To evaluate the efficacy and safety of intravitreal ranibizumab for branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO) in daily clinical practice.A prospective study enrolling all patients diagnosed with BRVO or CRVO who received intravitreal ranibizumab therapy at our department.Fifty-seven patients had BRVO and 49 had CRVO. By 12 months, the patients with BRVO improved a mean of 11.6 (P < 0.0001) ETDRS (Early Treatment Diabetic Retinopathy Study) letters, whereas the patients with CRVO improved a mean of 1.8 letters (P = 0.50). The proportion of patients gaining ≥ 15 ETDRS letters was 26.3% for BRVO and 16.7% for CRVO. The proportion of patients losing ≥ 15 ETDRS letters was 0% for BRVO and 8.3% for CRVO. The reduction in foveal center point thickness at 12 months was 248 μm for BRVO (P < 0.0001) and 222 μm for CRVO (P < 0.0001). Functional outcome did not mirror anatomical outcome, and younger patients had better outcome.Our 12-month results of BRVO treated with intravitreal ranibizumab in daily clinical practice are similar to the results of the BRAVO trial that led to the approval of the therapy. However, our results for CRVO failed to reproduce the results of the CRUISE trial.
Visually impaired patients may experience visual hallucinations due to the Charles Bonnet syndrome (CBS). While benign in nature, these hallucinations may cause distress in those unfamiliar with the phenomenon. The overall purpose of this study was to determine the degree of awareness of CBS in patients referred to our retina clinic.Consenting patients attending our retina clinic over a period of three months underwent a thorough ophthalmological examination, including slit-lamp fundus biomicroscopy, spectral-domain optical coherence tomography, fundus autofluorescence imaging and fluorescein/indocyanine green angiography (if applicable). Visual acuity was measured and the participants were subjected to a structured telephone interview.A total of 200 patients were included in this cross-sectional study. Twelve per cent of the participants were familiar with CBS. Patients who were clients at a low-vision rehabilitation clinic or were highly educated were more likely to be familiar with CBS. There was an association between low visual acuity and awareness of CBS. Logistic regression analysis revealed that only low visual acuity and university education were independently associated with familiarity with CBS. Fifteen per cent of the participants admitted to having visual hallucinations.Visually impaired patients are largely unfamiliar with CBS. Since unawareness of CBS may cause unnecessary distress in some patients, efforts to educate low-vision patients about CBS should be made.not relevant.not relevant.
Matrix metalloproteinase 9 (MMP-9) and tissue inhibitor of metalloproteinases 1 (TIMP-1) are regulating enzymes of the extracellular matrix. A systemic imbalance of MMP-9 and TIMP-1, thought to reflect an imbalance of the extracellular matrix homeostasis, is previously associated with polypoidal choroidal vasculopathy (PCV) in Asian patients. Previous studies suggest inter-ethnical differences in the genetic background and etiology of PCV. To further explore this issue, we studied the plasma levels of MMP-9 and TIMP-1 in Caucasian patients with PCV and compared to healthy age-matched controls.For this prospective case-control study, 60 participants were recruited who were either patients with PCV (n = 26) or healthy controls (n = 34). All participants underwent detailed clinical examination. We sampled fresh venous blood, isolated plasma, and quantified plasma concentrations of the extracellular matrix regulators MMP-9 and TIMP-1 using electrochemiluminescence immunoassays.Plasma levels of MMP-9 (p = 0.4), TIMP-1 (p = 0.9), and MMP-9/TIMP-1 ratio (p = 0.4) did not differ significantly between patients with PCV and healthy controls. No differences appeared after adjusting for influencing co-variates in multivariate analyses.We demonstrate that Caucasian patients with PCV do not have altered levels of plasma MMP-9 or plasma TIMP-1. These findings suggest no strong evidence of a systemic imbalance of the extracellular matrix homeostasis in Caucasian patients with PCV. Our findings are in line with studies of other aspects of PCV that are also subject to significant inter-ethnical differences.
