Developments in ophthalmology最新文献

{"title":"Is Laser Still Important in Diabetic Macular Edema as Primary or Deferral Therapy?","authors":"Maurizio Battaglia Parodi,&nbsp;Francesco Bandello","doi":"10.1159/000459696","DOIUrl":"https://doi.org/10.1159/000459696","url":null,"abstract":"<p><p>Laser treatment was used in the past to reduce the visual loss due to diabetic macular edema. The recent advent of anti-vascular endothelial growth factor (anti-VEGF) has completely revolutionized the management of diabetic retinopathy, with a significant improvement in the overall prognosis. Nevertheless, macular laser can still be applied in selected cases characterized by retinal thickness ≤400 microns, high visual acuity, extrafoveal location, and contraindications to the intravitreal approach with anti-VEGF and steroids. In addition, the combined therapy with anti-VEGF and macular laser can exploit the synergistic effects of both therapies, leading to a simpler and more practical management of patients over the long-term follow-up.</p>","PeriodicalId":77107,"journal":{"name":"Developments in ophthalmology","volume":"60 ","pages":"125-130"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000459696","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34928018","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":"Emerging Simplified Retinal Imaging.","authors":"Ashish Sharma","doi":"10.1159/000459690","DOIUrl":"https://doi.org/10.1159/000459690","url":null,"abstract":"<p><p>Diabetic retinopathy (DR), a major microvascular complication of diabetes, has a significant impact on the world's health systems. Globally, the number of people with DR will grow from 126.6 million in 2010 to 191.0 million by 2030, and it is estimated that the number with vision-threatening diabetic retinopathy will increase from 37.3 million to 56.3 million if prompt action is not taken. Lack of early diagnosis and management is the leading cause of blindness in working-age populations The gap between demand and annual eye examinations has been a big challenge. Furthermore lack of availability of cost effective simplified retinal imaging tools has limited the diabetic retinopathy screening program in many parts of the world in last few decades. This has led to the development of innovative ideas and availability of cost effective simplified retinal imaging tools. In this chapter we will be describing some of the well known commercially available emerging simplified (Non Tabletop, Hand Held, Portable) retinal imaging tools that have potential to help in screening diabetic retinopathy with ease and without increasing financial burden.</p>","PeriodicalId":77107,"journal":{"name":"Developments in ophthalmology","volume":"60 ","pages":"56-62"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000459690","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34928609","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":"Intravitreal Steroids in Diabetic Macular Edema.","authors":"Rosangela Lattanzio,&nbsp;Maria Vittoria Cicinelli,&nbsp;Francesco Bandello","doi":"10.1159/000459691","DOIUrl":"https://doi.org/10.1159/000459691","url":null,"abstract":"<p><p>Over the past decade, great strides have been made in the management of diabetic macular edema (DME). Therapeutic alternatives now include focal/grid laser photocoagulation, vitreo-retinal surgery, and intraocular injection of anti-angiogenic and steroid molecules. Intravitreal administration of steroids represents a fundamental alternative for recalcitrant and naive eyes with DME, especially in those cases when anti-vascular endothelial growth factor (VEGF) agents are contraindicated or a treatment regimen with fewer intravitreal injections is required. Currently, 3 intravitreal corticosteroid options for DME treatment are available: the dexamethasone delivery system, the fluocinolone acetonide insert, and off-label intravitreal triamcinolone acetonide. All 3 agents are associated with risk of cataract progression and intraocular pressure elevation, but they maintain a good safety profile. In patients who remain unresponsive to anti-VEGF therapy, are pseudophakic, at low risk for glaucoma, or who have significant cardiovascular risk, treatment with long-lasting intraocular steroids is suggested. There still remain many unanswered questions about intravitreal drugs, regarding dose, frequency, the correct regimen of each treatment, and the potential long-term side effects.</p>","PeriodicalId":77107,"journal":{"name":"Developments in ophthalmology","volume":"60 ","pages":"78-90"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000459691","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34928612","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 Eye as a Window to the Microvascular Complications of Diabetes.","authors":"Gianpaolo Zerbini,&nbsp;Silvia Maestroni,&nbsp;Valentina Turco,&nbsp;Antonio Secchi","doi":"10.1159/000459642","DOIUrl":"https://doi.org/10.1159/000459642","url":null,"abstract":"<p><p>Although microvascular complications of diabetes (retinopathy, neuropathy, and nephropathy) affect different organs, they are strongly correlated to each other. Based on recent data, their onset and progression could be directly monitored, focusing our attention only on the eye. When confirmed and standardized, this approach could allow one to simplify the way in which we follow the progression of different diabetic complications, and thus establish new strategies aimed at preventing, treating and, hopefully, inducing the remission of microvascular complications of diabetes.