Developments in ophthalmology最新文献

{"title":"Mini Drainage Devices for Anterior and Intermediate Filtration.","authors":"Marco Nardi,&nbsp;Chiara Posarelli,&nbsp;Francesco Nasini,&nbsp;Michele Figus","doi":"10.1159/000458489","DOIUrl":"https://doi.org/10.1159/000458489","url":null,"abstract":"<p><p>Mini glaucoma devices for external filtration may be implanted with an ab externo procedure (Ex-PRESS and InnFocus Microshunt) or with an ab interno procedure (XEN Gel stent). The Ex-PRESS is an FDA-approved mini glaucoma device that has been developed in order to simplify anterior guarded filtering procedures, making them faster, safer and easier. It is positioned under a scleral flap and it is introduced in the anterior chamber through a needle hole, avoiding the excision of the corneal-scleral button and the iridectomy. Like other anterior filtering guarded procedures, it may be associated with releasable sutures and with an everting suture (the safe Ex-PRESS procedure) in order to increase safety and efficacy. The InnFocus Microshunt is a new ab externo filtering device currently under investigation; it is very easy to implant and highly promising in terms of safety and efficacy. The XEN Gel stent is an ab interno implanted soft, collagen tube that makes a permanent bypass between the anterior chamber and the subconjunctival space. It is a smart, quick, effective and simple procedure that recently gained FDA approval.</p>","PeriodicalId":77107,"journal":{"name":"Developments in ophthalmology","volume":"59 ","pages":"90-99"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000458489","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34942203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis and Detection.","authors":"Giovanni Staurenghi,&nbsp;Marco Pellegrini,&nbsp;Alessandro Invernizzi,&nbsp;Chiara Preziosa","doi":"10.1159/000455268","DOIUrl":"https://doi.org/10.1159/000455268","url":null,"abstract":"<p><p>The aim of the chapter is to provide a practical but exhaustive guide in detecting macular edema and to describe its features according to the retinal condition that causes it. The most useful imaging techniques (biomicroscopy, retinography, optical coherence tomography, and fluorescein/indocyanine-green angiography will be analyzed in order to identify the best diagnostic algorithm in each pathology. There is a table at the end of the chapter which summarizes the important points of the chapter.</p>","PeriodicalId":77107,"journal":{"name":"Developments in ophthalmology","volume":"58 ","pages":"39-62"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000455268","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34862633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optical Coherence Tomography Angiography in Macular Edema.","authors":"Marco Lupidi,&nbsp;Florence Coscas,&nbsp;Carlo Cagini,&nbsp;Gabriel Coscas","doi":"10.1159/000455269","DOIUrl":"https://doi.org/10.1159/000455269","url":null,"abstract":"<p><p>OCT angiography is a promising new method to visualize the retinal vasculature and choroidal vascular layers in the macular area and provides depth resolved functional information of the blood flow in the vessels. Given that the main moving elements in the eye fundus are contained in vessels, determining a vascular decorrelation signal enables visualization of 3-dimensional retinal and choroidal vascular network without the administration of intravenous dye and thus reducing the risk of potential adverse events.</p>","PeriodicalId":77107,"journal":{"name":"Developments in ophthalmology","volume":"58 ","pages":"63-73"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000455269","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34862634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insights into the Physiopathology of Inflammatory Macular Edema.","authors":"Marc D de Smet","doi":"10.1159/000455279","DOIUrl":"https://doi.org/10.1159/000455279","url":null,"abstract":"<p><p>Macular edema is one of the most common causes of permanent vision loss in patients with uveitis. The current understanding of water balance and metabolism within the retina has given us better insight into the mechanisms underlying macular edema arising from both acute and chronic inflammation. Uveitic macular edema (UME) occurs when the equilibrium between water influx and efflux is lost, and more importantly when compensatory mechanisms are overwhelmed. While in the acute setting, control of inflammation can reestablish homeostasis, chronic inflammation can lead to alternate pathways to establish a water balance. To understand UME, one must understand the regulation and consequences of inflammation at the tissular level. A fine interplay exists between inflammation and the retina replete with compensatory mechanisms, bystander effects, and structural sequelae once inflammation subsides. This understanding may allow us to develop new therapeutic strategies for the treatment of inflammatory macular edema.</p>","PeriodicalId":77107,"journal":{"name":"Developments in ophthalmology","volume":"58 ","pages":"168-177"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000455279","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34862031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practical Lessons from Protocol T for the Management of Diabetic Macular Edema.","authors":"Lekha Mukkamala,&nbsp;Neelakshi Bhagat,&nbsp;Marco Zarbin","doi":"10.1159/000459694","DOIUrl":"https://doi.org/10.1159/000459694","url":null,"abstract":"<p><strong>Purpose: </strong>To review the results of Diabetic Retinopathy Clinical Research Network Protocol T, as applied to clinical practice.