To report best vitelliform macular dystrophy (BVMD) with an intriguing pattern of vascular flow on optical coherence tomography angiography (OCTA).Four eyes of two patients with BVMD were evaluated. Complete ophthalmic examination including best corrected visual acuity (BCVA), spectral domain optical coherence tomography (SD-OCT), and OCTA were performed. Diagnosis was confirmed by electroretinography (ERG) and electrooculography (EOG) testing.All eyes had the electrophysiologic confirmation of the BVMD. The first patient was 35 years old with BCVA of 20/20 and pseudohypopyon stage macular lesion in right eye (RE) and BCVA of 20/32 and vitelliruptive stage macular lesion in the left eye (LE). The second patient was 18 years old with BCVA of 20/25 and macular lesion in vitelliform stage in the RE and BCVA of 20/60 and choroidal neovascularization (CNV) in the LE. In all eyes, a distinct foveal avascular zone (FAZ) was not detectable in OCTA, with a bridging vessel in the FAZ. A dense subretinal capillary network compatible with CNV in the LE of second patient was observed.In our cases, we found bridging vessel in the FAZ, and it may be due to the effects of bestrophin on the calcium content and vascular endothelial growth factor (VEGF) secretion of the retinal pigment epithelium (RPE) cells.
To report the results of intravitreal injection of a bevacizumab biosimilar called StivantⓇ.This prospective interventional case series was conducted on eyes with neovascular age-related macular degeneration (nAMD), retinal vein occlusion (RVO), and diabetic macular edema (DME). StivantⓇ was injected in three consecutive months and changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) were measured at baseline and monthly up to one month after the third injection.Three hundred and eighty-five eyes with DME (234 eyes, 61%), nAMD (87 eyes, 22%), and macular edema secondary to RVO (64 eyes, 17%) were enrolled. The mean ± standard deviation age of the patients was 61.7 ± 7.20 years. The mean BCVA and CMT changed from 0.63 ± 0.3 to 0.51 ± 0.3 LogMAR (P = 0.12 ) and from 420.4 ± 47.3μm at baseline to 316.7 ± 50.6 μm (P< 0.001) in the DME group; from 0.79 ± 0.3 to 0.68 ± 0.3 LogMAR (P = 0.19) and from 376.1 ± 31.7 μm to 303 ± 31.3 μm (P = 0.019) in the nAMD group; and from 0.81 ± 0.4 to 0.63 ± 0.4 LogMAR (P = 0.05) and from 424.21 ± 18 μm to 303.4 ± 18.8 μm (P< 0.001) in the RVO group, respectively.Our limited experience showed that the intravitreal injection of StivantⓇ was well tolerated. Although the results of this case series showed relative improvement in CMT one month after the last injection of StivantⓇ, BCVA improvement was statistically significant only in the RVO group. This would be essential to design a randomized clinical trial to evaluate the non-inferiority of StivantⓇ in comparison to bevacizumab.
To assess the safety of biosimilar intravitreal aflibercept (CinnaGen Co., Iran) compared to the reference product (Eylea®; Bayer Schweiz AG, Zurich, Switzerland) in rabbit eyes through functional and histologic studies.Forty New Zealand albino rabbits were recruited to the study and were divided into four groups to be sacrificed at 48 hours, one, two, and four weeks after injections. In each group, five rabbits received 0.05 mL (2 mg) biosimilar aflibercept in the right eye and 0.05 mL saline in the left eye as the control, and in a similar manner, the remaining five rabbits received the reference drug in the right eye and saline in the left eye. All the rabbits underwent comprehensive ophthalmic examination and electroretinography (ERG) tests at baseline and also just before enucleation at the specific predefined time points. The enucleated eyes were prepared for retinal toxicity histological examination.No retinal toxicity was observed based on histologic and ERG findings in all groups. Choroidal congestion was revealed after 1 week in an eye that was injected with biosimilar aflibercept, although the similar finding was detected in the contralateral eye which received saline. Also, one subject which received the reference drug showed chronic vitritis and lymphoplasmocytic reaction of the optic disc at week 4. The remaining subjects showed no histologic changes.The 2 mg intravitreal injection of biosimilar aflibercept (CinnaGen Co., Iran) was found to be nontoxic in rabbit eyes in the short-term period. Further studies are required to warrant the efficacy and safety profile of the drug in human subjects.
