Impatto clinico della nadroparina nelle occlusioni venose retiniche

In questo studio abbiamo valutato la validità terapeutica della nadroparina calcica nelle varie forme di occlusione venosa retinica, confrontandola con l’efficacia dell’acido acetilsalicilico. La ricerca è stata condotta su 80 pazienti del Policlinico Umberto I di Roma (Day Hospital). Si è confermato che, oltre all’ipercolesterolomia, all’ipertrigliceridemia e al diabete, l’ipertensione arteriosa è un importante fattore predisponente per l’insorgenza delle occlusioni venose retiniche. Dai risultati dello studio si evince che la nadroparina calcica (un glicosaminoglicano a basso peso molecolare) ha una maggiore efficacia clinica, rispetto all’aspirina, nel migliorare l’acuità visiva post-occlusione. Saranno, tuttavia, necessari nuovi studi con un numero maggiore di pazienti e con un follow-up più lungo per confermare questa conclusione

Correlation between specratl-domain optical coherence tomography findings and visual outcome after primary rhegmatogenous retinal detachment repair.

Purpose: To correlate the postoperative visual outcome with the spectral-domain optical coherence tomography (SD-OCT) findings in the fovea after successful rhegmatogenous retinal detachment repair. Cross-sectional, observational study. Methods: Thirty-five patients with preoperative macula-on rhegmatogenous retinal detachment (12 eyes) and macula-off rhegmatogenous retinal detachment (23 eyes) who underwent scleral buckling surgery for primary rhegmatogenous retinal detachment were recruited. Early Treatment Diabetic Retinopathy Study best-corrected visual acuity measurement, microperimetry, and SD-OCT examination were performed on the same day. Foveal center retinal thickness, central 1-mm subfield thickness, and outer nuclear layer thickness were measured using SD-OCT. The presence or absence of epiretinal membrane, intraretinal fluid, and subretinal fluid was assessed. The status of the external limiting membrane, inner/outer segment junction, and intermediate line was also evaluated and judged as disrupted or complete. The correlations between SD-OCT findings and either postoperative best-corrected visual acuity or retinal sensitivities for central 12 degrees were analyzed. Results: The outer nuclear layer thickness was the only significant SD-OCT retinal measurement strongly correlated with both postoperative best-corrected visual acuity (r = 0.61; P < 0.001) and retinal sensitivities for central 12 degrees (r = 0.53; P = 0.001). Among the SD-OCT imaging findings, status of the external limiting membrane, inner/outer segment junction, and intermediate line and the presence of intraretinal fluid showed a significantly high correlation either with best-corrected visual acuity outcome (r = -0.60; P < 0.001, r = -0.63; P < 0.001, r = -0.66; P < 0.001, and r = -0.50; P = 0.002, respectively) or with postoperative retinal sensitivities (r = -0.59; P < 0.001, r = -0.61; P < 0.001, r = -0.66; P < 0.001, r = -0.50; P = 0.002, respectively). Multivariate analysis showed that the outer nuclear layer thickness and the status of the intermediate line were the most important predictors of visual outcome (P, 0.001 and P, 0.001, respectively). Conclusion: This study showed that not only the status of the external limiting membrane and the inner/outer segment junction but also the integrity of the intermediate line and the outer nuclear layer thickness changes may be important predictors of postoperative visual outcome after anatomically successful rhegmatogenous retinal detachment repair. RETINA 32:43-53, 201

Choroidal Neovascularization in Pathologic Myopia: Intravitreal Ranibizumab Versus Bevacizumab—A Randomized Controlled Trial

treating myopic choroidal neovascularization (CNV). ? DESIGN: Prospective, comparative, randomized, interventional study. ? METHODS: Thirty-two eyes from 32 patients with myopic CNV were consecutively enrolled and randomly treated, in a 1:1 ratio, with intravitreal ranibizumab (0.5 mg) or bevacizumab (1.25 mg) as needed, after the first injection. ETDRS best-corrected visual acuity (BCVA), foveal center thickness (FCT) on optical coherence tomography (OCT), and fluorescein angiographic findings were examined before and after treatment. Patients were followed up for 6 months. ? RESULTS: No statistically significant difference in the BCVA improvement, as well as in the FCT reduction, was found between groups during follow-up (P value at 1, 3, 6 months > .05). Complete resolution of fluorescein leakage was observed in all 16 bevacizumab-treated eyes and in 15 out of 16 (93.7%) ranibizumab-treated eyes. No ocular or systemic adverse effects from treatment were encountered. ? CONCLUSION: This randomized clinical study cannot determine a statistically significant difference in anti- VEGF treatment effect between ranibizumab and bevacizumab for the treatment of CNV secondary to pathologic myopia. A larger study is required to determine the relative efficacy and duration of action of these drugs. (Am J Ophthalmol 2010;149:458–464. © 2010 by Elsevier Inc. All rights reserved.

INTRAVITREAL BEVACIZUMAB FOR TREATMENT OF MYOPIC CHOROIDAL NEOVASCULARIZATION: THE SECOND YEAR OF A PROSPECTIVE STUDY.

