Intravitreal bevacizumab monotherapy in myopic choroidal neovascularisation: 5-year outcomes for the PAN-American Collaborative Retina Study Group

2017 ◽  
Vol 102 (4) ◽  
pp. 455-459 ◽  
Author(s):  
Jay Chhablani ◽  
Remya Mareen Paulose ◽  
Andres F Lasave ◽  
Lihteh Wu ◽  
Cristian Carpentier ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Adverse Events ◽  
Real Life ◽  
Intravitreal Bevacizumab ◽  
Term Treatment ◽  
Choroidal Neovascularisation ◽  
Long Term Treatment ◽  
The Mean

PurposeTo report the long-term anatomical and visual outcomes of intravitreal bevacizumab (IVB) monotherapy in naive choroidal neovascularisation (CNV) caused by myopia.MethodsRetrospective analysis of naive CNV secondary to myopia that underwent antivascular endothelial growth factor monotherapy was performed. Collected data included demographic details, clinical examination details including visual acuity at presentation and follow-up with imaging and treatment details. Main outcome measures were resolution of CNV activity at the last visit. Secondary outcomes included change in visual acuity, number of injections and adverse events.ResultsThirty-three eyes of 31 subjects with a mean age of 51.48±16.4 years were included. The mean follow-up was 66.47 months. 27 eyes had type 2 CNV and the rest seven eyes had type 1 CNV. The mean number of IVB injections per eye was 4.9. Mean visual acuity at baseline reduced from 0.65±0.33 logMAR units (Snellen equivalent=20/89) to 0.73±0.50 logMAR units (20/107) at final follow-up (p=0.003). The mean central macular thickness decreased from 309.31±86 µm at baseline to 267.5±70.89 µm at the last visit (p=0.03). However, visual acuity was maintained (±1 line of baseline) in 13 eyes (39.4%), ≥2 line improvement in nine (27.3%) eyes and more than two lines worsening in 11 eyes (33.3%). Foveal atrophy was observed at baseline and last visit in 6 (12.5%) and 14 (29.1%), respectively (p=0.007). No systemic adverse events were observed.ConclusionIVB monotherapy is safe and effective for long-term treatment of CNV secondary to myopia in real life.

scholarly journals Coats’ disease: trends and long-term treatment outcomes in a tertiary referral centre

2021 ◽  
Vol 13 ◽  
pp. 251584142110559
Author(s):  
Avadhesh Oli ◽  
Divya Balakrishnan ◽  
Subhadra Jalali
Keyword(s):  
Visual Acuity ◽  
Treatment Outcomes ◽  
Term Treatment ◽  
Lower Stage ◽  
Long Term Treatment ◽  
Coats Disease ◽  
The Mean ◽  
Anatomical Outcomes

Background: The long-term treatment outcomes in Coat’s disease – particularly in the era of newer pharmacotherapies such as anti-vascular endothelial growth factor (VEGF) agents and depot steroids – are poorly understood. Aim: To describe the clinical features and treatment outcomes of 148 eyes with Coats’ disease assessed in a referral centre over 30 years. Materials and methods: We conducted a retrospective chart review of patients diagnosed with Coats’ disease between 1 June 1987 and 31 July 2017. The demographic, clinical and treatment data were collected and long-term functional and anatomical outcomes were analysed based on the treatment either with conventional therapy (cryo/laser) or along with adjuvants like intravitreal steroids or anti-VEGFs. Results: The mean age at presentation was 15.22 years (median 11). Familial exudative vitreoretinopathy was the most common referral diagnosis, 76/148 (51.5%), followed by Coats’ disease, 37/148 (25%), and retinoblastoma, 35/148 (23.6%). Stage 3B was most common at presentation (31.8%), followed by 2B (22.3%) and 2A (16.9%). A total of 107 patients were treated either with conventional therapy or in combination with adjuvants. The mean follow-up period was 24.95 months. The visual acuity improved from baseline logMAR 2.17 (Snellen-20/2958) to logMAR 1.88 (Snellen-20/1517) at final follow-up ( p = 0.004). The improvement in visual acuity was better when the presenting BCVA was <1 logMAR (Snellen 20/200), p = 0.004. No statistically significant change in BCVA was noted between conventional and adjuvant groups, p = 0.5. However, the final anatomical outcome was good in 78/99 (78.8%) in the conventional group and 45/49 (91.8%) in the adjuvant group, respectively ( p = 0.046). Conclusion: In this series of patients with Coats’ disease over three decades, the use of intravitreal steroids or anti-VEGFs as adjuvants resulted in better anatomical outcomes. A better baseline visual acuity, lower stage of the disease, and older age at presentation were found to be the factors leading to favourable visual outcomes. Summary In the current series of 148 eyes with Coats’ disease, adjuvant treatment with intravitreal steroids or anti-VEGFs resulted in better outcomes as compared with conventional cryotherapy or laser photocoagulation alone. Patients with Coats’ disease who had presented with better visual acuity at baseline, lower stage of the disease and older age had better final visual outcomes.

