute endothelial failure after cosmetic iris implants (NewIris®).

We report a case of an acute endothelial failure after the implantation of a new cosmetic, colored, artificial iris diaphragm implant called NewIris(®). A 21-year-old woman came to us complaining of progressive loss of vision and pain after NewIris lenses had been implanted. Decreased visual acuity, corneal edema, and increased intraocular pressure in both eyes appeared only 3 weeks after the surgery. The lenses were removed as soon as possible but had already severely affected the endothelial cell count. NewIris implants are an alternative to cosmetic contact lenses, but they are not as safe as other phakic anterior chamber intraocular lenses, nor are they a good option for the patient.

Combined therapy: photodynamic therapy and bevacizumab to treat myopic neovascular membranes. One-year follow-up.

PURPOSE: The purpose of this study was to evaluate whether combined customized photodynamic therapy (PDT) and bevacizumab in myopic choroidal neovascularization can improve vision and whether it is possible to decrease the frequency and number of intravitreal antiangiogenic injections. METHODS: A prospective, consecutive, noncomparative, interventional case series of 36 patients with myopic choroidal neovascularization, treated with an initial dose of PDT and intravitreal bevacizumab 48 hours to 60 hours afterward. Retreatments were carried out as required with monthly bevacizumab and PDT every 3 months if there were relapses. Follow-up lasted 1 year in all cases. RESULTS: The mean best-corrected visual acuity increased from 44 letters before the initial treatment to 59.5 letters at the 12-month follow-up (P < 0.01). Compared with initial vision, 94.5% of the eyes had the same or better vision and 5.5% lost fewer than 6 lines of vision. The mean number of PDT treatments was 1.1 per patient, and the mean number of bevacizumab injections was 1.5 per patient. Only 1 initial treatment with PDT + bevacizumab was necessary in 28 cases (77.8%). CONCLUSION: Combined personalized PDT + bevacizumab therapy makes it possible to obtain visual results similar to those obtained in monotherapy studies but with fewer intravitreal injections. It appears to be an interesting option for this type of patient.

Combined ranibizumab and photodynamic therapy to treat exudative age-related macular degeneration: an option for improving treatment efficiency.

PURPOSE: The purposes of this study were to determine whether the association of photodynamic therapy (PDT) and intravitreal ranibizumab could improve vision in a group of patients with choroidal neovascularization secondary to age-related macular degeneration and whether it could reduce the number and frequency of intravitreal injections, thus minimizing adverse effects. METHODS: A nonrandomized, prospective, interventional study was conducted of a case series of 53 patients with sub- and juxtafoveal choroidal neovascularization secondary to age-related macular degeneration treated with a single initial dose of PDT and intravitreal ranibizumab. Retreatments were performed as required with monthly ranibizumab and PDT every 3 months if there were relapses. The retreatment criteria were based on visual acuity, optical coherence tomography, and fluorescein angiography. Follow-up lasted 12 months in all cases. RESULTS: The mean initial visual acuity was 40.6 letters versus 47.8 letters at the end of follow-up with a gain of 7.2 letters (P < 0.001). Moreover, 78.8% maintained or improved their initial vision, and 92.3% avoided moderate vision loss (>15 letters). A total of 65 PDT treatments (mean, 1.22 per patient) was performed and 126 doses of ranibizumab were injected (mean, 2.37 per patient). Only a single initial dose (PDT + ranibizumab) was required in 21 cases (39.6%). The central retinal thickness and choroidal neovascularization size decreased to 118 microm and 0.26 disk areas, respectively, from baseline to 12 months. CONCLUSION: Combined customized PDT + ranibizumab treatment can achieve visual results similar to those obtained with intravitreal monotherapy with the advantage of fewer intravitreous injections and reduced potential for adverse effects.

Photodynamic therapy for age-related macular degeneration treatment: epidemiological and clinical analysis of a long-term study.

