[Prevalence and risk factors of age-related macular degeneration (AMD) in a Tunisian hospital population].
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To describe the prevalence and the risk factors for the age related macular degeneration (AMD) in a Tunisian hospital population.A total of 2204 subjects 50 years of age and older were enrolled in a prospective study conducted between august 2004 and February 2009. Medical history was reviewed. Subjects underwent a complete ophthalmic examination, including best corrected visual acuity and slit lamp biomicroscopy with fundus examination. Fundus photography and fluorescein angiography were performed if clinical features of AMD were observed on fundus examination. Cases were classified in early and late stages of AMD.The prevalence of late AMD was higher than early AMD. Significant risk factors are age, male gender, smoking, excessive sunlight exposure and poor consumption of fish. Cardiovascular disease, diabetes and dyslipimia were not significantly associated to a high prevalence of AMD.AMD is a multifactorial disease. In our Tunisian hospital population, the prevalence of AMD was higher than in the Europeen population. It can be explained by genetic differences or risk factors. Age, cigarette smoking and sunlight exposure were associated with increasing prevalence of AMD in Tunisia.Keywords:
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Purpose: To report the effect of intravitreal injection of bevacizumab in macular drusen. Methods: A case report. Results: A 74 yeas old male patient presented to our clinic with the complaint of decreased visual acuity (OS) for several years. An age-related macular degeneration with macular drusen (OS) was noted during his fundus examination and fluorescein angiography (FAG). He received three intravitreal injection of bevacizumab (2.5 mg/0.1ml) consecutively. Post injection best-corrected visual acuity (BCVA), fundus exam, and FAG findings were carefully followed. Three months after intravitreal injection of bevacizumab, the fundus exam and FAG demonstrated regression of macular drusen with improvement of visual acuity. Conclusion: Intravitreal injection of bevacizumab regress the macular drusen and improved patient's vision. Therefore, intravitreal injection of bevacizumab may be useful for the treatment of macular drusen.
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In Brief Purpose: To investigate if anatomical characteristics of eyes undergoing ranibizumab therapy were predictive of best-corrected visual acuity (BCVA) outcomes over 2 years. Methods: Post hoc analyses of patients with age-related macular degeneration from PIER studies, defined by fundus fluorescein angiography, quantitative optical coherence tomography (OCT), and qualitative OCT, were performed to determine if associations with BCVA outcomes could be found. Results: Ranibizumab-treated subgroups defined by baseline fundus fluorescein angiography lesion size and composition did not differ in BCVA outcomes at Month 24 (P = 0.13–1.0). Inactivity on fundus fluorescein angiography at Month 3 was associated with a 12-letter gain by Month 12 (P < 0.01), whereas inactivity on Month 3 qualitative OCT was not (P > 0.05). Qualitative OCT inactivity at Month 5 and separately at Month 8 was associated with greater BCVA gains by Month 24 (7.1 and 9.5 letters, respectively; P ≤ 0.045) versus eyes with OCT activity. Conclusion: When assessed separately, eyes with qualitative OCT (Months 5 and 8) or fundus fluorescein angiography (Months 3 and 5) inactivity maintained vision gain from baseline at Month 24, while those with leakage not only lost initial vision gains achieved by intraocular ranibizumab but also had net vision losses from baseline at Month 24. The PIER infrequent dosing regimen likely exaggerated and accelerated the deleterious effects of retinal fluid on BCVA, and it is not known whether these findings are applicable to treatment regimens that use more frequent monitoring and dosing of ranibizumab. When assessed separately, eyes with qualitative optical coherence tomography (Months 5 and 8) or fundus fluorescein angiography (Months 3 and 5) inactivity maintained vision gain from baseline at Month 24 while those with leakage not only lost initial vision gains achieved by intraocular ranibizumab, but also had net vision losses from baseline at Month 24. The PIER infrequent dosing regimen likely exaggerated and accelerated the deleterious effects of retinal fluid on best-corrected visual acuity and it is not known whether these findings are applicable to treatment regimens that use more frequent monitoring and dosing of ranibizumab.
