Intravitreal sustained-release ganciclovir implantation to control cytomegalovirus retinitis in AIDS

1998 ◽  
Vol 9 (4) ◽  
pp. 227-230 ◽  
Author(s):  
B Dhillon ◽  
A Kamal ◽  
C Leen
Keyword(s):  
Visual Acuity ◽  
Disease Progression ◽  
Systemic Therapy ◽  
Health Data ◽  
Cmv Retinitis ◽  
Intravenous Treatment ◽  
Fundus Photographs ◽  
Control Disease ◽  
And Control

A novel form of therapy, the intravitreal ganciclovir implant (Vitrasert), was used to treat cytomegalovirus (CMV) retinitis in AIDS, when it was not possible to continue systemic therapy or disease progression was evident despite conventional intravenous treatment. A review of the ophthalmic and general health data, operative records and fundus photographs of 9 individuals who had Vitrasert implantation surgery in Edinburgh. Two patients received bilateral replacement implant procedures. Visual acuity, concomitant anti-CMV therapy, complications of implantation and control of retinitis were documented until final follow-up. Control of CMV retinitis was achieved in all individuals at one month postoperatively and remained controlled for a mean period of 5.8 months. Postoperative complications were mild and transient in all but 2 eyes of 2 patients who developed non-progressive macula oedema. Blinding complications as a result of surgery were not encountered and retinal detachment was not observed in this series. Vitrasert implantation is an acceptable and well tolerated treatment for CMV retinitis when systemic therapy fails to control disease progression.

scholarly journals Effect of capsular tension ring implantation on capsular stability after phacoemulsification in patients with weak zonules: a randomized controlled trial. CTR implantation in cataract patients with weak zonules

2020 ◽  
Author(s):  
Shangfei Yang ◽  
Hui Jiang ◽  
Kailai Nie ◽  
Liwen Feng ◽  
Wei Fan
Keyword(s):  
Visual Acuity ◽  
Prediction Error ◽  
Controlled Trial ◽  
Clinical Trial Registry ◽  
Capsular Tension Ring ◽  
Distant Visual Acuity ◽  
Pars Plana ◽  
And Control ◽  
Cataract Patients

Abstract Background: The use of capsular tension ring (CTR) implantation to treat cataract patients with weak zonules is still controversial. The aim of this study was to examine the effects of CTR implantation on capsular stability after phacoemulsification in patients with weak zonules, especially patients who have undergone pars plana vitrectomy (PPV) or those who suffer from severe myopia.Methods: A total of 42 patients who underwent phacoemulsification and received an intraocular lens (IOL) were randomized to undergo CTR implantation or not. The control and CTR groups were compared in terms of uncorrected distant visual acuity (UDVA), best corrected distant visual acuity (BCDVA), refractive prediction error, the area of anterior capsulorhexis, and IOL inclination angle. Follow-up visits were conducted postoperatively at 1 day, 1 week, 1 month and 3 months. subgroup analyses were performed based on PPV and severe myopia. Results: Surgery significantly improved UDVA and BCDVA to similar extents in CTR and control patients, and refraction prediction error was similar between the two groups at all follow-up times. At 3 months after surgery, the area of anterior capsulorhexis was significantly larger in CTR patients than in controls (p = 0.0199). These differences were also significant between the subgroups of patients with severe myopia. Vertical IOL inclination was less within CTR groups at 3 months after surgery, especially in patients with severe myopia (p = 0.0286). At 1 week postoperatively, the proportion of individuals whose posterior lens capsule that had completely adhered to the posterior IOL surface was significantly higher among CTR patients (p = 0.023). No serious surgical complications were observed.Conclusion: CTR implantation can benefit cataract patients with weak zonules by maintaining the shape of the capsular bag, reducing capsule shrinkage and stabilizing IOL inclination.Trial registration: Chinese Clinical Trial Registry ChiCTR-INR-17011217, date of registration April 22, 2017, prospectively registered.

