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Choroidal Neovascularization (choroidal + neovascularization)
Terms modified by Choroidal Neovascularization Selected AbstractsChoroidal neovascularization associated with cancer-associated retinopathyACTA OPHTHALMOLOGICA, Issue 5 2010Giuseppe Querques Abstract. Purpose:, To report an unusual association between cancer-associated retinopathy (CAR) associated with invasive thymoma and choriodal neovascularization (CNV), treated by photodynamic theraphy (PDT). Methods:, A 39-year-old man affected with thymoma and paraneoplastic syndrome (myasthenia gravis and diarrhoea) was observed between October 1997 and September 2007. The patient developed progressive visual dysfunction including bilateral visual acuity loss and concentric constriction of visual fields. Ophthalmological, immunological and systemic examinations were performed. Immunological evaluations included an assessment of antibody activity by indirect immunohistochemistry on sectioned rhesus monkey eye, and Western blot reactions upon an extract of pig retina. Results:, Fundus ophthalmoscopy and fluorescein angiography revealed retinal vessel attenuation and retinal pigment epithelium degeneration. Electroretinogram suggested both rod and cone dysfunction. Indirect immunohistochemistry identified antibody activity within the photoreceptor outer segments. Western blots on the retina revealed that most of the patient's antibody activity was focused upon a retinal protein antigen approximating 145 kD. These findings share the commonalities of size and retinal distribution of the interphotoreceptor retinoid-binding protein (IRBP), a recognized autoantigen. The surgically resected mediastinal tumour was diagnosed as invasive thymoma. No other malignancy has since been found throughout nearly 10 years of follow-up. In March 2006, the patient developed a subfoveal CNV in his left eye, which was treated by PDT. Conclusion:, We describe the third case of paraneoplastic retinopathy associated with invasive thymoma. This is the first example of CAR involving autoantibodies reactive with a retinal protein having the characteristics of the IRBP, and is also the first complicated by CNV treated by PDT. [source] Clinical and histological findings after intravitreal injection of bevacizumab (Avastin®) in a porcine model of choroidal neovascularizationACTA OPHTHALMOLOGICA, Issue 3 2010Nathan Lassota Abstract. Purpose:, To examine the effect of intravitreally injected bevacizumab (Avastin®) on the histological and angiographic morphology of choroidal neovascularization (CNV) in a masked and placebo-controlled animal study. Methods:, Choroidal neovascularization was induced surgically in 11 porcine eyes by perforating Bruch's membrane with a retinal perforator. After closure of the ports used for the vitrectomy, which was performed to facilitate the Bruch's membrane rupture, 0.05 ml of either bevacizumab or Ringer-Lactat (placebo) was injected into the vitreous cavity. Eyes were enucleated after 14 days. Fundus photographs and fluorescein angiograms (FAs) were obtained immediately prior to enucleation. Sections of formalin- and paraffin-embedded eyes were examined by light microscopy and by immunohistochemical staining. Results:, Placebo-injected eyes exhibited the highest propensity to leak, with five of six eyes leaking on FA, whereas only one of five bevacizumab-injected eyes exhibited leakage. On histological examination, all 11 eyes contained CNV membranes of similar size, regardless of treatment. The number of vascular endothelial cells was significantly reduced (p = 0.03) in CNV membranes from eyes that had been injected with bevacizumab when compared with CNV membranes from placebo-injected eyes. There was a trend towards more retinal pigment epithelium cells (p = 0.16) and fewer glial fibres (p = 0.08) in membranes from bevacizumab-treated eyes compared with placebo-treated eyes. Bevacizumab was identified immunohistochemically in the inner limiting membrane (ILM) and to a lesser degree in the remaining retina. Strong staining was also detected in both retinal blood vessels and entire CNV membranes with no cellular predisposition. Vascular endothelial growth factor expression was found in the CNV membranes, in the ILM, in the ganglion cell layer, in Müller cells throughout the neuroretina and in retinal blood vessels. Conclusions:, Bevacizumab significantly reduced the proliferation of vascular endothelial cells in CNV membranes and showed a strong trend towards a reduction of leakage from these membranes. After a single injection, bevacizumab did not exhibit a size reducing effect on CNV, but it was still present in the membranes 14 days after intravitreal injection. [source] Topographic variation of the choroidal watershed zone and its relationship to neovascularization in patients with age-related macular degenerationACTA OPHTHALMOLOGICA, Issue 3 2009Efstratios Mendrinos Abstract. Purpose:, To evaluate the patterns of choroidal watershed zones (WZs) in exudative age-related macular degeneration (AMD) and to describe their relationship with choroidal neovascularization (CNV). Methods:, We retrospectively evaluated 50 digital indocyanine green video-angiograms of 50 patients with exudative AMD demonstrating one or more WZs. In addition, the relationship between the site of CNV and the WZ was analysed. Results:, A stellate WZ was observed in 30 of 50 (60%) patients. Choroidal neovascularization occurred within the centre of the WZ in all cases. The WZ was vertically oriented in 18 of 50 (36%) patients. When the WZ coursed through or extended into the fovea, CNV occurred within the WZ, but it occurred at its margin when the WZ did not involve the fovea. An angled WZ coursing through the fovea with CNV occurring within it was observed in two of 50 (4%) patients. Conclusions:, In exudative AMD, the WZ most commonly conformed to the stellate pattern, followed by the vertical and angled patterns. Choroidal neovascularization occurred within the WZ in 44 of 50 (88%) patients. When the WZ did not involve the fovea (12%), CNV occurred at its margin. The relationship between the site of CNV and macular WZs suggests that macular WZs may be areas which are vulnerable to AMD and which are predisposed to CNV by the resulting