RESUMEN
PURPOSE: The aim of this study is to evaluate the 2-year visual and anatomic results of treatment with intravitreal injections of aflibercept in newly diagnosed, treatment-naive patients with neovascular age-related macular degeneration in routine clinical practice of a tertiary hospital of Southwestern Greece. METHODS: In this retrospective, single-center, non-randomized case-series study we analyzed the records of 32 treatment-naive eyes of 28 patients treated with intravitreal injections of aflibercept. Patients received treatment in the Department of Ophthalmology of the University Hospital of Patras from January 2017 to August 2019. The scheduled treatment regimen included a loading dose of 3 consecutive monthly injections of aflibercept and then injections at 8-week intervals for the next 9 months followed by a treat and extend treatment during the second year. Data such as age, gender, best corrected visual acuity (BCVA) and number of injections were recorded. Spectral domain optical coherence tomography (SD-OCT) findings including presence or absence of fluid and automated central macular thickness measurement at baseline, 12 and 24 months were also recorded. RESULTS: The mean age of the patients (14 male, 14 female) was 78.5±7.73 years. Over a period of 12 months, and after a median number of 6 visits (range 3-10), patients received a median number of 6 intravitreal injections of aflibercept (range 3-8). Twenty eyes completed 2 years of treatment with aflibercept. Over the 2-year period patients conducted a median of 14 visits (range 9-15) and received a median number of 10 IVAs (range 6-13). The median logMAR BCVA at 12 months was significantly better compared to baseline [0.412 (range 0.046-1.097) versus 0.549 (range 0-1.301) respectively; p=0.003] while median logMAR BCVA at 24 months [0.398 (range 0.222-1.097)] did not differ significantly compared to baseline (p=0.295). The central macular thickness at baseline was 398.75±98.16 µm and decreased statistically significantly at 12 (295.81±80.48 µm) and 24 months (289.29±34.25 µm) compared to baseline (p=0.0002 and p=0.002, respectively). At baseline SD-OCT examination subretinal fluid (SRF) was present in 26 eyes (81.25%), intraretinal fluid (IRF) was present in 20 eyes (62.5%) while pigment epithelium detachment (PED) was observed in 28 eyes (87.5%) At 12 months SRF was present in 16 eyes (50%), IRF was present in 10 eyes (31.25%) while PED was observed in 23 eyes (71.88%). At 24 months examination SRF was present in 4 eyes (20%), IRF was present in 10 eyes (50%) while PED was observed in 14 eyes (70%). No serious adverse events occurred during this period. CONCLUSION: Treatment with intravitreal injections of aflibercept in a real life setting resulted in a significant improvement in BCVA at 12 months and in a significant anatomic restoration throughout the 24-month follow-up.
Asunto(s)
Degeneración Macular/tratamiento farmacológico , Receptores de Factores de Crecimiento Endotelial Vascular/uso terapéutico , Proteínas Recombinantes de Fusión/uso terapéutico , Anciano , Femenino , Estudios de Seguimiento , Grecia , Humanos , Masculino , Oftalmología , Epitelio Pigmentado de la Retina/patología , Estudios Retrospectivos , Centros de Atención Terciaria , Tomografía de Coherencia Óptica , Resultado del Tratamiento , Agudeza VisualRESUMEN
PURPOSE: Treatment with intravitreal injections of anti-vascular endothelial growth factors, like aflibercept, has revolutionized the management of diabetic macular edema. The purpose of this study is to evaluate the 2-year results of treatment with aflibercept in newly diagnosed, treatment-naive patients with diabetic macular edema in a real-life setting in a tertiary hospital of Southwestern Greece. METHODS: In this retrospective, real-life, single-center, cohort study the records of diabetic patients were reviewed. In the study we included treatment naive eyes that started treatment with intravitreal injections of aflibercept in the Department of Ophthalmology of the University Hospital of Patras. The scheduled treatment regimen of aflibercept was based on the Summary of Product Characteristics of the product and included a loading dose of 5 monthly aflibercept injections followed by bimonthly treatment until the completion of the first year. During the second year a treat and extend treatment regimen was applied. We recorded data such as age, gender, number of visits and injections, best corrected visual acuity (BCVA) and central macular thickness (CMT) as it was evaluated by a spectral domain optical coherence tomography (SD-OCT). RESULTS: Thirty treatment-naive eyes of 22 patients (14 male, 8 female) received treatment with aflibercept for at least 1 year during the period between January 2017 and August 2019. The mean age of the patients was 68.64±7.35 years. Ninety percent of the patients suffered from type-II diabetes and 9% from type-I. The median time between the diagnosis of diabetic macular edema and initiation of treatment with intravitreal injections of aflibercept was 0.5 months (range 0-3 months). Median baseline logMAR BCVA was 0.398 (range 0.046-1.301). The mean CMT at baseline was 388.0±162.94µm. Over a period of 12 months, and after a mean number of 7.5±2.3 visits, patients received a mean number of 7±1.12 intravitreal injections of aflibercept. Eighteen eyes (60%) received an induction phase with 5 monthly injections according to aflibercept SPC. After 12 months the median BCVA (0.324, range 0.0-1.3) was statistically significantly better compared to baseline (p=0.024) and the CMT (295.67±70.99) was significantly lower compared to baseline (p=0.017). Eighteen eyes (60%) completed 2 years of treatment with aflibercept. Over the 2-year period patients made a mean number of 12.7±3.08 visits and received a mean number of 10.2±1.64 intravitreal injections of aflibercept. The median logMAR BCVA at 2 years (0.301, range 0-0.52) was statistically significantly better compared to baseline (p=0.013) and the CMT (293.53±65.93) was significantly lower compared to baseline (p=0.01). No serious adverse events were recorded during this period. CONCLUSION: Aflibercept resulted in significant functional and anatomic improvement after 12- and 24-month treatment in diabetic macular edema eyes in a real-life setting. The majority of the eyes completed the 2-year treatment regimen of aflibercept.
