A Propensity-Score Matching Comparison between 27-Gauge and 25-Gauge Vitrectomy Systems for the Repair of Primary Rhegmatogenous Retinal Detachment

Purpose. To compare the anatomical and visual results and complications of 27-gauge versus 25-gauge transconjunctival sutureless vitrectomy for the management of primary rhegmatogenous retinal detachment. Methods. A prospective, propensity score-matched 6-month study was performed. All patients underwent either 27-gauge or 25-gauge vitrectomy as the first surgical intervention and were followed up over a 6-month period, in order to evaluate anatomical success, change in best-corrected visual acuity (BCVA), and intraoperative and postoperative complications including intraocular pressure dysregulation. Results. Propensity score matching resulted in two groups of 37 eyes each. All eyes completed a six-month follow-up. Baseline demographic and preoperative ocular characteristics showed no statistically significant difference between the two cohorts. The single operation success rate was 33/37 (89%) for 27-gauge cases and 34/37 (92%) for 25-gauge cases (p=0.7). The final anatomical success rate was 100% for each of the two cohorts. Mean BCVA change at the 6-month postoperative follow-up visit was −0.67 logMAR in the 27-gauge group and −0.71 logMAR in the 25-gauge group (p=0.9). Two patients in the 25-gauge group experienced transient hypotony after surgery. Conclusion. No significant difference between 27-gauge and 25-gauge transconjunctival sutureless vitrectomy for the repair of primary rhegmatogenous retinal detachment was recorded in terms of reattachment rate, BCVA, intraoperative and postoperative complications

Pharmacokinetic and Pharmacodynamic Rationale for Extending VEGF Inhibition Increasing Intravitreal Aflibercept Dose

Background: The effects of various dosages and treatment regimens on intravitreal aflibercept concentrations and the proportion of free vascular endothelial growth factor (VEGF) to total VEGF were evaluated using a drug and disease assessment model. The 8 mg dosage received specific attention. Methods: A time-dependent mathematical model was developed and implemented using Wolfram Mathematica software v12.0. This model was used to obtain drug concentrations after multiple doses of different aflibercept dosages (0.5 mg, 2 mg, and 8 mg) and to estimate the time-dependent intravitreal free VEGF percentage levels. A series of fixed treatment regimens were modeled and evaluated as potential clinical applications. Results: The simulation results indicate that 8 mg aflibercept administered at a range of treatment intervals (between 12 and 15 weeks) would allow for the proportion of free VEGF to remain below threshold levels. Our analysis indicates that these protocols maintain the ratio of free VEGF below 0.001%. Conclusions: Fixed q12-q15 (every 12-15 weeks) 8 mg aflibercept regimens can produce adequate intravitreal VEGF inhibition

Intravitreal steroids for the treatment of retinal diseases

Diabetic macular edema (DME), pseudophakic cystoid macular edema (CME), age-related macular degeneration (AMD), retinal vascular occlusion (RVO), and uveitis are ocular conditions related to severe visual impairment worldwide. Corticosteroids have been widely used in the treatment of these retinal diseases, due to their well-known antiangiogenic, antiedematous, and anti-inflammatory properties. Intravitreal steroids have emerged as novel and essential tools in the ophthalmologist’s armamentarium, allowing for maximization of drug efficacy and limited risk of systemic side effects. Recent advances in ocular drug delivery methods led to the development of intraocular implants, which help to provide prolonged treatment with controlled drug release. Moreover, they may add some potential advantages over traditional intraocular injections by delivering certain rates of drug directly to the site of action, amplifying the drug’s half-life, contributing in the minimization of peak plasma levels of the drug, and avoiding the side effects associated with repeated intravitreal injections. The purpose of this review is to provide an update on the use of intravitreal steroids as a treatment option for a variety of retinal diseases and to review the current literature considering their properties, safety, and adverse events

The ideal intravitreal injection setting: office, ambulatory surgery room or operating theatre? A narrative review and international survey

PurposeThis study reviews evidence and provides recommendations for the ideal setting of intravitreal injection (IVI) administration of vascular endothelial growth factor (VEGF) inhibitors.MethodsA multi-step approach was employed, including content analysis of regulations and guidelines, a systematic literature review, and an international survey assessing perioperative complications and endophthalmitis incidence in relation to injection settings. The literature review searched PubMed and Cochrane databases from 2006 to 2022, focusing on studies reporting correlations between complications and treatment settings. The survey utilized a web-based questionnaire distributed to clinical sites and the international ophthalmic community, with data managed using electronic capture tools.ResultsWe reviewed regulations and guidelines from 23 countries across five continents, finding significant variation in IVI administration settings. In most countries, IVI is primarily administered in outpatient clean rooms (96%) or offices (39%), while in others, it is restricted to ambulatory surgery rooms or hospital-based operating theatres (4%). The literature review found that endophthalmitis risk after IVI is generally low (0.01% to 0.26% per procedure), with no significant difference between office-based and operating room settings. The international survey (20 centers, 96,624 anti-VEGF injections) found low overall incidences of severe perioperative systemic adverse events and endophthalmitis, independent of injection settings.ConclusionNo significant differences in perioperative complications were observed among various settings, including operating theatres, ambulatory surgery rooms, offices, hospitals, or extra-hospital environments. Choosing the appropriate clinical setting can optimize patient management, potentially increasing effectiveness, quality, productivity, and capacity

