A Pilot Study on Ocular Safety and Efficacy of Infliximab as an Antifibrotic Agent After Experimental Glaucoma Filtration Surgery.

Tumor necrosis factor-α (TNF-α) is a multifunctional, proinflammatory cytokine that mediates pleiotropic biological functions, especially inflammation and immunoregulation. We hypothesized that blocking TNF-α with a monoclonal antibody would decrease inflammation and subconjunctival scarring in an animal model of experimental filtration surgery. In a randomized, prospective, masked-observer study, 30 New Zealand albino rabbits underwent glaucoma filtration surgery. The animals were allocated to receive either intraoperative application of infliximab (group A) or mitomycin C (MMC) at a concentration of 0.2 mg/ml (group B) or balanced salt solution (BSS, control) (group C). Different infliximab doses, namely 1.0, 2.0, 3.0, 4.0, 5.0 mg in 0.1 ml, were applied. Bleb survival and characteristics were evaluated over a 30-day period. The animals were killed on postoperative day 15 or 30. Histology of the operated eyes was performed to evaluate and grade the amount of scarring in each group. Cellular density was evaluated in each case. Infliximab did not appear to improve outcomes in this model of glaucoma filtration surgery. Bleb survival was significantly higher in the MMC group compared to the other groups (p < 0.001 for both comparisons). Vascularity was also significantly lower in the MMC group compared to the other groups (p = 0.018 for both comparisons). There was a significant decrease in cellular density in the MMC group compared to the control (p = 0.0352) and the infliximab group (p < 001). Our results have shown that trabeculectomies in the infliximab group failed faster and displayed more scarring, compared to the control and MMC groups. This outcome suggests that the infliximab doses used in this pilot study resulted in a subconjunctival TNF-α concentration, which acted as a stimulator to fibroblasts

C wave of electroretinogram and visual evoked response in optic neuritis due to demyelinating diseases

In 21 consecutive cases with unilateral optic neuritis due to demyelinating disease, ERG, C wave of ERG and VER were recorded and studied in both eyes. Also 8 cases suffering from optic atrophy due to trauma or glaucoma were included. The analysis of data shows that the C-wave is significantly diminished in both eyes, namely the affected and the sound, in the cases of optic neuritis. Also in comparison to VER, C wave has a comparative probability in diagnosing optic neuritis due to demyelinating disease. The C wave of ERG is normal in the cases of optic atrophy. The mechanism of C wave involvement during the course of demyelinating disease may be related with an abnormality of the ionic homeostasis of the subretinal space. © 1992 S. Karger AG, Basel

Sustained ocular hypertension following intravitreal injections of 0.5 mg/0.05 ml ranibizumab

To report three cases with sustained ocular hypertension following intravitreal injections of 0.5 mg/0.05 ml ranibizumab and to underline the importance of monitoring intraocular pressure (IOP) following intravitreal injections of ranibizumab (Lucentis). Three patients were found to have high IOP after intravitreal injections of 0.5 mg/0.05 ml ranibizumab. IOP was elevated after the second ranibizumab injection in patients 1 and 2, and after the third injection in patient 3. The increase in IOP was sustained, requiring treatment with anti-glaucoma eye drops in all patients, the addition of systemic carbonic anhydrase inhibitor in one patient, and the application of selective laser trabeculoplasty (SLT) in another patient. None of the patients had a previous history of glaucoma or ocular hypertension. Sustained ocular hypertension may occur after intravitreal injections of 0.5 mg/0.05 ml ranibizumab. Although the precise mechanism of the pressure rise is unknown, three eyes in our series were controlled with topical or oral medication and one with SLT. The necessity of IOP monitoring is strongly emphasized after intravitreal injections of 0.5 mg/0.05 ml ranibizumab. © 2011 Springer Science+Business Media B.V

The a- and b-wave latencies as a prognostic indicator of neovascularisation in central retinal vein occlusion

To evaluate the prognostic value of ERG in cases of central retinal vein occlusion (CRVO) regardingm the development of neovascularisation (NV), we studied 20 patients with unilateral CRVO. Half of them were allocated in the non-perfused group and the other 10 finally developed NV and were allocated in the non-perfused group. Flash ERG was recorded from all patients. Our findings suggest that b-wave latency is the most reliable parameter in predicting NV, followed by the a-wave latency. The b/a wave amplitude of ERG ratio does not seem to be suitable for clinical use