Abstract PURPOSE: To evaluate the efficacy and safety of intravitreal bevacizumab for the treatment of myopic choroidal neovascularization (CNV). DESIGN: Prospective, non-randomized, interventional clinical study. METHODS: Twenty eyes from 20 patients with CNV secondary to pathologic myopia participated in this study. These patients had already completed 12 months of follow-up. All patients were scheduled for 3 monthly intravitreal bevacizumab 1.25 mg injections. ETDRS best-corrected visual acuity (BCVA), foveal center thickness (FCT) on OCT and CNV size as assessed by fluorescein angiography were examined before and after treatment. Patients were followed up for 24 months. RESULTS: Mean BCVA (+/- SD) at baseline was 24.8 (+/- 11.86) letters (Snellen equivalent: 20/80). At 24 months after treatment the mean BCVA (+/- SD) improved significantly (p less than 0.05) to 44 (+/- 13.99) letters (Snellen equivalent: 20/33). At 24 month follow-up, BCVA improved of 10 letters or more in 17 (85%) out of 20 treated eyes and improved of 15 letters or more in 15 (75%) eyes. No treated eyes experienced a worsening of BCVA from baseline. Mean foveal center thickness (FCT) (+/- SD) at baseline was 223 (+/- 47,43) microns. By month 24, mean FCT (+/-SD) reduced to 190 (+/- 29.01) microns (p less than 0.05). Mean area of the CNVs at baseline was 0.77 (+/- 0.78) mm2, which decreased to 0.31 +/- (0.51) mm2 and 0.30 (+/- 0.50) mm2 at 12 (p less than 0.05) and 24 months (p less than 0.05), respectively. At 24 months follow-up absence of fluoresce in leakage from the CNV was demonstrated in 18 (90%) out of 20 treated eyes. No ocular or systemic adverse effects from treatment were encountered. CONCLUSION: Eyes with myopic CNV treated with intravitreal bevacizumab over 2 years had significant anatomic and functional improvement. Further studies will be needed to confirm the long-term efficacy and safety of this treatment

Ophthalmic alterations in the Sturge-Weber Syndrome, Klippel-Trenaunay Syndrome, and the Phakomatosis Pigmentovascularis. an independent group of conditions?

The phakomatoses have been traditionally defined as a group of hereditary diseases with variable expressivity characterized by multisystem tumors with possible malignant transformation. The Sturge-Weber syndrome, Klippel-Trenaunay syndrome, and the phakomatosis pigmentovascularis have the facial port-wine stain in common. Numerous pathophysiogenetic mechanisms have been suggested such as venous dysplasia of the emissary veins in the intracranial circulation, neural crest alterations leading to alterations of autonomic perivascular nerves, mutation of the GNAO gene in the Sturge-Weber syndrome, PIK3CA mutation in malformative/overgrowth syndromes such as the Klippel-Trenaunay syndrome, and the twin-spotting phenomenon in phakomatosis pigmentovascularis. Other features linked to the port-wine stain and typical to all of the three conditions are glaucoma and choroidal alterations. Glaucoma can be due to malformations of the anterior chamber or high episcleral venous pressure and in phakomatosis pigmentovascularis it can also be associated with angle hyperpigmentation. The choroid can be thickened in all diseases. Furthermore, choroidal melanocytosis in the phakomatosis pigmentovascularis can lead to malignant transformation. Although the multiple pathophysiological mechanisms still require clarification, similarities in ophthalmic manifestations make it reasonable to classify these diseases in an independent group

Choroidal Neovascularization in Pathologic Myopia

With regard to the power calculations please note the following. The population covered by the present study consists of all subjects potentially affected with myopic CNV. It is a population of modalities, and therefore, is unlimited. The sample was selected according to inclusion and exclusion criteria, mentioned in the “Methods.” From a statistical point of view, it is a simple, random, no orderly sample without replacement: it is a nonprobabilistic sample with reasoned choice, which does not allow the application of the Horvitz-Thompson estimator to estimate variance, and then errors and best sample size. We elected to enroll every eligible patient who sought treatment from February 2008 through December 2008; therefore, the sample size was left to chance. The 1-tailed paired t test we used to compare the best-corrected visual acuity (BCVA) results applies with the compound hypothesis; therefore, the test power 1 - beta cannot be determined by the Neyman-Pearson lemma. The Neyman-Pearson test, indeed, applies to the case of a simple null hypothesis against a simple alternative hypothesis; on the contrary, the 1- beta varies with an alternate hypothesis. With a sample size of 16 patients in each arm, we found a standard deviation equal to 8.413 for BCVA in the bevacizumab group. We can assume a prudential alternate hypothesis of BCVA improvement equal to 7 letters; given an alfa error of 5%, we obtain a power of 0.942, and therefore a beta error of 5.8%. As for the proportional confidence interval of a complication rate, it is absolutely arbitrary to evaluate as 25% because we could not examine the problem, not being detected over all of the 32 patients. This means that the probability of complications is less than 3%, corresponding to a maximum proportional confidence interval equal to 11.7%, with an error of 5%