High-dose desvenlafaxine in outpatients with major depressive disorder

CNS Spectrums ◽  
2012 ◽  
Vol 17 (3) ◽  
pp. 121-130 ◽  
Author(s):  
James M. Ferguson ◽  
Karen A. Tourian ◽  
Gregory R. Rosas
Keyword(s):  
Major Depressive Disorder ◽  
Adverse Events ◽  
Depressive Disorder ◽  
Dose Range ◽  
Term Treatment ◽  
High Dose ◽  
Major Depressive ◽  
Long Term Treatment ◽  
The Mean

ObjectiveThis study investigated the safety and efficacy of long-term treatment with high-dose desvenlafaxine (administered as desvenlafaxine succinate) in major depressive disorder (MDD).MethodsIn this multicenter, open-label study, adult outpatients with MDD aged 18–75 were treated with flexible doses of desvenlafaxine (200–400 mg/d) for ≤ 1 year. Safety assessments included monitoring of treatment-emergent adverse events (TEAEs), patient discontinuations due to adverse events, electrocardiograms, vital signs, and laboratory determinations. The primary efficacy measure was mean change from baseline in the 17-item Hamilton Rating Scale for Depression [HAM-D(17)] total score.ResultsThe mean daily desvenlafaxine dose range over the duration of the trial was 267–356 mg (after titration). The most frequent TEAEs in the safety population (n = 104) were nausea (52%) and headache (41%), dizziness (31%), insomnia (29%), and dry mouth (27%). All TEAEs were mild or moderate in severity. Thirty-four (33%) patients discontinued from the study because of TEAEs; nausea (12%) and dizziness (9%) were the most frequently cited reasons. The mean change in HAM-D(17) total score for the intent-to-treat population (n = 99) was −9.9 at the last on-therapy visit in the last-observation-carried-forward analysis and −14.0 at month 12 in the observed cases analysis.ConclusionHigh-dose desvenlafaxine (200–400 mg/d) was generally safe and effective in the long-term treatment of MDD.

scholarly journals Flow-diverting devices in the treatment of unruptured ophthalmic segment aneurysms at a mean clinical follow-up of 5 years

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Przemysław Kunert ◽  
Katarzyna Wójtowicz ◽  
Jarosław Żyłkowski ◽  
Maciej Jaworski ◽  
Daniel Rabczenko ◽  
...  
Keyword(s):  
Aneurysm Rupture ◽  
Term Treatment ◽  
Long Term Treatment ◽  
Therapeutic Procedures ◽  
Endovascular Methods ◽  
The Mean ◽  
Ophthalmic Segment Aneurysms ◽  
Annual Risk

