Intravitreal Bevacizumab as Anti-Vascular Endothelial Growth Factor in the Management of Complications of Proliferative Diabetic Retinopathy

Vascular endothelial growth factor (VEGF) has been shown to be an endothelial cell-specific mitogen and an angiogenic inducer in a variety of in vitro and in vivo models. Furthermore, it has been demonstrated to increase retinal vessel permeability by increasing the phosphorylation of tight junction proteins. Recent work has found elevated levels of VEGF in ocular fluids of patients with proliferative diabetic retinopathy (PDR). Thus, it makes sense to consider anti-VEGF treatments in the management of PDR. The purpose of the current research is to determine if intravitreal bevacizumab as anti-VEGF is helpful in the management of complications of PDR

Retinal Research in Latin America: How Did We Get Here?

Among the numerous contributions by the Pan-American Association of Ophthalmology (PAAO) to the improvement of ophthalmology in Latin America, it has played an invaluable role in the development of the retina and vitreous subspecialty in the region. The quality of the research published in Latin America demonstrates the development of the retina subspecialty at this region and also the worldwide collaboration pioneered by PAAO and the Pan-American Collaborative Retina Study Group (PACORES). We would suggest further academic relationship at the regional as well as international levels as well as funding research institutes to assist retinal researchers in the region since it is generally thought that there is frequently a lack of government funding at all levels, from patient education to support for health teams to tertiary health care centers

From the Hypotheses to Clinical Evidence in Retinal Therapy

The off-label, therapeutic use of intravitreal bevacizumab (IVB) in vascular retinal diseases such as diabetic macular edema and proliferative diabetic retinopathy (PDR) has increased significantly due to its ability to reduce retinal neovascularization and slow progression of disease. Here, we will review the literature and investigative developments on the use of IVB as a preoperative adjuvant to vitrectomy in severe PDR, specifically focusing on its ability to reduce intra- and postoperative complications and its risk for progression or development of traction retinal detachment. In particular, this review will highlight the natural progression of evidence from case series and observations to prospective, randomized clinical trials

Retinal Research in Latin America: How Did We Get Here?

Among the numerous contributions by the Pan-American Association of Ophthalmology (PAAO) to the improvement of ophthalmology in Latin America, it has played an invaluable role in the development of the retina and vitreous subspecialty in the region. The quality of the research published in Latin America demonstrates the development of the retina subspecialty at this region and also the worldwide collaboration pioneered by PAAO and the Pan-American Collaborative Retina Study Group (PACORES). We would suggest further academic relationship at the regional as well as international levels as well as funding research institutes to assist retinal researchers in the region since it is generally thought that there is frequently a lack of government funding at all levels, from patient education to support for health teams to tertiary health care centers

Outer Retinopathies Associated with COVID-19 Infection:Case Reports and Review of Literature

Background. The coronavirus disease (COVID-19) is a highly contagious disease with profound health implications. It can affect any part of the body with variable severity. Various ophthalmic manifestations of coronavirus disease have been documented. Case Presentations. We reported three cases of outer retinopathies associated with COVID-19 infection. All three patients were young females. The first two patients presented within days of COVID-19 infection with complaints of black spots in the eyes. Multimodal retinal imaging showed lesions consistent with acute macular neuroretinopathy. Lesions were bilateral in the first patient and unilateral in the second one. Our third patient presented with blurred vision in one eye, 3 months after a suspected COVID-19 infection. Retinal imaging showed outer retinopathy. Our patients’ vision was good and maintained during the follow-up. All three were monitored on observation only, and symptoms and lesions improved with time. Conclusion. In conclusion, COVID-19-related thromboinflammatory response can result in localized vascular inflammation and hypoperfusion in any of the retinal capillary plexuses or choriocapillaris resulting in ischemia of the corresponding retinal or choroidal layers

Preservation of macular structure and function after intravitreal aflibercept for choroidal neovascularization associated with serpiginous choroiditis

Lund Univ, Scane Cty Univ Hosp, Dept Ophthalmol, Clin Sci, Lund, SwedenKing Khalid Eye Specialist Hosp, Vitreoretinal Div, Riyadh, Saudi ArabiaOFTALMOLOGICA, San Miguel De Tucuman, ArgentinaFed Univ Sao Paulo UNIFESP, Dept Ophthalmol, Sao Paulo, BrazilJohns Hopkins Univ, Sch Med, Wilmer Eye Inst, Retina Div, Baltimore, MD 21205 USADepartment of Ophthalmology, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, BrazilWeb of Scienc