hypoxia,ischaemia. [source] Pigment epithelium-derived factor inhibits retinal and choroidal neovascularizationJOURNAL OF CELLULAR PHYSIOLOGY, Issue 2 2001Keisuke Mori In this study, we investigated whether overexpression of pigment epithelium-derived factor (PEDF) by gene transfer can inhibit neovascularization by testing its effect in three different models of ocular neovascularization. Intravitreous injection of an adenoviral vector encoding PEDF resulted in expression of PEDF mRNA in the eye measured by RT-PCR and increased immunohistochemical staining for PEDF protein throughout the retina. In mice with laser-induced rupture of Bruch's membrane, choroidal neovascularization was significantly reduced after intravitreous injection of PEDF vector compared to injection of null vector or no injection. Subretinal injection of the PEDF vector resulted in prominent staining for PEDF in retinal pigmented epithelial cells and strong inhibition of choroidal neovascularization. In two models of retinal neovascularization (transgenic mice with increased expression of vascular endothelial growth factor (VEGF) in photoreceptors and mice with oxygen-induced ischemic retinopathy), intravitreous injection of null vector resulted in decreased neovascularization compared to no injection, but intravitreous injection of PEDF vector resulted in further inhibition of neovascularization that was statistically significant. These data suggest that sustained increased intraocular expression of PEDF by gene therapy might provide a promising approach for treatment of ocular neovascularization. © 2001 Wiley-Liss, Inc. [source] 2231: Age-related modifications in RPE cellsACTA OPHTHALMOLOGICA, Issue 2010E MANNERMAA Age-related macular degeneration (AMD) is a multi-factorial polygenetic aging disease. It has been shown that RPE dysfunction predisposes neural retinal dysfunction and the development of choroidal neovascularization. The pathogenesis of age-related macular degeneration (AMD) essentially involves chronic oxidative stress, increased accumulation of lipofuscin in retinal pigment epithelial (RPE) cells and extracellular drusen formation, as well as the presence of chronic inflammation. The capacity to prevent the accumulation of cellular cytotoxic protein aggregates is decreased in senescent cells which may evoke lipofuscin accumulation into lysosomes in postmitotic RPE cells. This presence of lipofuscin decreases lysosomal enzyme activity and impairs autophagic clearance of damaged proteins which should be removed from cells. Proteasomes are another crucial proteolytic machine which degrades especially cellular proteins damaged by oxidative stress. The cross-talk between lysosomes, autophagy and proteasomes in RPE cell protein aggregation, their role as a possible therapeutic target and their involvement in the pathogenesis of AMD is discussed. In addition, age related changes in Bruch's membrane and choroidal blood flow may take part in the pathogenesis of AMD. This will be also discussed. [source] 2255: Inflammatory neovascular membraneACTA OPHTHALMOLOGICA, Issue 2010P NERI Purpose To describe the most common mistakes in the management of inflammatory choroidal neovascularization (CNV). Methods The current literature is reviewed and the experience of a tertiary referral centre is reported. Results CNV is a potentially sight-threatening sequela of uveitis. Several mistakes can be done during patients examination: CNV might not be recognized both at biomicroscopy and at fluorescein angiography (FA), for instance. Moreover, since some doctors are not aware of the importance of Indocyanine Green Angiography (ICGA), the choroidal involvement during inflammatory CNV might not be appreciated. These are just some examples of possible errors which can be done during the daily practice. The outcome of subfoveal CNV is poor if untreated: several procedures have been considered, even though there is lack of guidelines. The most important mistake can be represented by the lack of criticism on the treatment techniques: several methods have been proposed, albeit some of them should not be used on the basis of the treatment rationale and on the better knowledge of CNV pathophysiology. The presentation shows the most typical cases where the above mentioned mistakes have been done, suggesting some methods in order to avoid them. Conclusion CNV secondary to uveitis is a severe sequela, which can lead to significant visual impairment. Several mistakes can be done during both the diagnosis and the therapeutic procedures. Although no guideline is provided, the current medical literature can give the basis for a successful treatment strategy. [source] 2266: Role of VEGF-isoforms in pathological choroidal angiogenesisACTA OPHTHALMOLOGICA, Issue 2010S VAN DE VEIRE Purpose The aim of this project is to study the specific role of the VEGF-isoforms in pathological angiogenesis, and to investigate the effect of blocking a single isoform on the formation of choroidal neovascularization (CNV). Methods Endothelial and fibroblast cell cultures were made; VEGF 12, 164 or 189 was added to study their effects. VEGF-isoform specific mice (VEGF 120/+, VEGF 164/164 and VEGF188/188 mice) , as well as double transgenic mice (VEGF 120/164, VEGF 164/188 and VEGF120/188 mice) are used to study the role of VEGF-isoforms in pathological angiogenesis. At first, these VEGF-isoform specific mice were backcrossed to a C75Bl/6 background. CNV was induced by placing 3 laser spots at the 9, 12 and 3 o'clock position (100µm spot size, 0.05 s spot duration and 400mW power). Quantification of the area of newly formed blood vessels was determined by retrobulbar dextran linked FITC perfusion. Results Preliminary data in endothelial cell and fibroblast cultures in vitro show that the VEGF121 and VEGF165 isoforms significantly the amount of angiogenesis, whereas the VEGF121 and VEGF189 isoforms play a role in fibrosis. In vivo, the same effects were checked on a fluorescent CD31 and Vimentin immunostaining of the choroids. An inhibition in neovascularization was present in all 3 isoform specific mice, but the effects were comparable. For the moment, mice colonies are being enlarged to repeat experiments and subsequently, these mice are intercrossed to obtain double transgenic mice. Conclusion