</p><p><strong>Methods: </strong>Review of major publications reporting the results of Protocol T, a randomized single-masked (in year-1 only), multicenter clinical trial comparing aflibercept, bevacizumab, and ranibizumab as treatment option for center-involving diabetic macular edema (DME). The main outcome measures were change in visual acuity (VA), central subfield thickness (CST) on optical coherence tomography, cost effectiveness, burden of care, and safety.</p><p><strong>Results: </strong>A total of 660 participants (mean age 61 ± 10 years, 47% women, 65% Caucasian) were randomized to treatment with aflibercept (n = 224), ranibizumab (n = 218), or bevacizumab (n = 218). The majority of patients (90%) had type II diabetes, with an average duration of 17 ± 11 years. About half the patients had baseline ETDRS VA of 20/32 to 20/40, and half had ETDRS VA of 20/50 to 20/320 in all 3 cohorts. Patients in all 3 cohorts received a similar number of injections during the study period (9-10 in year-1; 5-6 in year-2). The year-1 improvement in ETDRS letters was significantly higher for aflibercept than for ranibizumab and bevacizumab in patients with baseline VA 20/50 or worse (p = 0.003 and p < 0.001, respectively), but was no different in patients with better baseline VA of 20/32 to 20/40 (p = 0.69). By year-2, among patients with poorer baseline VA, there was a difference in mean letters gained between aflibercept and bevacizumab (p = 0.02), but no difference between aflibercept and ranibizumab (p = 0.18). At year-2, there was no clinically meaningful difference in VA improvement (i.e., gain or loss of ≥10 or ≥15 letters) among any of the agents (p > 0.74). Bevacizumab was less effective than the other agents in decreasing CST at years-1 and -2 in the overall cohort of patients (p < 0.001). However, bevacizumab is substantially cheaper and much more cost-effective (when comparing expense and quality of life measures) than aflibercept and ranibizumab. The cost of other agents would have to decrease by 80-90% to be cost-effective relative to bevacizumab. Intravitreal administration of anti-VEGF therapy has relatively few ocular and systemic side effects, but caution may be warranted for patients with a recent history or high risk of myocardial infarction or stroke.</p><p><strong>Conclusions: </strong>Aflibercept, bevacizumab, and ranibizumab are highly effective treatments for DME. Bevacizumab is more cost-effective than aflibercept and ranibizumab. Intravitreal administration of drugs is relatively safe; however, intravitreal administration may be associated with severe systemic side effects in a small percentage of patients, particularly in those with a prior history of or high risk of Anti-Platelet Trialists' Collaboration events.</p>","PeriodicalId":77107,"journal":{"name":"Developments in ophthalmology","volume":"60 ","pages":"109-124"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000459694","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34928017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enzymatic Vitreolysis for Vitreomacular Traction in Diabetic Retinopathy.","authors":"Stanislao Rizzo,&nbsp;Daniela Bacherini","doi":"10.1159/000460275","DOIUrl":"https://doi.org/10.1159/000460275","url":null,"abstract":"<p><p>Vitreomacular traction (VMT) is one of many possible factors involved in the etiology of diabetic macular edema (DME). Pharmacologic vitreoretinal separation is a potential alternative to vitrectomy for VMT in diabetic retinopathy. Small case series have been published on the use of enzymatic vitreolysis in tractional DME, and demonstrate that the enzymatic release of the posterior vitreous cortex is more likely following the injection of plasmin enzyme. Further prospective and randomized clinical trials are necessary to evaluate the clinical relevance of ocriplasmin for vitreomacular traction in diabetic retinopathy, and additional studies are needed to determine more accurately which patients might benefit most from this treatment and how often and at what concentration ocriplasmin should be administered.</p>","PeriodicalId":77107,"journal":{"name":"Developments in ophthalmology","volume":"60 ","pages":"160-164"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000460275","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34928021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetic Macular Edema.","authors":"Francesco Bandello,&nbsp;Maurizio Battaglia Parodi,&nbsp;Paolo Lanzetta,&nbsp;Anat Loewenstein,&nbsp;Pascale Massin,&nbsp;Francesca Menchini,&nbsp;Daniele Veritti","doi":"10.1159/000455277","DOIUrl":"https://doi.org/10.1159/000455277","url":null,"abstract":"<p><p>Diabetic macular edema (DME), defined as a retinal thickening involving or approaching the center of the macula, represents the most common cause of vision loss in patients affected by diabetes mellitus. In the last few years, many diagnostic tools have proven to be useful in the detection and the monitoring of the features characterizing DME. On the other hand, several therapeutic approaches can now be proposed on the basis of the DME-specific characteristics. The aim of the present chapter is to thoroughly delineate the clinical and morphofunctional characteristics of DME and its current treatment perspectives. The pathogenesis and the course of DME require a complex approach with multidisciplinary intervention both at the systemic and local levels.