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Transpupillary thermotherapy for choroidal neovascular membrane in age related macular degeneration  [cached]
Agarwal Manisha,Shanmugam Mahesh,Gopal Lekha,Shetty Nitin
Indian Journal of Ophthalmology , 2004,
Abstract: Purpose: To evaluate the efficacy of transpupillary thermotherapy (TTT) in choroidal neovasularisation (CNVM) secondary to age related macular degeneration ( AMD). Material and methods: Retrospective, non-randomized study of 28 eyes of 28 patients with subfoveal CNVM (classic, occult or mixed) secondary to AMD. Results: Fifteen patients (53.57%) maintained their pre-treatment vision, 2 (7.14%) patients showed improvement of more than 2 lines and 11(39.28%) patients showed deterioration of vision by> 2 lines. Angiographic and clinical regression of CNVM was noted in 19 patients (67.8%) on an average follow up of 15.32 ± 3.31 months. Conclusion: TTT leads to stabilisation of vision in 60% of treated eyes with CNVM due to AMD.
Transpupillary thermotherapy in subfoveal choroidal neovascular membrane secondary to age-related macular degeneration  [cached]
Verma Lalit,Tewari Hem,Nainiwal Sanjeev,Ravindranathan Jayaram
Indian Journal of Ophthalmology , 2004,
Abstract: Purpose: To report our initial experience in the treatment of subfoveal choroidal neovascular membrane, secondary to age-related macular degeneration (AMD) by transpupillary thermotherapy (TTT). Methods: Fifty consecutive patients with subfoveal choroidal neovascularisation (CNV) secondary to AMD, were included in the study. The parameters assessed before the TTT were visual acuity by ETDRS chart, scotoma score by Amsler grid chart, reading speed, fundus examination by direct and indirect ophthalmoscope as well as +90 Diopter lens followed by digital fundus photography and fluorescein angiography (FA). Results: The letter visual acuity improved or stabilized in 72% cases up to 12 weeks after TTT. Mean scotoma score decreased from a mean of 47.56, to 43.56 at 6 weeks and to 37 at 12 weeks. Mean reading speed increased from 27.04 words/minute at pretreatment to 34.52 words/minute at 6 weeks and 37.33 words/minute 12 weeks after TTT. Conclusion: TTT is not only a cheaper alternative to photodynamic therapy (PDT), but also is an efficacious tool in stabilisation or improvement of visual acuity in the management of subfoveal choroidal neovascular membrane due to AMD.
Early Responses to Intravitreal Ranibizumab in Typical Neovascular Age-Related Macular Degeneration and Polypoidal Choroidal Vasculopathy  [PDF]
Wataru Matsumiya,Shigeru Honda,Hiroaki Bessho,Sentaro Kusuhara,Yasutomo Tsukahara,Akira Negi
Journal of Ophthalmology , 2011, DOI: 10.1155/2011/742020
Abstract: Purpose. To evaluate the early response to intravitreal ranibizumab (IVR) in two different phenotypes of age-related macular degenerations (AMD): typical neovascular AMD (tAMD) and polypoidal choroidal vasculopathy (PCV). Methods. Sixty eyes from 60 patients (tAMD 28, PCV 32 eyes) were recruited. Three consecutive IVR treatments (0.5?mg) were performed every month. Change in the best-corrected visual acuity (BCVA) and central retinal thickness (CRT) was then compared between the tAMD and PCV groups. Results. The mean BCVA logMAR was significantly improved at month 1 and month 3 after the initial IVR in the tAMD group, but there was no change in the PCV group. Both phenotypes showed significant improvements in the CRT during the 3 months after the initial IVR. There were no significant differences in the improvements of the CRT in the tAMD versus the PCV group. In the stepwise analysis, a worse pretreatment BCVA and tAMD lesions were significantly beneficial for a greater improvement of BCVA at 3 months after the initial IVR. Conclusions. The phenotype of tAMD showed a significantly better early response to IVR than PCV in terms of BCVA improvement. 