This study will shed new light on the different role and the inhibition of the VEGF-isoforms in CNV formation during AMD. Thus, our project may open new perspectives for the treatment of various retinopathies that are known to be associated with VEGF upregulation. [source] 4366: Treatment of choroidal neovascularization associated with choroidal nevusACTA OPHTHALMOLOGICA, Issue 2010E PILOTTO Purpose Purpose:To evaluate safety and efficacy of different treatments of choroidal neovascularization (CNV) associated with choroidal nevus at the posterior pole. Methods Methods: Six patients affected by choriodal nevus complicated by CNV were treated with photodynamic therapy with verteporfin (PDT; 50 J/cm2, 83 seconds) (five cases), or intravitreal anti-VEGF (bevacizumab, 1.25 mg) (one case). All patients underwent an ophthalmologic evaluation, including fluorescein and indocyanine green angiography, A-and B scan ultrasonography and OCT at presentation and at each follow-up examination. CNV was extrafoveal in all PDT treated cases, and a foveal serous detachment was detectable. CNV was subfoveal in the eye treated with anti-VEGF. Results Results: Mean follow-up was 15.5 months (range: 6 , 24). Visual acuity improved in four of the PDT treated cases and in the anti-VEGF treated eye, while it remained unchanged in the remaining PDT treated lesion. In all eyes resolution of the foveal serous detachment was detectable. In all PDT treated eyes a single treatment was performed with no recurrence during follow-up. Meanwhile anti-VEGF was repeated after three months for CNV recurrence. Conclusion Conclusions: PDT and anti-VEGF seem both effective in the treatment of CNV secondary to choroidal nevus but a larger study is required to evaluate long-term efficacy and safety expecially of anti-VEGF therapy. [source] Clinical and histological findings after intravitreal injection of bevacizumab (Avastin®) in a porcine model of choroidal neovascularizationACTA OPHTHALMOLOGICA, Issue 3 2010Nathan Lassota Abstract. Purpose:, To examine the effect of intravitreally injected bevacizumab (Avastin®) on the histological and angiographic morphology of choroidal neovascularization (CNV) in a masked and placebo-controlled animal study. Methods:, Choroidal neovascularization was induced surgically in 11 porcine eyes by perforating Bruch's membrane with a retinal perforator. After closure of the ports used for the vitrectomy, which was performed to facilitate the Bruch's membrane rupture, 0.05 ml of either bevacizumab or Ringer-Lactat (placebo) was injected into the vitreous cavity. Eyes were enucleated after 14 days. Fundus photographs and fluorescein angiograms (FAs) were obtained immediately prior to enucleation. Sections of formalin- and paraffin-embedded eyes were examined by light microscopy and by immunohistochemical staining. Results:, Placebo-injected eyes exhibited the highest propensity to leak, with five of six eyes leaking on FA, whereas only one of five bevacizumab-injected eyes exhibited leakage. On histological examination, all 11 eyes contained CNV membranes of similar size, regardless of treatment. The number of vascular endothelial cells was significantly reduced (p = 0.03) in CNV membranes from eyes that had been injected with bevacizumab when compared with CNV membranes from placebo-injected eyes. There was a trend towards more retinal pigment epithelium cells (p = 0.16) and fewer glial fibres (p = 0.08) in membranes from bevacizumab-treated eyes compared with placebo-treated eyes. Bevacizumab was identified immunohistochemically in the inner limiting membrane (ILM) and to a lesser degree in the remaining retina. Strong staining was also detected in both retinal blood vessels and entire CNV membranes with no cellular predisposition. Vascular endothelial growth factor expression was found in the CNV membranes, in the ILM, in the ganglion cell layer, in Müller cells throughout the neuroretina and in retinal blood vessels. Conclusions:, Bevacizumab significantly reduced the proliferation of vascular endothelial cells in CNV membranes and showed a strong trend towards a reduction of leakage from these membranes. After a single injection, bevacizumab did not exhibit a size reducing effect on CNV, but it was still present in the membranes 14 days after intravitreal injection. [source] EXTEND-I: safety and efficacy of ranibizumab in Japanese patients with subfoveal choroidal neovascularization secondary to age-related macular degenerationACTA OPHTHALMOLOGICA, Issue 3 2010Yasuo Tano Abstract. Purpose:, To evaluate the efficacy and safety of intravitreal ranibizumab for subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) in Japanese patients. Methods:, This open-label, multicentre, Phase I/II study enroled patients into Group A (single injection of ranibizumab nonrandomized doses of 0.3 or 0.5 mg followed by 11 monthly injections of the same dose) and Group B (12 monthly injections of ranibizumab randomized to 0.3 or 0.5 mg). The primary efficacy endpoint was the mean change from baseline in best-corrected visual acuity (BCVA) score at Month 6. Safety was evaluated in all patients who received ranibizumab. Results:, Of 88 patients enroled, 12 entered Group A (six per dose) and 76 entered Group B (0.3 mg: n = 35; 0.5 mg: n = 41). Mean change from baseline in BCVA was significantly increased for both doses (Group B) at Month 6 (0.3 mg: +8.1 letters, p = 0.0006; 0.5 mg: +9.0 letters, p < 0.0001) and Month 12 (0.3 mg: +9.5 letters, p = 0.0001; 0.5 mg: +10.5 letters, p < 0.0001). At Month 12, one patient (0.3 mg) and 0 patients (0.5 mg) lost ,15 letters, while 37.1% (0.3 mg) and 31.7% (0.5 mg) of patients gained ,15 letters. Ocular serious adverse events (SAEs) of the study eye were reported in 1 and 2 patients in the 0.3- and 0.5-mg groups, respectively. Nonocular SAEs were experienced by 2 and 5 patients in the 0.3- and 0.5-mg groups, respectively. No cases of endophthalmitis were reported. Conclusion:, Ranibizumab was effective and well tolerated in Japanese patients with subfoveal CNV secondary to AMD. [source] Intravitreal bevacizumab (Avastin®) for neovascular age-related macular degeneration in treatment-naive patientsACTA OPHTHALMOLOGICA, Issue 7 2009Karen Bjerg Pedersen Abstract. Purpose:, To report the effects of intravitreal