Effects of blunt trauma of eye on retinal nerve fibre layer

2021 ◽  
Vol 2 (4) ◽  
pp. 228-232
Author(s):  
Kumar Aalok ◽  
Keyword(s):  
Visual Acuity ◽  
Contrast Sensitivity ◽  
Blunt Trauma ◽  
Color Vision ◽  
Control Groups ◽  
Rnfl Thickness ◽  
Department Of Ophthalmology ◽  
Significant Difference ◽  
And Control

AIM: To study the effects of blunt trauma of eye on visual acuity and retinal nerve fiber layer (RNFL). METHODS: A prospective observational study was done on the patients of a road traffic accident (RTA) having blunt trauma injury of the eye from august 2018 to July 2019 at the Department of Ophthalmology, Hind Institute of Medical Sciences, Barabanki. Patients between the age group of 20 to 65 years undergoing RTA with ocular complaints were included in this study. Colour vision, contrast sensitivity, and best-corrected visual acuity (BCVA) were recorded, RNFL analysis was done through OCT. RESULTS: A total of 108 patients were enrolled in this study and were grouped as 54 cases and 54 controls. The mean age was 43±2.3 years with 11 (20.37%) females and 43 (79.6%) males in the case group. At initial visit after RTA, the difference between color vision, contrast sensitivity and BCVA between right and left eyes of cases and controls were significant. After a follow up of 3mo only significant difference was noted in contrast sensitivity between cases and control groups. Change in color vision and BCVA after 3mo was insignificant. Similarly, an initial significant difference was noted in mean RNFL thickness between cases and control groups, but after follow up of 3mo mean RNFL thickness difference was significant only in superior and temporal quadrants. CONCLUSION: RTA or blunt trauma of eye can lead to persistent RNFL thinning and decreased visual function.

Cytomegalovirus Retinitis Outcomes in HIV-Infected and Non–HIV Patients at a Tertiary Care Center

2017 ◽  
Vol 1 (1) ◽  
pp. 57-64 ◽  
Author(s):  
Anton Orlin ◽  
Jennifer Nadelmann ◽  
Mrinali Gupta ◽  
Sarju Patel ◽  
Donald J. D’Amico ◽  
...  
Keyword(s):  
Risk Factors ◽  
Visual Acuity ◽  
Care Center ◽  
Tertiary Care ◽  
Significant Risk ◽  
Final Visual Acuity ◽  
Tertiary Care Center ◽  
Hiv Patients ◽  
Cmv Retinitis

Purpose: To describe cytomegalovirus (CMV) retinitis outcomes in HIV-infected and non–HIV patients at a tertiary care center. Participants: Twenty-six eyes from 20 patients with active CMV retinitis were included in this study. Patients were immunocompromised due to HIV or secondary to immunosuppressive therapy for malignancy and organ transplantation. Methods: This is a retrospective, observational study of patients with newly diagnosed active CMV retinitis. The main outcomes included the incidence of visual acuity loss, the loss of visual acuity to 20/200 or worse, and the loss of 3 lines of vision or more. Secondary outcomes included the identification of risk factors for these visual results and the development of various complications such as retinal detachment (RD) and cataract formation. Results: In all, 51.9% (n = 14) of eyes lost vision from baseline at most recent follow-up and 34.6% (n = 9) lost 3 lines or more of vision, 34.6% (n = 9) of the eyes lost significant vision at most recent follow-up and had a final vision of 20/200 or worse, and 22.73% of phakic eyes underwent cataract surgery, whereas 23.1% (n = 6) of eyes developed RD. Patients presenting with a CD4+ T-cell count <100 cells/µL were more likely to lose vision when compared to those presenting with a count >100 cells/µL ( P = .0440). Although not statistically significant, patients who were immunocompromised due to HIV were less likely to lose 3 or more lines of vision ( P = .1881) and less likely to have a final visual acuity of 20/200 or worse ( P = .1881), when compared to patients who were immunocompromised due to other reasons. There was also a nonsignificant trend for eyes affected by a larger area of CMV retinitis at baseline (>25%) to have a final visual acuity of 20/200 or worse when compared to eyes with CMV retinitis involving <25% of the total retina ( P = .089). We did not detect trends or associations between any other risk factors tested and visual outcomes. We did not identify an association between HIV status and baseline area or zone affected by CMV retinitis. Conclusions: Our cohort demonstrated that CMV retinitis remains a vision-threatening problem among patients who are immunocompromised due to HIV or other conditions. Immunocompromised patients are still at a significant risk of vision loss and complications from CMV retinitis and should be managed by a multidisciplinary team of physicians. In the immediate future, improved therapies are necessary to achieve immune recovery in patients, particularly for those remaining chronically immunosuppressed.

