Abstract Acute macular neuroretinopathy is a relatively rare condition originally defined by the presence of intraretinal, reddish-brown, wedge-shaped lesions, the apices of which tend to point ...toward the fovea. Acute onset of paracentral scotomas corresponding to the clinically evident lesions is both common and characteristic. Although the pathogenesis of acute macular neuroretinopathy is complex, recent research suggests a microvascular etiology. Advances in multimodal imaging have enabled better characterization of this retinal disorder and have led to newly proposed diagnostic criteria. We review 101 reported cases in the English and non-English language literature identified from 1975, when acute macular neuroretinopathy was first described, to December, 2014. We discuss common risk factors, demographic and clinical characteristics, and multimodal imaging findings, which together provide insights into pathogenesis and guide areas of future investigation.
Since its introduction in the early 1990s, optical coherence tomography (OCT) has evolved in resolution and technological advances, and in recent years its initial application of assessing the ...morphology of a tissue has been implemented by the study of its functional blood flow, through optical coherence tomography angiography (OCTA). This novel technique details capillary networks by comparing the amount of light returned from static and moving targets without the need for intravenous dye administration. While this imaging modality has been used for various ocular conditions, the application OCTA to uveitis conditions remains sparse.
This review aims to establish the basis of OCTA and its current application to ocular inflammatory disorders, with an emphasis on monitoring progression and response to treatment, as well as predicting visual complications. In particular, this review explores the use of OCTA in iris vessel dilation seen in various forms of iritis, as a predictive factor for further episodes of inflammation. OCTA can also depict ischemia in the deep plexus layers of the retina and identify true choroicapillaris ischemia in cases of placoid diseases or masking of the indocyanine green dye, as in multiple evanescent white dot syndrome. In addition, OCTA can depict neovascularization in granulomatous disease of the retina or choroid not previously depicted with previous imaging methods. While OCTA provides several advancements in the imaging, management and prognosis of uveitis diseases, we emphasize that further studies are required to fully understand its application to these conditions.
Age-related macular degeneration is a common cause of blindness. In this study, intraocular injection of an agent (pegaptanib) that blocks the receptor for vascular endothelial growth factor (VEGF) ...retarded the rate of vision loss caused by age-related macular degeneration. Endophthalmitis occurred in a few of the patients who received injections. Although the long-term safety and efficacy of pegaptanib therapy are unknown, these results suggest that long-term studies of pegaptanib in the treatment of age-related macular degeneration are needed.
Intraocular injection of pegaptanib retarded the rate of vision loss caused by age-related macular degeneration.
The use of a specific antagonist of an angiogenic factor as a strategy to treat disease was proposed in the
Journal
more than 30 years ago.
1
Since that time, extensive evidence has suggested a causal role of vascular endothelial growth factor (VEGF) in several diseases of the human eye in which neovascularization and increased vascular permeability occur.
1
–
12
In humans, ocular VEGF levels have been shown to rise synchronously with and in proportion to the growth and leakage of new vessels.
2
–
4
Animal models of corneal,
5
iridic,
6
retinal,
7
and choroidal
8
neovascularization have shown that neovascularization is dependent on the presence . . .
Alternative career paths for ophthalmologists Callaway, Natalia F; Cunningham, Jr, Emmett T
Current opinion in ophthalmology,
2023-Sep-01, 2023-09-00, 20230901, Letnik:
34, Številka:
5
Journal Article
Traditionally, ophthalmologists complete training and then choose a clinical care setting. The skills required to become an ophthalmologist can be applied to a variety of alternative career paths ...within and beyond healthcare. Not unexpectedly, therefore, there is a growing trend for ophthalmologists to explore alternative career paths in both healthcare and the life science industry more broadly. In this invited editorial, we summarize the more commonly considered 'alternative career paths,' and provide personal perspectives that have helped us and others when weighing such options.
Prior to pursuing an alternative career path, it is important to reflect on one's motivations and goals. A number of alternative careers paths are available, and the choice of when and what to pursue is both personal and personalizable. While it can be difficult to know a priori whether and to what extent a given path will be both enjoyable and rewarding, insights and advice from those who have walked that path before you can be invaluable. We review the more common paths of administrative leadership, entrepreneurship and innovation, product development, healthcare policy, nonprofit organizations, and investing, noting that these are just examples of the many options currently available.
Ophthalmologists should feel empowered to design a career that is both purposeful and personally meaningful, as this will result ultimately in the greatest happiness and fulfillment. There is a world of opportunity available to those who are willing to explore and create their own path.
