Search

Lavnish Joshi,1–3 Asaf Bar,4 Oren Tomkins-Netzer,1,3 Satish Yaganti,1 Jiten Morarji,1 Panayiotis Vouzounis,1 Sophie Seguin-Greenstein,1,4 Simon R Taylor,3,5 Sue Lightman1,3 1Department of Clinical Ophthalmology, UCL Institute of Ophthalmology and Moorfields Eye Hospital, London, UK; 2Ophthalmology Department, Ashford & St Peter’s NHS Foundation Trust, Ashford, Middlesex, UK; 3Ophthalmology Department, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, UK; 4Ophthalmology Department, Wolfson Medical Center, Holon Israel; 5Ophthalmology Department, University of Surrey, Guildford, Surrey, UK Background: Outcomes of intravitreal antivascular endothelial growth factor injections are variable among patients with diabetic macular edema (DME). The aim of this study was to determine the ocular and systemic predictors of DME response to intravitreal bevacizumab (IVB). Methods: Retrospective review over 2 years of 78 eyes from 54 patients. An anatomical response to IVB was defined as a 20% reduction in central macula thickness after the first course (three injections) of IVB. Results: Twenty-eight percent of patients had an anatomical response after the first course of IVB. Systemic hypertension (odds ratio, 95% confidence interval: 12.1, 0.7–21) was a statistically significant predictor (P=0.025) of a good response to IVB, whereas previous macular laser was a statistically significant (P=0.0005) predictor of a poor response (0.07, 0.01–0.32). Sixty-eight percent of eyes underwent subsequent treatment for DME after the first course of IVB. The visual acuity gain at 24 months in hypertensive (0.7±3.6 letters) and nonhypertensive (5.2±3.7 letters) patients was not significantly different (P=0.41). Conclusion: Hypertension and previous macular laser were positive and negative predictors of response to IVB, respectively. However, long-term visual acuity changes were not significantly different between eyes with and without systemic hypertension. Keywords: diabetes, macular edema, intravitreal therapy

Use of iodinated contrast media (ICM) for angiography can result in contrast-induced nephropathy (CIN). Gadolinium-based contrast media (GCM) have been used in angiography with a goal to reduce the incidence of CIN. We performed a retrospective analysis involving 85 patients with renal insufficiency who underwent 97 carotid artery angiography and stenting (CAAS) procedures with a combination of GCM and ICM. The incidence of peri-procedural death, Q wave myocardial infarction (QWMI), stroke and CIN were recorded. Patients in GCM group had worse preprocedure renal function compared to ICM group. There were no peri-procedural deaths or QWMI in both groups. The incidence of stroke was 2.2% in GCM group and 0% in ICM group. The incidence of CIN were similar in GCM and ICM groups (8.5% vs. 10%, respectively, p NS). However, the predicted risk of CIN was 18.5% for GCM group and 10.4% for ICM group. Use of GCM and ICM combination for CAAS resulted in a 50% reduction in the incidence of predicted CIN risk compared to ICM. [ABSTRACT FROM AUTHOR]

