Alkaline-earth phosphonate MOFs with reversible hydration-dependent fluorescence

A new rigid tritopic phosphonic ligand, 2,4,6-tris(4-phosphonophenyl)pyridine (H6L), was synthesized and used to assemble isostructural barium (1) and strontium (2) phosphonate metal organic frameworks that exhibit fully reversible and selective water-dependent fluorescence red-shift at room temperature

Twelve months of follow-up after intravitreal injection of ranibizumab for the treatment of idiopathic parafoveal telangiectasia

Alexandros Rouvas,1 Panagiotis Malamos,2 Maria Douvali,1 Amalia Ntouraki,1 Nikos N Markomichelakis1 12nd Department of Ophthalmology, Medical School of Athens University, Athens, Greece; 2Department of Ophthalmology, NHS, “G Gennimatas” General Hospital, Athens, Greece Aims: To report the anatomic and functional outcomes of intravitreal ranibizumab in idiopathic parafoveal telangiectasia (IPT). Material and methods: Four eyes of three patients were included in this interventional case series. One patient (two eyes) had bilateral IPT (type 2) and two patients (two eyes) had unilateral (type 1) IPT. Retreatment was scheduled in case of leakage persistence in combination with visual acuity (VA) deterioration. Fluorescein angiography and optical coherence tomography were performed together with a full ophthalmic examination at baseline, 1, 3, 6, 9, and 12 months after injection. Results: One intravitreal injection of ranibizumab was performed in all four eyes. Complete cessation of leakage was documented postintervention in three eyes and partial cessation in one eye, followed by improvement of best corrected VA in one of them. In all eyes, structural changes of the photoreceptor layer were detected in tomography and were responsible for visual loss, which was in most cases, refractory to the applied therapy. Conclusion: Use of ranibizumab might be efficient in eliminating leakage activity in the macular region in patients with IPT. Nevertheless, improvement in VA was infrequent. Preexisting early photoreceptor alteration in IPT might render such patients unable to improve VA. Keywords: idiopathic parafoveal telangiectasis, intravitreal ranibizumab, fluorescein angiography, high-definition optical coherence tomograph

The effect of subconjunctival ranibizumab on corneal and anterior segment neovascularization: Study on an animal model

Purpose: To evaluate the effect of subconjunctival anti-vascular endothelial growth factor (VEGF) ranibizumab on corneal and anterior segment neovascularization. Methods: In this experimental study and laboratory investigation, chemical cauterization was utilized to induce corneal neovascularization in 16 rabbits randomly divided in 2 equal groups. Cauterized eyes were either treated with 0.1 mL (1 mg) of subconjunctival ranibizumab or administered a sham injection. A third group of 4 rabbits served as control for side effects after ranibizumab administration. All animals were monitored daily for 14 days and the extent of corneal scarring and neovascularization was measured on days 1, 7, and 14. After enucleation, ocular tissues were separated under a surgical microscope and VEGF levels were measured with ELISA. Statistical analysis was performed to compare the extent of corneal neovascularization and VEGF levels between treated and untreated eyes. Results: Subconjunctival ranibizumab inhibited corneal neovascularization significantly both in the first and the second week compared to untreated controls (p = 0.006 and p = 0.001, respectively). The VEGF levels were significantly lower in all anterior segment tissues like the cornea, iris, aqueous humor, and conjunctiva of the treated eyes (p<0.01). The reduction of VEGF levels ranged from 19% to 73% in different ocular tissues. Corneal scarring was not significantly affected by anti-VEGF treatment (p = 0.7). No side effects were noticed. Conclusions: Early subconjunctival administration of ranibizumab may successfully inhibit alkali-induced corneal neovascularization in an animal model. Subconjunctival ranibizumab reduces VEGF levels significantly not only in the cornea and the bulbar conjunctiva but also in the aqueous humor and the iris. © 2013 Wichtig Editore

Retinal angiomatous proliferation (rap) in a 42-year-old woman with syphilitic retinitis rap in a young patient with syphilitic retinitis

Purpose: To present a case of a young individual with retinal angiomatous proliferation (RAP) on the background of syphilitic retinitis. Methods/Design: Interventional case report. Results: A 42-year-old Caucasian with confirmed diagnosis of syphilitic retinitis in both eyes revealed the existence of RAP in the RE that responded well to one session of intravitreal triamcinolone acetonide and photodynamic therapy. Conclusion: To the best of our knowledge this is the first report of RAP in such a young individual. Further research is required in order to examine the possibility of inflammation playing a role in the pathophysiology of RAP. Copyright © 2009 Informa Healthcare USA, Inc

Intravitreal ranibizumab versus thermal laser photocoagulation in the treatment of extrafoveal classic choroidal neovascularization secondary to age-related macular degeneration