AbstractA shift toward the endovascular treatment of ophthalmic segment aneurysms is noticeable. However, it is not clear if the long-term treatment results improve with the development of endovascular methods. The aim of this study was to present the outcomes of the treatment of unruptured ophthalmic aneurysms using flow diverting devices (FDD) with or without coiling. This retrospective study included 52 patients with 65 UIAs treated in 2009–2016. The mean aneurysm size was 8.8 mm. Eight aneurysms were symptomatic. Therapeutic procedures included: 5 failed attempts, 55 first sessions with FDD deployment (bilateral procedures in 3) and 3 retreatment procedures. To cover 55 ICAs, 25 Silk, 26 Pipeline, 9 Fred and 1 Surpass FDD were used. FDD with coiling was applied in 19(29.2%), mainly for symptomatic and larger aneurysms. Mean radiological and clinical follow-up was 12 and 61 months, respectively. Postprocedural deterioration was noted in 3(5.8%) patients, but in long-term the modified Rankin Scale grades 0–2 were achieved in 98.1% of patients. One patient died from the treated aneurysm rupture (annual risk—0.07%). Raymond–Roy occlusion classification class I or II was achieved in 98.5% in the long term, with similar results in both groups. Complications occurred in 40.4% of patients and the most frequent were: imperfect FDD deployment (15%), failed attempt of FDD deployment (9.6%) and late FDD stenosis (9.6%). Flow-diverting devices, with additional coiling in selected cases, may offer a very high proportion of satisfactory outcomes. However, in our experience the high risk of complications remains.

1418Adverse effects of spironolactone in long-term treatment of resistant arterial hypertension

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Vaclavik ◽  
L Jelinek ◽  
J Jarkovsky ◽  
K Benesova ◽  
D Tavacova ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Adverse Events ◽  
Arterial Hypertension ◽  
Adverse Reactions ◽  
Term Treatment ◽  
Kaplan Meier ◽  
Long Term Treatment ◽  
The Mean ◽  
Resistant Arterial Hypertension

Abstract Background Spironolactone is recommended as a fourth line antihypertensive drug by current hypertension guidelines. This drug had relatively few adverse effects in short term clinical trials, but data about their occurrence during long-term treatment of resistant hypertension are scarce. Purpose To evaluate the occurrence and type of adverse effects of spironolactone during long-term treatment and their possible clinical and laboratory predictors. Methods We prospectively followed 274 patients with resistant arterial hypertension who started treatment with spironolactone between September 2007 and December 2016. The duration of spironolactone use, its dose, the incidence of adverse events, blood pressure, and laboratory findings were recorded at baseline and during the last clinical examination. Results Patients were followed for an average of 35 (± 29) months, the mean dose of spironolactone was 27.5 mg/day. Adverse effects occurred in 72 patients (26.3%) and in 61 (84.7%) lead to discontinuation of spironolactone. The most common adverse reactions were gynaecomastia (30.6%), hyperkalaemia (30.6%) and symptomatic hypotension (26.4%). The mean duration of spironolactone treatment before their occurrence was 25 (± 27) months. According to the Kaplan-Meier curve, the median for the incidence of adverse events would be 97 months (91.5–102.5 months), i.e. 50% of patients could be treated with no adverse events for more than 8 years. Adverse events were more common in the elderly (hazard ratio – HR 1.38, P=0.007), patients with higher baseline serum creatinine (HR 1.12, P=0.035) and patients taking angiotensin receptor blockers (HR 1.65, P=0.040). Kaplan-Meier estimate – adverse events Conclusion During long-term treatment of resistant hypertension with spironolactone, more than a quarter of patients experience adverse reactions that usually require discontinuation of spironolactone. Acknowledgement/Funding Supported by the grants of Palacký University in Olomouc Nr. IGA_LF_2016_038 and IGA_LF_2017_029.