1. Introduction The intravitreal injection of ranibizumab (IVR) is currently the treatment of choice for subfoveal choroidal neovascularization (CNV) due to age-related macular degeneration (AMD), a leading cause of central visual loss in the elderly in industrialized countries [1, 2]. Several studies from Western countries have reported a significant improvement in vision at 3 months with monthly IVRs [3, 4]. However, the efficacy of IVR has not been investigated well for exudative AMD in the Japanese population. A recent report described a good response to intravitreous bevacizumab in Japanese AMD patients with classic CNV lesions, but there was limited efficacy in those with occult CNV lesion [5]. We hypothesized that those results might be attributed to the proportion of AMD subtypes in the Japanese population, which includes polypoidal choroidal vasculopathy (PCV) as the major phenotype of exudative AMD [6], and the effects of antivascular endothelial growth factor (VEGF) therapy for PCV may differ from those for typical neovascular AMD (tAMD). Recent publications have reported that the effects of anti-VEGF therapy were limited in PCV [7–9]. However, to our knowledge, no comparative studies have been published on the effectiveness of IVR associated with the different phenotypes of AMD. In this study, we first performed a comparative assessment to determine whether the early responses to IVR were
Detection of heat shock protein 70 in choroidal neovascular membranes secondary to age related macular degeneration
Andreas PW J?res, D?rthe Carstesen, Gabriele Thumann, Peter Walter, Andreas WA Weinberger
BMC Research Notes , 2011, DOI: 10.1186/1756-0500-4-115
Abstract: CNV membranes were removed by pars plana vitrectomy (ppV) and subretinal extraction. The membranes were analysed by light microscopy and the presence of Hsp 70 was examined using histochemistry. HeLa Cells served as controls.Of the 14 membranes analysed 11 were Hsp70 positive and 3 negative. In the no pre-treatment group of 8 membranes 6 were Hsp70 positive and 2 negative; in the PTD group all 4 membranes were positive and in the TTT group 1 membrane was positive and 1 membrane was negative for Hsp70.Hsp70 is present in the most CNV membranes secondary to AMD. Pre-treatment of the membrane with PTD or TTT does not appear to influence the expression of Hsp70.Choroidal neovascularization (CNV) is the leading cause of severe visual impairment in patients with age-related macular degeneration (AMD) since when left untreated CNV leads to disciform scarring of the macula [1,2].Several therapeutic strategies have been attempted to reduce the destructive effects of CNV membranes and stabilize vision. Since 2006 the preferred treatment for neovascular AMD is the intravitreal injections of inhibitors of VGF's especially the monoclonal antibodies bevacizumab (Avastin?) and ranibizumab (Lucentis?) [3,4]. Photodynamic therapy (PDT), submacular surgery and laser procedures have become second line options. While argon laser photocoagulation destroys the CNV and overlying retina, transpupillary thermotherapy (TTT) has been thought to selectively damage the CNV by hyperthermia, inducing thrombotic vessel occlusion while sparing the overlying retina [5].Heat shock proteins function as intra-cellular chaperones for other proteins and play a critical role in protein-protein interactions, assist in generating proper protein conformation and prevent pathological protein aggregation. Hsp proteins are expressed under physiological condition in all organisms and play an essential role in protein maintenance [6,7].Hsp70's are a family of proteins that, as other heat shock proteins, aid in pr
Early Responses to Intravitreal Ranibizumab in Typical Neovascular Age-Related Macular Degeneration and Polypoidal Choroidal Vasculopathy  [PDF]
Wataru Matsumiya,Shigeru Honda,Hiroaki Bessho,Sentaro Kusuhara,Yasutomo Tsukahara,Akira Negi
Journal of Ophthalmology , 2011, DOI: 10.1155/2011/742020
Abstract: Purpose. To evaluate the early response to intravitreal ranibizumab (IVR) in two different phenotypes of age-related macular degenerations (AMD): typical neovascular AMD (tAMD) and polypoidal choroidal vasculopathy (PCV). Methods. Sixty eyes from 60 patients (tAMD 28, PCV 32 eyes) were recruited. Three consecutive IVR treatments (0.5 mg) were performed every month. Change in the best-corrected visual acuity (BCVA) and central retinal thickness (CRT) was then compared between the tAMD and PCV groups. Results. The mean BCVA logMAR was significantly improved at month 1 and month 3 after the initial IVR in the tAMD group, but there was no change in the PCV group. Both phenotypes showed significant improvements in the CRT during the 3 months after the initial IVR. There were no significant differences in the improvements of the CRT in the tAMD versus the PCV group. In the stepwise analysis, a worse pretreatment BCVA and tAMD lesions were significantly beneficial for a greater improvement of BCVA at 3 months after the initial IVR. Conclusions. The phenotype of tAMD showed a significantly better early response to IVR than PCV in terms of BCVA improvement.