bevacizumab (Avastin®) in treatment-naive patients with exudative age-related macular degeneration (ARMD) assessed by visual acuity (VA), optical coherence tomography (OCT) and contrast sensitivity. Methods:, A prospective, uncontrolled, pilot study of 26 eyes of 26 patients, all previously treatment-naive to photodynamic therapy, argon laser or anti-vascular endothelial growth factor (VEGF), were treated with one or more intravitreal injections of 1.25 mg bevacizumab. Of the 26 patients, 15 (57.7%) had occult choroidal neovascularization (CNV), 6 (23.1%) had predominantly classic CNV and 5 (19.2%) had minimally classic CNV. Ophthalmic outcome measures included changes in standardized Early Treatment Diabetic Research Study (ETDRS) VA, contrast sensitivity and OCT. The patients were examined at baseline and 1 week, 6 weeks, 3 months and 6 months after the first injection. Re-treatment was given on an ,as needed' basis. Results:, Twenty-four eyes of 24 patients completed 6 months of follow-up. Two patients chose to discontinue the study. Mean ETDRS VA score improved from 55 letters at baseline to 60 letters at 1 week (P < 0.01) and to 61 letters at 6 weeks (P < 0.01). No significant improvement in VA from baseline was found after 3 and 6 months. Patients with pigment epithelial detachment (PED) had a significantly worse outcome in VA at 6 months. Contrast sensitivity improved from baseline to 3 or 6 months, but this improvement was not statistically significant. Mean macular thickness decreased significantly from baseline to all follow-up examinations (P < 0.01). Conclusion:, Mean ETDRS VA improved significantly after 1 and 6 weeks; thereafter, it remained stable throughout the study period. Macular thickness improved significantly at all time points. The results indicate that 1.25 mg intravitreal bevacizumab is associated with functional as well as morphological improvement among treatment-naive ARMD patients. [source] Prophylactic laser treatment of soft drusen maculopathy: a prospective, randomized Nordic studyACTA OPHTHALMOLOGICA, Issue 7 2009Christina I. Frennesson Abstract. Purpose:, This study aimed to investigate whether mild laser treatment of soft drusen maculopathy might reduce the incidence of choroidal neovascularization (CNV) and/or significantly reduce loss of visual acuity compared with outcomes in a control group. Methods:, A total of 135 patients (mean age 70.4 years) were randomized into a treatment group of 67 subjects and a control group of 68 subjects. The treatment group was subdivided into a group of 54 subjects with bilateral soft drusen and a group of 13 subjects with unilateral soft drusen in the study eye and advanced AMD in the fellow eye. The control group was subdivided into a bilateral group of 54 subjects and a unilateral group of 14 subjects. Sub-threshold or barely visible laser spots were scattered on and between drusen in the posterior pole. Inclusion of patients was stopped prematurely as other studies did not show any benefit from the treatment. Mean follow-up time was 3.7 years. Results:, More CNVs developed in the treated group (4/54 eyes in the bilateral group, 3/13 eyes in the unilateral group; 7/67 eyes in total) than in the control group (3/54 eyes in the bilateral group, 2/14 eyes in the unilateral group; 5/68 eyes in total) but these differences were not statistically significant for either the bilateral or unilateral groups (p = 0.20,0.32). No CNV developed in the bilateral treated group before 4 years of follow-up. Visual acuity was significantly reduced from baseline to the last follow-up in all groups (p < 0.0001,0.02) except the unilateral control group (p = 0.08), but there were no significant differences between the treated and control groups for either the bilateral or unilateral groups (p = 0.17,0.97). Conclusions:, Mild prophylactic laser treatment of soft drusen maculopathy was neither beneficial nor harmful and cannot be recommended. [source] Ocular haemodynamic changes after single treatment with photodynamic therapy assessed with non-invasive techniquesACTA OPHTHALMOLOGICA, Issue 6 2009Noemi Maar Abstract. Purpose:, To investigate in patients with neovascular age-related macular degeneration (ARMD) the changes in ocular perfusion caused by single treatment with photodynamic therapy (PDT) by different non-invasive methods; to evaluate correlations between relative changes of ocular haemodynamic parameters after PDT among each other and compared to morphological parameters; and to assess this in relation to early changes of visual acuity. Methods:, Study population: 17 consecutive patients with subfoveal choroidal neovascularization (CNV) caused by ARMD scheduled for PDT without previous PDT treatment (four patients with predominantly classic CNV and 13 patients with occult CNV). Observation procedures: best-corrected visual acuity (before PDT, 6 and 8 weeks after PDT), fundus photography, fluorescein angiography, haemodynamic measurements with laser Doppler flowmetry (LDF), laser interferometry and ocular blood flow (OBF) tonometry (baseline and 1, 2, 6 and 8 weeks after treatment). Main outcome measures: choroidal blood flow (CHBF), fundus pulsation amplitude (FPA), pulsatile ocular blood flow (POBF), visual acuity. Changes smaller than 20% were considered clinically irrelevant. Results:, Ocular haemodynamic parameters did not change significantly in the follow-up period. Changes of haemodynamic parameters showed no correlation to treatment spot, morphological changes or visual acuity. Changes of visual acuity were comparable to results of earlier studies. Conclusion:, Single treatment with PDT did not modify ocular blood flow parameters above 20% as assessed with different non-invasive methods. [source] Intravitreal bevacizumab for choroidal neovascularization in toxoplasmosisACTA OPHTHALMOLOGICA, Issue 6 2009Rainer Guthoff No abstract is available for this article. [source] Progress in the appraisal and management of inflammatory CNVsACTA OPHTHALMOLOGICA, Issue 2009P NERI Purpose To review the current Literature and to describe the experience of a tertiary referral centre on the progress in the appraisal and the management of inflammatory choroidal neovascularization (CNV). Methods The current literature is reviewed and the experience of a tertiary