The purpose of this study was to determine the efficacy of combined intravitreal bevacizumab and triamcinolone in the treatment of macular edema due to retinal vein occlusion. A prospective ...randomized trial was conducted in the Department of Ophthalmology, Osijek University Hospital Centre in Osijek including 51 patients divided into three groups depending on the drug received. The first group received 1.25 mg intravitreal bevacizumab, the second group received 1 mg intravitreal triamcinolone, and the third group received a combination of 1.25 mg bevacizumab and 1 mg intravitreal triamcinolone on the same day. Changes in the central macular thickness, intraocular pressure and visual acuity were monitored during the follow up period. The retinal perfusion status was evaluated by fluorescein angiography. The group that received combined treatment had better outcome in terms of reduction of macular thickness. There was no statistically significant intraocular pressure elevation among the three treatment groups or within each group of patients. A positive trend regarding visual improvement was observed in the group receiving combined treatment in spite of the lowest initial visual acuity, highest value of macular thickness and longest mean duration of symptoms. In conclusion, combined treatment with bevacizumab and triamcinolone for the treatment of retinal vein occlusion is more potent, safe, efficient and cost-effective. It can also be recommended because fewer injections are needed in patients undergoing treatment for macular edema. Key words: Retinal vein occlusion; Macular edema; Intravitreal application; Triamcinolone; Bevacizumab Cilj rada bio je utvrditi ucinkovitost kombinirane intravitrealne terapije bevacizumabom i triamcinolonom kod makularnog edema nastalog kao posljedica okluzije mreznicne vene. Prospektivno randomizirano ispitivanje provedeno je na Odjelu za ocne bolesti Klinickoga bolnickog centra Osijek. U ispitivanje je bio ukljucen 51 ispitanik, koji su podijeljeni u tri skupine ovisno o vrsti lijeka koji su primali. Bolesnici u prvoj skupini primali su 1,25 mg bevacizumaba intravitrealno, druga skupina ispitanika je primala 1 mg triamcinolona intravitrealno, a treca skupina je primala kombinaciju 1,25 mg bevacizumaba i 1 mg triamcinolona intravitrealno u istom posjetu. Tijekom razdoblja pracenja promatrane su promjene u centralnoj makularnoj debljini, vidnoj ostrini, kao i vrijednosti intraokularnog tlaka. Fluoresceinska angiografija primijenjena je za procjenu perfuzijskog statusa retine. Skupina koja je primila kombiniranu terapiju s oba lijeka imala je bolji ishod u vidu smanjenja makularne debljine. Nije bilo znacajnijeg povisenja ocnog tlaka unutar skupina, kao ni usporedbom medu skupinama. U skupini ispitanika koji su primili kombinaciju oba lijeka zabiljezen je pozitivan trend u oporavku vidne ostrine, iako su imali najnize ulazne vrijednosti vidne ostrine, najvecu vrijednost centralne makularne debljine mjerenu optickom koherentnom tomografijom i najduze prosjecno trajanje okluzije u odnosu na ostale skupine ispitanika. Zakljucno, smanjenje broja injekcija kod primjene kombinacije oba lijeka predstavlja ekonomicniji pristup lijecenju okluzije mreznicne vene, a takoder djeluje potentnije na snizenje centralne makularne debljine u odnosu na pojedinacnu primjenu svakog lijeka. Kljucne rijeci: Okluzija mreznicne vene; Makularni edem; Intravitrealnaprimjena; Triamcinolon; Bevacizumab
Limbal stem cell transplantation (LSCT) and amniotic membrane transplantation may improve corneal recovery after a chemical burn. Amniotic membrane was applied as a patch in 5 eyes; LSCT from healthy ...contralateral eye was performed in 6 eyes, and a combination of these techniques was performed in 4 eyes. There were no complications during surgical procedure. Epithelization was completed after 2 weeks in patients with LSCT, and after 3 weeks in the amniotic membrane transplantation group. Visual acuity improved in all patients. No complication was observed on either the donor or the recipient eye during a follow-up period of >13 months in all groups. Amniotic membrane is effective in promoting re-epithelization and reducing inflammation when applied alone in patients with 3- to 6-hour limbal involvement, as well as combined with LSCT in patients with >6-hour limbal ischemia. LSCT is an effective procedure for rehabilitation after severe chemical trauma of the eye with more than 50% limbal involvement.
Increasing evidence suggests that both male and female sex hormones may be associated with the development of atherosclerosis, but almost all such data are based on studies of patients with coronary ...artery disease. To our knowledge, there are no data on the effects of endogenous sex hormones on atherosclerosis of the retinal arteries in men, and the purpose of this study was to explore that association.
In 101 consecutive adult male patients treated in a university hospital outpatient clinic, atherosclerotic changes of the retinal vessels were identified prospectively by direct ophthalmoscopy and were graded on a scale of 1 to 4 according to Scheie. Commercial radioimmunoassay kits were used to measure serum levels of testosterone, estradiol, progesterone, androstenedione, and dehydroepiandrosterone sulfate. The chi-square test was used to compare the results with those from 47 matched male subjects with healthy retinal vessels.
