scholarly journals The Optimization of an Anti-VEGF Therapeutic Regimen for Neovascular Glaucoma

2022 ◽  
Vol 8 ◽  
Author(s):  
Ling Bai ◽  
Yanfen Wang ◽  
Xindi Liu ◽  
Yuping Zheng ◽  
Wenjing Wang ◽  
...  
Keyword(s):  
Mitomycin C ◽  
Neovascular Glaucoma ◽  
Stage Iii ◽  
Safety And Efficacy ◽  
Corrected Visual Acuity ◽  
Intracameral Injection ◽  
Pan Retinal Photocoagulation ◽  
Three Stages ◽  
To Receive ◽  
Retinal Photocoagulation

This study investigates the safety and efficacy of conbercept injection through different routes for neovascular glaucoma (NVG) treatment, in which seventy-four patients (81 eyes) with NVG caused by ischemia retinopathy had participated. Patients were divided into three stages according to the progression of NVG and were randomly assigned to receive intracameral or intravitreal conbercept injection. After conbercept injection, patients experienced improved best-corrected visual acuity (BCVA), good intraocular pressure (IOP) control, and neovascularization of Iris (NVI) regression. In stage III, patients required trabeculectomy with mitomycin C plus pan-retinal photocoagulation (PRP) to achieve complete NVI regression. Compared to the intravitreal group, the intracameral group had significantly lower IOP in 2 days in stage III and 1 day in stages I and II after injection, complete NVI regression before PRP in stages I and II, and better NVI regression in stage III. The rates of hyphema after trabeculectomy and malfunction filtering bleb suffering needle bleb revision were lower in the intracameral group, but only the hyphema rate was significantly different. Injections through different routes are all safe. We recommend intravitreal injections for patients in stages I and II, but for stage III, intracameral injection is better, and trabeculectomy with mitomycin C should be conducted within 2 days after injection to maximally reduce the risk of perioperative hyphema.Trial Registration:ClinicalTrials.gov, identifier NCT03154892.

scholarly journals Intracameral anti-VEGF injection for advanced neovascular glaucoma after vitrectomy with silicone oil tamponade

2021 ◽  
Vol 14 (3) ◽  
pp. 456-460
Author(s):  
Ling Bai ◽  
◽  
Yi-Dan He ◽  
Shu Zhang ◽  
Feng Wang ◽  
...  
Keyword(s):  
Silicone Oil ◽  
Time Window ◽  
Neovascular Glaucoma ◽  
Optimal Time ◽  
Intracameral Injection ◽  
Pan Retinal Photocoagulation ◽  
Before And After ◽  
Silicone Oil Tamponade ◽  
Retinal Photocoagulation

AIM: To evaluate the effect of intracameral injection of conbercept for the treatment of advanced neovascular glaucoma (NVG) after vitrectomy with silicone oil tamponade. METHODS: Conbercept 0.5 mg/0.05 mL was injected into the anterior chamber of 5 eyes, which had developed advanced NVG after vitrectomy with silicone oil tamponade. Then, trabeculectomy with mitomycin C and pan-retinal photocoagulation (PRP) or extra-PRP were conducted within 2d. The follow-up time was 6mo. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), neovascularization of iris (NVI) were recorded before and after treatment. RESULTS: Within 2d after injection, IOP control, and NVI regression were optimal for trabeculectomy. Hyphema occurred in one eye in the process of injection. But none of them present hyphema after trabeculectomy. At the end of follow-up time, all eyes had improved BCVA, well-controlled IOP, and completely regressed NVI. CONCLUSION: Intracameral injection of conbercept is safe and effective in the treatment of patients with advanced NVG after vitrectomy with silicone oil tamponade. Within 2d after injection is the optimal time window for trabeculectomy, which can maximally reduce the risk of perioperative hyphema.

scholarly journals Low Luminance Visual Acuity and Low Luminance Deficit in Proliferative Diabetic Retinopathy

2021 ◽  
Vol 10 (2) ◽  
pp. 358
Author(s):  
Eleni Karatsai ◽  
Piyali Sen ◽  
Sarega Gurudas ◽  
Sobha Sivaprasad
Keyword(s):  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Proliferative Diabetic Retinopathy ◽  
Low Luminance ◽  
Pan Retinal Photocoagulation ◽  
Treatment Naïve ◽  
The Mean ◽  
Post Hoc ◽  
To Receive ◽  
Retinal Photocoagulation