Long-Term Treatment Outcomes for Heroin Dependence: The 11-Year Follow-Up of the ATOS Study

2013 ◽  
Author(s):  
Christina Marel ◽  
Maree Teesson ◽  
Shane Darke ◽  
Katherine Mills ◽  
Joanne Ross ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Term Treatment ◽  
Heroin Dependence ◽  
Long Term Treatment

scholarly journals Clinical Features of Iris Cysts in Long-Term Follow-Up

2021 ◽  
Vol 10 (2) ◽  
pp. 189
Author(s):  
Joanna Konopińska ◽  
Łukasz Lisowski ◽  
Zofia Mariak ◽  
Iwona Obuchowska
Keyword(s):  
Visual Acuity ◽  
Ultrasound Biomicroscopy ◽  
Anatomical Location ◽  
Long Term Follow Up ◽  
Temporal Quadrant ◽  
The Mean ◽  
Multiple Cysts ◽  
Cyst Growth

This study evaluated the characteristics and clinical course of patients with iris cysts in the long-term follow-up (24–48 months). We retrospectively analyzed the medical records of 39 patients with iris cysts (27 women and 12 men). Age, visual acuity, intraocular pressure (IOP), slit-lamp evaluation, and ultrasound biomicroscopy images were assessed. The mean age at diagnosis was 40.6 ± 17.48 years. Thirty (76.9%) cysts were peripheral, five (12.8%) were located at the pupillary margin, two (5.1%) were midzonal, and two (5.1%) were multichamber cysts extending from the periphery to the pupillary margin. A total of 23 (59%) cysts were in the lower temporal quadrant, 11 (28.2%) were in the lower nasal quadrant, and 5 (12.8%) were in the upper nasal quadrant. Cyst size was positively correlated with patient age (rs = 0.38, p = 0.003) and negatively correlated with visual acuity (rs = −0.42, p = 0.014). Cyst growth was not observed. The only complication was an increase in IOP in three (7.7%) patients with multiple cysts. The anatomical location of the cysts cannot differentiate them from solid tumors. The vast majority of cysts are asymptomatic, do not increase in size, and do not require treatment during long-term follow-up.

scholarly journals The Effects of Long-Term Administration of Sodium Nedocromil on Bronchial Hypereactivity

2003 ◽  
Vol 1 (3) ◽  
pp. 119-123 ◽  
Author(s):  
G. Ilonidis ◽  
G. Anogianakis ◽  
CH. Trakatelli ◽  
A. Anogeianaki ◽  
M. Chomatidis ◽  
...  
Keyword(s):  
Allergic Asthma ◽  
Term Treatment ◽  
Bronchial Hyperreactivity ◽  
Methacholine Challenge ◽  
Intrinsic Asthma ◽  
Group I ◽  
Long Term Treatment ◽  
The Mean ◽  
Group Ii

The effect of long-term treatment with sodium nedocromil on airway hypereactivity was investigated in two groups of 20 patients each. Group I patients presented with allergic asthma while Group II patients presented with intrinsic asthma. For each subject of the two groups, the base FEV1 was measured and nebulized methacholine was administrated in consecutively higher concentrations until a decrease in FEV1 of >20 % was observed. Following measurement, all patients included in the study were treated with 12 mg of sodium nedocromil per day for 12 months. At the end of the treatment, bronchial hyperreactivity was evaluated for a second time by administering the same dosage of methacholine that originally produced a decline in FEV1 of >20 %. In Group I patients (allergic asthma) mean FEV1 was 3126 ml, before challenge, while after methacholine challenge FEV1 was 2400ml. Following 1-year of sodium nedocromil administration the FEV1 was 2601ml (P<0.05). Before treatment, the mean fall in FEV1, following methacholine challenge, was 23.67% while following a 1-year-long sodium nedocromil administration this value reduced to 15.70% (P<0.05). Correspondingly, PC20 was 5.59 while after sodium nedocromil administration it increased to 11.66 (P<0.05). In Group II patients (intrinsic asthma) mean FEV1 was 2750 ml, before challenge, while after methacholine challenge FEV1 was 2066ml. Following 1-year of sodium nedocromil administration the FEV1 was 2223ml (P<0.05). Before treatment, the mean fall in FEV1, following methacholine challenge, was 27.65 % while following a 1-year-long sodium nedocromil administration this value reduced to 21.92 % (P<0.05). Correspondingly, PC20 was 5.91 while after sodium nedocromil administration it increased to 6.19 (P<0.05). The results suggest a positive effect of long-term sodium nedocromil administration in bronchial hyperreactivity for both groups of patients.

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