Background – Premacular subhyaloid hemorrhage is one of the etiologies of sudden visual loss. It may be due to vascular or blood abnormalities or Valsalva retinopathy. Spontaneous absorption of blood may take months and result in macular complications and permanent impairment of vision. Posterior hyaloidotomy by Nd-YAG laser is an outpatient procedure which may obviate the need for more complex surgical interventions. This study evaluates the success of this approach in patients with premacular subhyaloid hemorrhage of different etiologies. Methods – In this interventional case-series study, 12 eyes of 12 patients with premacular subhyaloid hemorrhage were enrolled. All patients had a comprehensive ocular examination before the operation and color fundus photographs were obtained. Fluorescein angiography was performed when necessary. Hyaloidotomy was performed using Nd-YAG laser. Main outcome measures were: success rate in hyaloidotomy (based on release of blood into the vitreous cavity and its subsequent absorption) and improvement in visual acuity and possible complications. Results – Twelve eyes of 12 patients (16.7% males and 83.3% females) with premacular subhyaloid hemorrhage were enrolled. The mean age of the patients was 48.5 ± 10.33 years. The predisposing factor was diabetic retinopathy in eight (66.7%), macroaneurysm (due to hypertension) in one (8.3%), and Valsalva retinopathy in three (25%). Hyaloidotomy was successful in all (100%) of the patients and the trapped blood was released into the vitreous cavity and absorbed within 6 to 16 (average = 9) days. The range of preoperative visual acuity was hand motions to counting fingers at 3 meters which improved from 20/50 to 20/20 postoperatively. Compared with those with vascular pathologies, visual improvement was best in the patients with Valsalva retinopathy. No complications were observed during their average follow-up of 24.5 (range: 8 to 72) months.
Purpose: We evaluated the role of multiparametric magnetic resonance imaging (mpMRI) in the diagnosis of prostate cancer and predicting of surgical staging of prostate cancer.
Materials and Methods: The study was done in 110 subjects who got mpMRI before radical prostatectomy in our hospital from 2016 to 2019. Preoperative mpMRI findings of 110 were compared to surgical pathology results following radical Prostatectomy. A comparison was made between pathologic staging of prostate cancer and the mpMRI findings.
Results: pathologic evaluation confirmed prostate cancer foci (237) were recognized in 110 subjects. Generally, mpMRI sensitivity of 46.4% was found for prostate cancer detection (110/237). Pathological tumor volume was a significant predictor of prostate cancer detection using mpMRI. In 33% of the cases, the pathologic staging is precisely similar to mpMRI and in 43%of the cases, there was a slight difference between the pathologic staging and staging by mpMRI but the cancer was confined to the prostate.in 24% of the cases, there was a significant difference between the pathologic staging and staging by mpMRI. The mpMRI was not able to identify the significant cancer in 24% of the cases.
Conclusion: The preoperative mpMRI was useful in detecting prostate cancer and in predicting surgical staging. However, the detection of 24% of clinically significant cancer was missed using mpMRI. As we move toward personalized medicine, use of MRI to biopsy each man's prostate differently rather than based on a pre-defined 12 core seems to be supported in the recent literature.
In Brief Purpose: To evaluate the efficacy and safety of combined intravitreal triamcinolone acetonide (IVTA) injection plus panretinal photocoagulation (PRP) and macular photocoagulation (MPC) in comparison with PRP and MPC in eyes with coexisting high-risk proliferative diabetic retinopathy (PDR) and clinically significant macular edema (CSME). Methods: Twenty-three patients diagnosed with both high-risk PDR and CSME were enrolled in our prospective, randomized clinical trial study. One eye of each patient was selected to undergo IVTA injection one week before initial PRP and MPC (IVTA eye), and the other eye was treated with PRP and MPC (control eye) based on block randomization. Panretinal photocoagulation was performed in 3 sessions at 1 week intervals. Baseline characteristics included best-corrected visual acuity (BCVA) using Snellen charts, intraocular pressure and patients were observed at 1, 4, and 6 months of treatment. Main outcome measures included change in central macular thickness (CMT) as measured by optical coherence tomography (OCT), logarithm of the minimum angle of resolution BCVA (logMAR), and complications occurring within the follow-up period. Results: Of 23 enrolled patients, 5 patients did not complete follow-up visits due to dense vitreous hemorrhage, tractional retinal detachment and loss of future follow-up. Mean baseline logMAR BCVA was 0.46 ± 0.29 and 0.56 ± 0.27 in IVTA eyes and controls. Final mean logMAR BCVA was 0.39 ± 0.29 (IVTA eyes) and 0.55 ± 0.33 (control eyes), which was not significantly different (P = 0.08). Mean baseline CMT was 319.2 ± 79.1μm (IVTA eyes) and 345.9 ± 100.6 μm (control eyes). Significant reduction of CMT in IVTA eyes was observed at 1 month (P = 0.024), which had not remained stable after 6 months showing no significant difference as compared with baseline CMT (P = 0.06). In control eyes, CMT was not significantly reduced at 1 and 6 months of treatment. The standardized change in macular thickening (SCMT) was 29.4 ± 52.2 (IVTA group) versus 5.66 ± 31.5 (control group) (P = 0.12) at 1 month. At 6 months, SCMT was 16.8 ± 55.8 (IVTA group) versus 5.03 ± 47.4 (control group) (P = 0.51). Conclusion: Combined IVTA plus PRP and MPC in coexisting high-risk PDR and CSME eyes do not have a significant beneficial effect on BCVA improvement and CMT reduction compared with standard treatment. Combined IVTA plus PRP and MPC in coexisting high-risk PDR and CSME eyes do not have a significant beneficial effect on BCVA improvement and CMT reduction compared with standard treatment.