Retinal vessel atherosclerosis was inversely correlated with the serum progesterone concentration (P<0.001). The lower the progesterone concentration, the more advanced the stage of retinal vessel disease. A similar but less statistically significant correlation was noticed for dehydroepiandrosterone sulfate (P<0.05). A weak (P<0.05) similar association between the degree of retinal artery atherosclerosis and estradiol levels was also found.
Low endogenous progesterone levels and, to a degree, low dehydroepiandrosterone sulfate and estradiol levels might be associated with atherosclerosis of the retinal arteries in men.
Diabetes mellitus is a metabolic disorder primarily characterized by elevated blood glucose levels and by microvascular and macrovascular complications which increase the morbidity and mortality. The ...aim of this study was to assess whether in high risk patients with type 2 diabetes mellitus whose blood pressure and lipid levels are well controlled still exist risk factors for microvascular changes and target organ damage (nephropathy and retinopathy). In this case control retrospective study 326 patients (111 with nephropathy and/or retinopathy and 215 controls) were enrolled. Nephropathy or retinopathy was present in 10.1% and 26.9% cases, respectively. Only 71% of patients (no significant difference between cases and controls) were treated with antidiabetic drugs. Therefore their diabetes was not properly controlled (hemoglobin A1c was 7.96% in cases and 7.58% in controls). Patients with microvascular changes had significantly longer diabetes than the controls (p < 0.05) but there were no significant differences between these two groups concerning lipids concentrations. Statins and fibrates were used by significantly less (p < 0.05) patients with microvascular complications than by those without them (21.6% vs. 36.3% and 1.8% vs. 17.2% respectively). The results of this study suggest that the duration of the disease and adequate control of glycaemia in patients with type 2 diabetes mellitus are more important for microvascular complications than the serum lipoproteins levels. Lipid-lowering treatment might have an impact on microvascular complications in patients with type 2 diabetes, irrespectively of their serum lipid levels.
Premda još nije potpuno jasno dokazano jesu li povišeni trigliceridi izravno aterogeni ili nisu, rezultati mnogih istraživanja upućuju na to da su oni nedvojbeno važan čimbenik rizika i/ili biljeg ...koronarne bolesti srca (KBS). Stoga u osoba koje imaju velik rizik od KBS-a treba liječiti hipertrigliceridemiju. Povišeni su trigliceridi često udruženi sa sniženom koncentracijom HDL-kolesterola, osobito u bolesnika s dijabetesom tipa 2 i/ili metaboličkim sindromom koji imaju velik rizik od KBS-a. Takav se poremećaj lipida naziva aterogena dislipidemija i ima sve veću prevalenciju. Liječenje hipertrigliceridemije ponajprije se mora temeljiti na intenzivnoj promjeni nezdravog načina života (smanjenje tjelesne težine u debelih, smanjenje unosa alkohola te šećera, fruktoze i transmasnih kiselina, redovita aerobna tjelesna aktivnost) čime se trigliceridi mogu sniziti za čak do 50%. Osobe s velikim rizikom od KBS-a koje ne mogu promjenom načina života dovoljno smanjiti hipertrigliceridemiju moraju se liječiti lijekovima. U ovom času od lijekova za taj poremećaj imamo fibrate, nijacin i pripravke omega 3-masnih kiselina koji su registrirani kao lijekovi. Ako je istodobno povišen i LDL-kolesterol, bolesnici trebaju uzimati kombiniranu terapiju. Na temelju rezultata najnovijih istraživanja takvim se bolesnicima preporučuje uzimanje statina uz fenofibrat i/ili omega 3-masne kiseline.
Policosanol is an agent that includes mixtures of aliphatic primary alcohols extracted primarily from sugercane wax. Policosanol has been shown to lower total and LDL cholesterol in animal models, ...healthy volunteers and hypercholesterolemic patients. However, these findings have been challanged recently. Up to now, there has been no study investigating the effects ofpolicosanol on blood coagulation factors. This study investigated the effects of rice policosanol (Oryza sp.) 10 mg/day on blood coagulation factors in 66 hypercholesterolemic patients of both sexes aged 20 to 78 years in a single center, randomized, double-blind, placebo-controlled, crossover trial. After an 8-week run-in period in which patients were placed on therapeutic lifestyle changes, in particular a cholesterol-lowering diet, they were randomly assigned to receive rice policosanol 10 mg tablets or placebo tablets once daily with the evening meal for 8 weeks. During next 8 weeks those receiving policosanol during the first 8 weeks, received placebo and those taking placebo during the first 8 weeks, received policosanol. Plasma fibrinogen, factors VII, VIII, XII and XIII were measured before and after the treatment. Rice policosanol treatment did not change significantly neither fibrinogen nor factors VII, VIII, XII and XIII.
Policosanol is an agent that includes mixtures of aliphatic primary alcohols extracted primarily from sugar-cane wax. This mixture has been shown to lower total and low-density lipoprotein (LDL) ...cholesterol in animal models, healthy volunteers and hypercholesterolaemic patients.
