Adverse events associated with intraocular injection of anti-VEGF(bevacizumab) in retinal vein ccclusion: a case report

Introduction: Antiangiogenic agents are often administered for treatment of Branch Retinal Vein Occlusion (BRVO). Among them, Bevacizumab has noticeable antiangiogenic and antiedemigenic properties and possesses great capacity to penetrate the retinal tissue, particularly in pathological circumstances characterized by altered external or internal blood-retinal barrier.Bevacizumab has an optimal bio-efficacy based on inhibition of the activity of Vascular Endothelial Growth Factor (VEGF). Nonetheless, despite its efficacy, here we describe the adverse effects associated with intraocular injection of bevacizumab in a patient affected by retinal vein occlusion. Case presentation: We present a case report of an 11-year old Caucasian malesubject affected by BRVO in his left eye. The patient underwent an intra-vitreal (i.v.) injection of bevacizumab 100 (1.25 mg/0.05ml). After that, the patient was monitored over time through a series of analyses including Ocular Coherence Tomography, Fluorangiography, Bulbar Ultrasound, Angio MRI BCVA scores and Intra Ocular Pressure. Results: Immediately after the i.v. injection, the patient experienced a strong and relentless pain radiating from the left ocular orbit, caused by a serious and unexpected malignant glaucoma and phthisis bulbi. Furthermore, the patient did not show any sign of improvement in visual function in the follow-up and at last required an ophthalmic prosthesisas a result of a subatrophic and hypotonic eyeball. Conclusion: This case report suggests that i.v. injections of anti-VEGFs should be considered wit

Filariosi oculare: diagnosi e trattamento.

Gli autori riportano 2 casi di filariosi oculare i cui aspetti clinici variabili realizzano dei veri problemi diagnostici. In particolare il primo caso presentava una localizzazione cutanea palpebrale curato per più di sei mesi per calazio. Il secondo presentava una localizzazione sottocongiuntivale. La ricerca parassitologia nel sangue e l’isolamento della filaria adulta in entrambi i casi ci ha permesso di porre diagnosi certa di filariasi LoaLoa e di eseguire il trattamento specifico con dietilcarbamazina (Notézine®) In seguito all’osservazione di questi due casi abbiamo eseguito un richiamo clinico, epidemiologico e terapeutico di questa rara affezione nei paesi non endemici. La localizzazione palpebrale per uno specialista poco esperto potrebbe essere causa di confusione diagnostica con altre patologie che realizzano gli stessi quadri patologici

Ocular Alterations in a Rare Case of Segmental Neurofibromatosis Type 1 with a Non-Classified Mutational Variant of the NF-1 Gene

BACKGROUND: Neurofibromatosis type 1 (NF-1) is an autsomal dominant disorder which can occasionally result from somatic mosaicism and manifest as segmental forms of the disease. METHODS: A 37-year-old woman with ascertained NF-1, based on clinical diagnostic criteria and genetic analysis, was referred for ophthalmological evaluation. Genetic analysis, magnetic resonance imaging (MRI), complete ophthalmological examination, and near infrared reflectance (NIR) images at 815 nm of the retina were obtained. RESULTS: Genetic analysis revealed a non-classified mutational variant of the NF-1 gene identified as NM_000267.3:c2084T > C (p.Leu695Pro.T). MRI demonstrated non-symptomatic bilateral optic nerve gliomas. The only cutaneous sign was a subcutaneous neurofibroma of the posterior cervical region. Slit-lamp examination showed bilateral Lisch nodules. NIR images of the retina did not show any choroidal hamartomas. DISCUSSION: We report a rare case of segmental neurofibromatosis with a non-classified mutational variant of the NF-1 gene described in only one previous case in the literature. The patient presented with clinical features of NF-1 localized to the head and neck region, compatible with diagnosis of segmental NF-1. Interestingly, ocular manifestations included bilateral optic nerve gliomas and Lisch nodules, but no choroidal hamartomas. KEYWORDS: Lisch nodules; mosaicism; neurofibromatosis type 1 gene; segmental neurofibromatosi

Spectral domain optical coherence tomography and B-scan ultrasonography in the evaluation of retinal tears in acute, incomplete posterior vitreous detachment

BACKGROUND: The purpose of this study was to evaluate the extension and traction effects of posterior vitreous detachment (PVD) complicated with retinal tears using spectral domain optical coherence tomography (OCT) and B-scan ultrasonography. METHODS: Complete ophthalmological examination, B-scan ultrasonography and spectral domain OCT were performed in patients with acute PVD and retinal tears. Vitreous detachment was classified as complete or incomplete, based on extent of posterior pole or peripheral vitreous detachment. Retinal tear location and persistent traction on the retinal flap was evaluated with B-scan ultrasonography and OCT. Categorical data were evaluated with Fisher's exact test. Statistical significance was considered as P < 0.05. RESULTS: Twenty-six eyes of 25 patients were assessed. Four eyes (15 %) presented complete PVD with detachment at the posterior pole and periphery. 22 eyes (85 %) presented incomplete PVD with detachment in the periphery. Twenty eyes presented retinal tears in the superior quadrants with respect to only 6 in the inferior quadrants (p = 0.006). There was a higher incidence of retinal tears in the pre with respect to post-equatorial areas (19 vs 7 eyes, p = 0.019). B-scan ultrasonography and OCT revealed persistent traction on the retinal tear flap in 19 and 15 eyes, respectively. CONCLUSIONS: In acute PVD, retinal tears are prevalently associated with peripheral vitreous detachment. The impact of complete or incomplete PVD can be of clinical value when evaluating patients with retinal tears

Evaluation of retinal ganglion cell layer in patients with macular edema treated with intravitreal anti-VEFG and corticosteroid

Purpose: The aim of the study is to detect the effect of the different intravitreal therapies (anti-VEFG drugs and corticosteroids) on the single layer of retinal ganglion cells (GCL) in patients affected by macular edema. Methods: Forty (17 males/23 females) Caucasian patients (40 eyes) affected by macular edema treated with intravitreal injections (anti-VEGF and steroids) are included. Spectralis HRA-OCT device with a specific protocol for the acquisition and evaluation of the GCL layer has been used. Macular GCL thickness is assessed with automated retinal segmentation based on ETDRS grid rings. Retinal layer automated segmentation is carefully assessed and manually corrected for any misalignment. GCL measurements are correlated with best-corrected visual acuity (BCVA) measured with Early Treatment Diabetic Retinopathy Study (ETDRS), central macular thickness (CMT) and intraocular pressure (IOP). All patients have been evaluated at baseline and at the subsequent follow-up: 4 weeks, 8 weeks and 12 weeks. Results: Neither anti-VEFG drugs (Bevacizumab, Ranibizumab and Aflibercept) nor corticosteroids (Dexametasone) has a significant effect on GCL layers during three months of follow up compared to long-term treatments. A significant correlation between GCL and ETDRS has found (p=0.0453, R2=0.023). Conclusions: This study shows that anti-VEFG drugs and corticosteroids do not significantly affect GCL layer over three months of treatment. This study also demonstrates that the ganglion cell layer is correlated to visual acuity, an important factor for future investigations on the effects of new treatments