Asunto(s)
Infecciones Parasitarias del Ojo , Toxocariasis , Animales , Niño , Ensayo de Inmunoadsorción Enzimática , HumanosRESUMEN
PURPOSE: To evaluate and compare the efficacy of subconjunctival bevacizumab injections alone, photodynamic therapy alone and combined treatments for reduction of corneal neovascularization. METHODS: This study was conducted as a prospective case series. A total of seven eyes of 7 patients with corneal neovascularization caused by ocular surface disorders including fungal infectious keratitis and penetrating keratoplasty were included in the study. Patients were randomized into the three following groups: patients in group A received a single subconjunctival injection of 10mg (0.4mL) of bevacizumab, patients in group B were treated with photodynamic therapy with verteporfin (6mg/m(2)) to the neovascularized area and those in group C received a subconjunctival injection of bevacizumab and photodynamic therapy 7 days later. Morphological changes in neovascularization were evaluated over 6 months using slit-lamp biomicroscopy and digital corneal photography. A computer-assisted semi-automatic analysis of the area of corneal neovascularization was performed with Image J software. RESULTS: Recession of corneal vessels was observed in all eyes at 1 month post-treatment. The neovascularized surface area in all groups combined showed a decrease in the first month after treatment and this decrease continued up to the 6th month. The surface area of corneal neovascularization decreased by 34.05±8.28% in group A (subconjunctival injection of bevacizumab), by 42.06±28.36% in group B (photodynamic therapy with verteporfin) and by 51.67±18.93% in group C (combined subconjunctival injection of bevacizumab and photodynamic therapy). A combined treatment consisting of a subconjunctival injection followed by a PDT session 7 days later might be more effective for the treatment of corneal neovascularisation. No serious local or systemic adverse events were observed. CONCLUSIONS: Our medium-term results suggest that combined subconjunctival injection of bevacizumab and photodynamic therapy with verteporfin might be used safely and effectively to reduce corneal neovascularization surface. This combined therapy may show a tendency toward greater efficacy than the individual monotherapies. Controlled prospective randomized multicentric trials with a larger sample size are necessary to assess long-term efficacy and to confirm these results.
Asunto(s)
Inhibidores de la Angiogénesis/uso terapéutico , Bevacizumab/uso terapéutico , Neovascularización de la Córnea/tratamiento farmacológico , Fotoquimioterapia , Fármacos Fotosensibilizantes/uso terapéutico , Porfirinas/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Inhibidores de la Angiogénesis/administración & dosificación , Bevacizumab/administración & dosificación , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Procesamiento de Imagen Asistido por Computador , Inyecciones Intraoculares , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento , VerteporfinaRESUMEN
PATIENTS AND METHODS: Biometric measurements were recorded in the eyes of 238 children with hypermetropia (3-16 years of age), using the Lenstar 900 biometer (Haag-Streit(®)) with no contact. Four refractive groups were divided by objective refraction and spherical equivalent (group 1, more than 6.00 D; group 2, +4.50 to +99 D; group 3, +3.00 to +4.49 D; group 4, +1.50 to +2.99 D). Many parameters (i.e., axial length of the eye, anterior chamber depth, crystalline lens thickness, and central pachymetry) were analyzed in refractive groups. Two statistical analyzes were carried out: Pearson correlations on the various measurements and nonparametric tests (LSD tests). RESULTS: This statistical study showed the refractive characteristics of this pediatric population and the incidence of refraction on ocular biometry. There was a correlation between crystalline lens thickness, axial length, and anterior chamber depth. Axial length was significantly correlated in a positive way with age (r=0.332, p<0.001) and with anterior chamber depth (r=0.403, p<0.001), and in a negative way with crystalline lens thickness (r=-0.427, p<0.001). The study of refractive group parameters found a significant difference (p<0.01) between groups in axial length level. Anterior chamber depth decreased when the spherical equivalent increased. The study of crystalline lens thickness found a significant difference (p<0.01) between all four groups and pachymetry, as well as between groups 1 and 4 (p<0.05). CONCLUSION: The Lenstar LS 900 biometer (Haag-Streit(®)) provided a complete biometrical assessment of children's eye in a single and easy measurement procedure. In this pediatric population with hypermetropia, axial length of the eye was mainly correlated with spherical equivalent and other biometric parameters. The relation between these various parameters was influenced and modified by age.