Intravitreal dexamethasone implant for recalcitrant cystoid macular edema secondary to retinitis pigmentosa: a pilot study

cited By 0International audienceBackground: To determine the utility of the intravitreal dexamethasone implant as therapy for cystoid macular edema (CME) secondary to retinitis pigmentosa (RP) recalcitrant to carbonic anhydrase inhibitor therapy over 2 years as a pilot study. Methods: This was a prospective case series. Patients who showed either an incomplete or no response to topical dorzolamide for at least 1 month and oral acetazolamide therapy for at least 15 days were recruited for the study with informed consent. A complete anterior and posterior segment examination was performed including fundus fluorescein angiography (FFA), optical coherence tomography scan (OCT) and electroretinogram to confirm the diagnosis. The dexamethasone implant was injected using a standardized technique. Follow ups were scheduled on days 1, 7, and 30 and then monthly thereafter for 2 years. The primary outcome measure was the change in corrected distance visual acuity (CDVA) and central subfield thickness (CST) at months 1, 6, 12, 18, and 24. The secondary outcome measure was complications, if any. Appropriate statistical analysis was done. Results: Five patients (two males; six eyes; median age 49 years) were recruited for the study. All patients required at least two injections over 2 years. All patients demonstrated significant improvement in CDVA (p = 0.004) as well as CST measurements (p = 0.0038) over 2 years. No complications were noted. Conclusion: The intravitreal dexamethasone implant provides significant improvement in CDVA and CST measurements in patients with recalcitrant CME secondary to RP. © 2017, Springer-Verlag Berlin Heidelberg

Long Non-Coding RNAs Associated with Heterochromatin Function in Immune Cells in Psychosis

Psychosis is associated with chronic immune dysregulation. Many long non-coding RNAs (lncRNAs) display abnormal expression during activation of immune responses, and play a role in heterochromatic regulation of gene promoters. We have measured lncRNAs MEG3, PINT and GAS5, selected for their previously described association with heterochromatin. Peripheral blood mononuclear cells (PBMCs) were isolated from blood samples collected from 86 participants with a diagnosis of psychosis and 44 control participants. Expression was assessed in relation to diagnosis, illness acuity status, and treatment with antipsychotic medication. We observed diagnostic differences with MEG3, PINT and GAS5, and symptom acuity effect with MEG3 and GAS5. Medication effects were evident in those currently on treatment with antipsychotics when compared to drug-naïve participants. We observed that clinical diagnosis and symptom acuity predict selected lncRNA expression. Particular noteworthy is the differential expression of MEG3 in drug naïve participants compared to those treated with risperidone. Additionally, an in vitro cell model using M2tol macrophages was used to test the effects of the antipsychotic drug risperidone on the expression of these lncRNAs using quantitative real-time PCR (qRT-PCR). Significant but differential effects of risperidone were observed in M2tol macrophages indicating a clear ability of antipsychotic medications to modify lncRNA expression

First-line treatment algorithm and guidelines in center-involving diabetic macular edema

cited By 0Management of center-involving diabetic macular edema represents a real therapeutic challenge. Diabetic macular edema is the leading cause of visual acuity impairment in diabetic patients. Since the advent of intravitreal drugs, management of diabetic macular edema has significantly evolved. The historical grid laser photocoagulation is no longer recommended as first-line treatment of diabetic macular edema owing to the findings of the pivotal randomized controlled trials, and anti-vascular endothelial growth factor therapy has emerged as first-line therapy. Steroids also represent a valid treatment option in the management of naïve diabetic macular edema and their efficacy has also been confirmed in several studies. The optimal treatment for diabetic macular edema should consider both general and ophthalmological comorbidities. Patient compliance and motivation should also be carefully evaluated as some treatments require monthly follow-up. Based on recent literature evidence, the present review provides clinicians with a first-line treatment algorithm for center-involving diabetic macular edema tailored to the patient’s individual characteristics. © The Author(s) 2019

Current Treatments and Innovations in Diabetic Retinopathy and Diabetic Macular Edema

Diabetic retinopathy (DR) is one of the leading causes of blindness worldwide. Multiple treatment options have been used over time to attempt to modify the natural progression of the disease in both proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME). These two retinal complications are the result of microvascular occlusions and vascular hyperpermeability and are considered one of the leading causes of irreversible blindness in patients of working age. It is now well demonstrated that PDR and DME are associated with increased levels of inflammatory and pro-angiogenic factors in the ocular compartment. To date, laser photocoagulation, vascular endothelial growth factor (VEGF) inhibitors, and corticosteroids have demonstrated efficacy in their treatment in large randomized controlled trials and in real-life observational studies. This manuscript aims to provide a comprehensive review of current treatments, including the main drugs used in diabetic pathologic manifestations, as well as new therapeutic alternatives, such as extended-release intraocular devices