referral centre is reported. Results CNV is a potentially severe sequela of posterior uveitis. The role of chronic inflammation has been described in experimental uveitis. For such reasons, even when biomicroscopy and fluorangiography (FA) cannot detect abnormalities, Indocyanine Green Angiography (ICGA) can show choridal anomalies. ICGA greatly improved the appraisal of the choroidal involvement, by providing reliable data for the diagnosis and for the management of inflammatory CNV. The new spectral domain optical coherence tomography (OCT) equipments can provide further informations that can be useful for a correct clinical assessment. The out-come of subfoveal CNV is poor if untreated: several procedures have been considered, even though there is lack of guidelines. Steroids, both local and systemic, are the first line therapy for non-infectious choroidal inflammation, although their long-term use can lead to unpleasant sequala, such as glaucoma and cataract. Immunesuppressive agents, lasers photocoagulation, photodynamic treatment, surgical removal and anti-Vascular Endothelial Growth Fact (VEGF) are other options. Conclusion CNV secondary to uveitis is a severe sequela leading to significant visual impairment. ICGA is mandatory in order to obtain relevant informations about the choroidal status. Several therapeutic options have been considered, but no guidelines are available at the moment. [source] Spectral domain OCT of exudative AMDACTA OPHTHALMOLOGICA, Issue 2009N LEVEZIEL Age-related Macular Degeneration (AMD) is the main cause of vision loss in developed countries. Spectral domain OCT (SD-OCT) is a non invasive technique providing in vivo imaging of the retina, with a higher resolution than time domain OCT. This SIS will describe the clinical features of exudative AMD with SD-OCT, including occult choroidal neovascularization (CNV), classic CNV, idiopathic polypoïdal vasculopathy, and chorioretinal anastomosis. The improvement of the resolution of retinal imaging will provide a better classification and explanation of the pathological processes observed during AMD. [source] Mycophenolate mofetil in uveitisACTA OPHTHALMOLOGICA, Issue 2009P NERI Purpose To review the current Literature and to describe the experience of a tertiary referral centre on the use of mycophenolate mofetil (MMF) treatment in uveitis. Methods The current literature is reviewed and the experience of a tertiary referral centre is reported. Results The long-lasting remission in several systemic diseases, such as Crohn's disease, severe atopic dermatitis, Wegener's granulomatosis and microscopic polyangioitis, rheumatoid arthritis, pemphigus vugaris, and psoriasis, have been proven. Recent publications have have recently confirmed the satisfactory control of uveitis with MMF in a large cohort of patients. Moreover, the long-term control of cystoid macular oedema (CMO) unresponsive to the traditional therapy has been described, as well as for the choroidal neovascularization (CNV). Conclusion Non-infectious uveitis is one of the leading causes of visual impairment in ophthalmology. Steroids can control such disease, even though a long-term treatment is not recommended: several complications, such as high blood sugar level, osteoporosis, blood cell abnormalities, cataract and glaucoma, can occur. MMF is a reversible, non competitive, selective inhibitor of the de-novo pathway of purine synthesis; mycophenolic acid has a strong effect to Type II isoform of inosine monophosphate dehydrogenase enzyme, providing a stronger cytostatic effect on lymphocytes than on other cells types, with minor action to Type I expressed in most other cells. The specific action of MMF on selected targets makes it a promising drug for the control of non-infectious intraocular inflammations. [source] Primary photodynamic therapy of choroidal melanomaACTA OPHTHALMOLOGICA, Issue 2009H HEIMANN Purpose To review our initial experience with photodynamic therapy of choroidal melanoma at the Ocular Oncology Service in Liverpool. Methods Patients were included in the study if they underwent primary photodynamic therapy for choroidal melanoma. The treatment was administered using the same protocol as for choroidal neovascularization. Results The patients (12 male and 5 female) had a mean age of 62.2 years. The melanomas were located in the right eye in 11 patients and the left eye in 6 patients. The tumour margin extended anteriorly to pre-equatorial choroid in one patient and posteriorly to include optic disc in 7 patients. The melanomas had a mean diameter of 7.6 mm and a mean thickness of 2.0mm. The initial visual acuity was 6/12 or better in 13 patients and 6/18-6/60 in 4 patients. Biopsy showed the tumour to be of spindle cell type in two patients and to contain epithelioid cells in three patients. One patient was found to have monosomy 3 so that the tumour was treated with proton beam radiotherapy. The follow-up ranged to 622 days with a median of 101 days. Four patients subsequently underwent proton beam radiotherapy and one patient was treated by endoresection. The last known visual acuity was 6/12 or better in 11 patients, 6/18 to 6/60 in 4 patients and 3/60 to Counting Fingers in 2 patients. Conclusion Photodynamic therapy may be worth attempting in patients with a small choroidal melanoma when other methods are likely to cause visual loss. Many patients subsequently require more aggressive treatment to achieve local tumour control. [source] Encouraging results of a VEGF kinoid against experimental choroidal neovascularizationACTA OPHTHALMOLOGICA, Issue 2009B ABITBOL Purpose The goal of this preliminary study was to evaluate the preventive and curative antiangiogenic properties of a VEGF KINOID vaccine produced by NEOVACS againt experimentally laser induced murine choroidal neovessels Methods 3 groups of 12 adult mice (30g) were submitted to laser impacts breaking slightly the Bruch's membrane and initiating the development of subretinal choroidal neovessels. These laser impacts did not create immediately obvious choroidal lesions leading to blood hemorrhages.One Group of mice was submitted to repeated immunizations up to 5 immunizations by the VEGF Kinoid vaccine associated to a modified freund's adjuvant solution. One group of mice received only the mofified