High-dose (5000-μg) Intravitreal Ganciclovir Combined with Highly Active Antiretroviral Therapy for Cytomegalovirus Retinitis in HIV-Infected Patients in Venezuela

2005 ◽  
Vol 15 (5) ◽  
pp. 610-618 ◽  
Author(s):  
J.F. Arevalo ◽  
R.A. Garcia ◽  
A.J. Mendoza
Keyword(s):  
Visual Acuity ◽  
Highly Active Antiretroviral Therapy ◽  
Control Group ◽  
High Dose ◽  
Complete Regression ◽  
Cmv Retinitis ◽  
Highly Active ◽  
High Doses ◽  
Haart Therapy

Purpose To describe the use of high doses of intravitreal ganciclovir combined with highly active antiretroviral therapy (HAART) for the treatment of cytomegalovirus (CMV) retinitis in human immunodeficiency virus (HIV)-infected patients. Methods Thirteen HIV-infected patients (18 eyes) with active CMV retinitis (83.3% in zone 1 and 38.4% resistant) participated in this prospective interventional case series. Patients were treated with high dose intravitreal ganciclovir (5.0 mg/0.1 mL once a week) in combination with HAART therapy. Intravitreal injections were discontinued once CMV retinitis healed if there was a significant increase in CD4+ count (any increase of ≥50 cells/μL to levels over 100 cells/μL sustained for at least 3 months). Mean follow-up was 15.6 months. Main outcome measures included assessment of visual acuity and retinal inflammation (CMV retinitis activity). A matched historical control group of 20 eyes (15 patients) with CMV retinitis treated with systemic ganciclovir (intravenous [induction] and oral [maintenance]) was included. Results Complete regression of the retinitis was obtained with high doses of intravitreal ganciclovir in 88.8% of eyes (two patients died during follow-up) at a mean of 4.5 weeks (2 to 8 weeks). Visual acuity improved two or more lines in 61.1% of eyes. No ganciclovir retinal toxicity was identified. Three eyes presented CMV retinitis reactivation at a mean of 25.6 days after their last injection. Complications (33.3%) included retinal detachment (RD; 3 eyes), immune recovery uveitis (IRU; 2 eyes), and endophthalmitis (1 eye). In our control group complete regression of the retinitis was obtained in 100% of eyes at a mean of 4 weeks (3 to 7 weeks). However, 12 eyes (60%) presented with CMV retinitis relapse at a mean of 29 days (21 to 32 days) after initiating oral ganciclovir (maintenance). Complications included RD (7 eyes, 35%) and IRU (3 eyes, 15%). Severe neutropenia occurred in 2 patients (13%). Conclusions High doses of intravitreal ganciclovir (5.0 mg) once a week in combination with HAART therapy is effective to control CMV retinitis, and may be discontinued after CMV retinitis has healed if immune reconstitution with a significant increase in CD4+ count has occurred.

scholarly journals Effect of capsular tension ring implantation on capsular stability after phacoemulsification in patients with weak zonules:a randomized controlled trail.