BACKGROUND AND OBJECTIVE: The aim of this article was to analyze the long-term results of patients with exudative age-related macular degeneration treated with photodynamic therapy (PDT). PATIENTS AND METHODS: This prospective nonrandomized clinical trial included 262 patients with exudative age-related macular degeneration who were treated with PDT in accordance with the Protocol of the Treatment of Age-Related Macular Degeneration with Photodynamic Therapy Study. The followup lasted 48 months. RESULTS: There was a significant loss of visual acuity 3 months after the first PDT treatment, a slow, progressive decrease of vision until month 12, and then visual acuity remained stable from months 24 to 48. The choroidal neovascularization size increased noticeably during the first 12 months, particularly the first 3 months after PDT. The higher the classic component of choroidal neovascularization, the better it responded to PDT. The evolution of juxtafoveal choroidal neovascularization was worse than that of subfoveal choroidal neovascularization after PDT because it grew quickly toward the fovea and visual acuity loss was greater. CONCLUSION: PDT is a safe, long-term treatment for exudative age-related macular degeneration, but it is not definitive because this treatment cannot stop the initial growth of the choroidal neovascularization lesion.

One-year follow-up of combined customized therapy. Photodynamic therapy and bevacizumab for exudative age-related macular degeneration.

PURPOSE: To evaluate whether combined, personalised photodynamic therapy (PDT) and Bevacizumab in choroidal neovascularization associated with age-related macular degeneration can improve vision, and whether it is possible to decrease the frequency and number of intravitreal antiangiogenics. METHODS: A prospective, noncomparative, interventional study of a case series of 63 patients with exudative age-related macular degeneration, treated with an initial dose of PDT and intravitreal Bevacizumab 24 to 48 hours afterwards. Retreatments were carried out as required with monthly Bevacizumab and PDT every 3 months if there were relapses. Follow-up lasted 1 year in all cases. RESULTS: After the first month of treatment, the mean best-corrected visual acuity increased by 4.85 letters, reaching 5.65 letters at the 12-month follow-up (P < 0.05). Compared with initial vision, 79.3% of the eyes had the same or better vision and 95.2% lost fewer than 15 letters. The total number of PDT treatments was 92 (a mean of 1.46 treatments per patient). The mean number of Bevacizumab injections was two per patient. In 29 cases (46%), only one initial treatment with PDT + Bevacizumab was necessary. In 15 cases (23.8%), more than two combined treatments per patient were necessary. CONCLUSIONS: Combined, customized PDT + Bevacizumab therapy makes it possible to obtain visual results similar to those obtained in monotherapy, but with fewer intravitreal injections. It appears to be an interesting option for this type of patients.

Bilateral intraorbital abscesses and cavernous sinus thromboses secondary to Streptococcus milleri with a favorable outcome.

A 51-year-old woman with left proptosis, diplopia, headache, and nausea was found to have bilateral intraorbital abscesses, left superior ophthalmic vein thrombosis, bilateral cavernous sinus thromboses, and a left temporal lobe intracerebral abscess. Because the paranasal sinuses were unaffected, a dental origin was suspected and confirmed. The causative organism was Streptococcus milleri. Aggressive surgical intervention included bilateral orbital abscess drainage and dental extraction, and medical therapy included intravenous metronidazole, ceftriaxone, heparin, and methylprednisolone. A left sixth cranial nerve paresis was the only long-term sequela.

Early lipoic acid intake protects retina of diabetic mice.

The aim of this study was to test the effect of lipoic acid treatment on the retina after a short diabetic insult. Diabetes was induced by alloxan and mice were divided into sub-groups; control, diabetic, diabetic+insulin and all groups received+/-lipoic acid (100 mg/kg body weight) for 3 weeks. GSH content, MDA concentration, GPx activity were measured and electroretinograms (ERG) were recorded. Early administration of lipoic acid to diabetic mice prevented the statistically significant decreases of GSH content and GPx activity and normalized MDA concentration. Moreover, lipoic acid restored electroretinogram b-wave amplitude of diabetic animals to control values. Lipoic acid has a protective effect on the diabetic retina.

Ranibizumab for choroidal neovascularization in fundus flavimaculatus.

PURPOSE: To report the features of a case with late-onset fundus flavimaculatus (FFM) complicated by choroidal neovascularization (CNV) and treated with ranibizumab. METHODS: Retrospective interventional case report. PATIENT: A 51-year-old woman presented with right eye decreased vision. Fundus flavimaculatus with CNV was diagnosed by electroretinography and fluorescein angiography. RESULTS: Two intravitreal injections of ranibizumab were needed for the treatment. At the end of follow-up (9 months) no leakage was observed and visual acuity improved. CONCLUSION: Choroidal neovascularization is a rare complication of FFM. Ranibizumab, an anti-VEFG drug, stopped neovascularization and improved final visual acuity in this case, so it must be considered in the treatment of CNV in late onset FFM.