We have reviewed studies investigating the effect of physical activity on prevention of early age-related macular degeneration (AMD), progression to late AMD, and risk modulation of morbidity and mortality in patients with AMD. Regular physical activity may lower risk of developing early AMD and progression of early AMD to late AMD at a level comparable with smoking cessation or dietary supplements. Studies suggest that AMD itself is associated with physical inactivity which can result in higher morbidity levels. Patients with AMD may benefit from physical activity counselling at all stages of the disease.
To investigate regulatory T cells (Tregs) and subsets of the Treg population in patients with neovascular age-related macular degeneration (AMD).Twenty-one neovascular AMD cases and 12 age-matched controls without retinal pathology were selected. Patients were recruited from our outpatient retinal clinic. Control individuals were typically spouses. The diagnosis of neovascular AMD was confirmed using fluorescein and indocyaningreen angiography. Fresh venous blood was analyzed by flow cytometry using fluorochrome-conjugated antibodies to the Treg surface antigens CD4, CD25, CD127, CD45RA, and CD31. Main outcome measures were the percentage of CD25(high)CD127(low) Tregs, the percentage of CD45RA(+) naïve Tregs, and the percentage of CD31(+) recent thymic emigrant Tregs.Comparing patients with neovascular AMD to controls, no significant differences were found in the percentages of CD4(+) lymphocytes, CD25(high)CD127(low) Tregs, CD45RA(+) naïve Tregs, or CD31(+) recent thymic emigrant Tregs.Our data does not indicate an altered state of systemic Treg cells in neovascular AMD.
Dysregulation of the complement system is involved in development of age-related macular degeneration (AMD). The complement cascade is regulated by membrane bound complement regulatory proteins (Cregs) on mononuclear leukocytes among others. This study aims to investigate systemic complement proteins and Cregs in AMD stages and their association with treatment response in neovascular AMD (nAMD).
To investigate circadian intraocular pressure variation in patients treated with topical beta-blockers as monotherapy.Circadian IOP curves were measured on 25 patients (47 eyes) treated with topical beta-blockers. IOP was recorded 4 times during the day and twice at night. All IOP measurements were taken using a non-contact tonometer.IOP at night was significantly higher than IOP during the day. Thirty-four percent exhibited an increase in IOP of more than 5 mmHg at night, and 15% exhibited an increase of 10-18 mmHg at night. The median range of circadian IOP variation was 7 mmHg. Determined separately by day, the range of IOP variation was 4 mmHg.Patients treated with beta-blockers as monotherapy may experience greater variations in IOP than can be detected by conventional daytime IOP measurements.
Abstract Age‐related macular degeneration ( AMD ) is aetiologically linked to immunological ageing and dysfunction. One aspect of this is the altered neutrophil‐to‐lymphocyte ratio ( NLR ), which in other domains have been associated with inflammation and angiogenesis, and therefore investigated in patients with AMD in several papers. In this systematic review and meta‐analysis, we summarize findings in patients with AMD in relation to NLR , both qualitatively and quantitatively. We searched PubMed/ MEDLINE , EMBASE , Web of Science, and the Cochrane Central and identified six studies from where we extracted data on 1178 individuals (777 patients with AMD and 401 healthy controls). Patients with AMD had a higher NLR (weighted mean difference: 0.37, CI 95% 0.08 to 0.66, p = 0.013) when compared to healthy controls. In subgroup analyses, we did not find a significant difference between patients with dry AMD and healthy controls (weighted mean difference: 0.34, CI 95% −0.03 to 0.69, p = 0.068), but did find a strong significant difference between patients with neovascular AMD and healthy controls (weighted mean difference: 0.54, CI 95% 0.23 to 0.86, p = 0.00068). Hence, we find that the association between AMD and elevated NLR may have stronger relevance to the neovascular subtype of AMD . However, the clinical value of measuring the NLR remains unclear.
