Cost-effectiveness of intravitreal therapy in Age-Related Macular Degeneration

Age-related macular degeneration (AMD) is still referred to as the leading cause of severe and irreversible visual loss world-wide. Advances in medical research have identified vascular endothelial growth factor (VEGF) as an important pathophysiological player in neovascular AMD and intraocular inhibition of VEGF as one of the most efficient therapies. Anti-VEGFs currently used to treat AMD included a monoclonal antibody (bevacizumab), an antibody fragments (ranibizumab), a fusion protein (aflibercept), and an aptamer (pegaptanib). The wide introduction of anti-VEGF therapy has led to an improvement in the prognosis of patients affected by AMD, with a consequent effects on the burden of care due to highly priced drugs, increasing patient numbers, and long-term disease chronicity. Aim of this review is to present an overview of available therapeutic strategies in AMD in term of clinical efficacy and economic sustainability

North Atlantic simulations in Coordinated Ocean-ice Reference Experiments phase II (CORE-II). Part I: Mean states

Simulation characteristics from eighteen global ocean–sea-ice coupled models are presented with a focus on the mean Atlantic meridional overturning circulation (AMOC) and other related fields in the North Atlantic. These experiments use inter-annually varying atmospheric forcing data sets for the 60-year period from 1948 to 2007 and are performed as contributions to the second phase of the Coordinated Ocean-ice Reference Experiments (CORE-II). The protocol for conducting such CORE-II experiments is summarized. Despite using the same atmospheric forcing, the solutions show significant differences. As most models also differ from available observations, biases in the Labrador Sea region in upper-ocean potential temperature and salinity distributions, mixed layer depths, and sea-ice cover are identified as contributors to differences in AMOC. These differences in the solutions do not suggest an obvious grouping of the models based on their ocean model lineage, their vertical coordinate representations, or surface salinity restoring strengths. Thus, the solution differences among the models are attributed primarily to use of different subgrid scale parameterizations and parameter choices as well as to differences in vertical and horizontal grid resolutions in the ocean models. Use of a wide variety of sea-ice models with diverse snow and sea-ice albedo treatments also contributes to these differences. Based on the diagnostics considered, the majority of the models appear suitable for use in studies involving the North Atlantic, but some models require dedicated development effort

Intraocular Inflammation Control and Changes in Retinal and Choroidal Architecture in Refractory Non-Infectious Uveitis Patients after Adalimumab Therapy

Background: Non-infectious uveitis represents a leading cause of visual impairment, and inflammation control represents a major priority in tackling visual acuity loss due to complications such as macular edema; different immunomodulatory drugs are currently being used, including anti-TNF-alpha Adalimumab. Methods: This was a monocentric observational study of 18 eyes of 18 patients with non-infectious uveitis treated with Adalimumab. The primary endpoint was the control of ocular inflammation. The secondary endpoints included the study of macular and choroidal thickness and architecture, visual acuity, changes in other treatments, and adverse effects. Results: Ocular inflammation was controlled at 12 months for 83.3% of patients. Central macular thickness improved from a median of 229.75 µm at baseline to 213 µm at 12 months, while choroidal thickness decreased by 11.54% at the end of the follow-up. A reduction of vasculitis on fluorescein angiography and of hyperreflective spots on optical coherence tomography was noted. Visual acuity also improved from 0.51 (logMAR) before treatment to 0.24 at more than 12 months (p = 0.01). A total of 11.1% of patients experienced side effects. Conclusion: Our study confirms the efficacy of adalimumab for the control of ocular inflammation, visual acuity preservation, and for corticosteroid sparing

Terapia combinata nella gestione delle complicanze in dome-shaped macula: esperienza della clinica oculistica di Ancona