2020 ◽  
Author(s):  
Shangfei Yang ◽  
Hui Jiang ◽  
Kailai Nie ◽  
Liwen Feng ◽  
Wei Fan
Keyword(s):  
Visual Acuity ◽  
Prediction Error ◽  
Randomized Controlled ◽  
Capsular Tension Ring ◽  
Distant Visual Acuity ◽  
Pars Plana ◽  
Randomized Controlled Trail ◽  
And Control ◽  
Capsular Bag

Abstract Background: Patients who had previously undergone pars plana vitrectomy (PPV) or who had severe myopia may have weaker zonules, for which a capsular tension ring (CTR) implantation is still controversial. This study is to test the effect of CTR implantation on capsular stability after phacoemulsification in those patients. Methods: A total of 42 patients who underwent phacoemulsification and received an intraocular lens (IOL) were randomized to undergo CTR implantation or not. The primary outcomes were uncorrected distant visual acuity (UDVA), best corrected distant visual acuity (BCDVA), refractive prediction error, the area of anterior capsulorhexis, and IOL inclination angle. Follow-up visits were conducted postoperatively at 1 day, 1 week, 1 month and 3 months. Outcomes were compared between all CTR and control patients, as well as between subgroups who had previously undergone PPV or who had severe myopia. Results: Surgery significantly improved UDVA and BCDVA to similar extents in CTR and control patients, and refraction prediction error was similar between the two groups at all follow-up times. At 3 months after surgery, the area of anterior capsulorhexis was significantly larger in CTR patients than in controls (p = 0.0199). These differences were also significant between the subgroups of patients with strong myopia. Vertical IOL inclination was less within CTR groups at 3 months after surgery, especially in patients with severe myopia(p=0.0286). At 1 week postoperatively, the proportion of individuals whose posterior lens capsule that had completely adhered to the posterior IOL surface was significantly higher among CTR patients (p = 0.023). No serious surgical complications were observed. Conclusion: CTR implantation can benefit cataract patients with weak zonules by maintaining the shape of the capsular bag, reducing capsule shrinkage and stabilizing IOL inclination.

scholarly journals Effect of capsular tension ring implantation on capsular stability after phacoemulsification in patients with weak zonules:a randomized controlled trail. CTR implantation in cataract patients with weak zonules

2020 ◽  
Author(s):  
Shangfei Yang ◽  
Hui Jiang ◽  
Kailai Nie ◽  
Liwen Feng ◽  
Wei Fan
Keyword(s):  
Visual Acuity ◽  
Prediction Error ◽  
Clinical Trial Registry ◽  
Capsular Tension Ring ◽  
Distant Visual Acuity ◽  
Pars Plana ◽  
Randomized Controlled Trail ◽  
And Control ◽  
Cataract Patients

Abstract Background Patients who had previously undergone pars plana vitrectomy (PPV) or who had severe myopia may have weaker zonules, for which a capsular tension ring (CTR) implantation is still controversial. This study is to test the effect of CTR implantation on capsular stability after phacoemulsification in those patients. Methods A total of 42 patients who underwent phacoemulsification and received an intraocular lens (IOL) were randomized to undergo CTR implantation or not. The primary outcomes were uncorrected distant visual acuity (UDVA), best corrected distant visual acuity (BCDVA), refractive prediction error, the area of anterior capsulorhexis, and IOL inclination angle. Follow-up visits were conducted postoperatively at 1 day, 1 week, 1 month and 3 months. Outcomes were compared between all CTR and control patients, as well as between subgroups who had previously undergone PPV or who had severe myopia. Results Surgery significantly improved UDVA and BCDVA to similar extents in CTR and control patients, and refraction prediction error was similar between the two groups at all follow-up times. At 3 months after surgery, the area of anterior capsulorhexis was significantly larger in CTR patients than in controls (p = 0.0199). These differences were also significant between the subgroups of patients with strong myopia. Vertical IOL inclination was less within CTR groups at 3 months after surgery, especially in patients with severe myopia(P = 0.0286). At 1 week postoperatively, the proportion of individuals whose posterior lens capsule that had completely adhered to the posterior IOL surface was significantly higher among CTR patients (p = 0.023). No serious surgical complications were observed. Conclusion CTR implantation can benefit cataract patients with weak zonules by maintaining the shape of the capsular bag, reducing capsule shrinkage and stabilizing IOL inclination. Trail Registration: This study was registered at the Chinese Clinical Trial Registry (ChiCTR-INR-17011217).

scholarly journals Intravenous Immunoglobulin for Management of Non-paraneoplastic Autoimmune Retinopathy