Freund's adjuvant and one group of mice sham injections of PBS in the same conditions. Results We were able to observe a decrease or even the disappearance of the abnormal choroidal neovessels even in animals that had been immunized but had not reached adequate levels of neutralizing antibodies against VEGF. Transient adverse effects were observed in some mice in all the groups of mice. Conclusion Obviously The modified freund's adjuvant solution utilized in this first set of experiments must be avoided or modified in order to avoid adverse effects. The chemistry for the production of the VEGF kinoid production must be improved in order to obtain a better immunizing vaccine. Commercial interest [source] The effect of upregulated LOX and LOXL2 on inflammation and fibrosis in a laser induced CNV modelACTA OPHTHALMOLOGICA, Issue 2009S VAN DE VEIRE Purpose Lysyl oxidase (LOX) and lysyl oxidase-like protein 2 (LOXL2) are involved in the cross-linking of collagen and elastin in the extracellular space. Therefore, these proteins play a major role in the process of fibrosis. This study was designed to elucidate the role of LOX and LOXL2 in inflammation and fibrosis after choroidal neovascularization (CNV). Methods CNV was induced in 8 to 10 weeks old C75Bl/6 mice (n=5 per timepoint), by placing 3 laser spots at 9, 12 and 3 o'clock position (50µm, 0.1s and 400mW). Mice were sacrificed 2, 4, 7, 14, 28 and 35 days after lasering. LOX and LOXL2 expression in choroid and retina was analyzed using real time RT-PCR. Inflammation and fibrosis was studied by different (immuno)stainings. Results Both LOX and LOXL2 were significantly increased over time in the choroid and retina of lasered mice. LOX was 2.1, 3.2, 1.75, 1.3, 2 and 1.3 times upregulated on days 2, 4, 7, 14, 28 and 35 after laser, respectively, compared to non-lasered eyes. LOXL2 was 1.1, 1.6, 1.3, 1.1, 1.5 and 1.2 times upregulated on day 2, 4, 7, 14, 28 and 35 after laser, respectively, versus non-lasered eyes. On day 2 and 4 after the laser, the number of inflammatory cells was increased with 16% compared to control. A significant increase of collagen deposition was shown in the choroid on days 14, 28 and 35. Conclusion A biphasic upregulation of LOX and LOXL2 was observed after CNV induction, which was associated with the inflammatory and fibrotic phase. Our data suggest that LOX and LOXL2 play a role in the process of inflammation and fibrosis after the induction of CNV. This finding can open new perspectives in the treatment of age-related macular degeneration by inhibiting LOX and LOXL. [source] Intravitreal bevacizumab for treatment-naïve subfoveal occult choroidal neovascularization in age-related macular degenerationACTA OPHTHALMOLOGICA, Issue 4 2009Claudio Furino Abstract. Purpose:, This study aimed to evaluate the efficacy of multiple injections of intravitreal bevacizumab for treatment-naïve subfoveal occult choroidal neovascularization (CNV) in age-related macular degeneration (AMD). Methods:, Twelve eyes of 12 patients (mean age 76 ± 6 years) with mean best corrected visual acuity (BCVA) of 20/100 and occult subfoveal CNV at fluorescein angiography (FA), indocyanine-green (ICG) angiography and optical coherence tomography (OCT), showing intra- or subretinal fluid with or without retinal pigment epithelial detachment (PED), underwent multiple intravitreal injections (mean 2.4 ± 0.7) of 1.25 mg (0.05 ml) bevacizumab. Visual acuity and OCT findings were assessed at the end of follow-up. Results:, After a mean follow-up of 5.7 ± 2 months, BCVA improved from 20/100 (range 20/50,20/303) to 20/60 (range 20/28,20/200) (p = 0.038). Five eyes (42%) increased BCVA by , 3 lines, six eyes (50%) increased BCVA by < 3 lines and one eye (8%) remained stable. Macular thickness decreased from 298 ± 71 ,m to 223 ± 72 ,m (p = 0.017). No ocular or systemic side-effects were observed. Conclusions:, Short-term results suggest that multiple intravitreal injections of 1.25 mg bevacizumab are well tolerated and associated with significant improvements in BCVA and decreased retinal thickness by OCT in most patients with treatment-naïve occult CNV. Further evaluation of intravitreal bevacizumab for the treatment of occult CNV is warranted. [source] Marginal crack after intravitreal bevacizumab for myopic choroidal neovascularizationACTA OPHTHALMOLOGICA, Issue 4 2009Kaori Sayanagi Abstract. Purpose:, To report new indocyanine green angiographic (ICGA) findings after intravitreal bevacizumab (IVB) for myopic choroidal neovascularization (mCNV). Cases report:, Three eyes of three patients with mCNV were examined with fluorescein angiography (FA) and ICGA using Heidelberg Retinal Angiograph 2 and the conventional fundus camera before and after IVB. The cessation of angiographic leakage on FA was achieved in all eyes (100%) after IVB, however the hypofluorescent line delineating the margin of the neovascular tissue appeared in ICGA seemingly according to the contraction of mCNV. It was not detected either on FA or ICGA with the conventional camera. This hypofluorescence line enlarged over the time. Conclusion:, The contraction-associated hypofluorescence line, namely marginal crack line, indicates the early damage of retinal pigment epithelium and seems to lead to expanding macular chorioretinal atrophy typically seen in mCNV. [source] Topographic variation of the choroidal watershed zone and its relationship to neovascularization in patients with age-related macular degenerationACTA OPHTHALMOLOGICA, Issue 3 2009Efstratios Mendrinos Abstract. Purpose:, To evaluate the patterns of choroidal watershed zones (WZs) in exudative age-related macular degeneration (AMD) and to describe their relationship with choroidal neovascularization (CNV). Methods:, We retrospectively evaluated 50 digital indocyanine green video-angiograms of 50 patients with exudative AMD demonstrating one or more WZs. In addition, the relationship between the site of CNV and the WZ was analysed. Results:, A stellate WZ was observed in 30 of 50 (60%) patients. Choroidal neovascularization occurred within the centre of the WZ in all cases. The WZ was vertically oriented in 18 of 50 (36%) patients. When the WZ coursed through or extended into the fovea, CNV occurred within the WZ, but it occurred at its margin when the WZ did not involve the fovea. An angled WZ coursing through the fovea with CNV occurring within it was observed in two of 50 (4%) patients. Conclusions:, In exudative AMD, the WZ most commonly conformed to the stellate pattern, followed by the vertical and angled patterns. Choroidal neovascularization occurred within the WZ in 44 of 50 (88%) patients. When the WZ did not involve the fovea (12%), CNV occurred at its margin. The relationship between the site of CNV and macular WZs suggests that macular WZs may be areas which are vulnerable to AMD and which are predisposed to CNV by the resulting hypoxia,ischaemia. [source] Photodynamic therapy with verteporfin in age-related macular degeneration: a systematic review of efficacy, safety, treatment modifications and pharmacoeconomic propertiesACTA OPHTHALMOLOGICA, Issue 2 2009Alan F. Cruess Abstract. Photodynamic therapy (PDT) with verteporfin has been used less comprehensively in the treatment of exudative age-related macular degeneration (AMD), and specifically of choroidal neovascularization (CNV), since the advent of antiangiogenic therapies. Recently, there has been a renewed interest in PDT as an adjunct to these and other agents in the treatment of neovascular AMD. In light of this new development and the European Medicines Evaluation Agency's (EMEA) recent labelling decision to rescind approval for the use of PDT in occult CNV lesions, the present systematic review was undertaken to revisit the evidence supporting its clinical application. Photodynamic therapy provided the first pharmacological treatment for patients suffering from subfoveal CNV, the major cause of severe vision loss in AMD. Key clinical trials evaluating efficacy and safety have examined patients with all lesion subtypes, with the primary labelled indication (i.e. lesions containing a classic component of , 50% ) deriving from the results of the Treatment of Age-related Macular Degeneration with Photodynamic Therapy (TAP) Study. The subsequent TAP Study Group post hoc categorization of lesions as predominantly classic is open to question, however, as it appears that the overall efficacy in this group only may have reflected the especially strong response in 100% classic lesions. Based on a subgroup analysis of the Verteporfin in Photodynamic Therapy Study, the indication for PDT subsequently was expanded in some jurisdictions, including that of the EMEA, to include occult lesions with no classic component. However, the subsequent Visudyne in Occult Study found no benefit in 100% occult lesions, resulting in the EMEA rescinding its approval for this indication. [source] Photodynamic therapy with intravitreal application of triamcinolone acetonide in age-related macular degeneration: functional results in 54 patientsACTA OPHTHALMOLOGICA, Issue 2 2009Adjoa Frimpong-Boateng Abstract. Purpose:, This study aimed to investigate the functional results, efficacy and complications after photodynamic therapy (PDT) combined with intravitreal triamcinolone acetonide injection (IVTA) in patients with choroidal neovascularization (CNV) caused by age-related macular degeneration (AMD). Methods:, A retrospective analysis of clinical data for 54 patients with CNV resulting from AMD was carried out. All patients had a follow-up of 12 months. The patients were treated with standardized PDT and IVTA (4 mg) as a first-line treatment or following PDT failure. Visual acuity (VA), greatest linear diameter (GLD) of the CNV and foveal thickness were evaluated. Results:, Mean VA at baseline was 0.8 logMAR (0.4,1.4). After 12 months VA improved (> 2 lines) in 20.4% of patients and stabilized (± 2 lines) in 64.8%. There was no statistical significance in VA outcome between patients undergoing first-line treatment and patients with PDT failure; however, fewer PDT treatments were required to stop CNV activity in patients undergoing first-line treatment. At 12 months, a reduction in foveal thickness was seen in 67.7% of patients and a reduction in CNV GLD in 32.7%. Complications occurred in 22% of patients and included a transient rise in intraocular pressure, cataract and sterile hypopyon. Conclusions:, Our analysis shows that fewer PDT treatments were required to stop CNV activity when triamcinolone was used as first-line treatment. We can thus conclude that PDT combines synergistically with IVTA and the combination may lead to a cost reduction compared with PDT therapy alone. The overall complication rate of 22% is high and must be compared with complication rates caused by new intravitreal anti-VEGF (vascular endothelial growth factor) drugs in combination with PDT. [source] Inflammation in AMD pathologyACTA OPHTHALMOLOGICA, Issue 2008JZ NOWAK Age-related macular degeneration (AMD) is a progressive retinal disease that leads to substantial irreversible vision loss in elderly patients. Two clinical categories of AMD are distinguished: the "dry" atrophic form and the exudative neovascular or "wet" form. There is neither a preventive therapy nor a cure for both forms, although recent efforts succeeded in a more effective treatment of the wet AMD with PDT and anti-VEGF drugs. AMD is a multifactorial pathology which involves complex interaction of metabolic, genetic and environmental factors, with major biochemical-clinical abnormalities seen in four functionally interrelated tissues: photoreceptors, retinal pigment epithelium, Bruch's membrane and choriocapilaries. Four processes specifically contribute to the development of AMD pathology: lipofuscinogenesis (in RPE cells), drusogenesis (with drusen located between RPE and Bruch's membrane), inflammation (local) and choroidal neovascularization (in wet form). Although the role of immune system and inflammation has been implicated in AMD pathogenesis for many years, an impetus to intensify the research in this direction gave a recent discovery of polymorphisms in genes that encode for elements of the complement system, including factor H (CFH; Y402H), factor B, and complement component 2. An increased activity of the complement alternative pathway due to the lack of or insufficient control by CFH appears to contribute to AMD progression via immunologic mechanism which drives inflammatory response. An arising question is whether blockade of overactive complement system will be a