Obiettivo: valutare la variazione di spessore retinico maculare dopo trattamento combinato: fotodinamica (pdt) e laser giallo sotto soglia micropulsato nei pazienti con distacco sieroso del neuroepitelio (DNE) secondario a “dome shaped “refrattari a light fotodinamica(PDT), sicurezza ed efficacia di tali trattamenti. materiali e metodi: pazienti con diagnosi di DNE secondaria a dome shaped macula trattati presso la Clinica Oculistica di Ancona. Tutti i pazienti sono stati sottoposti a visita oculistica ,retinografia , autofluorescenza retinica,fluorangiografia (fag), esame al verde indocianina(icga),sd-oct,EDI-oct. 11 occhi miopi di 11 pazienti 8 di sesso femminile e 3 maschile con un’età media di 48 anni già sottoposti, almeno nei 3 mesi antecedenti, a light PDT e scarsamente responsivi a tale terapia sono stati oggetto di studio. Tutti i pazienti sono stati sottoposti a light PDT ICGA-guidata e dopo 2 settimane ad una seduta di laser giallo micropulsato sottosoglia 577. Risultati: alll’ultimo follow-up si mostravano uno spessore coroideale medio pari a 183.3μm (SD 75 .41μm) e uno spessore retinico foveale pari a 271.8μm (SD 64.19μm). Sono stati considerati responders i pazienti che mostravano una riduzione del DSNF > 30% rispetto al baseline. I responders al follow-up dei 6 mesi risultavano essere 5 occhi di 5 pazienti, con risoluzione del distacco sieroso in 2 occhi già rilevabile all’OCT eseguito alla visita di follow-up dei 3 mesi. Per quanto concerne l’acuità visiva in 6 occhi si è riscontrato un aumento di almeno 2 linee della BCVA, nessun peggioramento della BCVA né un aumento dello spessore retinico foveale è stato osservato Conclusioni:. Nel nostro studio abbiamo utilizzato la “combo therapy” ,PDT con effetto angio- occlusivo coroideale e laser giallo 577 micropulsato sottosoglia volto a stimolare l’attività di pompa dell’EPR i quali sembrano avere un effetto sinergico su due vie eziopatogenetiche alla base del distacco sieroso in dome shaped macula. Tale approccio si è rivelato sicuro nei pazienti presi in esame in quanto nessun paziente ha mostrato un peggioramento della BCVA né un aumento del DSNF né comparsa di neovascolarizzazione coroideale.Purpose: the aim of the present study is to report on the results obtained in a pilot study with a combined treatment of half-fluence half-dose photodynamic therapy (PDT) and subthreshold 577 nm micropulse laser treatment (STLT) for SRD(sub retinal detachment) related to DSM(dome shaped macula) poorly responsive to previous LIGHT-PDT: Efficacy and Safety. Methods : 11 Patients (8 females and 3 males) referred to the Department of Ophthalmology of University Politecnica delle Marche with the diagnosis of symptomatic DSM were prospectively enrolled in the study. Inclusion criteria included the diagnosis of symptomatic DSM, associated with SRD; DSM was regarded as symptomatic whenever associated with visual acuity deterioration and distortion. DSM definition was based on the OCT identification of an inward bulge inside the chorioretinal posterior concavity of the macular area, according to Gaucher’s description. Patients who had undergone any previous treatment in the last 3 months or were affected by any other ocular disease were excluded from the study.Each patient underwent a complete ophthalmologic examination, including best-corrected visual acuity(BCVA) on standard Early Treatment Diabetic Retinopathy Study (ETDRS) charts, blue-light fundus autofluorescence, fluorescein angiography ( FA), indocyanine green angiography (ICGA), OCT and OCT Angiography (OCTA). The patients were regularly scheduled. Each patient was first treated with half-fluence half-dose photodynamic therapy; after two weeks subthreshold 577 nm micropulse laser treatment was performed. Results :Overall, 11 eyes of 11 patients were included in the study. Subfoveal choroidal thickness was 183μm(SD 75.41μm ) and mean Central foveal thickness was 271.8μm (SD 64.19μm) to the last follow-up.Half-fluence half-dose photodynamic therapy and subthreshold micropulse laser treatment were uneventfully performed in all the cases, and were addressed to the ICGA- detected hyperfluorescent area. Serous retinal detachment diminished in all cases, and 5 eyes registered complete resolution at the end of the 6 month follow-up. No case showed enlargement of atrophic alterations, as assessed on blue-light fundus autofluorescence, or development of choroidal neovascularization at the end of the follow-up.Conclusions :a multimodal imaging evaluation is mandatory in order to better evaluate the patient with dome-shaped macula and its complications and to choose the best treatment in each case. To date, there is no validated therapy leading to DSM-related SRD resolution. Many different therapeutic approaches to SRD secondary to DSM have been attempted, with variable results.A combined treatment PDT and subthreshold 577 nm micropulse laser, with different therapeutic targets, has not been evaluated yet. In our experience, “combo therapy” can be considered an effective and safe therapy in the treatment of SRD secondary to DSM