</p>","PeriodicalId":77107,"journal":{"name":"Developments in ophthalmology","volume":"58 ","pages":"102-138"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000455277","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34862032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Burden of Diabetes: Emerging Data.","authors":"Paola Maffi,&nbsp;Antonio Secchi","doi":"10.1159/000459641","DOIUrl":"https://doi.org/10.1159/000459641","url":null,"abstract":"<p><p>In recent times, the global prevalence of diabetes has increased substantially, reaching 8.3% in 2014, which corresponds to 387 million patients. Studies in Europe and USA have shown increased incidence of type 1 Diabetes (T1D) over time at a rate of 3-5% per year. Another most worrying feature of the rapid increase of diabetes is the emergence of type 2 Diabetes (T2D) in children, adolescents, and young adults. The well-known behavioral risks factors and epigenetic mechanisms recently observed require an integrated approach to prevent T2D. Diabetes significantly influences the patient' survival, quality of life, and development of organ system degeneration. Epidemiological studies have shown increased mortality in diabetic patients, especially women, which increased approximately fivefold, whereas cardiovascular mortality increased 20- to 30-fold when compared to the normal population. Diabetes is the leading cause of end-stage renal disease and vision loss in developed countries. Around 40% of T1D and T2D start on renal replacement therapy. While after 40 years of diabetes, the cumulative proportion of patients with any retinopathy and advanced retinopathy was 84.1 and 50.2%, respectively. However, the most prevalent chronic complication of diabetes is neuropathy. Distal Symmetric Polyneuropathy occurs in at least 20% of people with T1D after 20 years and in 10-15% of newly diagnosed T2D, increasing to 50% after 10 years. Cardiovascular Autonomic Neuropathy may be present in up to 60% of patients after 15 years and is an independent risk factor for cardiovascular mortality.</p>","PeriodicalId":77107,"journal":{"name":"Developments in ophthalmology","volume":"60 ","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000459641","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34930313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep Sclerectomy.","authors":"Sylvain Roy,&nbsp;André Mermoud","doi":"10.1159/000458484","DOIUrl":"https://doi.org/10.1159/000458484","url":null,"abstract":"<p><p>Filtering surgery evolved from the classic trabeculectomy, in which penetration into the anterior chamber is a necessary step, toward nonpenetrating deep sclerectomy. The first procedure presents several serious complications, such as durable hypotony, hyphema, flat anterior chamber, choroidal detachment, endophthalmitis, and surgery-induced cataract. To avoid such drawbacks, a novel nonpenetrating technique was designed to improve the predictability of the intraocular pressure (IOP)-lowering action, while reducing the incidence of the immediate postoperative complications encountered with the penetrating method. This surgery works by building up new outflow pathways for the drainage of the aqueous humor while maintaining the integrity of the anterior chamber. Deep sclerectomy acts at the bulk of main resistance to aqueous humor egress, located at the juxtacanalicular meshwork and at the inner wall of Schlemm's canal. It consists of dissection of these two structures while keeping a thin filtering membrane through which aqueous humor is drained. The membrane prevents overfiltration and ensures a reproducible postoperative IOP. This surgery is indicated for most glaucomas, with the exception of angle closure and neovascular cases. The procedure consists in opening the conjunctiva and Tenon's capsule and creating a 5 × 5-mm limbus-based superficial scleral flap. A deeper scleral flap measuring about 4 × 4 mm is dissected and the roof of Schlemm's canal is removed. A space maintainer is inserted and the flap and conjunctiva are closed. Results after 10 years are good, with an IOP of 12.2 ± 4.7 mmHg and an overall success rate of 77.6% with few complications.</p>","PeriodicalId":77107,"journal":{"name":"Developments in ophthalmology","volume":"59 ","pages":"36-42"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000458484","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34941169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanisms of Retinal Fluid Accumulation and Blood-Retinal Barrier Breakdown.","authors":"José Cunha-Vaz","doi":"10.1159/000455265","DOIUrl":"https://doi.org/10.1159/000455265","url":null,"abstract":"<p><p>Macular edema is the swelling of the central portion of the human retina and it is associated with increased retinal thickness. It can be simply defined as an excess of fluid within the retinal tissue. It must be realized that the normal retina possesses a functional extracellular space. With regard to the extracellular volume of the retina, there have been few physiologic studies, but there are reported values of 24.8% for the cerebrum and 23.6% for the cerebellum. It is accepted that the retinal extracellular space is similar to the brain. It is generally agreed that the proximate cause of macular edema and retinal fluid accumulation is a breakdown of the blood-retinal barrier (BRB). When there is a breakdown of the BRB, retinal edema can be interpreted in terms of basic principles of capillary filtration (Starling's law). Therefore, the main factors influencing retinal edema formation are BRB permeability, capillary hydrostatic pressure, tissue hydrostatic pressure, tissue osmotic pressure, and plasma osmotic pressure. Active transport by the retinal pigment epithelium is necessary to remove water that percolates through the retina from intraocular pressure and is also as a safety mechanism against fluid accumulation in disease. Clinical evaluation of the BRB and retinal edema can be performed noninvasively by using an OCT-based method designated OCT-Leakage, which is capable of identifying and quantifying sites of alteration of the BRB, and by mapping sites of low optical reflectivity, i.e., changes in the retinal extracellular fluid.</p>","PeriodicalId":77107,"journal":{"name":"Developments in ophthalmology","volume":"58 ","pages":"11-20"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000455265","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34862630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}