Asunto(s)
Retinopatía Diabética/tratamiento farmacológico , Mácula Lútea/patología , Edema Macular/tratamiento farmacológico , Receptores de Factores de Crecimiento Endotelial Vascular/uso terapéutico , Proteínas Recombinantes de Fusión/uso terapéutico , Anciano , Retinopatía Diabética/patología , Femenino , Estudios de Seguimiento , Hemoglobina Glucada/análisis , Grecia/epidemiología , Humanos , Inyecciones Intravítreas , Edema Macular/patología , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Centros de Atención Terciaria , Tomografía de Coherencia Óptica , Resultado del Tratamiento , Agudeza VisualRESUMEN
PURPOSE: To evaluate the immediate 24-hour effect on intraocular pressure (IOP) of a single session of micropulse laser trabeculoplasty (MLT) in patients with pseudoexfoliation glaucoma (PEXG). PATIENTS AND METHODS: In this single-center, one-arm, prospective study, patients with PEXG on prostaglandin analogue monotherapy with inadequate IOP control were treated with 360-degree 532nm MLT. Intraocular pressure was evaluated at 1, 4, 8, 12 and 24hours after MLT. Twenty-three eyes of eighteen patients (10 male, 8 female) were enrolled in the study. RESULTS: The mean age of the patients was 71.83±6.51 years, and the mean IOP prior to MLT was 20.61±1.8mmHg. The mean IOP was reduced by 2.17±3.31mmHg, 2.69±3.85mmHg, 0.87±3.02mmHg, 2.13±2.8mmHg and -0.87±3mmHg at 1, 4, 8 and 24hours after MLT, respectively. At 4 and 12hours after MLT, the mean IOP was statistically significantly lower compared to the pre-MLT IOP (P=0.043 and P=0.021 respectively). No eye experienced an IOP spike≥5mmHg during the first 24hours after MLT. CONCUSION: Treatment with MLT in PEXG eyes did not result in any significant, potentially dangerous IOP spikes during the first 24hours after MLT.
Asunto(s)
Síndrome de Exfoliación/cirugía , Glaucoma de Ángulo Abierto/cirugía , Presión Intraocular , Terapia por Láser , Cuidados Posoperatorios , Trabeculectomía , Anciano , Síndrome de Exfoliación/complicaciones , Femenino , Glaucoma de Ángulo Abierto/complicaciones , Humanos , Terapia por Láser/métodos , Masculino , Estudios Prospectivos , Factores de Tiempo , Trabeculectomía/métodosAsunto(s)
Mácula Lútea/irrigación sanguínea , N-Metil-3,4-metilenodioxianfetamina/efectos adversos , Hemorragia Retiniana/inducido químicamente , Trastornos Relacionados con Sustancias/complicaciones , Adulto , Humanos , Mácula Lútea/patología , Masculino , Hemorragia Retiniana/diagnóstico , Hemorragia Retiniana/patología , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos de la Visión/inducido químicamente , Trastornos de la Visión/diagnósticoRESUMEN
BACKGROUND: Τo perform a molecular epidemiological analysis of viral conjunctivitis among excess conjunctivitis cases recorded at the University Hospital of Patras, Greece, for the period March to June 2012. METHODS: A structured questionnaire containing demographic and clinical data was developed in order to collect retrospective data on the cases. Eye swab specimens were collected and molecular detection of adenoviruses was performed by nested PCR. Positive results were confirmed by sequencing. To determine the relatedness between the isolated sequences, a phylogenetic analysis was conducted. RESULTS: The epidemiological analysis (including retrospective data) included 231 conjunctivitis cases (47.1% male, and 52.8% female). Based on clinical features 205 of the cases were diagnosed of viral origin (46.3% male and 53.7% female), 4 of bacterial origin (50% male and 50% female) while 22 were undefined conjunctivitis. The outbreak excess cases (included 156 cases) affected all age groups regardless gender predilection. For the positive samples indicated that 29 samples (72.5%) were AdV17, and 5 (12.5%) as AdV54. CONCLUSIONS: Molecular analysis could define the cause of viral conjunctivitis, while epidemiological data contributed to the assessment of the risk factors and underlined possible preventive measures. This study is one of the very few on viral conjunctivitis in Greece. This outbreak underscores the need for a national surveillance system for acute infectious conjunctivitis outbreaks. The epidemiological as well as molecular investigation on HAdV ocular infections is rather absent in Greece, which has no surveillance system for viral conjunctivitis.