This study aimed to determine the relation of best corrected visual acuity (BCVA) and low luminance visual acuity (LLVA) in proliferative diabetic retinopathy (PDR) following treatment with either aflibercept or pan-retinal photocoagulation (PRP). The study was conducted as a post-hoc analysis of the CLARITY trial in which naïve and PRP treated PDR patients were randomised to receive either aflibercept or PRP. BCVA and LLVA were assessed at baseline and at week 52. Our analyses showed that the BCVA and LLVA correlate well in treatment naïve PDR with an average low luminance deficit of 11.79 Early Treatment Diabetic Retinopathy Score (ETDRS) letters. However, LLVA at lower levels of BCVA showed more variance. Post aflibercept therapy, the mean change in BCVA and LLVA at 52 weeks after aflibercept was +2.1 (SD 6.05) letters and +0.39 (SD 5.6) letters, respectively. Similarly, after PRP, it was −2.5 (SD 4.9) letters and −1.9 (SD 8.7) letters, respectively. When comparing treatment arms, BCVA change was found to be statistically significant (p < 0.001) whereas LLVA was not (p = 0.11). These findings show that LLVA does not respond as well as BCVA following any treatment for PDR, even though BCVA and LLVA both test foveal function.

scholarly journals Descemet membrane suturing to manage recurrent graft detachment in a patient with Descemet membrane endothelial keratoplasty on failed penetrating keratoplasty

2021 ◽  
Vol 13 ◽  
pp. 251584142110277
Author(s):  
Zahra Ashena ◽  
Thomas Hickman-Casey ◽  
Mayank A. Nanavaty
Keyword(s):  
Visual Acuity ◽  
Penetrating Keratoplasty ◽  
Anterior Segment ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Descemet Membrane ◽  
Ocular Coherence Tomography ◽  
Corrected Visual Acuity ◽  
Intracameral Injection ◽  
History Of

A 65-year-old patient with history of keratoconus, mild cataract and penetrating keratoplasty over 30 years ago developed corneal oedema subsequent of graft failure with best corrected visual acuity (BCVA) of counting fingers. He underwent a successful cataract surgery combined with a 7.25 mm Descemet’s Membrane Endothelial Keratoplasty (DMEK) with Sodium Hexafluoride (SF6) gas. His cornea remained oedematous inferiorly at 4 weeks, despite two subsequent re-bubbling due to persistent DMEK detachment inferiorly. This was managed by three radial full thickness 10-0 nylon sutures placed in the inferior cornea along with intracameral injection of air. Following this, his anterior segment ocular coherence tomography (OCT) confirmed complete attachment of the graft, and the sutures were removed 4 weeks later. Unaided visual acuity was 20/63 and BCVA was 20/32 after 8 months. DMEK suturing can be helpful in persistent DMEK detachments, which is refractory to repeated re-bubbling due to uneven posterior surface of previous PK.

scholarly journals Accidental Corneal Intrastromal Intraocular Lens Implantation with the Wound-Assisted Technique and Clinical Course with Anterior Segment Optical Coherence Tomography

2021 ◽  
pp. 283-287
Author(s):  
Jo Moriya ◽  
Shinichi Sakamoto ◽  
Satoru Inoda ◽  
Hidenori Takahashi ◽  
Hidetoshi Kawashima
Keyword(s):  
Optical Coherence Tomography ◽  
Intraocular Lens ◽  
Anterior Segment ◽  
Corneal Stroma ◽  
Age Related Macular Degeneration ◽  
Optical Coherence ◽  
Corrected Visual Acuity ◽  
Age Related ◽  
Intracameral Injection ◽  
Air Tamponade

Accidental intraocular lens (IOL) implantation into the corneal stroma is a rare clinical entity that can occur during the wound-assisted technique. In this report, we describe a case of an 81-year-old man who underwent cataract surgery in which the IOL was implanted into the corneal stroma with the wound-assisted technique, and we present changes in anterior segment optical coherence tomography. The IOL was removed and reinserted after widening the incision. Air tamponade was created by intracameral injection. An anterior chamber tap was performed 10 h later to reduce increased intraocular pressure. Interlayer separation of the corneal stroma was confirmed 30 min postoperatively but was corrected 4 days later. The patient’s best-corrected visual acuity (BCVA) was logMAR 0.30, and he had been diagnosed with age-related macular degeneration before surgery. Although the opacity of the corneal stroma persisted, BCVA improved to logMAR 0. When using the wound-assisted technique for IOL insertion, surgeons should take care not to implant the IOL into the corneal stroma.