Anti-VEGF Drugs Dynamics: Relevance for Clinical Practice

Background: A drug and disease assessment model was used to evaluate the impact of different treatment regimens on intravitreal ranibizumab, bevacizumab, aflibercept, and brolucizumab concentrations and the proportion of free vascular endothelial growth factor (VEGF) to total VEGF. Methods: A time-dependent mathematical model using Wolfram Mathematica software was used. The pharmacokinetic and pharmacodynamic data for anti-VEGFs were obtained from published reports. The model simulated drug concentration after single and multiple doses of ranibizumab, bevacizumab, aflibercept, and brolucizumab, and it extrapolated time-dependent intraocular free VEGF proportion values. Various fixed treatment regimens (q4, q8, q10, q12) were simulated and evaluated as candidates for clinical utilization. Results: Our mathematical model shows good correlation between intraocular VEGF proportion values and clinical data. Simulations suggest that each anti-VEGF agent would allow for distinct treatment intervals to keep the proportion of free VEGF under threshold levels. Regimens scheduling q8 ranibizumab, q8 bevacizumab, q12 aflibercept, and q10 brolucizumab administration permit to maintain the proportion of unbound VEGF below 0.001%. Conclusions: Fixed q8 ranibizumab, q8 bevacizumab, q12 aflibercept, or q10 brolucizumab regimens may produce adequate intraocular VEGF inhibition

Triamcinolone acetonide for the treatment of diabetic macular oedema

Diabetic macular oedema is a major cause of severe visual loss whose pathogenesis appears to be complex and multifactorial. For many years laser photocoagulation has been the standard of care for the treatment of this condition. Emerging pharmacologic approaches are being evaluated through randomised controlled trials. Triamcinolone acetonide has been proposed as a promising option, due to its well-known anti-inflammatory, anti-permeability and anti-angiogenic properties. Intravitreal delivery allows bypassing of the blood-retinal barrier to achieve a more concentrated dose of steroid in the vitreal cavity for a prolonged time. Intravitreal triamcinolone acetonide is effective in reducing central macular thickness and improving visual acuity, even if the duration of action is often provisional and requires repeated injections. Drug-related and injection-related side effects have been reported; the most common are induced cataract and increased intraocular pressure. To extend the duration of steroid effects and to minimise the risk of complications, alternative routes of administration and extend-release implants are being investigated. \ua9 TOUCH BRIEFINGS 2012

Automated diabetic retinopathy detection with two different retinal imaging devices using artificial intelligence: a comparison study

In this study, we evaluated the diagnostic performance of an automated artificial intelligence-based diabetic retinopathy (DR) algorithm with two retinal imaging systems using two different technologies: a conventional flash fundus camera and a white LED confocal scanner

Low-concentration infracyanine green-assisted internal limiting membrane peeling in idiopathic macular pucker 25-gauge surgery

PURPOSE. To investigate the efficacy of 25-gauge infracyanine green-assisted idiopathic macular pucker surgery and to identify prognostic factors. METHODS. In this retrospective interventional case series, 83 patients with idiopathic macular pucker who underwent 25-gauge surgery with infracyanine green-assisted internal limiting membrane (ILM) peeling were retrospectively reviewed. Best-corrected visual acuity (BCVA) measurement, complete ophthalmologic evaluation, and optical coherence tomography were performed at baseline and during follow-up. Preoperative and postoperative prognostic factors were correlated with final visual outcomes. RESULTS. Mean follow-up was 10.5 months (range 3-44). Best-corrected visual acuity improved from 0.56\ub10.27 logMAR (\ub1SD) to 0.26 \ub10.18 logMAR (p<0.001); central retinal thickness decreased from 441\ub1115 \u3bcm to 355\ub172 \u3bcm (p<0.001). Greater postoperative visual gain was correlated with baseline BCVA (r=-0.65, p<0.0001), and BCVA gain after 1 week (r=0.64, p<0.0001) and 1 month (r=0.58, p<0.0001). Final BCVA was influenced by baseline BCVA (r=0.46, p<0.0001), BCVA change after 1 month (r=0.34, p=0.002), and presence of intraretinal fluid (r=0.28, p=0.01). No cases of endophthalmitis, retinal tears, or retinal detachments were reported. CONCLUSIONS. Low-concentration infracyanine green-assisted ILM peeling during minimally invasive surgery is associated with significant visual acuity improvement. Preoperative BCVA and optical coherence tomography appearance may be helpful in predicting the final visual outcome. \ua9 2011 Wichtig Editore