Coexistence of vitreomacular traction and exudative age-related macular degeneration. A case report

Vitreomacular traction is a common phenomenon causing a decrease in visual acuity, metamorphopsia, and disorders of central vision. The introduction of intravitreal ocriplasmin injection provided a new possibility of noninvasive treatment of this syndrome. The novelty of this case is that the ocriplasmin is a new treatment possibility and its combination with ranibizumab treatment has rarely been reported. The aim was to report a case of an 83-year-old man treated with intravitreal ocriplasmin and ranibizumab injections because of coexisting vitreomacular traction and exudative age-related macular degeneration. A patient was referred to our clinic due to complaints about progressive central visual acuity decrease and metamorphopsia in the right eye observed within the last year. Before intravitreal 125-μg ocriplasmin injection the patient underwent ophthalmic examinations including best corrected visual acuity, slit-lamp, and fundoscopy and optical coherence tomography. After diagnosing with exudative age-related macular degeneration the patient was referred to three loading doses of anti-VEGF therapy. Three weeks after ocriplasmin injection the patient’s best corrected visual acuity improved. Ophthalmic examinations revealed the occurrence of exudative age-related macular degeneration. After three loading doses of anti-VEGF therapy ophthalmic examinations disclosed vitreomacular traction release and retinal fluid absorption. Coexistence of vitreomacular diseases may be the reason for poor response to anti-VEGF treatment in patients with exudative age-related macular degeneration. Simultaneously, pharmacological vitreolysis using ocriplasmin injection may be an effective and safe method of vitreomacular traction treatment.

Early treatment of subretinal haemorrhage in the course of exudative AMD using SF6 gas infusion and injection of intravitreal anti-VEGF — case report

Submacular haemorrhages, which are mostly caused by exudative age-related macular degeneration, lead to a significant deterioration of visual acuity and have a poor prognosis. Therefore, quick implementation of treatment is essential. The aim was to report a case of 68-year-old patient suffering from extensive haemorrhage covering the macula treated with pure sulphur hexafluoride (SF6) gas infusion and two anti-vascular endothelial growth factor (anti-VEGF) intravitreal injections. A patient was referred to the clinic due to a sudden deterioration of vision and the appearance of a black spot in central vision in the right eye. The patient underwent the infusion of 0.5 ml of pure SF6 followed by maintenance of face-down position postoperatively resulting in partial displacement of submacular haemorrhage. One month after the surgery the patient was referred to two intravitreal injections of anti-VEGF in monthly intervals. The effectiveness of the treatment is confirmed by OCT examination and visual acuity results (from CF 1’ before treatment to 5/12 after the treatment). A combination of SF6 gas infusion and anti-VEGF intravitreal injections turned out to be an effective and safe method of submacular haemorrhage treatment. Early diagnosis and treatment implementation resulted in significant improvement of visual acuity

OCT angiography as a novel diagnostic possibility in age-related macular degeneration

INTRODUCTION. The aim of the study is to compare classical vein imaging methods used to diagnose Age-related Macular Degeneration (AMD), like fluorescein angiography (FA), with non-invasive modern methods of ultrafast optical blood flow detection (Optical Coherence Tomography-angiography, Angio-OCT). METHODS. Images obtained during examination using AF and Angio-OCT methods of four randomly selected patients treated for AMD in the Department of Ophthalmology Medical University of Silesia, Katowice, Poland were used for evaluation. RESULTS. Images obtained during routine check-up of patients treated for AMD were compared. CONCLUSIONS. Angio-OCT is a non-invasive, non-contact, fast, and safe examination of patients treated for AMD. Angio-OCT is a modern method that provides important information about the progression of the disease, and it is used to evaluate retinal and choroidal vessels in patients with AMD

Rola doszklistkowych steroidów we współczesnym leczeniu cukrzycowego obrzęku plamki

Powikłania cukrzycy są jednym z najczęstszych i najpoważniejszych problemów we współczesnej okulistyce. W pracy przedstawiono dane epidemiologiczne i zasady leczenia retnopatii cukrzycowej i cukrzycowego obrzęku plamki. Szczególną uwagę zwrócono na rolę iniekcji doszklistkowych, w tym steroidów, które w niektórych przypadkach mogą być alternatywą dla inhibitorów naczyniowo-śrdódbłonkowego czynnika wzrostu (anty-VEGF). Zdaniem grupy ekspertów konieczne jest stworzenie programu lekowego obejmującego leczenie cukrzycowego obrzęku plamki, który istotnie poprawi dostęp do nowoczesnej terapii dużej grupie chorych. W programie lekowym lekiem pierwszego rzutu powinien być anty-VEGF z możliwością zmiany na doszklistkowy implant deksametazonu, w przypadku braku odpowiedzi na leczenie lub istnienia przeciwskazań do terapii anty-VEGF. Należy stworzyć precyzyjne kryteria kwalifikacji do programu, zdefiniować brak odpowiedzi na leczenie oraz określić wskazania do zmiany leku

Is intravitreal dexamethasone implant a better choice than anti-VEGF therapy to treat complications of RVO in the retina?

Retinal vein occlusion (RVO) is a retinal vein disease whose complications can lead to decreased visual acuity and even blindness. The most common cause of decreased visual acuity during RVO is a chronic cystoid macular edema. The therapy involves medications with proven efficacy from the anti-VEGF group: ranibizumab, aflibercept, off-label bevacizumab and corticosteroids: dexamethasone in the form of a prolonged-release implant, fluocinolone, and off-label triamcinolone, characterized by short half-life. Scientific reports and clinical trials confirm the efficacy of anti-VEGF drugs and corticosteroids in the treatment of RVO. Therapy should be selected individually for each patient, including accompanying diseases, both systemic and local ailments. Anti-VEGF drugs and corticosteroids improve the retinal and choroidal morphology and restore the function of the retina by improving its sensitivity; confirmed in the microperimetric examination, which translates into improved visual acuity. Anti-VEGF therapy is associated with the necessity of reinjection, especially in the case of recurrence of macular edema and decreased visual acuity, which may result in the possibility of a reduced response to the medicine being used. In this situation, it is recommended to switch to another anti-VEGF drug or to a dexamethasone treatment.Zakrzep naczyń żylnych siatkówki (RVO, retinal vein occlusion) to choroba naczyń siatkówki, której powikłania mogą prowadzić do obniżenia ostrości wzroku, a nawet ślepoty. Najczęstszą przyczyną obniżenia ostrości wzroku w przebiegu RVO jest przewlekły torbielowaty obrzęk plamki. W terapii stosuje się preparaty o udowodnionej skuteczności z grupy anty-VEGF: ranibizumab, aflibercept i off-label bewacyzumab, oraz glikokortykosteroidy: deksametazon w postaci implantu o przedłużonym uwalnianiu, fluocynolon i off-label triamcynolon, charakteryzujący się krótkim okresem półtrwania. Liczne doniesienia naukowe oraz badania kliniczne potwierdzają skuteczność preparatów anty-VEGF oraz glikokortykosteroidów w leczeniu RVO. Terapia powinna być dobrana indywidualnie dla każdego pacjenta, z uwzględnieniem chorób towarzyszących, zarówno ogólnoustrojowych, jak i miejscowych. Leki anty-VEGF i glikokortykosteroidy poprawiają morfologię siatkówki i naczyniówki oraz przywracają funkcję siatkówki poprzez poprawę jej czułości potwierdzoną w badaniu mikroperymetrycznym, co przekłada się na poprawę ostrości wzroku. Leczenie preparatami z grupy anty-VEGF związane jest z koniecznością reiniekcji w razie wystąpienia nawrotu obrzęku plamki i obniżenia ostrości wzroku, co z kolei wiąże się z możliwością wystąpienia zmniejszonej odpowiedzi na stosowany lek. W takiej sytuacji zaleca się zamianę na inny lek anty-VEGF (switch) lub na deksametazon

Three-Month Results of Brolucizumab Intravitreal Therapy in Patients with Wet Age-Related Macular Degeneration

The purpose of the study was to evaluate changes in best corrected visual acuity, central retinal thickness, area and flow in the neovascular membrane and to compare therapeutic outcomes from baseline in patients who received three doses of Beovu (brolucizumab) at three-month follow-up. Material and methods: A prospective observational study conducted at the Prof. K. Gibiński University Clinical Center of the Medical University of Silesia in Katowice. Eight patients with exudative form of age-related macular degeneration (AMD) were observed. Results: The mean best corrected visual acuity (BCVA) outcome increased with each subsequent visit. The mean central retinal thickness (CRT) result also improved (decreased) with each subsequent visit, except for the last measurement. A statistically significant change in neovascular membrane area was observed after the first injection. In further treatment, the membrane area underwent changes that were not statistically significant. A statistically significant change in neovascular membrane flow was demonstrated after the first and second injections. Discussion: Our study confirmed the efficacy of brolucizumab in the treatment of patients with exudative AMD in terms of improvements in best corrected visual acuity (BCVA), central retinal thickness (CRT), neovascular membrane area, and neovascular membrane flow area

Changes in plasma VEGF and PEDF levels in patients with central serous chorioretinopathy

Background and Objectives: Retinal pigment epitheliopathy and hyperpermeability of choroidal vessels were postulated to be involved in the pathogenesis of central serous chorioretinopathy (CSC). Imbalanced levels of vascular endothelial growth factor (VEGF) and pigment-epithelium–derived factor (PEDF) were previously implicated in the development of chorioretinal diseases characterized by increased vascular permeability. We aimed to compare the plasma levels of proangiogenic VEGF and antiangiogenic PEDF for 26 patients with acute CSC, 26 patients with chronic CSC, and 19 controls. Materials and Methods: VEGF and PEDF levels were measured using a multiplex immunoassay or enzyme-linked immunosorbent assay. Correlations with disease duration were assessed. Results: VEGF levels differed between groups (p = 0.001). They were lower in patients with acute CSC (p = 0.042) and chronic CSC (p = 0.018) than in controls. PEDF levels were similar in all groups. The VEGF-to-PEDF ratio was lower in CSC patients than in controls (p = 0.04). A negative correlation with disease duration was noted only for PEDF levels in the group with chronic CSC (rho = −0.46, p = 0.017). Discussion: Our study confirmed that patients with CSC have imbalanced levels of VEGF and PEDF. This finding may have important implications for the pathogenesis of CSC. VEGF-independent arteriogenesis rather than angiogenesis may underlie vascular abnormalities in these patients