New guidelines in the treatment of persistent central serous chorioretinopathy: PDT with half-dose verteporfin.

BACKGROUND: In persistent central serous chorioretinopathy (CSC) resolution of detachment can be achieved by photodynamic therapy. Our objective was to evaluate the efficacy of half-dose verteporfin compared to full-dose verteporfin. PATIENTS AND METHODS: In 2009 the standard PDT regimen for CSC in our clinic was changed from full-dose to half-dose verteporfin. After a retrospective analysis 11 cases of half-dose PDT with documented course in 11 patients are presented. A comparison was performed with a control group of 11 consecutive patients with documented course who had received full-dose PDT before 2009. RESULTS: Prior to PDT there were no statistically significant differences between the groups concerning age, central foveal thickness, thickness of detachment, BCVA (EDTRS) and size of spot. 6 weeks after PDT a significant reduction of foveal thickness and detachment was detected in both groups, as well as a significant increase in BCVA. No statistically significant differences in outcome could be found between the two groups (Mann-Whitney U-test, p < 0.05). CONCLUSIONS: PDT with half-dose verteporfin seems to be an effective and safe treatment for persistent CSC. Our data showed comparable results after half-dose and after full-dose PDT.

[Photodynamic therapy in "Secondary Sick RPE Syndrome" after repeated intravitreal injections of VEGF inhibitors in patients with wet age-related macular degeneration]. / Fotodynamische Therapie bei "Secondary Sick RPE Syndrome" nach wiederholten intravitrealen Injektionen von VEGF-Inhibitoren bei Patienten mit feuchter altersabhängiger Makuladegeneration.

BACKGROUND: After repeated injections of VEGF inhibitors for wet AMD some patients show therapy-resistant isolated subretinal fluid (here named secondary sick RPE syndrome). The efficacy of photodynamic therapy was examined in these cases. PATIENTS AND METHODS: A group of in total 18 patients with wet AMD (14 eyes with occult and 4 with minimal classic CNV) showed therapy-resistant isolated subretinal fluid after repeated intravitreal injections of VEGF inhibitors (bevacizumab or ranibizumab). These eyes were treated with photodynamic therapy with verteporfin. After PDT the need for further intravitreal injections of VEGF inhibitors and visual acuity was examined. RESULTS: After a mean number of 7.1 injections of VEGF inhibitors (bevacizumab or ranibizumab), in 14 patients one PDT, in 4 patients two PDT were performed. Twelve of 18 patients showed complete resorption of subretinal fluid and needed no further intravitreal injections during a mean of 11.6 months (4 - 26) after PDT. Six patients needed a mean of 4.3 additional injections. Twelve of 18 patients showed stable visual acuity (± 5 letters ETDRS), 6 improved more than 5 letters while none of them showed visual loss. CONCLUSIONS: In patients with wet AMD and isolated subretinal fluid after repeated injections of bevacizumab or ranibizumab photodynamic therapy could be an option to reduce the number of further injections and to stabilise visual acuity.

The treatment of choroidal neovascularizations in age-related macular degeneration using either Avastin or Lucentis.

BACKGROUND: Either Avastin or Lucentis was used in our clinic to treat choroidal neovascularizations in age-related macular degeneration. The number of injections necessary for drying the macular findings was especially assessed. PATIENTS AND METHODS: From April 2006 to August 2008 324 eyes were treated with Avastin, and from January 2007 to August 2008 348 eyes were treated with Lucentis. The intravitreal injections with Avastin (1.25 mg in 0.05 mL) were performed every six weeks, and with Lucentis (0.05 mg in 0.05 mL) every four weeks until the macular findings were considered to be dry. Fluorescein angiography and optical coherence tomography were used for the diagnosis and for the checks which were carried out every twelve weeks. The visual acuity was measured with an ETDRS chart. RESULTS: The treatment with Avastin is completed in 319 eyes with an average improvement of the visual acuity of 5.1 letters after 3.3 injections, and with Lucentis in 226 eyes with an average improvement of the visual acuity of 6.4 letters after 3.4 injections (p = 0.24; one way ANOVA). CONCLUSION: Both of the drugs allow the drying of the macular findings in the great majority of the cases after a short time and lead to a quite similar improvement of the visual acuity. A definitive stabilization of the disease after stopping the treatment is not foreseeable.

The treatment of choroidal neovascularisation with intravitreal injections of bevacizumab (Avastin).