</p>","PeriodicalId":77107,"journal":{"name":"Developments in ophthalmology","volume":"60 ","pages":"6-15"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000459642","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34930314","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":"Achievements and Limits of Current Medical Therapy of Glaucoma.","authors":"Pelagia Kalouda,&nbsp;Christina Keskini,&nbsp;Eleftherios Anastasopoulos,&nbsp;Fotis Topouzis","doi":"10.1159/000458482","DOIUrl":"https://doi.org/10.1159/000458482","url":null,"abstract":"<p><p>Prescribing medical therapy for the treatment of glaucoma can be a complex process since many parameters should be taken into consideration regarding its achievements and limits. Today, a variety of options, including multiple drug classes and multiple agents within classes, are available to the clinician, but caution should be given to their side effects and contraindications. Glaucoma patients with preexisting ocular surface disease should be treated with caution, and preferably with preservative-free formulations, as there is an increased risk for symptom deterioration. The development and use of fixed-combination therapies has reduced the preservative-related side effects that threaten patient adherence and has minimized the washout effect of multiple instillations. Adherence to medical treatment is not only crucial to its efficacy but also to its cost-effectiveness. Further factors to consider are that there are patients who are nonresponders to treatment, and also that the target intraocular pressure (IOP) cannot be reached in all patients, regardless of the response to treatment. The progression of damage can occur even under maximum medical treatment or maximally tolerated medical treatment, and regardless of whether low IOP levels are reached. Furthermore, there is some conflict between medical treatment and quality of life due to long-term everyday use and to side effects of treatment. New molecules and new delivery systems are being investigated to open new horizons in glaucoma management. Although the general rule is to initiate glaucoma management with medical treatment, the limits of medical therapy should be considered to identify those patients in need of surgical management.</p>","PeriodicalId":77107,"journal":{"name":"Developments in ophthalmology","volume":"59 ","pages":"1-14"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000458482","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34941167","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":"Wound Healing and Glaucoma Surgery: Modulating the Scarring Process with Conventional Antimetabolites and New Molecules.","authors":"Gábor Holló","doi":"10.1159/000458488","DOIUrl":"https://doi.org/10.1159/000458488","url":null,"abstract":"<p><p>Subconjunctival absorption of aqueous humor is an essential part of glaucoma filtration surgery. Mitomycin C (MMC) and 5-fluorouracil have been used to reduce postoperative episcleral fibrosis and scar formation in the filtering bleb area for more than 2 decades. Both antimetabolites have also been frequently injected before needling revision of failing filtering blebs. Recently, MMC was also tried in tube surgery and nonpenetrating filtering surgery, but its usefulness in these applications has not yet been determined. The main complications and side effects of antimetabolite-enhanced filtration surgery comprise the development of thin-walled cystic blebs, late bleb leaks, bleb infections, endophthalmitis, chronic hypotony, hypotony maculopathy and corneal epithelial toxicity. Besides MMC and 5-fluorouracil, several other agents were proposed for decreasing episcleral healing after glaucoma filtering surgery. Only a few were evaluated in randomized clinical trials, and none became generally accepted or widely used.</p>","PeriodicalId":77107,"journal":{"name":"Developments in ophthalmology","volume":"59 ","pages":"80-89"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000458488","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34941173","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":"When Should We Give Up Filtration Surgery: Indications, Techniques and Results of Cyclodestruction.","authors":"Marisse Masis Solano,&nbsp;Guofu Huang,&nbsp;Shan C Lin","doi":"10.1159/000458496","DOIUrl":"https://doi.org/10.1159/000458496","url":null,"abstract":"PURPOSE Cyclodestructive procedures are traditionally used in cases of glaucoma that are refractory to medical and surgical therapy. The goal of this chapter is to describe the indications, contraindications, techniques, and pitfalls of cyclodestructive procedures, including transscleral cyclophotocoagulation (TCP), micropulse TCP (MP-TCP), endoscopic cyclophotocoagulation (ECP), and ultrasound cilioplasty. METHODS A literature search for cyclodestructive techniques was performed, and relevant studies were included for evaluation and review. RESULTS It is encouraging that TCP seems relatively efficacious even for patients who have been refractory to other treatments, depending on the energy setting, follow-up period, and definition of success. Repeated TCP is often required. TCP was more often used in eyes with limited visual potential caused by severe forms of glaucoma than in eyes with good visual potential. Serious complications were significant vision loss, inflammation, hypotony, and phthisis. ECP came later into clinical use for the treatment of refractory glaucoma. ECP is able to specifically target the ciliary epithelium under direct viewing as compared to TCP, which is an indirect cyclodestructive procedure. In the literature, it has been demonstrated that ECP has overall good success with relatively low complication rates when used for adult forms of glaucoma. A new technology using MP-TCP is a promising alternative to conventional cyclophotocoagulation. Early evidence shows that MP-TCP has clinical utility and a good safety profile. Ultrasound cilioplasty is a possible alternative to laser cyclodestruction that is already being commercialized and is currently under investigation. CONCLUSIONS Both TCP and ECP are effective cyclodestructive procedures and alternatives for the treatment of glaucoma refractory to medical and surgical therapy, though potential for serious complications exists. TCP, ECP, and ultrasound cilioplasty are being used increasingly as the primary surgery for various kinds and stages of glaucoma.","PeriodicalId":77107,"journal":{"name":"Developments in ophthalmology","volume":"59 ","pages":"179-190"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000458496","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34942210","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":"Macular