Ranibizumab For Diabetic Macular Edema Refractory To Multiple Prior Treatments

Purpose: Diabetic macular edema can be refractory to multiple treatment modalities. Although there have been anecdotal reports of ranibizumab showing efficacy when other modalities provided limited benefit, little has been published on treatment for refractory diabetic macular edema. This study sought to investigate this observation further. Methods: Retrospective chart review. Results: Thirty-three eyes of 22 patients with refractory diabetic macular edema were treated with 0.3 mg intravitreal ranibizumab. This group of eyes received an average of 5.1 prior treatments (macular laser, intravitreal bevacizumab, triamcinolone acetonide, or dexamethasone implant). The mean best corrected visual acuity before the initial ranibizumab injection was 20/110 and the mean central subfield thickness was 384 μm. After 7 visits over an average of 48 weeks, during which an average of 6 ranibizumab injections were administered, the mean visual acuity improved to 20/90 and the mean central subfield thickness improved to 335 μm. Both central subfield thickness and best corrected visual acuity improved with number of days of follow-up in a statistically significant fashion (P < 0.01). Similarly, both central subfield thickness and visual acuity improved with number of ranibizumab injections in a linear fashion, but this was not statistically significant. Conclusion: Ranibizumab can improve diabetic macular edema refractory to prior treatments of laser photocoagulation, intravitreal triamcinolone acetonide, and bevacizumab

Efficacy of Dexamethasone Intravitreal Implant For Refractory Macular Edema Caused by Retinal Vein Occlusion

Purpose: To investigate efficacy of dexamethasone intravitreal (DEX) implant in treating refractory macular edema caused by retinal vein occlusion. Methods: Retrospective chart review. Results: Twenty-two eyes with refractory macular edema caused by retinal vein occlusion were treated with a mean of 2.2 DEX over 12 months. Patient had previously received a mean of 7 treatments (laser, bevacizumab, and/or triamcinolone) for macular edema present for at least 4 months duration (mean 20.8 ± 17.6 months, range 4–72 months) before starting DEX. Mean baseline visual acuity was 20/91, and mean central subfield thickness was 506 μm. DEX improved mean best-corrected visual acuity to 20/75 and 20/66 at 7 weeks and 6 months follow-up, although it worsened to 20/132 at 12 months. Mean central subfield thickness improved to 292, 352, and 356 μm at 7 weeks, 6 months, and 12 months follow-up, respectively. There was a statistically significant association between number of DEX treatments and central subfield thickness (P = 3.28 × 10−9). There was a statistically significant association between number of days followed and best-corrected visual acuity (P = 0.006). Six of 12 (50%) phakic patients developed visually significant cataract requiring surgery. Five of 22 (23%) patients developed ocular hypertension (intraocular pressure > 30) and consequently did not undergo further treatment with DEX. Conclusion: DEX resulted in sustained anatomical reduction of retinal vein occlusion–associated refractory macular edema, although this did not translate into long-term best-corrected visual acuity improvement in either phakic or pseudophakic patients, possibly related to chronic structural alterations in the retina despite reduction of edema

Treatment Strategies for Refractory Diabetic Macular Edema: Switching Anti-VEGF Treatments, adopting corticosteroid-based treatments, and combination therapy

Introduction: The pathophysiology of diabetic macular edema (DME) is complex, involving vascular endothelial growth factor (VEGF) and other inflammatory mediators. DME is currently treated first-line with intravitreal anti-VEGF treatments, though some cases are refractory to multiple anti-VEGF treatments. Areas covered: This article examines the evolution of treatment practices for DME, with discussion of the recent studies that guide treatment for refractory cases of DME. A literature search was performed using the following terms: anti-VEGF, DME, aflibercept, bevacizumab, ranibizumab, refractory macular edema, and VEGF. Expert opinion: Focal extrafoveal DME may be treated first-line with laser. In patients with center-involving DME and only mild vision loss, consider starting treatment with bevacizumab, especially when cost is an issue, whereas aflibercept may be considered more strongly in patients with moderate visual loss or worse. There are no standard protocols that define ‘treatment failure,’ but several studies have reported that switching from bevacizumab to either ranibizumab or aflibercept will result in further reduction of CSFT and improvement in BCVA. Further study with prospective randomized trials is warranted to validate these findings. Switching to intravitreal corticosteroids may be of particular benefit to pseudophakic patients. Anti-VEGF combination with sustained-release corticosteroids also appears promising for refractory DME

Whose Turn Is It? Problems of Reconciling Family and Work in Dual-Career Couples.