To describe a case of bilateral multiple serous retinal detachments (SRD) following bone marrow transplantation (BMT), which showed bilateral response to a single unilateral intravitreal bevacizumab injection.A 37-year-old man with acute myelogenous leukemia who had received bone marrow transplantation four months prior was referred to our clinic with the chief complaint of gradually decreasing vision in both eyes for three months. During the funduscopic examination, multiple serous retinal detachments (SRD) were observed bilaterally, and he was diagnosed with multiple foci of central serous chorioretinopathy (CSCR). He was advised to discontinue the steroid dosage, which did not make significant improvement, and he was treated with intravitreal bevacizumab injection in the more severely affected eye. One month later, significant improvement was noticed in both eyes.Serous retinal detachment is a rare complication following BMT. Significant bilateral improvement after single unilateral intravitreal bevacizumab injection shows not only the possible role of increased level of vascular endothelial growth factor (VEGF) in this case, but also the systemic diffusion of the drug and effect on the contralateral eye following unilateral injection.
A 52-year-old man presented with decreased vision in his right eye from 1 month ago. He had no history of systemic disorders or drug consumption. Best corrected visual acuity (BCVA) was 1/10 in his right eye and 10/10 in the left eye at presentation. Anterior segment examination and intraocular pressure were within normal limits. Based on fundus examination, optical coherence tomography (OCT) (Figures 1 and 2) and fluorescein angiography (FA) findings (Figures 3 and 4), he received 1.25 mg intravitreal bevacizumab (IVB) in his right eye. After 6 weeks, he was not satisfied with the result and no improvement in BCVA was noted. OCT images (Figures 5 and 6), FA and indocyanine green angiography (ICGA, Figures 7 and 8) taken 6 weeks after injection are presented. ● What are the differential diagnoses? ● What do you suggest for the management of this patient?
This research intended to fabricate the thiolated chitosan-dextran nanoparticles (NPs) containing topotecan (TPH-CMD-TCS-NPs) to assess the ability of NPs in improving the efficacy of intravitreal chemotherapy of retinoblastoma in a rabbit xenograft model.The coacervation process was used to produce the NPs. The cellular uptake of Cyanine-3 (CY3)-labeled NPs were investigated in human retinoblastoma Y79 cells using confocal microscopy. Also, the prepared TPH-CMD-TCS-NPs were tested in vitro by the tetrazolium dyes II (XTT) and flow cytometry in order to assess their cytotoxicity. In addition, a rabbit xenograft model of retinoblastoma was developed to test the antitumor effectiveness of TPH-CMD-TCS-NPs through intravitreal administration.NPs had a mean diameter, polydispersity index, and zeta potential of 30 ± 4 nm, 0.24 ± 0.03 and +10 ± 3 mV, respectively. NPs (IC50s 40.40 compared to 126.20 nM, P = 0.022) were more effective than free topotecan as a dose-based feature. The tumor reaction to intravitreal chemotherapy with NPs was measured by evaluating the percentage of necrosis in the tumor tissue (91 ± 2%) and vitreous seeds (89 ± 9%) through hematoxylin and eosin (H&E) staining. In comparison with the control group, the TPH-CMD-TCs-NPs treated group showed a significant decrease in tumor volume seven days after the intravitreal injection (P = 0.039). No significant changes were found in the ERG parameters after the intravitreal injection of TPH-CMD-TCs-NPs or TPH (P> 0.05).This investigation revealed definitive antitumor efficacy of TPH-CMD-TCS-NPs by intravitreal administration in the rabbit xenograft retinoblastoma model.
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