scholarly journals Brolucizumab for Choroidal Neovascular Membrane with Pigment Epithelial Tear and Subretinal Fluid

2021 ◽  
Vol 10 (11) ◽  
pp. 2425
Author(s):  
Alper Bilgic ◽  
Laurent Kodjikian ◽  
Shail Vasavada ◽  
Shyamal Jha ◽  
Samaresh Srivastava ◽  
...  
Keyword(s):  
Retinal Pigment ◽  
Case Series ◽  
Subretinal Fluid ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Visual Response ◽  
Pigment Epithelial ◽  
One Year ◽  
Age Range ◽  
Rpe Tear

The aim of this study was to determine the utility of brolucizumab in the management of choroidal neovessels (CNV) with a retinal pigment epithelial (RPE) tear and subretinal fluid. We used a case series of patients with CNV who developed an RPE tear either spontaneously or following an intravitreal injection. All patients received intravitreal brolucizumab as primary or switch therapy. Appropriate data were collected. Follow-up was one year. The paired t-test was used to determine the significance of the results. The primary outcome measure was the change in best corrected visual acuity (BCVA). Secondary outcome measures were the change in subretinal fluid and complications, if any. A total of five patients were included in the analysis. The age range was 67−74 years and baseline BCVA was from 20/80 to 20/100. On average, all patients showed improvement in BCVA (p = 0.012) and also showed a significant anatomical improvement (p = 0.03). None of the patients had any complications, and all patients responded to additional anti-VEGF injections. In conclusion, all patients showed significant visual and anatomical improvement with brolucizumab; no complications were noted. All patients, including those who received switch, demonstrated a favorable anatomical and visual response to intravitreal brolucizumab without safety concerns.

scholarly journals Hydranencephaly treatments: retrospective case series and review of the literature

2020 ◽  
Vol 26 (3) ◽  
pp. 228-231 ◽  
Author(s):  
Grace M. Thiong’o ◽  
Susan S. Ferson ◽  
A. Leland Albright
Keyword(s):  
Palliative Care ◽  
Treatment Options ◽  
Case Series ◽  
Primary Outcome Measure ◽  
Head Size ◽  
Secondary Outcome ◽  
Retrospective Case ◽  
Number Of Patients ◽  
One Year ◽  
Improving Patient Care

OBJECTIVEThe objective of this study was to review treatment options for infants with hydranencephaly and to consider the pros and cons of each treatment modality.METHODSThis paper is a review of hydranencephaly as well as a retrospective analysis evaluating the outcomes of 52 infants with hydranencephaly who were treated at the Kijabe Hospital, Kijabe, Kenya, in one of four ways: ventriculoperitoneal shunt (VPS) insertion, endoscopic choroid plexus coagulation (CPC), open choroid plexectomy (CPlx), and palliative care. The primary outcome measure was control of head size, with the aim of improving patient care. One-year mortality was a secondary outcome.RESULTSOf the 52 patients analyzed, 11 underwent VPS insertion, 17 CPC, 14 CPlx, and 10 were treated palliatively. Head size was controlled at the 3-month evaluation interval in 5 of 7 infants treated with VPS, 10 of 16 of those treated with CPC, 6 of 9 of those treated with CPlx, and 1 of 4 treated palliatively. The number of infants in each category with complete follow-up data that were needed to analyze change in head size was lower than the total number of patients included in each category. Mortality at 1 year of age was 9 of 11 in the VPS group, 14 of 17 in the CPC group, 6 of 14 in the CPlx group, and 7 of 10 in the palliative group.CONCLUSIONSHead size decreased by 1 cm or more in similar proportions (62%–71%) of infants with hydranencephaly who were treated by VPS insertion, CPC, and CPlx, and progressed in those who received palliative care. Mortality at 1 year of age was similar in infants treated by a VPS, CPC, and palliative care (70%–82%), but lower (43%) in those treated with CPlx.

scholarly journals Impact of Same-Session Trabectome Surgery on Ahmed Glaucoma Valve Outcomes

2018 ◽  
Author(s):  
Hamed Esfandiari ◽  
Tarek Shazly ◽  
Priyal Shah ◽  
Kiana Hassanpour ◽  
Pooya Torkian ◽  
...  
Keyword(s):  
Survival Rates ◽  
Case Series ◽  
Glaucoma Surgery ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Cumulative Probability ◽  
Ahmed Glaucoma Valve ◽  
Trabectome Surgery ◽  
Hypertensive Phase ◽  
One Year

