Effectiveness of the Dexamethasone Intravitreal Implant for Treatment of Patients with Diabetic Macular Oedema

Diabetic macular oedema (DMO) is a leading cause of vision loss in the working-age population worldwide. Corticosteroid drugs have been demonstrated to inhibit the expression of both the vascular endothelial growth factor (VEGF) gene and other anti-inflammatory mediators, such as prostaglandins. Triamcinolone, fluocinolone and dexamethasone are the main steroids that have been studied for the treatment of macular oedema. Over the last few years, several studies have suggested an important role for dexamethasone in the management of DMO. The dexamethasone intravitreal implant (DEX implant) (Ozurdex®; Allergan, Inc., Irvine, CA) is a novel approach approved by the US Food and Drug Administration (FDA) and by the EU for the intravitreal treatment of macular oedema after branch or central retinal vein occlusion, and for the treatment of non-infectious uveitis affecting the posterior segment of the eye. We reviewed manuscripts that had investigated the pharmacokinetics, efficacy and safety of the DEX implant regarding DMO treatment

Full-Thickness Macular Hole After Lamellar Macular Hole Surgery: a Case Report

PURPOSE: To describe a case of full-thickness macular hole (FTMH) after vitrectomy for lamellar hole (LH). METHODS: Case report. RESULTS: The authors report a patient with progressive visual loss secondary to LH who developed FTMH following a vitrectomy repair. The postoperative findings as well as the clinical course after the second surgical approach are described. CONCLUSIONS: Surgeons should be aware of this complication following LH surgical approach.info:eu-repo/semantics/publishedVersio

Early microvascular and neural changes in patients with type 1 and type 2 diabetes mellitus without clinical signs of diabetic retinopathy

Purpose: To assess and compare early modifications in inner retinal layer thickness and optical coherence tomography angiography parameters in patients with diabetes mellitus (DM) Types 1 and 2 without clinical signs of diabetic retinopathy. Methods: Ninety eyes of 90 subjects (24 Type 1 DM, 36 Type 2 DM, and 30 healthy controls) were prospectively evaluated with spectral domain OCT, swept-source OCT angiography, and color fundus photography (on the same day). Retinal nerve fiber layer, ganglion cell layer (GCL+), and nerve fiber layer + GCL+ (GCL++) thickness were automatically determined by the instrument in the 1, 3, and 6 central mm. On OCT angiography, the following parameters were evaluated: area of foveal avascular zone, number of focally dilated endings of the capillaries (detected only on OCT angiography), presence of regular/irregular foveal avascular zone, capillary loss, and capillary network irregularities in the superficial capillary plexus (SCP) and deep capillary plexus (DCP). Results: Ganglion cell layer+ (P = 0.0099) and GCL++ (P = 0.0367) were significantly thicker in DM Type 1 versus DM Type 2 in 1 central mm, after adjustment for age and DM duration. The area of foveal avascular zone was significantly larger in DM Type 1 versus controls in both SCP and DCP and in DM Type 1 versus Type 2 only in DCP (P , 0.05 for all); the number of focally dilated endings of the capillaries was higher in DM Type 1 versus controls in both SCP and DCP (P , 0.01 for all); and in DM Type 2 versus controls only in DCP (P = 0.007). Perifoveal capillary loss in SCP and inner retinal layer thickness had the highest correlation in both DM types. Conclusion: There are specific neural and microvascular modifications even before clinical signs of diabetic retinopathy in DM Types 1 and 2. Perifoveal capillary loss in the SCP is highly correlated with inner retinal layer. These data may help in characterization of patients at the preclinical stage of diabetic retinopathy

Aflibercept and Ranibizumab modulate retinal pigment epithelial cells function by acting on their cross talk with vascular endothelial cells

Background/Aims: We performed co-culture experiments between human RPE cells (ARPE-19) and human umbilical vascular endothelial cells (HUVEC) in order to evaluate how anti-VEGF drugs could affect NO release, mitochondrial function, the oxidative status, proliferation and migration of RPE cells through modulation of their cross talk with vascular endothelial cells. Materials: The co-culture HUVEC/RPE, was exposed to Ranibizumab/Aflibercept in the absence/presence of the NO synthase (NOS) inhibitor, the phosphatidylinositol 3\u2032-kinase (PI3K), the extracellular-signal-regulated kinases 1/2 (ERK1/2) and the p38 mitogen-activated protein kinase (p38 MAPK) blockers. Specific kits were used for cell viability, mitochondrial membrane potential, NO, ROS and GSH production. Western blot was performed for apoptosis markers, NOS isoforms, and others kinases detection. Cell migration was analyzed by scratch assay, whereas cell proliferation and cell cycle through xCELLigence and flow cytometry. Results: In RPE cells co-cultured with HUVEC in physiological conditions, Aflibercept/Ranibizumab increased NO release in a dose and time-dependent way. Opposite results were obtained in peroxidative conditions. Both anti-VEGF agents were able to prevent the fall of cell viability and mitochondrial membrane potential, an effect which was reduced by various inhibitors, and increased cell migration. Aflibercept/Ranibizumab counteracted the changes of apoptosis markers, NOS expression/activation, PI3K and ERK1/2 activation caused by peroxidation. These results were confirmed by cell cycle analysis. Conclusion: This study has shown new mechanisms at the basis of protective effects elicited by Aflibercept/Ranibizumab in RPE cells. HUVEC stimulated with Aflibercept/Ranibizumab, could release some paracrine factors that can modulate the RPE cells response in both physiologic and peroxidative conditions

En face optical coherence tomography of inner retinal defects after internal limiting membrane peeling for idiopathic macular hole

To describe the appearance of inner retinal defects using en face spectral domain optical coherence tomography (SD-OCT) after idiopathic full-thickness macular hole (FTMH) surgery, referred to as concentric macular dark spots (CMDS

Hallazgos preliminares sobre la eficacia del programa Crianza Reflexiva para cuidadores de niños entre 4 y 12 años de edad

El Programa Crianza Reflexiva es un método para fomentar en los cuidadores, una mejor conexión, una mayor curiosidad en el mundo interno de los niños y un mayor disfrute de las interacciones con sus hijos. Los cuidadores, al estar conscientes de los estados mentales de sus hijos y de los suyos propios, cultivan la función reflexiva y/o mentalización y la seguridad emocional de ellos. El objetivo de esta investigación es medir la efectividad del programa Crianza Reflexiva en cuidadores de niños de 4 a 12 años, en la ciudad de Panamá. Se realizó un ensayo controlado aleatorizado con tres mediciones, un pre-test, una post-test y un follow-up a tres meses. Una muestra de cuarenta cuidadores de niños entre 4 y 12 años de edad, fueron incluidos en el estudio y asignados de manera aleatoria a uno de dos grupos: control (n=20) y experimental (n=20). En los tres momentos de medición los participantes completaron cuestionarios de autoreporte para medir el estrés parental (PSI-SF), la eficacia parental (BPES), la función reflexiva parental (PRFQ) y la regulación emocional de niños (SDQ y ERC). Los resultados preliminares obtenidos mediante modelos de efectos mixtos permiten identificar que el programa de crianza reflexiva tuvo un efecto significativo, sobre el interés y curiosidad de los padres acerca de los estados mentales de sus hijos, sobre el estrés parental, y sobre los problemas externalizantes de sus hijos. Los efectos se mantuvieron a los tres meses de seguimiento. Estos hallazgos aportan evidencia sobre la efectividad del programa Crianza Reflexiv