BACKGROUND: Although bevacizumab (Avastin) has only been approved for the treatment of colorectal carcinoma, many reports have shown that its intravitreal administration against choroidal neovascularisation (CNV) leads to a stabilisation or even a regression of the pathological neovessels, and thus to a positive evolution of visual acuity. PATIENTS AND METHODS: From April 2006 to July 2007, the CNV of different aetiologies were treated with intravitreal injections of bevacizumab (1.25 mg in 0.05 mL) in 300 patients with an average age of 75, 78 years. Fluorescein angiography and optical coherence tomography were used for the diagnosis and for the checks which were carried out every twelve weeks. The intravitreal injections were performed every six weeks until the macular findings were considered to be dry. The visual acuity was checked using an ETDRS chart. RESULTS: In all the groups considered the visual acuity was stabilised or improved on an average with + 4.44 ETDRS letters after 3.04 injections. During the follow-up six cardiovascular diseases were diagnosed and in one case a patient died. No ocular complications were reported after 1036 injections. CONCLUSIONS: The results clearly show that the intravitreal injections of bevacizumab are effective, safe and cost-effective. However, further randomised studies are needed to confirm the duration of the effect, as well as the good ocular and systemic tolerability of the drug.

[Visual acuity and magnification requirement after ranibizumab in patients with wet age-related macular degeneration]. / Fernvisus und Vergrösserungsbedarf nach Ranibizumab bei Patienten mit feuchter altersbedingter Makuladegeneration.

BACKGROUND: The purpose of this study was to examine the visual outcome by measuring visual acuity (VA) and magnification requirement (MR) in patients with wet AMD after repeated intravitreal injections of ranibizumab. PATIENTS AND METHODS: A total of 195 eyes were treated with repeated intravitreal injections of ranibizumab "as needed". VA (Snellen chart) and MR (SZB reading chart) at baseline of 114 eyes with occult or minimally classic lesions, 42 eyes with predominantly classic lesions and 39 with retinal angiomatous proliferations (RAP) were compared at 3 and 6 months after beginning of treatment. RESULTS: The whole group of 195 patients with wet AMD (688 intravitreal injections within 6 months) demonstrated a mean improvement of VA of 0.72 lines after 3 months (p < 0.001) and 1.54 lines after 6 months (p < 0.001) and a mean improvement of MR of 0.59 log units after 3 months (p < 0.001) and 0.73 log units after 6 months (p < 0.001). Mean change in VA after 3 and 6 months demonstrated a significant improvement (p < 0.001 to p < 0.05) for eyes with occult CNV (+ 0.8 /+ 1.6 lines) and RAP (+ 1.2 /+ 1.9 lines) whereas mean improvement in VA for classic CNV (+ 0.02 /+ 0.87 lines) did not reach significance compared to baseline. Comparable results were obtained for the mean change of MR after 3 and 6 months for eyes with occult CNV (+ 0.75 log units/+ 0.92 log units). For eyes with RAP mean improvement of MR was + 0.74 log units after 3 months (p < 0.05) and it was not significant with + 0.8 log units after 6 months (p > 0.05). MR did not show a significant change during follow-up for classic CNV. Apart from eyes with classic CNV, in more than 90 % of the eyes both VA and MR remained stable or improved (loss < 3 lines in VA or deterioration of MR of < 3 log units). Although 45 % of the eyes with predominantly classic CNV had received photodynamic therapies with Verteporfin prior to the intravitreal injections with ranibizumab, MR remained stable in 80 % over 6 months. CONCLUSION: With repeated injections of ranibizumab "as needed", VA could be improved as well as MR could be lowered in a majority of patients with wet AMD and therefore reading ability could be optimized. Over 6 months the treatment frequency was lower compared to the monthly administration.

K-lymphocytes (killer-cells) in Crohn's disease and acute virus B-hepatitis.

Total lymphocyte counts, B-, T-, C'3 receptor-bearing lymphocytes, and K-cell activity were studied in peripheral blood in patients with Crohn's disease and inflammatory liver disease. Patients with active untreated Crohn's disease and acute virus B hepatitis exhibited a markedly increased K-cell activity measured in a plaque assay when compared with normal controls (P less than 0.01). Patients with immunosuppressive treated Crohn's disease, HBsAg-positive chronic active hepatitis, and cirrhosis of the liver showed only a slight increase of K-cell activity (P less than 0.01). In the postacute phase of hepatitis (four to 12 weeks from onset) K-cell activity fell to normal levels. The number of B-lymphocytes showed a relative and absolute decrease in all groups of patients. With the exception of patients with acute HBsAg-positive hepatitis and the post-acute phase of hepatitis all the other groups showed statistically decreased absolute numbers for C'3 receptor-bearing lymphocytes. The significant decrease in K-cell activity and the number of T-lymphocytes in Crohn's disease treated with immunosuppressive drugs was interpreted as an effect of azathioprine and prednisone on these lymphocyte subpopulations.