ABSTRACT
BACKGROUND: Neovascular age-related macular degeneration (AMD) is associated with rapid vision loss due to choroidal neovascularization (CNV), leakage, and scarring. Steroids have gained attention in their role for the treatment of neovascular AMD for their antiangiogenic and anti-inflammatory properties. OBJECTIVES: This review aims to examine effects of steroids with antiangiogenic properties in the treatment of neovascular AMD. SEARCH STRATEGY: We searched for trials in CENTRAL, MEDLINE, EMBASE, and LILACS on 2 October 2006. SELECTION CRITERIA: We included randomised controlled clinical trials of intra- and peri-ocular steroids in people diagnosed with neovascular AMD. DATA COLLECTION AND ANALYSIS: Review authors extracted the data and assessed trial quality independently. We did not pool data since the included studies evaluated difference comparisons. MAIN RESULTS: We report the risk of losing three or more lines vision at 12 months - "vision loss". One trial (139 people randomized) reported that a single dose of intravitreal triamcinolone (n = 75) (4 mg) had no significant effect on the risk of vision loss compared to placebo (n = 76). (Risk ratio vision loss 0.97, 95% confidence interval (CI) 0.74 to 1.26). Eyes treated with triamcinolone were more likely to develop cataracts and experience increased intraocular pressure (IOP) compared to untreated eyes. One trial (128 people randomized) reported the effects of anecortave acetate (3 mg (n = 32), 15 mg (n = 33) or 30 mg (n = 33) single dose with retreatment every six months if indicated) compared to placebo (n = 30). Risk ratio vision loss 0.80 (95% CI 0.45 to 1.45) in the 3 mg group, 0.45 (95% CI 0.21 to 0.97) in the 15 mg group and 0.91 (95% CI 0.52 to 1.58) in the 30 mg group. Side effects were similar in all treatment groups with the anecortave group having a slightly higher incidence of foreign body sensation compared to placebo. There was a high loss to follow-up. The final analysis may have been subject to selection bias as participants who were not selected for retreatment, possibly with worsening disease, were excluded. There was also a possibility of type I error due to multiple statistical comparisons. The sample size was estimated on the basis of a single 2-way comparison but three 2-way comparisons were analysed and presented. One trial reported that anecortave acetate (n = 263) (15 mg administered at beginning of study and six months) gave similar results to photodynamic therapy (n = 267) (risk ratio vision loss 1.08, 95% CI 0.91 to 1.29). AUTHORS' CONCLUSIONS: Overall there is weak evidence as to the benefits and harms of steroids with antiangiogenic properties for treating neovascular AMD with only three published trials of variable quality. Intravitreal triamcinolone injection for neovascular AMD does not appear to prevent severe vision loss and is associated with increased IOP and higher risk of cataract formation. Anecortave acetate 15 mg may have a mild benefit in stabilizing vision, but further better quality evidence is needed. The role of steroids in combination with other treatment modalities is yet to be determined.
Subject(s)
Angiogenesis Inhibitors/administration & dosage , Choroidal Neovascularization/drug therapy , Macular Degeneration/drug therapy , Choroidal Neovascularization/complications , Drug Implants , Humans , Macular Degeneration/etiology , Pregnadienediols/administration & dosage , Randomized Controlled Trials as Topic , Triamcinolone Acetonide/administration & dosageABSTRACT
Depressive illness and related suicide attempts have been reported to have seasonal variation, possibly related to weather. This study sought to determine the effects of weather and time of year on suicide attempts by carbon monoxide (CO) poisoning. Cases of patients in western Washington State attempting suicide by CO poisoning and referred to a regional hyperbaric oxygen treatment center from 1981-1995 were reviewed retrospectively. Information from the National Climatic Data Center was used to compare date of treatment to local weather data on the day of attempted suicide and on each day of the preceding week. The study population consisted of 264 patients attempting suicide by CO poisoning on 251 days of the 15-yr period. Mean and total precipitation in the preceding 7 days strongly correlated with attempted suicide rate, with incident rate ratios ranging from 1.75 to 2.77 and 1.14 to 1.75, respectively (P values <0.05). A decrease in minimum daily temperature also correlated with attempted suicide rate. No other weather variables showed significant correlation with dates of CO suicide attempts. February, March, and October were seen to be separate factors related to a higher incidence of attempted suicide by CO poisoning. Precipitation in Seattle, change in minimum temperature, and month of the year correlated with the regional incidence of suicide attempts with CO poisoning.
Subject(s)
Carbon Monoxide Poisoning/epidemiology , Seasons , Suicide, Attempted/statistics & numerical data , Weather , Humans , Incidence , Retrospective Studies , Washington/epidemiologyABSTRACT
We examined the eyes of four strains of mice to determine if some or all contained an antigen which might cross-react with an antigen of guinea pig retina. To do this, we prepared guinea-pig antibody to guinea-pig retinal extract by immunizing Hartley guinea pigs with guinea-pig retinal extract in two different adjuvants. The retinal tissue of Balb/c and C57B1/6J mice stained well when we used the guinea-pig antibody to guinea-pig retinal extract. In contrast, the eyes of a subline, i.e., C57B1/6J-rd with retinal degeneration, did not stain. Likewise, the eyes of C3H/HeJ and SJL mice with abnormal retinas did not stain. The latter two strains are known to have retinal degeneration. The control studies were negative. This study shows that normal murine eyes have at least one antigen which cross-reacts with a guinea-pig retinal antigen. It also shows abnormal mouse retinas lack this antigen.
Subject(s)
Autoantigens/immunology , Retina/immunology , Retinal Degeneration/immunology , Species Specificity , Animals , Cross Reactions , Fluorescent Antibody Technique , Mice , Mice, Inbred StrainsABSTRACT
High-pressure liquid chromatography was used to provide a qualitative biochemical assessment of laser effects on retinal metabolism. The adenosine triphosphate-adenosine diphosphate ratio and the Atkinson energy charge are considerably increased in laser-treated rabbit retinas compared to the contralateral untreated retinas.
Subject(s)
Adenosine Diphosphate/metabolism , Adenosine Triphosphate/metabolism , Laser Therapy , Lasers/adverse effects , Retina/metabolism , Animals , Energy Metabolism , Pigment Epithelium of Eye/pathology , Rabbits , Retina/pathology , Wound HealingABSTRACT
This case report describes the fluorescein angiography, the radioactive scintigraphy, and the pathologic findings of an intraocular metastasis from bronchogenic carcinoma which occurred in a 64-year-old white man. In spite of extensive studies, no definitive differential diagnosis between primary and secondary eye lesion could be established before enucleation for intractable pain. This case illustrates that presently available methods are not adequate for correct differential diagnosis in such cases.