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To report a case of sequential retinal pigment epithelium (RPE) tears following intravitreal Ranibizumab injections for neovascular age-related macular degeneration (AMD).Retrospective, observational case.A 75-year-old hypertensive male was diagnosed with active neovascular AMD and pre-existing RPE tear in the left eye. His presenting best-corrected visual acuity was counting finger @ 1 metre,
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Objective
To determine the prevalence of visual impairment and eye abnormalities in Oklahoma Indians.Methods
The cross-sectional study included 1019 Oklahoma Indians, aged 48 to 82 years; 60.2% were women. All participants gave a personal interview, and all underwent an eye examination, including the determination of best-corrected visual acuity and an ophthalmoscopic examination. In addition, two 45° fundus photographs were taken of each eye, and these photographs were graded by the Fundus Photography Reading Center at the University of Wisconsin, Madison.Results
Among the 1019 participants, 77.4% had a visual acuity of 20/20 or better, 19.5% and 2.5% had visual acuities of between 20/25 and 20/40 and between 20/50 and 20/190, respectively; and 0.6% were legally blind, all in the better eye. Cataract was the most frequent contributing cause and age-related macular degeneration the second most frequent contributing cause of visual impairment. The overall prevalence proportions of age-related macular degeneration, cataract, diabetic retinopathy, and definite glaucoma were 33.6%, 39.6%, 20.1%, and 5.6%, respectively. Most of the other eye abnormalities were rare in the study participants, except for pinguecula (42.4%) and dermatochalasis (30.1%).Conclusions
Oklahoma Indians have a higher prevalence of visual impairment, age-related macular degeneration, and diabetic retinopathy than other ethnic groups. The implementation of adequate treatment and prevention programs for eye diseases is indicated.Eye examination
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To report our initial experience in the treatment of subfoveal choroidal neovascular membrane, secondary to age-related macular degeneration (AMD) by transpupillary thermotherapy (TTT).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).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.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.
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Background
Intravitreal injection of ranibizumab is a primary approach to the treatment of wet age-related macular degeneration (wAMD), but whether it is necessary for wAMD with subfoveal scarring and active lesion to receive the intravitreal injection of ranibizumab is in dispute.
Objective
This study was to evaluate the possible therapeutic effect of intravitreal injection of ranibizumab on wAMD with subfoveal scarring and active lesion.
Methods
The clinical data of the patients with wAMD with subfoveal scarring and active lesion were retrospectively analyzed, including 89 eyes of 89 cases who received diagnoses and treatments in Second Hospital of Yunnan Province from February 2013 to May 2015.Sixty-eight patients who received intravitreal injections of ranibizumab were treated group, and 21 patients who received clinical observations only served as the untreated group.Intravitreal injection of ranibizumab was carried out following the 3+ prn principle, and all of the patients were followed-up for 6-24 months.Best corrected visual acuity (BCVA) of the patients were examined with ETDRS chart.The fundus findings was examined by fundus color photography and fundus fluoresceinangiography (FFA). The subjective assessment of visual improvements was obtained from each patient, and the recession of retinal active lesions was assessed by OCT, including the absorbing state of subretinal fluid, the change of central retinal thickness (CRT) and subfoveal scarring.
Results
The mean injection times were (4.1±1.2) for each eye.The BCVA at the end of following-up was evidently improved in both groups, and no significant difference was found among various time points (P>0.05). However, the patient rate of BCVA improvement was 69.12% in the treated group, which was signnificantly higher than 28.58% of the untreated group (P=0.016). In the treated group, subretinal fluid was gradually absorbed in all eyes in the treating duration, however, in the untreated group, the fluid was completely absorbed in 7 eyes, unchanged in 8 eyes and increased in 6 eyes.The CRT reduced by (220.16±34.76)μm in treated group, and that in the untreated group was (101.56±31.59)μm, showing significant difference between them (P=0.004). The patient rate of perceived improvement of vision was 91.12% and 42.85% in the treated group and untreated group respectively, with significant difference between the two groups (P=0.008).