Retinal Detachment in Down Syndrome: Characteristics and Surgical Outcomes

Purpose. To determine the functional and anatomic outcomes of rhegmatogenous retinal detachment (RRD) surgery in patients with Down syndrome. Methods. A retrospective chart review was performed of patients with Down syndrome who had undergone surgery for RRD at King Khalid Eye Specialist Hospital between 1995 and 2014. Results. A total of 245 patients with Down syndrome were evaluated during the study period. Eighteen eyes of 15 patients (6.1%) with RRD were identified. Three out of 15 patients (20%) presented with bilateral retinal detachment. All eyes presented with macula off retinal detachment. The retina was successfully reattached in 16/18 (88.8%) eyes after a mean follow-up of 48 months. The final postoperative visual acuity ranged from light perception to 20/125 (median: hand motion) (11/18 eyes). Conclusions. The anatomic success rate of retinal reattachment surgery in patients with Down syndrome is comparable to the general population. Patients with Down syndrome should undergo regular ophthalmic examinations for early diagnosis. Despite late diagnosis and the presence of proliferative vitreoretinopathy (PVR) in some patients, favorable anatomical outcomes can be achieved

Ophthalmic Manifestations of Congenital Zika Syndrome in Colombia and Venezuela

IMPORTANCE The ocular manifestations and sequelae of Zika virus infection are not well known. Recently, the World Health Organization changed the declaration of Zika as a public health emergency and designated the viral outbreak and related microcephaly clusters as a long-term program of work. This change indicates the urgent need to evaluate and document ophthalmic manifestations in patients for timely management of this disease. In addition, confirmation whether the public health problem in Brazil extends to other regions in South America is needed. OBJECTIVE To report the ocular manifestations of congenital Zika syndrome with microcephaly in Colombia and Venezuela. DESIGN, SETTING, AND PARTICIPANTS This prospective case series included 43 patients from 2 ophthalmic centers in Colombia and Venezuela who underwent evaluation from October 1, 2015, through June 30, 2016, and were clinically diagnosed with congenital Zika syndrome. Twenty patients were Hispanic; 13, African; 8, white; and 2, Native American. INTERVENTIONS Ophthalmic and systemic evaluations and serologic testing were performed on all infants. Patients underwent external ocular examination and dilated ophthalmoscopy. Serologic testing ruled out toxoplasmosis, rubella, cytomegalovirus, syphilis, and human immunodeficiency virus. MAIN OUTCOMES AND MEASURES Ophthalmic manifestations of congenital Zika syndrome. RESULTS Of the 43 patients included in this series (28 female and 15 male), the mean (SD) age at examination was 2.1 (1.5) months. The mothers of all the children had no ophthalmic findings and did not report ocular symptoms during pregnancy. All patients had bilateral ophthalmic manifestations. Optic nerve findings included hypoplasia with the double-ring sign, pallor, and increased cup-disc ratio in 5 patients (11.6%). Macular abnormalities included mild to severe pigment mottling in 27 patients (63%) and lacunar maculopathy in 3 (6.9%). Chorioretinal scarring was present in 3 patients (7%). Eleven patients (26%) had a combination of lesions in the posterior pole. Five patients (12%) were diagnosed with congenital glaucoma, characterized by the clinical triad of epiphora, photophobia, and blepharospasm; increased intraocular pressure; corneal clouding at birth; and buphthalmos. These data reveal that 12%(95%CI, 5%-24%) of cases of congenital Zika with microcephaly had anterior segment abnormalities and 88%(95%CI, 76%-94%) had important macular and optic nerve abnormalities. The visual sequelae of these ophthalmic manifestations remain unknown. CONCLUSIONS AND RELEVANCE Congenital Zika syndrome in the current study had severe ocular abnormalities, and all patients had bilateral involvement. Ocular findings were focal macular pigment mottling, chorioretinal atrophy with a predilection for the macular area, congenital glaucoma and optical nerve hypoplasia, and optic disc abnormalities. Ophthalmic examination is recommended in patients with congenital Zika syndrome