2020 ◽  
Author(s):  
Sahba Fekri ◽  
Masoud Soheilian ◽  
Babak Rahimi-Ardabili
Keyword(s):  
Visual Acuity ◽  
Disease Progression ◽  
Intravenous Immunoglobulin ◽  
Multimodal Imaging ◽  
Visual Field Loss ◽  
Clinical History ◽  
Autoimmune Retinopathy ◽  
One Year ◽  
The One

Purpose: To report a case of non-paraneoplastic autoimmune retinopathy (npAIR) treated with intravenous immunoglobulin (IVIG). Case report: A 12-year-old boy presented with progressive visual field loss, nyctalopia, and flashing for three months. He had suffered from common cold two weeks before the onset of these symptoms. On the basis of clinical history and paraclinical findings, he was diagnosed with npAIR, and IVIG without immunosuppressive therapy was started. During the one-year follow-up period after the first course of IVIG, flashing disappeared completely. Visual acuity remained 10/10, but nyctalopia did not improve. Multimodal imaging showed no disease progression. Conclusion: Although established retinal degenerative changes seem irreversible in npAIR, IVIG may be a suitable choice to control the disease progression.

Radical prostatectomy as a component of multimodal therapy for highly selected M1 prostate cancer patients.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 251-251
Author(s):  
Matthew O'Shaughnessy ◽  
James Andrew Eastham ◽  
Bernard H. Bochner ◽  
Vincent Paul Laudone ◽  
Brett Stewart Carver ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lymph Node ◽  
Disease Progression ◽  
Lymph Node Dissection ◽  
Systemic Therapy ◽  
Multimodal Therapy ◽  
Node Dissection ◽  
Metastatic Burden

251 Background: Men who present with limited metastasis at the time of prostate cancer (PCa) diagnosis are typically managed with systemic therapy alone and the primary site of disease is not addressed. Systemic therapy with recently approved agents has been shown to improve survival in men with metastatic PCa; however the role of local therapy remains untested. Here, we examine the role of definitive surgical treatment of the primary tumor in a multimodal approach to highly selected patients with oligometastatic disease to maximize local and systemic cancer control. Methods: 20 patients with limited metastatic burden underwent RP as a component of multimodal therapy. Baseline characteristics, details of management, surgical outcomes, and disease progression defined as initiation of chemotherapy, new metastasis, or reinitiation of ADT were characterized. Results: Median age at RP was 61 years. Metastatic burden was assessed with whole body imaging; 17 of 20 patients had bone metastases (mets) (median 1, IQR 1,3) and 7 of 20 patients had retroperitoneal node mets. No patients had visceral mets. All patients had RP and pelvic lymph node dissection; 4 patients also had retroperitoneal lymph node dissection. There was one grade III surgical complication. 75% of patients reported continence within 12 months of RP. Patients received RT to bone (n=10), bone and pelvis (n=4), or no RT (n=6). Median neoadjuvant ADT was 4 months (IQR 3, 5) for all patients and neoadjuvant + adjuvant ADT was 9 months (IQR 6, 10) in 11 patients who discontinued ADT. At median follow-up of 19 months (IQR 10, 33) since RP, 12-month PFS was 65% (95%CI 35, 84). Among the 11 patients who discontinued ADT, 5 were non-castrate and had no evidence of disease progression. 4 patients had continuous ADT due to disease progression. There were no local recurrences after surgery. Conclusions: Multimodal therapy that includes RP is feasible and well-tolerated with acceptable low rate of surgical complications and good return of urinary continence. ADT was discontinued in a limited number of patients without signs of disease progression at short-term follow-up. Further evaluation of this therapeutic strategy should be considered in a prospective clinical trial.