New approaches in the management of choroidal neovascular membrane in age-related macular degeneration.  [cached]
Verma Lalit,Das Taraprasad,Binder Susanne,Heriot Wilson
Indian Journal of Ophthalmology , 2000,
Abstract: Age-related macular degeneration (AMD) is a leading cause of blindness in the elderly population. The prevalence is reported to be 1.2-1.4% in several population-based epidemiological studies. Currently 25-30 million people worldwide are blind due to AMD. With the aging world population it is bound to increase significantly, and could become a significant public health problem in next two decades, with serious socio-economic implications. Several strategies are today available to treat the wet form of AMD, which is responsible for significant visual loss. These were until recently confined to laser photocoagulation, and subretinal surgery, but today two other modalities, namely, radiation and photodynamic therapy, are available. These treatment modalities however, are aimed at preservation of vision only, and not at reversing the process of the disease. Further research on antiangiogenic drugs and gene therapy could significantly help AMD patients.
Can macular translocation be a satisfactory management of subfoveal choroidal neovascular membrane?  [cached]
Árpád Bereczki,Zsolt Bíró
Clinical Ophthalmology , 2008,
Abstract: árpád Bereczki1, Zsolt Bíró21“Petz Aladár” County Teaching Hospital, Department of Ophthalmology, Gyor, Hungary; 2St Imre Hospital, Department of Ophthalmology, Budapest, HungaryPurpose: To report histopathological observations regarding one of our macular translocation cases.Methods: We have performed macular translocation with 360 degree retinotomy since 1997, and limited macular translocation with or without subretinal membrane removal since 2002. One of our patients died on the fifth postoperative day, so extensive histological examination of the removed neovascular membrane and entire globe was performed.Results: We found that pigment epithelium remained attached to the neurosensory retina during retinal separation, in which case the rotated fovea will be relocated in a partially devoided pigment epithelial zone. In addition, even after complete surgical removal of the membrane during macular translocation, large membrane remnants are still detectable by histological examination.Conclusion: In our opinion, macular translocation is not a satisfactory management of subfoveal neovascular membranes, because of changes in the pigment epithelium during surgery, and large subretinal neovascular membrane remnants.Keywords: age-related macular degeneration (AMD), choroidal neovascularization (CNV), choroidal subretinal membrane, macular translocation, histology
The Relationship between Neovascular Age-Related Macular Degeneration and Erectile Dysfunction  [PDF]
Harun ?akmak,Tolga Kocatürk,Sema Oru? Dündar,Mehmet Dündar,Müjdat Karabulut
Journal of Ophthalmology , 2013, DOI: 10.1155/2013/589274
Abstract: Purpose. To evaluate association between erectile dysfunction (ED) and neovascular age-related macular degeneration (AMD). Methods. 195 men enrolled in this cross-sectional study. 90 of them had neovascular AMD and 105 of them were healthy volunteers. The International Index of Erectile Function (IIEF) questionnaire’s erectile function (EF) domain was used to assess ED. The patients in the study and control groups were statistically compared according to visual acuity, EF score, and body mass index. Results. The mean ages were 62 (54.5–73) and 60 (54–68), in the neovascular AMD and control groups, respectively. The total EF scores were 9 (6–16) in neovascular AMD and 18 (9.5–27) in control group. The results of IIEF questionnaire on neovascular AMD patients revealed that 85 men (94.4%) had some degree of ED, whereas 68 men (64.8%) had some degree of ED on control group. Patients with neovascular AMD had a significantly higher incidence of ED than control patients ( ). There was a significant association between ED and neovascular AMD ( ). Conclusions. Our results suggested that neovascular AMD has a high association with ED. 1. Introduction Age-related macular degeneration (AMD) is the most common cause of blindness in industrialized countries affecting individuals over the age of 55 [1]. Neovascular AMD affects only 10–15% of AMD patients but approximately 90% of blindness due to this condition [2]. The main cause of vision loss in neovascular AMD is the development of choroidal neovascularization, which is ultimately the result of a break in a structural layer beneath the retina known as Bruch’s membrane, which separates the nourishing vascular layer called the choroid from the retina. These vessels can leak fluid or blood, initially distorting or blurring vision, and may eventually lead to scar in the macula and severe loss of central vision [3]. Erectile dysfunction (ED) is defined as the inability to attain or maintain the penile erection required for sufficient sexual performance [4]. ED is a common health problem in middle aged and elderly men [5]. The prevalence of this dysfunction increases steadily from 10% to 80% with age [6]. ED is a multifactorial disease; the vascular, neurogenic, hormonal, psychogenic, cavernosal, iatrogenic, and anatomic causes lie in its pathophysiology. ED can affect emotional, sexual, social, recreational, and intellectual intimacy [7]. The impact of ED can be devastating because evidence has shown that sexual function is one of the very important indices of quality of life [8]. Cross-sectional studies have reported