Ranibizumab in the treatment of choroidal neovascularisation due to age-related macular degeneration: An optical coherence tomography and multifocal electroretinography study

Background: The aim of this study was to evaluate, by optical coherence tomography (OCT) and multifocal electroretinography (mfERG), the macular function of eyes with choroidal neovascularisation due to age-related macular degeneration (AMD) before and after the intravitreal use of ranibizumab. Methods: Fifteen eyes with choroidal neovascularisation due to AMD were studied with OCT and mfERG before, during and at the end of the treatment, one year after the first injection of ranibizumab. The eyes received 0.5mg ranibizumab every month for the first three months, followed by doses every three months. Thus, during the 12-month study, a total of six ranibizumab injections were given. Results: The level of visual acuity increased significantly with time. A linear mixed-effect analysis showed a borderline negative association between the amount of foveal thickness and time, with a decrease in the mean foveal thickness for one time increment. The retinal response density of the mfERG showed a significant increase in ring 1 and remained almost unchanged in ring 2, whereas there was a statistically insignificant increase in ring 3. Finally, the mean latency remained unchanged throughout the 12months of treatment in all three rings. Conclusion: The intravitreal use of ranibizumab might result in an increase of the mfERG in the foveal area. Only a borderline inverse association was shown between the amount of foveal thickness and time. Also, the level of visual acuity statistically significantly improved over time. Randomised long-term clinical trials are needed to determine the potential clinical benefit of ranibizumab. © 2011 The Authors. Clinical and Experimental Optometry © 2011 Optometrists Association Australia

Visual field examination using a video projector: comparison with Humphrey perimeter

Dimitrios Brouzas, Stylianos Tsapakis, Eirini Nitoda, Marilita M Moschos First Department of Ophthalmology, Medical School, University of Athens, Greece Purpose: To present a method of visual field examination using a video projector. Also, we compare our results with those of a Humphrey perimeter, which is accepted as standard in automated perimetry. Materials and methods: Software implementing a full-threshold 4-2-step staircase algorithm for the central 30-2 of the visual field (76 points) has been developed and tested in nine eyes of seven patients using an Epson TW 700 video projector. The results were compared to those obtained from the same patients using the Humphrey perimeter. Results: High correlation between the video projector visual fields and those of the Humphrey perimeter was found. The point-to-point correlation coefficient ranged from 0.75 to 0.90, with P<0.0001 for each eye. Conclusion: Visual field examination results using a video projector have high correlation with those of a Humphrey perimeter. The method is possibly suitable for clinical use. Keywords: visual fields, video projector, computerized perimetry, automated perimetry, visual field softwar

Large bilateral foveal cysts in the inner retina of a patient treated with tamoxifen, diagnosed with Fourier-domain optical coherence tomography

Ilias Georgalas, Theodore Paraskevopoulos, Dimitris Papaconstaninou, Dimitiris Brouzas, Chryssanthi Koutsandrea Department of Ophthalmology, "G Gennimatas" Hospital of Athens, NHS, University of Athens, Athens, Greece Purpose: To report a case of a patient receiving tamoxifen with visual deterioration and describe the unusual optical coherence tomography (OCT) findings. Method: Observational case report. Results: A 55-year-old female patient was referred to our department complaining of gradual visual deterioration in both eyes. Medical history was unremarkable apart from breast cancer for which she had received tamoxifen for 10 years (mean dosage 20 mg/day). Best corrected visual acuity was 20/400 in her right eye and 20/40 in her left eye. Fundoscopy in both eyes was without any obvious signs of maculopathy. However, Fourier-domain OCT demonstrated bilateral extensive areas of disruption in inner retinal layers without any signs of crystalline retinopathy. Six months after the cessation of tamoxifen, the situation remains unchanged. Conclusion: Patients receiving tamoxifen should be monitored with high-resolution OCT for fundoscopically invisible changes in the inner retinal layers, the progression of which may seriously affect the patient's vision and subsequently their quality of life. Keywords: maculopathy, OC