Acute Retinal Pigment Epitheliitis

Acute retinal pigment epitheliitis (ARPE) is a benign, acute, self-limiting inflammation affecting selectively the retinal pigment epithelium (RPE) with reduced visual acuity, metamorphopsia and subtle changes at the level of the RPE

Measles

Measles is an acute, infective, highly contagious disease, caused by a virus belonging to the family of Paramyxoviridae, genus Morbillivirus

Idiopathic Retinal Vasculitis Aneurysms and Neuroretinitis (IRVAN) Syndrome

Idiopathic retinal vasculitis aneurysms and neuroretinitis (IRVAN) is the acronym used to describe a rare syndrome characterised by a peripheral retinal vascular occlusion secondary to a retinal vasculitis with multiple posterior retinal arterial aneurysms (Fig. 88.1). In 1995, Chang et al. [3] proposed “IRVAN”, describing ten cases with these features. This disorder is also known as “bilateral neuroretinopathy with multiple retinal arterial aneurysms”

Papillary Vessel Density Changes After Intravitreal Anti-VEGF Injections in Hypertensive Patients with Central Retinal Vein Occlusion: An Angio-OCT Study

To investigate papillary microvascular changes in patients affected by macular edema due to Central Retinal Vein Occlusions (CRVO) after anti-Vascular Endothelial Growth Factor (VEGF) therapy

Recovery of Enterococcus faecalis in root canal lumen of patients with primary and secondary endodontic lesions

none7The presence of Enterococcus faecalis in root canal teeth affected by primary and secondary periapical lesions was studied using polymerase chain reaction (PCR) assays. The association between presence of E. faecalis with clinical signs of apical lesions was assessed to evaluate a possible relationship between clinical findings. Microbial samples were obtained from healthy patients affected by different periapical lesions, 79 teeth with primary periapical lesion and 23 with secondary periapical lesion. For each tooth, clinical symptoms and X-ray appearance were examined. E. faecalis was detected in 6 of 79 samples with primary lesion (7.6%), and in 9 of 23 with secondary lesion (39.1%). Suggested association was found between E. faecalis and secondary apical lesions. As regard specific signs and symptoms E. faecalis was more associated with asymptomatic lesions (all p<0.05) than with symptomatic apical lesions. The study confirms the high presence of E. faecalis in secondary apical lesions. However, its effective role in endodontic pathogenesis such as bone periapical lesions needs to be clarified.nonePirani C; Bertacci A; Cavrini F; Foschi F; Acquaviva GL; Prati C; Sambri V.Pirani C; Bertacci A; Cavrini F; Foschi F; Acquaviva GL; Prati C; Sambri V

Acute Posterior Multifocal Placoid Pigment Epitheliopathy

Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is a term introduced by Gass in 1968 to describe a syndrome of multiple plaque-like post-equatorial, circumscribed, flat, gray-whitish, subretinal lesions involving the retinal pigment epithelium associated with visual loss