therapeutic strategy safe for patients and effective to prevent or slowing down the macula-devastating and vision-threatening disease. Supported by grant no. 503-1023-1 from Medical University of Lodz. [source] Placental growth factor (PlGF) inhibition reduces choroidal neovascularization in a mouse model for age-related macular degenerationACTA OPHTHALMOLOGICA, Issue 2007S VAN DE VEIRE Purpose: To evaluate whether and through which mechanism PlGF blockage can inhibit choroidal neovascularization (CNV) in a mouse model of age-related macular degeneration (ARMD). Methods: CNV was induced in mice by placing 3 Argon laser burns on the choroid. In a first experiment we compared CNV formation between PlGF knock-out and wild type mice. Secondly, 144 wild-type mice were injected every 2 days with 5, 10, 20 or 40 mg/kg of either an anti-PlGF-antibody, an anti-VEGF receptor-2 (VEGFR2) antibody or an irrelevant control antibody. The CNV lesions were evaluated on histological cross-sections. The amount of endothelial cells, pericytes and inflammatory cells in the lesions were morphometrically analyzed after immunostaining for CD31, smooth muscle alpha-actin and F4/80 respectively. Results: CNV formation was significantly reduced in the PlGF knockout mice. The dose-response experiment showed that the 20 mg/kg dose of anti-PlGF significantly reduced the number of vessels in the lesions as compared to control antibody (p= 0.045), although less than a comparable dose of anti-VEGFR2 (p=0.027). Moreover, smooth muscle cell coverage was significantly increased in the anti-PlGF treated (p=0.04) and reduced in the anti-VEGFR2 treated mice (p=0.03) as compared to control mice. Finally, a significant reduction in number of inflammatory cells was observed in the lesions treated with anti-PlGF (p=0.017) but not in the anti-VEGFR2 treated mice (p=0.33). Conclusions: Anti-PlGF treatment inhibits CNV formation in a mouse model for ARMD. Both anti-PlGF and anti-VEGFR2 impair capillary growth, but in contrary to VEGFR2 blockage, anti-PlGF also reduces inflammation and promotes vessel maturation. [source] Treatment of choroidal neovascularization using intravitreal bevacizumabACTA OPHTHALMOLOGICA, Issue 5 2007Robert Pedersen Abstract. Purpose:, This study aimed to assess the pharmacodynamic profile of intravitreal bevacizumab in relation to best corrected visual acuity (BCVA), foveal thickness, and other aspects of macular morphology after intravitreal injection of bevacizumab in eyes with subretinal choroidal neovascularization (CNV). Methods:, A retrospective observational, uncontrolled case series including 26 eyes in 25 patients followed for up to 6 months after intravitreal injection of bevacizumab 1 mg repeated as deemed necessary after monthly assessments by biomicroscopy, optical coherence tomography, colour fundus photography, fluorescein angiography and BCVA determination. At follow-up, cases were classified by morphological treatment response (reduction or elimination of pathological neovascular leakage, retinal thickening or serous retinal detachment) or absence of response (deterioration or lack of improvement). Primary disease entities included age-related macular degeneration (22 eyes, four of which had evidence of retinal angiomatous proliferation), idiopathic peripapillary neovascularization (one eye), and angioid streaks (three eyes in two patients). Results:, One month after the first injection, apparent morphological improvement was observed in 24/26 eyes and mean BCVA had improved by 3.1 ± 7.8 letters (p = 0.05). Of these 24 responders, which included all primary diagnoses, 11 (46%) demonstrated BCVA improvement of ,,5 letters. The two non-responders (7.7%) had lost >,3 lines of vision at 2 months follow-up. Overall, 18 eyes completed 6 months follow-up, with a mean BCVA improvement of 0.5 ± 12.7 letters, and 22 eyes completed 3 months follow-up, with a mean BCVA improvement of 2.0 ± 11.0 letters. Two months after the first injection, 11 (46%) of the 24 responders demonstrated signs of recurrent CNV activity, defined as decreased BCVA and/or increased retinal thickness and/or fluorescein angiographic CNV leakage. No serious drug-related adverse events were observed during the course of the study. Conclusions:, Overall mean BCVA remained stable throughout the study. Morphological signs of reduced CNV activity were seen in the majority of eyes at 2,4 weeks after intravitreal bevacizumab injection. Half the responders showed signs of renewed CNV activity at 2 months after their first injection. All first-injection responders were also second-injection responders. [source] Retinal pigment epithelium changes after photodynamic therapy for choroidal neovascularization in pathological myopiaACTA OPHTHALMOLOGICA, Issue 1 2007Maurizio Battaglia Parodi Abstract. Purpose:, To describe changes in the retinal pigment epithelium (RPE) induced by photodynamic therapy (PDT) in eyes with subfoveal choroidal neovascularization (CNV) associated with pathological myopia (PM). Methods:, We carried out an open-label, prospective, interventional case series including 26 patients affected by subfoveal CNV in PM who underwent PDT with a 12-month follow-up. Particular attention was paid to the detection of changes at the RPE level in the areas exposed to the laser compared with baseline conditions. Results:, The median age of the patients was 58.5 years and the median duration of symptoms was 2 weeks. A pigmentary zone was present before PDT in 20 eyes (77%), incompletely encircling the CNV in all but two of the 20 eyes. At the end of the follow-up, the CNV in all eyes was seen to be completely or incompletely encircled by a band of hyperpigmentation, which was surrounded by RPE alterations, including depigmentation in all cases and atrophic changes in 14 eyes. Conclusions:, After PDT, alterations in the RPE develop in myopic eyes. These include accentuation of the pigmentary zone surrounding the CNV and progressive atrophic changes. Further studies are needed to correlate post-PDT RPE damage with longterm visual outcome. [source] Improvement of visual acuity after photodynamic therapy for choroidal neovascularization in choroidal osteomaACTA OPHTHALMOLOGICA, Issue 4 2005Pierre Blaise No abstract is available for this article. [source] | ||||||||||