Breaking barriers: insight into the pathogenesis of neovascular age-related macular degeneration  [cached]
Wang H,Wittchen ES,Hartnett ME
Eye and Brain , 2011,
Abstract: Haibo Wang1, Erika S Wittchen2, M Elizabeth Hartnett11Department of Ophthalmology, John A Moran Eye Center, University of Utah, Salt Lake City, UT; 2Department of Cell and Developmental Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USAAbstract: Neovascular age-related macular degeneration (AMD) is a leading cause of central visual acuity loss in a growing segment of the population, those over the age of 60 years. Treatment has improved over the last decade, with the availability of agents that inhibit the bioactivity of vascular endothelial growth factor (VEGF), but it is still limited, because of tachyphylaxis and potential risk and toxicity of anti-VEGF agents. The authors have sought to understand the mechanisms of choroidal endothelial cell (CEC) activation and transmigration of the retinal pigment epithelium (RPE) and of RPE barrier dysfunction, events preceding vision-threatening neovascular AMD. The authors developed physiologically relevant human RPE and CEC coculture and transmigration models that have been important in helping to understand causes of events in human neovascular AMD. The authors can control for interactions between these cells and can separately assess activation of signaling pathways in each cell type relevant during CEC transmigration. Using these models, it was found that VEGF, particularly the cell-associated VEGF splice variant VEGF189, accounts for about 40% of CEC transmigration across the RPE. This percentage is in the range of similar reports following clinical inhibition of VEGF in neovascular AMD. RPE VEGF189 working through CEC VEGF receptor 2 activates the small guanosine triphosphatase (GTPase) of the Rho family, Rac1, in CECs, which in turn facilitates CEC transmigration. Conversely, inhibition of Rac1 activity prevents CEC transmigration. Once activated, Rac1 aggregates with subunits of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase, resulting in the generation of reactive oxygen species. Activated NADPH oxidase increases choroidal neovascularization in animal models of laser-induced injury. Rac1 is also downstream of the eotaxin-CCR3 pathway, another pathway important in human neovascular AMD. Studies also suggest that active Ras-related protein 1 (Rap1), another small GTPase, in RPE can strengthen the RPE barrier integrity and can resist CEC transmigration of the RPE, suggesting Rap1 activation may be another potential target for preventing neovascular AMD.Keywords: choroidal endothelial cell (CEC), Rac1/Rap1 GTPase, retinal pigment epithelium (RPE), vascular endothelial g
Ranibizumab: the evidence of its therapeutic value in neovascular age-related macular degeneration  [cached]
Peter K. Kaiser
Core Evidence , 2008,
Abstract: Peter K. KaiserCole Eye Institute, The Cleveland Clinic Foundation, Cleveland, Ohio, USAIntroduction: Neovascular age-related macular degeneration (AMD) is the leading cause of severe, irreversible visual impairment in people over 60 years of age. Neovascular AMD is characterized by abnormal growth of blood vessels under the retina, specifically the macula. These vessels leak blood and fluids, damaging the retina and its photoreceptors, resulting in permanent loss of central vision. Vascular endothelial growth factor-A (VEGF-A) has been shown to play a critical role in the pathogenesis of neovascular AMD. In the US, ranibizumab, a VEGF-A blocker, is approved and indicated for the treatment of patients with neovascular AMD.Aims: To review the clinical evidence for ranibizumab in the treatment of neovascular AMD.Evidence review: Phase III clinical trial data have established ranibizumab as a safe and well-tolerated treatment for neovascular AMD. Monthly intravitreal injections of ranibizumab result in a statistically significantly greater proportion of patients losing <15 letters of visual acuity (VA) and statistically significant increases in the mean number of letters gained compared with controls. Anatomically, ranibizumab results in stabilization in the mean area of choroidal neovascularization (CNV) and statistically significant reductions in the mean area of leakage compared with controls. Although there is limited economic evidence available, ranibizumab therapy for neovascular AMD appears to deliver a significant degree of value gain in terms of quality of life when compared with other neovascular AMD interventions.Place in therapy: Clinical evidence establishes ranibizumab as a first-line therapy option for virtually all treatable neovascular AMD patients. Updating neovascular AMD treatment guidelines to reflect the evidence base for ranibizumab as a preferred first-line therapy would be beneficial for physicians in making informed treatment choices and ultimately helping to ensure the best care for patients.Key words: ranibizumab, evidence, neovascular age-related macular degeneration
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