Conclusions
Intravitreal injection of ranibizumab can make active lesion recess in end-stage wAMD with subfoveal scarring and active lesion and improve the life quality of the patients.
Key words:
Ranibizumab; Wet macular degeneration/complications; Cicatrix/surgery; Antibodies, monoclonal, humanized; Tomography, optical coherence; Visual acuity; Intravitreal injections; Retrospective studied
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Abstract Purpose To report three cases of retinal pigment epithelial (RPE) tears after repeated intravitreal injection of bevacizumab for the treatment of neovascular age‐related macular degeneration (AMD). To present fundus photography, fluorescein angiography (FA) and optical coherence tomography (OCT) findings. Methods Out of 433 patients treated with intravitreal bevacizumab injections for choroidal neovascularization, three patients with vascularized RPE detachment developed RPE tear. Case 1: the patient developed RPE tear shortly after the third intravitreal injection into the left eye; cases 2 and 3: the patients developed RPE tear after a single injection into the right eye and left eye, respectively. Visual acuity testing, fundus photography and OCT were performed for all patients monthly for over a year after the first injection. Results The preoperative size of the RPE detachment was 9.14 sq. mm for case 1, 5.16 sq. mm for case 2 and 5.93 sq. mm for case 3. At diagnosis of RPE tear, the patients suffered vision loss of three lines in cases 1 and 2 and two lines in case 3. After further treatment with bevacizumab, visual acuity at 12‐month follow‐up improved by two lines in case 1 and one line in cases 2 and 3. Conclusion 1. RPE tear can occur following treatment with intravitreal bevacizumab and is associated with significant visual loss. 2. Large RPE detachment may be a predictor for RPE tear. 3. Visual acuity improved in all three cases after further treatment with bevacizumab following RPE tear.
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To investigate the effects on near visual acuity, reading speed, central visual field and related quality of life of ranibizumab treatment of wet age-related macular degeneration (AMD).The study was a prospective, non-comparative consecutive case series, followed for 3 months and investigator-driven. Thirty eyes of 30 patients with wet AMD were included, mean age 75 years (range 69-95 years). In addition to a full ophthalmological examination--including best-corrected visual acuity (BCVA; Early Treatment Diabetic Research Study chart), fundus biomicroscopy, fundus photography, fluorescein angiography, indocyanine green angiography (occult cases) and ocular coherence tomography--near visual acuity, reading speed, central visual field and quality of life for related activities were also investigated at baseline and at 3 months after ranibizumab treatment.Mean BCVA increased from 62 +/- 11 to 66 +/- 14 letters at 3 months (7%; p = 0.018). Near vision improved from 9 +/- 5 to 6 +/- 3 points (33%; p = 0.0006) and reading speed increased from 59 +/- 40 to 85 +/- 50 words/min (44%; p < 0.0001). The mean deviation from normal of the visual field improved from -9 +/- 7 to -6 +/- 5 dB (33%; p < 0.0001). Quality of life improved for distance activities from 54 +/- 28 to 63 +/- 28 points (17%; p < 0.0001) but significantly (p = 0.024) more for near activities, from 49 +/- 26 to 63 +/- 26 points (29%; p < 0.0001). Reading newspaper text in the group in which the better eye was treated showed the highest increase in quality of life score of all: 116%.The increase in BCVA after ranibizumab treatment is well established. The present study also showed significant improvements in other important visual qualities, such as near visual acuity, reading speed, central visual field and several activities influencing quality of life. The improvement was greater for near activities than for distance activities. Therefore, the beneficial effects of ranibizumab treatment shown here are more extensive than those reported previously.
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