Background: To compare the efficacy of thermal laser photocoagulation versus intravitreal ranibizumab for the treatment of extrafoveal classic choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). Methods: We conducted a retrospective study on 24 eyes with extrafoveal classic CNV secondary to AMD, treated either with thermal laser photocoagulation (group 1) or with intravitreal ranibizumab (group 2). Visual acuity, number of injections/sessions and recurrence rate were assessed. Results: The mean follow-up time was 23.6 ± 2.26 and 19.1 ± 9.74 months for group 1 and 2, respectively. Mean best corrected visual acuity (BCVA) of groups 1 and 2 was 0.59 ± 0.32 and 0.46 ± 0.30 logMAR, respectively (p = 0.343). At the end of the follow-up, mean BCVA of group 1 was 0.92 ± 0.35 and of group 2 0.16 ± 0.12 logMAR and differed statistically compared to baseline (p = 0.02 and p = 0.006, respectively). There was a statistically significant difference between the two groups as far as BCVA at the end of the follow-up was concerned (p < 0.0001). The patients in group 1 received on average 1.38 sessions of thermal laser photocoagulation, while patients in group 2 received on average 4 injections of ranibizumab. The recurrence rate in the laser group was 84.6%, while in the ranibizumab group it was 18.2% (p < 0.001). Specifically, the mean time of recurrence in the laser group was 11.5 months, whereas in the ranibizumab group it was 18 months (p = 0.048). Conclusion: Intravitreal ranibizumab showed promising results in BCVA improvement and decrease in macular thickness in patients with extrafoveal classic CNV due to AMD, with a small number of injections. Laser photocoagulation treatment presented worsening in BCVA and high recurrence rate in our study with long-term follow-up. Copyright © 2012 S. Karger AG, Basel

Intravitreal ranibizumab (Lucentis) for branch retinal vein occlusion-induced macular edema: Nine-month results of a prospective study

PURPOSE:: The purpose of this study was to evaluate the effect of individualized repeated intravitreal injections of ranibizumab (Lucentis, Genentech, South San Francisco, CA) on visual acuity and central foveal thickness (CFT) for branch retinal vein occlusion-induced macular edema. METHODS:: This study was a prospective interventional case series. Twenty-eight eyes of 28 consecutive patients diagnosed with branch retinal vein occlusion-related macular edema treated with repeated intravitreal injections of ranibizumab (when CFT was >225 μm) were evaluated. Optical coherence tomography and fluorescein angiography were performed monthly. RESULTS:: The mean best-corrected distance visual acuity improved from 62.67 Early Treatment of Diabetic Retinopathy Study letters (logarithm of the minimum angle of resolution = 0.74 ± 0.28 [mean ± standard deviation]) at baseline to 76.8 Early Treatment of Diabetic Retinopathy Study letters (logarithm of the minimum angle of resolution = 0.49 ± 0.3; statistically significant, P < 0.001) at the end of the follow-up (9 months). The mean letter gain (including the patients with stable and worse visual acuities) was 14.3 letters (2.9 lines). During the same period, 22 of the 28 eyes (78.6%) showed improved visual acuity, 4 (14.2%) had stable visual acuity, and 2 (7.14%) had worse visual acuity compared with baseline. The mean CFT improved from 349 ± 112 μm at baseline to 229 ± 44 μm (significant, P < 0.001) at the end of follow-up. A mean of six injections was performed during the follow-up period. Our subgroup analysis indicated that patients with worse visual acuity at presentation (≤50 letters in our series) showed greater visual benefit from treatment. "Rebound" macular edema was observed in 5 patients (17.85%) at the 3-month follow-up visit and in none at the 6- and 9-month follow-ups. In 18 of the 28 patients (53.6%), the CFT was <225 μm at the last follow-up visit, and therefore, further treatment was not instituted. No ocular or systemic side effects were noted. CONCLUSION:: Individualized repeated intravitreal injections of ranibizumab showed promising short-term results in visual acuity improvement and decrease in CFT in patients with macular edema associated with branch retinal vein occlusion. Further studies are needed to prove the long-term effect of ranibizumab treatment on patients with branch retinal vein occlusion. Copyright © by Ophthalmic Communications Society, Inc