Results of complicated cataract surgery in patients with neovascular glaucoma in case of diabetic proliferative retinopathy or postthrombotic macular edema

2021 ◽  
pp. 17-21
Author(s):  
L.N. Boriskina ◽  
◽  
A.S. Zotov ◽  
A.S. Balalin ◽  
S.V. Balalin ◽  
...  
Keyword(s):  
Cataract Surgery ◽  
Macular Edema ◽  
Neovascular Glaucoma ◽  
Proliferative Retinopathy ◽  
Iol Implantation ◽  
Second Stage ◽  
Corrected Visual Acuity ◽  
Complicated Cataract ◽  
Diabetic Proliferative Retinopathy ◽  
Transscleral Cyclophotocoagulation

Objective. To evaluate the results of complicated cataract surgery in patients with neovascular glaucoma in case of diabetic proliferative retinopathy or postthrombotic macular edema. Material and methods. A retrospective study of the complicated cataract surgery with IOL implantation results was performed in 38 patients (38 eyes) with neovascular glaucoma. The first stage was Lucentis intravitreal injection, then after 2 weeks intraocular pressure (IOP) under combined medical therapy was determined: 1) if IOP was <25 mm Hg, then phacoemulsification was performed; 2) if IOP remained >25 mm Hg, the second stage was transscleral cyclophotocoagulation, and 2 weeks later – cataract phacoemulsification. Results. All patients with neovascular glaucoma had significant increase of the best corrected visual acuity from the initial level on the 1st day, 1- and 3-months post-op. IOP values under medical treatment corresponded to the range of the average statistical norm. There was no recurrence of neovascularization or IOP increase. Conclusion. The application of Lucentis intravitreal injections as well as IOP lowering to the average statistical norm range under medication or laser surgery provide the basis for an effective and safe complicated cataract surgery with IOL implantation in patients with neovascular glaucoma in case of diabetic proliferative retinopathy or post-thrombotic macular edema. Key words: cataract, neovascular glaucoma, phacoemulsification.

Thoracic radiotherapy PLUS durvalumab in elderly and/or frail NSCLC stage III patients unfit for chemotherapy: Employing optimized (hypofractionated) radiotherapy to foster durvalumab efficacy—The TRADE-hypo trial.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. TPS8585-TPS8585
Author(s):  
Farastuk Bozorgmehr ◽  
Jessica Juergens ◽  
Michaela Hammer-Hellmig ◽  
Christian Meyer Zum Bueschenfelde ◽  
Johannes Classen ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Objective Response ◽  
Stage Iii ◽  
Hypofractionated Radiotherapy ◽  
Poor Performance Status ◽  
Thoracic Radiotherapy ◽  
Therapy Algorithm ◽  
Safety And Efficacy ◽  
Unresectable Stage ◽  
Stage Iii Nsclc