The work-family life conflict affects various aspects of dual-career families. Parenthood and the work-family life balance lead to an overload of responsibility and disparity at the expense of women, on a private as well as on a social level. In our research, we examined WIF (work to family) and FIW (family to work) conflicts in a sample of 483 dual-career couples. The main results underline an increase in familiar duties concerning child birth and childcare, as associated with the traditional work-family life balance strategy. The data seems to reflect differences in traditional roles between public-male- breadwinner and private-female-homemaker

Induced pluripotent stem cell-based therapy for age-related macular degeneration

Introduction: In age-related macular degeneration (AMD), stem cells could possibly replace or regenerate disrupted pathologic retinal pigment epithelium (RPE), and produce supportive growth factors and cytokines such as brain-derived neurotrophic factor. Induced pluripotent stem cells (iPSCs)-derived RPE was first subretinally transplanted in a neovascular AMD patient in 2014. Areas covered: Induced PSCs are derived from the introduction of transcription factors to adult cells under specific cell culture conditions, followed by differentiation into RPE cells. Induced PSC-derived RPE cells exhibit ion transport, membrane potential, polarized VEGF secretion and gene expression that is similar to native RPE. Despite having similar in vitro function, morphology, immunostaining and microscopic analysis, it remains to be seen if iPSC-derived RPE can replicate the myriad of in vivo functions, including immunomodulatory effects, of native RPE cells. Historically, adjuvant RPE transplantation during CNV resections were technically difficult and complicated by immune rejection. Autologous iPSCs are hypothesized to reduce the risk of immune rejection, but their production is time-consuming and expensive. Alternatively, allogenic transplantation using human leukocyte antigen (HLA)-matched iPSCs, similar to HLA-matched organ transplantation, is currently being investigated. Expert opinion: Challenges to successful transplantation with iPSCs include surgical technique, a pathologic subretinal microenvironment, possible immune rejection, and complications of immunosuppression

L'IMMAGINE FILMICA NELLA FORMAZIONE: LE NARRAZIONI SULLA VIOLENZA ALL'INFANZIA

Il presente contributo rivolge l’attenzione alle risonanze emotive, alla soggettività di chi affronta il tema della violenza all’infanzia. Lo studio si propone di esplorare i processi attraverso i quali i soggetti, posti all’interno di un gruppo impegnato in attività formativa, organizzano informazioni e costruiscono rappresentazioni sull’abuso sui minori. Il gruppo dei partecipanti all’indagine è composto da 163 soggetti (122 studenti universitari, e 41 professionisti tra cui N = 12 agenti delle Forze dell’ordine e N = 29 operatori sociosanitari) ai quali è stata proposta la visione del film documentario Una storia americana (Capturing the Friedmans, USA 2003). I contenuti delle riflessioni sono stati analizzati attraverso l’analisi delle frequenze ed i test statistici del Chi2 . Lo studio conferma l’importanza dell’utilizzo, nella formazione, dei laboratori cinematografici che rendono possibile anche la narrazione interiore permessa dalla relazione, e dalla protezione, che si crea all’interno del gruppo per mezzo del quale si dà pensabilità all’accaduto ed una motivazione agli eventi e al loro senso.This paper directs its attention towards the emotional repercussions and the subjectivity of whoever is tackling the subject of child abuse. This study intends to explore the processes through which individuals placed within a group involved in educational activity organise their information and build up representations regarding child abuse. The group of participants in the study was made up of 163 individuals (122 university students and 41 professional persons, of whom N = 12 police officers and N = 29 social-medical workers), who were shown a documentary film, Capturing the Friedmans, (USA 2003). The results of the subsequent deliberations were examined via an analysis of frequency and the Chi-square statistical tests. The study confirms the importance of the utilisation, in education, of cinematographic laboratories; they also provide an opportunity for interior narration, which is permitted by the relationship (and the protection) created within the group. Through these the conceivable aspects of the event can emerge, along with the meaning and motivation behind the events

Research to Practice: Vocational Rehabilitation Services Received by Youth with Autism: Are they Associated with an Employment Outcome?