Aptamers are oligonucleotide ligands that are selected for high-affinity binding to molecular targets. Pegaptanib sodium (Macugen; Eyetech Pharmaceuticals/Pfizer) is an RNA aptamer directed against ...vascular endothelial growth factor (VEGF)-165, the VEGF isoform primarily responsible for pathological ocular neovascularization and vascular permeability. After nearly a decade of preclinical development to optimize and characterize its biological effects, pegaptanib was shown in clinical trials to be effective in treating choroidal neovascularization associated with age-related macular degeneration. Pegaptanib therefore has the notable distinction of being the first aptamer therapeutic approved for use in humans, paving the way for future aptamer applications.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
8.
Drug-induced uveitis Moorthy, Ramana S; Moorthy, Meena S; Cunningham, Emmett T
Current opinion in ophthalmology,
2018-November, Letnik:
29, Številka:
6
Journal Article
PURPOSE OF REVIEWNearly one-half of all uveitis cases seen at tertiary referral centers have no identifiable cause. Many systemic, paraocular, intraocular, topical medications, and even vaccines can ...induce intraocular inflammation, scleritis, and rarely orbititis and are often overlooked as causes of uveitis. This review was undertaken to elucidate the strength of association of these medications with uveitis and to make clinicians aware of these associations, especially among newer medications.
RECENT FINDINGSMedication-induced uveitis has become particularly important and more frequently seen because of the advent of biologic therapies such as immune checkpoint inhibitors (ICPIs), BRAF, and MEK inhibitors, antivascular endothelial growth factor agents, and antitumor necrosis factor agents, as well as newer systemic bisphosphonates are strongly associated with uveitis.
SUMMARYThe ever-broadening scope of pharmaceuticals now available to treat previously untreatable conditions, such as advanced metastatic cutaneous melanoma, have resulted in unintended ocular inflammatory diseases. Ophthalmologists must recognize that drugs such as ICPIs, BRAF, and MEK inhibitors, anti-vascular endothelial growth factor agents, tumor necrosis factor-α inhibitors, cidofovir, bisphosphonates, topical prostaglandin analogues, topical brimonidine, BCG vaccination can cause of uveitis. Utilizing a thorough review of systems, physicians may readily identify medications that may cause uveitis and avoid expensive and unnecessary laboratory testing.
To assess the relationship between best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) features in noninfectious uveitis (NIU)-related macular edema.
Clinical cohort study from ...post hoc analysis of 2 phase 3 clinical trials.
Correlation and longitudinal treatment analyses were performed. Of 198 patients with NIU, 134 received suprachoroidal CLS-TA (proprietary formulation of a triamcinolone acetonide injectable suspension), and 64 received sham, with 12.9% and 72%, respectively, receiving rescue therapy.
At baseline, mean BCVA progressively worsened with each ordinal drop in central subfield ellipsoid zone (EZ) integrity. Eyes with normal baseline EZ experienced greater 24-week change in BCVA versus those with some degree of baseline EZ disruption (11.9 vs 9.4 letters, P = .006). In contrast, eyes with baseline central subfield cystoid spaces and/or subretinal fluid showed more improvement (13.7 or 17.2 letters, respectively) at 24 weeks, versus those without such findings (5.5 P = .012 or 9.5 letters P < .001, respectively). Longitudinal modeling for CLS-TA–treated eyes showed that central subfield thickness (CST) reached 90% of maximal improvement by week 3, whereas 90% maximal response in BCVA was not reached until week 9. CLS-TA-treated eyes that showed CST reduction of ≥50 µm at 4 weeks experienced a greater 24-week improvement in BCVA versus those without such an early response (14.6 vs 6.5 letters, P = .006 for difference).
Pretreatment EZ integrity and the presence of central subfield cystoid spaces or subretinal fluid each predict improved therapeutic response to treatment in eyes with NIU. In CLS-TA treated eyes, longitudinal modeling shows CST improvement preceding BCVA improvement.
Retinal injury from handheld lasers: a review Bhavsar, Kavita V.; Michel, Zachary; Greenwald, Miles ...
Survey of ophthalmology,
March-April 2021, 2021 Mar-Apr, 2021-03-00, 20210301, Letnik:
66, Številka:
2
Journal Article
Recenzirano
Retinal photic injury induced by handheld lasers is a burgeoning public health concern due to the wider accessibility of high-powered devices. Retinal damage from thermal energy can cause potentially ...severe and permanent vision loss in children and young adults who are particularly vulnerable because of comorbid behavioral, learning, and psychiatric impairments. Understanding the spectrum of specific clinical and imaging features of such laser injuries aids in prompt and accurate diagnosis. Multimodal retinal imaging is important for the identification of the outer retinal abnormalities that characterize this condition. We reviewed 171 reported cases in the English and non-English language literature published from 1999, when handheld laser injury was first described, to December, 2018. Risk factors, demographic and clinical characteristics, as well as multimodal imaging findings, were collected and summarized. These findings both provide insights for public health awareness and guide areas of future investigation.
PDF