Angiographic and OCT features of retinal angiomatous proliferation

BackgroundTo propose a classification system for retinal angiomatous proliferation (RAP) on the basis of the indocyanine green angiography (ICG).MethodsRetrospective chart review of 55 eyes of 55 patients presenting with RAP. Fluorescein angiography (FA), ICG and optical coherence tomography (OCT) were used to evaluate the patients.ResultsAll RAP lesions appeared as occult or minimally classic CNV on FA without clear evidence of pigment epithelium detachment (PED). We were able to identify five different patterns of RAP on the basis of ICG. These were focal (27.2), irregular (21.8), circular (21.8), multifocal (18.2), and combined (10.9) hyperfluorescence. The sudden termination of retinal vessel course sign was observed in 14 of 55 eyes (25.4), which had a circular or irregular pattern on the ICG. Only the circular RAP exhibited a late hypofluorescence (wash out) with staining of the surrounding tissue on the ICG. Forty eight of 55 eyes (86) had PED according to the OCT. Out of these 48 eyes, 19 had intraretinal fluid (IRF) alone, and the rest had IRF and subretinal fluid. The eight eyes (14) without PED belonged to the focal hyperfluorescence group and the fluid was located intraretinally in cystic spaces. In addition, in four eyes (7) with coexisting CNV a band of tissue beneath the RAP protruding in the PED was observed.ConclusionWe propose a classification system for RAP on the basis of ICG and present the angiographic and OCT findings of these lesions. These data may further aid in the early diagnosis of RAP and can be also used for prognosis and clinical course documentation. © 2010 Macmillan Publishers Limited. All rights reserved

Intravitreal ranibizumab for the treatment of inflammatory choroidal neovascularization

Purpose: To evaluate the effect of individualized repeated intravitreal injections of ranibizumab (Lucentis) on visual acuity and central foveal thickness in patients with choroidal neovascular membrane (CNV) associated with various ocular inflammatory clinical entities. Methods: Our study was a retrospective, noncomparative, interventional, and observational case series. Sixteen eyes of 15 consecutive patients diagnosed with inflammatory CNV treated with repeated intravitreal injections of ranibizumab were evaluated. The underlying diagnoses were toxoplasmosis (n = 4), serpiginous choroidopathy (n = 2), punctate inner choroidopathy (n = 5), multifocal choroiditis (MFC, n = 3), and scleroderma (n = 2). All patients underwent monthly optical coherence tomography (OCT) scans and fluorescein angiography/indocyanine green angiography every 1 month after every injection and then every 3 months. Optical coherence tomography scans and fluorescein angiography were performed by the same experienced physician. Repeated intravitreal injections were performed when persistent/recurrent fluid on OCT and/or signs of active CNV on angiography were present. Changes in Early Treatment Diabetic Retinopathy Study visual acuity and central foveal thickness were statistically analyzed. Results: The mean follow-up time was 70.4 ± 24 weeks (17.6 months; range, 44-116 weeks [11-29 months]). The mean number of injections performed was 2.3, and the mean best-corrected visual acuity improved from 55 Early Treatment Diabetic Retinopathy Study letters (logarithm of the minimum angle of resolution, 0.9 ± 0.4 [mean ± SD]) at baseline to 70.3 Early Treatment Diabetic Retinopathy Study letters (logarithm of the minimum angle of resolution, 0.6 ± 0.4) at the end of the follow-up, a statistically significant change compared with baseline (P < 0.0001). The mean letter gain was 15.3 letters, and best-corrected visual acuity improved in 14 of 16 patients (88%) and remained stable in 2 patients (12.5%) without any patient demonstrating deterioration. The mean central foveal thickness (although not excessively increased at baseline) improved from 285 ± 20 μm at baseline to 233 ± 21 μm (statistically significant compared with baseline, P < 0.0001) at the end of the follow-up. At the end of the follow-up, all patients demonstrated CNV regression, and retinal pigment epithelial atrophy surrounding the regressed CNV was developed in 11 of the 16 eyes (68.8%). During the same period, no CNV recurrence was observed and no injection-related complications such as cataract, retinal detachment, endophthalmitis, or exacerbation of uveitis were noted. Conclusion: Overall, our findings suggest that intravitreal injections of ranibizumab have shown promising results in visual acuity improvement and a decrease in macular thickness in patients with inflammatory CNV. Of course, further studies are needed to confirm the exact benefit and standardize the optimal treatment regimen. Copyright © Ophthalmic Communications Society, Inc

Safety and efficacy of 5-azacytidine treatment in myelodysplastic syndrome patients with moderate and mild renal impairment

Myelodysplastic syndrome (MDS) patients with renal impairment (RI) were not assessed in the approval trials of 5-azacytidine, thus the optimal use of 5-azacytidine in such patients is currently undefined. We retrospectively analyzed 42 IPSS intermediate-2 and high-risk patients with moderate, mild or no RI undergoing 5-azacytidine therapy in a non-trial setting. We demonstrate that patients in all three groups achieved comparable responses and had similar overall and event-free survival. Likewise, both treatment toxicity and dose adjustments were not significantly influenced by renal function status. A transient but reversible decline in glomerular filtration rate was observed in patients either with or without RI, without affecting the therapeutic schedule. Our results provide the first evidence that 5-azacytidine is effective and well-tolerated in patients with mild and moderate RI and, if confirmed by prospective randomized studies, advocate that such patients can be managed in an analogous fashion to patients with normal renal function. © 2013 Elsevier Ltd