This study investigated the efficacy and tolerability of rice policosanol (Oryza sp.) 10 mg/day in 70 hypercholesterolaemic patients of both sexes aged 20-78 years in a randomised, double-blind, crossover, placebo-controlled, single-centre trial. After an 8-week run-in period during which patients were placed on therapeutic lifestyle changes, in particular a cholesterol-lowering diet, they were randomly assigned to receive rice policosanol 10mg tablets or placebo tablets once daily with the evening meal for 8 weeks. During the next 8 weeks those patients who received policosanol during the first 8 weeks received placebo, and those who received placebo during the first 8 weeks, received policosanol. Total, LDL, high-density lipoprotein (HDL), HDL2 and HDL3 cholesterol, triglycerides, oxidised LDL (ox-LDL), apoproteins (Apos) AI and B, lipoprotein (a) Lp(a), fibrinogen, homocysteine and C-reactive protein (CRP) levels were measured.
Rice policosanol significantly reduced plasma total cholesterol from 7.37 +/- 1.42 mmol/L to 6.99 +/- 1.33 mmol/L (p = 0.007) and increased Apo AI from 1.49 +/- 0.39 mmol/L to 1.58 +/- 0.38 mmol/L (p = 0.037) but did not change plasma triglycerides, HDL, HDL2, HDL3 and LDL cholesterol, ox-LDL, Lp(a), Apo B, fibrinogen, homocysteine or CRP levels.
Rice policosanol 10 mg/day moderately decreased plasma total cholesterol and increased Apo AI. Rice policosanol was also well tolerated, with no drug-related effects on safety parameters such as serum aminotransferases and creatine phosphokinase detected or found on physical examination.
Although it is still not clear whether elevated serum triglycerides are directly atherogenic or not, the results of many studies indicate that they are undoubtedly an important risk factor/biomarker ...for coronary heart disease (CHD). Therefore, targeting hypertriglyceridaemia should be beneficial for subjects at high risk for CHD. Elevated triglycerides are often accompanied with low HDL cholesterol, particularly in high risk patients with diabetes type 2 and/or metabolic syndrome. Such a disturbance is called atherogenic dyslipidaemia and has an increasing prevalence. The treatment of hypertriglyceridaemia has to be focused primarily on intensive lifestyle changes (weight reduction in obesity, reduction of alcohol consumption as well as reduction of added sugars, fructose and trans-fatty acids, regular aerobic physical activity) by which reduction of up to 50% in triglycerides can be achieved. Subjects with high CHD risk who cannot lower hypertriglyceridaemia by lifestyle measures should be treated with pharmacological therapy. The available medications include fibrates, niacin and prescription omega-3 polyunsaturated fatty acids. If LDL cholesterol is elevated too, combination therapy is needed. Based upon recent studies in such patients a combination of a statin with fenofibrate and/or omega-3 fatty acids can be recommended.
It has been known for quite a long time that the concentration of HDL-cholesterol correlates inversely with cardiovascular disease (CVD) risk and that low HDL-cholesterol is an independent CVD risk ...factor. This review aims to highlight evidence on several topics concerning the role of HDL particles and the importance of HDL-cholesterol. The main antiatherogenic functions of HDL particles are presented in details--reverse cholesterol transport, but also their anti-oxidant, anti-inflammatory, anti-thrombotic and anti-apoptotic properties as well as endothelial stabilizing and repair properties. Lifestyle management of low HDL-cholesterol is explained, particularly physical activity and aerobic exercise, smoking cessation, weight reduction in the overweight individuals and composition of the diet but also moderate alcohol consumption stressing the fact that HDL particles from alcoholics are dysfunctional. This is important since it has been shown that it is not only the quantity of HDL particles, and thus HDL-cholesterol level in plasma, that matters, but their quality and impaired functionality as well. HDL from diabetic subjects also lose some of their antiatherogenic properties but a common feature of patients with diabetes type 2 is atherogenic dyslipidemia which is characterized exactly by low HDL-cholesterol and high triglycerides. Diabetic patients with such dyslipidemia are at particularly high CVD risk and the results of recent studies such as ACCORD-Lipid suggest that in them treatment of these lipid abnormalities may be beneficial. Treatment options with fibrates, particularly fenofibrate, and niacin are discussed based upon published trials, as well as combination therapy with these medicines and other lipid-lowering drugs.
Increased serum total and LDL-cholesterol concentrations are major risk factors for cardiovascular diseases. Many clinical trials have proven that plant sterol and stanol esters can effectively ...decrease high serum total and LDL cholesterol. They reduce the intestinal absorption of cholesterol by decreasing the incorporation of dietary and biliary cholesterol into micelles displacing cholesterol from these micelles. They also increase LDL receptor activity on liver cells causing a higher uptake of LDL cholesterol and thus decreasing the serum LDL cholesterol concentration. Animal studies have indicated that plant sterols and stanols may also lower atherosclerotic lesions development. However, the evidence from human studies to confirm this is still lacking. Anyhow, plant sterol and stanol esters can be considered as an effective and safe cholesterol-lowering functional food ingredient. To achieve additional effects they can be combined with statin therapy, and this combination is also well tolerated and safe.
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