Fast and Successful Management of Intraocular Inflammation with a Single Intravitreal Dexamethasone Implant

Purpose: To investigate the efficacy and safety of a single dexamethasone intravitreal implant (Ozurdex®, 700 µg). Methods: In this prospective noncomparative case series, 84 patients (54 females) received a dexamethasone intravitreal implant. At weeks 4, 12 and 24 after the injection, vitreous haze, macular thickness and best corrected visual acuity (BCVA) were assessed and adverse events reported. Results: Clearance of vitreous haze could be achieved after 4 weeks in 61% of all eyes (p < 0.001) and remained significant until week 24 (p < 0.001). This was paralleled by a reduction of central retinal thickness after 4 (p < 0.001), 12 (p < 0.001) and 24 weeks (p < 0.006). Significant and fast improvement of BCVA was already achieved after 4 weeks (p < 0.001) but vanished by week 24. Intraocular pressure reached ≥35 mm Hg in 3 eyes and was significantly more frequent in intermediate uveitis compared to posterior uveitis (p < 0.016). Conclusions: The dexamethasone implant is effective in controlling intraocular posterior segment inflammation and reduces central retinal thickness fast and effectively. © 2014 S. Karger AG, Basel

Myocardial bridging evaluated with 128-multi detector computed tomography coronary angiography

Purpose: The aim of the study was to evaluate the prevalence, length, depth, and location of myocardial bridging of the coronary arteries using 128-multi detector computed tomography coronary angiography. Methods: The study cohort consisted of 875 patients who underwent coronary computed tomography angiography (CTA) for various indications. We evaluated the presence, length, and location of complete and incomplete bridging. In cases of complete bridging the thickness of the overlying muscle was also measured. Results: From a total of 875 subjects, 184 subjects (21%) were found to a single myocardial bridge. Complete bridging was detected in 161 patients (18.4%) and incomplete bridging in 23 patients (2.6%). The coronary arteries involved were the mid portion of the left anterior descending artery (LAD) (67.9%), the distal portion of the LAD (28.8%), and the proximal portion of the LAD (3.2%). No myocardial bridging was detected in other arteries in our study. The mean length and maximum myocardial thickness overlying the complete bridging were 20.9 mm (range 8-32 mm) and 2.6 mm (range 1.2-5.3 mm), respectively. The mean length of the incomplete bridging was 17 mm (range 9-2.3 mm). Conclusions: Multi detector computed tomography is a reliable non-invasive modality for diagnosing myocardial bridging. The prevalence of myocardial bridging in this patient group was 21%. Our results are in agreement with those reported in pathologic studies, the gold standard for detecting this anomaly. © 2009 Springer-Verlag

International survey of T2* cardiovascular magnetic resonance in ß-thalassemia major

PubMed ID: 23812939Accumulation of myocardial iron is the cause of heart failure and early death in most transfused thalassemia major patients. T2* cardiovascular magnetic resonance provides calibrated, reproducible measurements of myocardial iron. However, there are few data regarding myocardial iron loading and its relation to outcome across the world. A survey is reported of 3,095 patients in 27 worldwide centers using T2* cardiovascular magnetic resonance. Data on baseline T2* and numbers of patients with symptoms of heart failure at first scan (defined as symptoms and signs of heart failure with objective evidence of left ventricular dysfunction) were requested together with more detailed information about patients who subsequently developed heart failure or died. At first scan, 20.6% had severe myocardial iron (T2*?10ms), 22.8% had moderate myocardial iron (T2* 10-20ms) and 56.6% of patients had no iron loading (T2*>20ms). There was significant geographical variation in myocardial iron loading (24.8-52.6%; P<0.001). At first scan, 85 (2.9%) of 2,915 patients were reported to have heart failure (81.2% had T2* <10ms; 98.8% had T2* <20ms). During follow up, 108 (3.8%) of 2,830 patients developed new heart failure. Of these, T2* at first scan had been less than 10ms in 96.3% and less than 20ms in 100%. There were 35 (1.1%) cardiac deaths. Of these patients, myocardial T2* at first scan had been less than 10ms in 85.7% and less than 20ms in 97.1%. Therefore, in this worldwide cohort of thalassemia major patients, over 43% had moderate/severe myocardial iron loading with significant geographical differences, and myocardial T2* values less than 10ms were strongly associated with heart failure and death. © 2013 Ferrata Storti Foundation