TPS8585 Background: Non-small cell lung cancer (NSCLC) is the most common cause of cancer death worldwide highlighting the importance of improving current therapeutic options. In particular, elderly and frail patients are not only underrepresented in clinical trials, but also frequently do not receive standard treatment regimens due to comorbidities. For example, patients with unresectable stage III NSCLC who are unfit for chemotherapy (CHT) do not benefit from the recent seminal therapy algorithm change for this disease, i.e. consolidation therapy with the immune checkpoint inhibitor (ICI) durvalumab after combined radiochemotherapy (RChT). Instead, these patients are treated with radiotherapy only, raising the serious concern of undertreatment. This issue is addressed by the TRADE-hypo clinical trial that investigates a novel therapy option for NSCLC stage III patients not capable of receiving CHT. To this end, thoracic radiotherapy (TRT) is administered together with durvalumab, employing the synergism created by the combination of restoring anti-tumor immune response by the ICI with the induction of immunogenicity by irradiation. The latter effect has been suggested to be further boosted by hypofractionated radiotherapy, which could also be more practicable for the patient. Taken these considerations into account, the TRADE-hypo trial addresses safety and efficacy of durvalumab therapy combined with either conventional or hypofractionated TRT. Methods: The TRADE-hypo trial is a prospective, randomized, open-label, multicentric phase II trial. Eligible patients are diagnosed with unresectable stage III NSCLC and not capable of receiving sequential RChT due to high vulnerability as reflected by a poor performance status (ECOG 2 or ECOG1 and CCI≥ 1) and/or high age (≥ 70)]. Two treatment groups are evaluated: Both receive durvalumab (1,5000 mg, Q4W) for up to 12 months. In the CON-group this is combined with conventionally fractionated TRT (30 x 2 Gy), while in the HYPO-group patients are treated with hypofractionated TRT (20 x 2.75 Gy). In the HYPO-arm, a safety stop-and-go lead-in phase precedes full enrollment. Here, patients are closely monitored with regard to toxicity (i.e., pneumonitis grade ≥ 3 within 8 weeks after TRT) in small cohorts of 6. The primary objective of the trial is safety and tolerability. As a primary efficacy endpoint, the objective response rate after 3 months will be evaluated. Further endpoints are additional parameters of safety and efficacy, as well as the comprehensive collection of biomaterials to be analyzed regarding treatment-induced changes and potential novel biomarkers. As of February 10, 2021, 9 patients of planned 88 patients have been enrolled in the TRADE-hypo trial. Clinical trial information: NCT04351256.

scholarly journals Prevention of adhesions post-abdominal surgery: Assessing the safety and efficacy of Chitogel with Deferiprone in a rat model

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0244503
Author(s):  
Rajan Sundaresan Vediappan ◽  
Catherine Bennett ◽  
Clare Cooksley ◽  
John Finnie ◽  
Markus Trochsler ◽  
...  
Keyword(s):  
Tensile Strength ◽  
Abdominal Surgery ◽  
Rat Model ◽  
Adhesion Formation ◽  
Pelvic Surgery ◽  
Albino Rats ◽  
Adhesion Barrier ◽  
Midline Laparotomy ◽  
Safety And Efficacy ◽  
To Receive

Introduction Adhesions are often considered to be an inevitable consequence of abdominal and pelvic surgery, jeopardizing the medium and long-term success of these procedures. Numerous strategies have been tested to reduce adhesion formation, however, to date, no surgical or medical therapeutic approaches have been successful in its prevention. This study demonstrates the safety and efficacy of Chitogel with Deferiprone and/or antibacterial Gallium Protoporphyrin in different concentrations in preventing adhesion formation after abdominal surgery. Materials and methods 112 adult (8–10 week old) male Wistar albino rats were subjected to midline laparotomy and caecal abrasion, with 48 rats having an additional enterotomy and suturing. Kaolin (0.005g/ml) was applied to further accelerate adhesion formation. The abrasion model rats were randomized to receive saline, Chitogel, or Chitogel plus Deferiprone (5, 10 or 20 mM), together with Gallium Protoporphyrin (250μg/mL). The abrasion with enterotomy rats were randomised to receive saline, Chitogel or Chitogel with Deferiprone (1 or 5 mM). At day 21, rats were euthanised, and adhesions graded macroscopically and microscopically; the tensile strength of the repaired caecum was determined by an investigator blinded to the treatment groups. Results Chitogel with Deferiprone 5 mM significantly reduced adhesion formation (p<0.01) when pathologically assessed in a rat abrasion model. Chitogel with Deferiprone 5 mM and 1 mM also significantly reduced adhesions (p<0.05) after abrasion with enterotomy. Def-Chitogel 1mM treatment did not weaken the enterotomy site with treated sites having significantly better tensile strength compared to control saline treated enterotomy rats. Conclusions Chitogel with Deferiprone 1 mM constitutes an effective preventative anti-adhesion barrier after abdominal surgery in a rat model. Moreover, this therapeutic combination of agents is safe and does not weaken the healing of the sutured enterotomy site.

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