Purpose: To describe the long-term outcome of eyes with uveitis after repeated treatment with dexamethasone implants (Ozurdex; Allergan, Inc., Irvine, CA)., Design: Retrospective, observational case series., Participants: Thirty-eight eyes of 27 patients with uveitis that were treated with 61 dexamethasone implants., Methods: All eyes underwent dexamethasone pellet implantation. Anatomic and functional outcomes, as well as ocular complications, were noted., Main Outcome Measures: Best-corrected visual acuity (BCVA), central retinal thickness (CRT), vitreous haze score, and presence of increased intraocular pressure or cataract., Results: Average follow-up was 17.3 ± 1.8 months after the first implant (median, 13.3 months; range, 3-54.5 months; 54.65 eye-years), with 14 eyes (36.9%) receiving a single implant and 24 eyes (63.1%) receiving multiple implantations. After the first implantation, average BCVA improved significantly from 0.47 ± 0.05 logarithm of the minimum angle of resolution (logMAR) units (Snellen equivalent, 20/60) to 0.27 ± 0.07 logMAR (Snellen equivalent, 20/37; P<0.001); CRT decreased by 263 ± 44.22 μm (P = 0.003), although macular edema persisted in 50% of eyes, and the percentage of eyes achieving a vitreous haze score of 0 increased from 58% to 83% (P = 0.03). The median duration of therapeutic effect after the first injection was 6 months (range, 2-42 months), with a similar response achieved after each repeat implantation. The accumulated effect of repeat dexamethasone implants resulted in a continued improvement in BCVA (R(2) = 0.91; P<0.0001), with significant improvement and stabilization of CRT. After repeated implantations, 2 eyes had progression of posterior subcapsular opacities, although neither required surgery. There were 7 instances of increased intraocular pressure of more than 21 mmHg at a rate of 0.13 per eye-year, all of which responded to pharmacologic treatment., Conclusions: The accumulated effect of repeat dexamethasone pellet implantations improves retinal thickness and resolves ocular inflammation, resulting in restoration of ocular function. Ocular complications were minimal, with no eyes requiring surgery for increased ocular pressure or progression of cataract., (Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the outcomes of changing immunosuppressive therapy for noninfectious uveitis after failure., Design: Retrospective cohort study., Participants: Patients with noninfectious uveitis managed at 2 tertiary uveitis clinics in the United Kingdom and Australia., Methods: Participants with a history of using immunosuppressive therapy were identified in clinics, and notes were reviewed by doctors trained in uveitis therapy. Each treatment episode/course (starting or changing a therapy) was identified, and demographic details, clinical characteristics, drug used (second-line immunosuppressive agent [ISA] or biologicals), and drug doses were obtained., Main Outcome Measures: For each treatment episode, the reasons for changing therapy, corticosteroid-sparing effects, and control of inflammation were determined., Results: A total of 147 patients were identified who underwent 309 different treatment episodes. Fifty-five percent of patients eventually required a change in treatment after their first treatment episode/course. Forty-five episodes involved switching from one ISA to another, with 50% to 100% of these patients achieving "success" (prednisolone ≤10 mg and sustained control) with the new ISA. A combination of ISAs were used in 53 episodes, with "success" being achieved in 50% to 71% of these patients. Biological agents were used in 45 episodes, the most common one being infliximab, which achieved success in 80% of patients., Conclusions: Our data suggest that control of inflammation can be achieved after switching or combining ISAs., (Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Objective: To report the 12-month outcomes of the dexamethasone intravitreal implant in retinal vein occlusion (RVO), using an as-needed repeat injection protocol., Design: Retrospective consecutive case series of 51 eyes of 49 patients with macular oedema as a result of RVO that received an intravitreal dexamethasone implant and were followed up for at least 12 months., Results: 70% of patients responded to dexamethasone implant injection with an improvement in visual acuity (VA) and macular oedema within 3 months of injection, but only 30% of eyes gained ≥15 letters. The mean change in VA letter score at 12 months compared with baseline for branch RVO (BRVO) and central RVO (CRVO) was 5.7±2.3 and 11.5±11.0 EDTRS letters, respectively. 56% of patients relapsed, with the median time to relapse being 17 weeks for patients with branch RVO and 18 weeks for patients with CRVO. Repeat injections achieved similar VA gains, but the duration of effect of repeat dexamethasone implants was much shorter at 10 weeks. 14 eyes (27%) developed a significant rise in intraocular pressure, and three of these required treatment with oral acetazolamide. Four eyes with CRVO developed neovascular glaucoma during the study., Conclusions: The intravitreal dexamethasone implant does not last the 6 months implied by the retreatment protocol in the GENEVA trial, and improved results can be achieved with an as-needed retreatment protocol, particularly in CRVO. However, visual outcomes remain similar to those previously seen with triamcinolone in the SCORE study and neovascular complications remain a feature of CRVO.

We have previously identified two aquaporins (HC-1, HC-2) and a glyceroporin (HC-3), homologs, respectively, of mammalian AQP1, AQP2, and AQP3, from the freeze-tolerant treefrog Hyla chrysoscelis. The objective of the present study was to investigate by Western blotting and immunohistofluorescence the expression and localization of these proteins in warm-acclimated, hydrated treefrogs. We hypothesized that patterns of protein expression would reflect unique osmoregulatory roles for the three aquaporins. Western blots revealed a spectrum of protein bands from 28 kDa to 65+ kDa; treatment with N-glycosidase suggested that this reflected variable glycosidation of the aquaporins. HC-1 was expressed in all organs, including dermis of skin, sinusoids and septa of liver, Bowman's capsule of kidney, intestinal lacteal vessels, and perimysium and vasculature of muscle. HC-3 expression was also widespread, but with different localization, including epidermis and dermis of skin, renal collecting ducts, and colonic villous epithelium. HC-2 expression was limited to osmoregulatory organs (renal collecting ducts and epidermis). In many ways, the expression of these proteins paralleled their mammalian homologs. For example, HC-2 and HC-3 expression in collecting ducts appeared similar to the mammalian pattern (the former more apical, the latter more basal). However, some aspects of localization (e.g. HC-1 in Bowman's capsule) were unique, and the ubiquity of HC-3 expression may relate to its facilitation of glycerol transport in this animal that possesses glycerol-dependent freeze tolerance., (Copyright (c) 2010 Elsevier Inc. All rights reserved.)

Cardiac hemangiomas are rare cardiac tumors with fewer than 50 surgically treated cases reported in the literature. Incidence of valvular hemangiomas is extremely low, as cardiac valves are predominantly avascular structures. In this case report, we describe a 33-year-old woman who presented with progressively worsening cardiovascular symptoms. Echocardiography revealed a mitral valve mass for which she underwent surgical resection and mitral valve replacement. Histological examination of the mass revealed cavernous hemangioma of the mitral valve. Postoperative course was uncomplicated, and the patient's symptoms improved after surgery. Surgical excision of valvular hemangiomas appears to be curative in most cases and is the treatment of choice. Periodic echocardiographic follow-up is advised for early detection of tumor recurrence.