Reduced fluence corneal cross-linking in mild to moderate keratoconus: One year-follow-up

2020 ◽  
pp. 112067212096656
Author(s):  
Seyed Reza Ghaffari ◽  
Saeed Khaheshi ◽  
Fateme Alipour ◽  
Somayye Mashhadi Farahani ◽  
Amir-Hooshang Beheshtnejad ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Eligible Patient ◽  
Case Series ◽  
Control Group ◽  
Data Analyst ◽  
Cell Counts ◽  
Group 2 ◽  
One Year ◽  
And Control

Purpose: To evaluate the safety and efficacy of reduced fluence CXL (lower dose of UV-A irradiation) in mild to moderate keratoconus. Setting: Farabi Eye Hospital, Tehran, Iran. Design: Non-randomized prospective comparative interventional case series. Every eligible patient included in the study (mild to moderate progressive keratoconus) was randomly allocated to case (reduced fluence) and control (standard) groups, except for bilateral patients. In these patients the eye with more advanced disease was allocated to control group and the other eye was randomly assigned in either case or control group. Operators performing refraction and images and the data analyst were masked, but patients and physicians were not. Methods: Forty-six eyes of 38 patients were recruited. Group 1 received 7 min (fluence of 3.8 J/cm2), while group 2 received 10 min of 9 mW/cm2 UV-A (fluence of 5.4 J/cm2). Visual, keratometric and biomechanical outcomes were compared between groups. Results: At last follow-up (mean12 months, range 6–24 months), there were no statistically significant differences in changes in uncorrected visual acuity, best corrected distance visual acuity, Kmax, Kmean, corneal hysteresis, corneal resistance factor, endothelial cell counts, demarcation line depth, and intraoperative pain scores between groups (all p-values < 0.05). Conclusion: The results of this study show comparable one-year outcomes between 3.8 and 5.4 J/cm2 accelerated CXL in mild to moderate keratoconus. Should the results of this study be confirmed in longer follow-ups, using a reduced fluence setting could be considered as an alternative to standard treatment in these patients.

scholarly journals Effect of capsular tension ring implantation on capsular stability after phacoemulsification in patients with weak zonules: a randomized controlled trial. CTR implantation in cataract patients with weak zonules

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shangfei Yang ◽  
Hui Jiang ◽  
Kailai Nie ◽  
Liwen Feng ◽  
Wei Fan
Keyword(s):  
Visual Acuity ◽  
Prediction Error ◽  
Controlled Trial ◽  
Clinical Trial Registry ◽  
Capsular Tension Ring ◽  
Distant Visual Acuity ◽  
Pars Plana ◽  
And Control ◽  
Cataract Patients

Abstract Background The use of capsular tension ring (CTR) implantation to treat cataract patients with weak zonules is still controversial. The aim of this study was to examine the effects of CTR implantation on capsular stability after phacoemulsification in patients with weak zonules, especially patients who have undergone pars plana vitrectomy (PPV) or those who suffer from severe myopia. Methods A total of 42 patients who underwent phacoemulsification and received an intraocular lens (IOL) were randomized to undergo CTR implantation or not. The control and CTR groups were compared in terms of uncorrected distant visual acuity (UDVA), best corrected distant visual acuity (BCDVA), refractive prediction error, the area of anterior capsulorhexis, and IOL inclination angle. Follow-up visits were conducted postoperatively at 1 day, 1 week, 1 month and 3 months. Subgroup analyses were performed based on PPV and severe myopia. Results Surgery significantly improved UDVA and BCDVA to similar extents in CTR and control patients, and refraction prediction error was similar between the two groups at all follow-up times. At 3 months after surgery, the area of anterior capsulorhexis was significantly larger in CTR patients than in controls (p = 0.0199). These differences were also significant between the subgroups of patients with severe myopia. Vertical IOL inclination was less within CTR groups at 3 months after surgery, especially in patients with severe myopia (p = 0.0286). At 1 week postoperatively, the proportion of individuals whose posterior lens capsule that had completely adhered to the posterior IOL surface was significantly higher among CTR patients (p = 0.023). No serious surgical complications were observed. Conclusion CTR implantation can benefit cataract patients with weak zonules by maintaining the shape of the capsular bag, reducing capsule shrinkage and stabilizing IOL inclination. Trial registration Chinese Clinical Trial Registry ChiCTR-INR-17011217, date of registration April 22, 2017, prospectively registered.

Sign in / Sign up

Export Citation Format

Share Document