Edema - Rationale for Therapy.","authors":"Thomas J Wolfensberger","doi":"10.1159/000455275","DOIUrl":"https://doi.org/10.1159/000455275","url":null,"abstract":"<p><p>Macular edema represents the end-stage of multiple pathophysiological pathways in a multitude of ocular vascular, inflammatory, and other diseases. The rationale for clinical treatment of macular edema is based on the understanding and the inhibition of these pathophysiological mechanisms. When macular edema is caused by a generalized health problem such as diabetes, high blood pressure, or generalized inflammatory conditions, treatment of these generalized diseases can in many cases cure macular edema directly. In ocular diseases, the local exudation of fluid from blood vessels is governed by Starling's law as well as by intricate cellular mechanisms linked to the tight junctions in the inner and outer blood-retinal barrier. Drugs used in clinical practice, such as nonsteroidal anti-inflammatory drugs, corticosteroids, carbonic anhydrase inhibitors, and anti-vascular endothelial growth factor agents, all act in one way or another through these cellular mechanisms. Novel treatments such as neuroprotective agents like nerve growth factors, somatostatins and antiapoptotic agents like calpain, the glutamate blocker memantine, and different caspase inhibitors may in the future inhibit neuronal cell death in the retina by separate pathways. Using dimmed nocturnal illumination may be an additional novel method to reduce hypoxic stress during dark adaptation of the rod photoreceptors in diabetes. Successful surgical treatment of macular edema using vitrectomy and peeling relies, apart from the evident release of vitreomacular traction, on many other cellular and biochemical mechanisms activated by the surgery such as oxygenation of the inner retina, removal of the posterior hyaloid as a growth factor sink, and possible Müller cell remodeling with fluid redirection after internal limiting membrane peeling.</p>","PeriodicalId":77107,"journal":{"name":"Developments in ophthalmology","volume":"58 ","pages":"74-86"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000455275","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34862033","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":"Postsurgical Cystoid Macular Edema.","authors":"Dinah Zur,&nbsp;Anat Loewenstein","doi":"10.1159/000455280","DOIUrl":"https://doi.org/10.1159/000455280","url":null,"abstract":"<p><p>Cystoid macular edema (CME) is a primary cause of reduced vision following both cataract and successful vitreoretinal surgery. The incidence of clinical CME following modern cataract surgery is 0.1-2.35%. Preexisting conditions such as diabetes mellitus and uveitis as well as intraoperative complications can raise the risk of postsurgical CME. The etiology of CME is not completely understood. Prolapsed or incarcerated vitreous and postoperative inflammatory processes have been proposed as causative agents. Pseudophakic CME is characterized by poor postoperative visual acuity. Fluorescein angiography shows the classical perifoveal petaloid staining pattern and late leakage of the optic disk. Optical coherence tomography is a useful diagnostic tool, which displays cystic spaces in the outer nuclear layer. The most important differential diagnoses include age-related macular degeneration and other causes of CME such as diabetic macular edema. Most cases of pseudophakic CME resolve spontaneously. The value of prophylactic treatment is doubtful. First-line treatment of postsurgical CME should include topical nonsteroidal anti-inflammatory drugs and corticosteroids. Oral carbonic anhydrase inhibitors can be considered complementary. In cases of resistant CME, periocular or intraocular corticosteroids present an option. Antiangiogenic agents, though experimental, should be considered for nonresponsive persistent CME. Surgical options should be reserved for special indications.</p>","PeriodicalId":77107,"journal":{"name":"Developments in ophthalmology","volume":"58 ","pages":"178-190"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000455280","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34862636","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":"Emerging Issues for Optical Coherence Tomography.","authors":"Luisa Pierro,&nbsp;Alessandro Rabiolo","doi":"10.1159/000459723","DOIUrl":"https://doi.org/10.1159/000459723","url":null,"abstract":"<p><p>Almost 25 years after its introduction, optical coherence tomography (OCT) is still a crucial test in the evaluation of patients affected by diabetic retinopathy. In this chapter, the authors provide an extensive overview of the posterior segment pathological changes induced by diabetes, characterized using OCT. OCT plays a key role in diabetic macular edema (DME) as it assesses related retinal changes both in a qualitative (i.e., DME pattern, presence and aspects of cysts, fluid localization, integrity, and reflectivity of retinal layers) and quantitative (i.e., macula volume, central and sectorial retinal thickness) way, and it is therefore essential for diagnosis, characterization, and follow-up of DME. Diabetic macular ischemia is associated with retinal structural changes which can be investigated using OCT, although its diagnosis relies mostly on fluorescein angiography. Beyond DME and macular ischemia, OCT permits the individuation of many other lesions occurring in the setting of both non-proliferative (i.e., hyperreflective spots, micropseudocysts, hard exudates, microaneurysm, cotton-wool spots) and proliferative (i.e., neovascularization, vitreoschisis, tractional retinal detachment, hemorrhage) retinopathies. OCT provides precious information on several structures, including vitreo-retinal interface, retinal nerve fiber layers, ganglion cell complex, and choroid.</p>","PeriodicalId":77107,"journal":{"name":"Developments in ophthalmology","volume":"60 ","pages":"28-37"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000459723","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34928606","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}