While youth with autism represent a small percentage of all vocational rehabilitation (VR) closures, the number who closed out of VR more than tripled between 2003 and 2008 (see Institute for Community Inclusion Data Note 26). As increasing numbers of youth with autism are accessing VR services, it is important to understand how they are using these services and the relationship of these services to outcomes and costs

DILATION TREATMENT OF BENIGN STRICTURED OF COLOCOLONIC ANASTOMOSES

SCOPO DI QUESTO ARTICOLO E' DI METTERE IN LUCE LA COMPLIANCE, I BENEFICI ED IL MIGLIORAMENTO DELLA QUALITA' DELLA VITA, NEI SOGGETTI AFFETTI DA STENOSI BENIGNA POST-ANASTOMOTICA COLO-COLICA E COLO-RETTALE E TRATTATI CON DILATAZIONE ENDOSCOPICA DEL TRATTO STENOTICO. LA DILATAZION PER VIA ENDOSCOPICA RISULTA ESSERE SICURA E DI SEMPLICE ESECUZIONE E PERMETTE DI OTTENERE RISULTATI SODDISFACENTI ANCHE PER PERIODI PROLUNGATI. I CRITERI STANDARD PER UNA EFFICACE DILATAZIONE VARIANO TRA 1 10 E 13 MM

Regression analysis to design a solar thermal collector for occasional use

Optimal design of a solar thermal system is necessary to minimize payback time and to diffuse renewable energy use for Domestic Hot Water production in residential areas. More accurate design is crucial in the case of seasonal or occasional use of the system; indeed, the standard criteria generally applied to a design system for continuous use, can lead to considerable over-sizing. To speed up the design phase and to help the planner in the identification of the best solution without any complex evaluation or long computational time, it would be interesting to have available a simpler method than the standard procedures, but one that is reliable and accurate for the evaluation of the best configuration, taking into account occasional use, seasonal and monthly domestic hot water demand, orientation and primary flow rate. To this end, the authors investigated a methodology for the identification of some empirical correlations based on the analysis of data coming from a parametric simulation; in this way the identified correlations can indicate, with high reliability, the optimal design knowing only well-known parameters. In detail, the data output was extracted and processed to evaluate the best design configurations under any operative conditions. Determination of the best configuration identifies the operative parameters that maximize the Solar Fraction of the plant and minimize the auxiliary energy. To highlight the reliability of this methodology, in this work, the authors describe a case study of the Sicilian region proposing a set of simple, reliable correlations that allow the determination of the best tilt angle for monthly or seasonal use. Following the same steps the procedure can be replicate in any context and in any conditions

Vital Dyes in Vitreomacular Surgery

Vital dyes contain complex molecules with chromophores that stain living tissues and have greatly enhanced identification and removal of transparent vitreoretinal tissues during surgery. Several “chromovitrectomy” dyes are frequently used by vitreoretinal specialists, including indocyanine green, trypan blue, brilliant blue G, and triamcinolone acetonide; other dyes are also under investigation. Trypan Blue was approved by the U.S. Food and Drug Administration (FDA) for epiretinal membrane removal, and preservative-free triamcinolone acetonide was approved by the FDA for intraocular use. However, currently available chromovitrectomy dyes have their limitations, and of particular concern for some of them is the possibility for acute and chronic toxicity to the neurosensory retina and retinal pigmented epithelium. The potentially irreversible acute toxicity and other limitations, such as lack of long-term safety profiles, highlight the need for further advancements