Purpose: To evaluate the efficacy and survival rates of same session ab interno trabeculectomy with the trabectome and Ahmed glaucoma valve implant (AT) in comparison to the Ahmed glaucoma valve alone (A). Method: A total of 107 eyes undergoing primary glaucoma surgery were enrolled in this retrospective comparative case series, including 48 eyes which underwent AT and 59 eyes which received A alone. Participants were identified using the procedural terminology codes, and their medical records were reviewed. The primary outcome measure was surgical success, defined as intraocular pressure (IOP) > 5 mmHg, ≤ 21 mmHg, and IOP reduction ≥ 20% from baseline at two consecutive visits after three months, no reoperation for glaucoma. Secondary outcome measures were IOP, the number of glaucoma medications, incidence of a hypertensive phase, and best corrected visual acuity (BCVA). Results: The cumulative probability of success at one year was 70% in AT, and 65% in A (p=0.85). IOP decreased significantly from 26.6 ± 10.1 mmHg at baseline to 14.7 ± 3.3 mmHg at the final follow-up in AT (p= 0.001). The corresponding numbers for A were 28.8 ± 10.2 and 16.7 ± 4.9, respectively (p= 0.001). The final IOP was significantly lower in AT (p= 0.022). The number of medications at baseline was comparable in both groups (2.6 ± 1.2 in AT and 2.5 ± 1.3 in A, p=0.851). Corresponding number at 1 year visit was 1.2±2 in AT and 2.8±1.8 in A (p=0.001). The incidence of a hypertensive phase was 18.7% in AT and 35.5% in A (p=0.05). HP resolved in only 30% of eyes. The criteria for HP resolution were fulfilled in 9 eyes (30%). There was no difference in the rate of resolution of the hypertensive phase between AT and A (33.3% and 28.5%, respectively, p=0.67). Conclusion: Ahmed glaucoma valve implant with same session trabectome surgery significantly decreased the rate of the hypertensive phase and postoperative IOP as well as the number of glaucoma medications.

scholarly journals Systemic steroids for the management of choroidal neovascular membrane with pigment epithelial tear and recalcitrant subretinal fluid

2019 ◽  
Vol 12 (9) ◽  
pp. e231262
Author(s):  
Alper Bilgic ◽  
Aditya Sudhalkar
Keyword(s):  
Retinal Pigment ◽  
Disease Process ◽  
Subretinal Fluid ◽  
Age Related Macular Degeneration ◽  
Final Visit ◽  
Systemic Steroids ◽  
Pigment Epithelial ◽  
Age Related ◽  
The Right ◽  
Rpe Tear

A 67-year-old man was diagnosed to have dry age related macular degeneration in the right eye and a choroidalneovascular membrane (CNVM) with a large pigment epithelial detachment in the left eye, confirmed with clinical examination, angiography and optical coherence tomography scans. He received an intravitreal injection of bevacizumab in the right eye and developed a retinal pigment epithelial (RPE) tear 3 weeks later. 3 consecutive ranibizumab injections failed to clear the subretinal fluid (SRF). A course of systemic steroids was administered and this improved the vision. Subsequently, the patient received one more ranibizumab injection and the disease process resolved. The left eye corrected distance visual acuity (LE CDVA) was 20/30 at the final visit (1 year after the last injection). Systemic steroids may be a management option in patients with CNVM and RPE tear with recalcitrant SRF if there is no contraindication to their use.

Small Choroidal Melanoma: Correlation of Growth Rate with Pathology

2021 ◽  
pp. 1-10
Author(s):  
Vishal Raval ◽  
Shiming Luo ◽  
Emily C. Zabor ◽  
Arun D. Singh
Keyword(s):  
Growth Rate ◽  
Retinal Pigment ◽  
Choroidal Melanoma ◽  
Case Series ◽  
Subretinal Fluid ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Basal Diameter ◽  
Orange Pigment ◽  
Rpe Atrophy

<b><i>Purpose:</i></b> The aim of the study was to evaluate equivalence of growth rate and pathologic confirmation in small choroidal melanoma (SCM). <b><i>Design:</i></b> This study is a case series. <b><i>Subjects, Participants, and Controls:</i></b> A total of 61 patients with a choroidal melanocytic tumor of size 5.0–16.0 mm in the largest basal diameter and 1.0–2.5 mm in thickness were classified into the pathology-confirmed group (<i>n</i> = 19), growth-confirmed group (<i>n</i> = 30), and with combined observations (<i>n</i> = 12). <b><i>Methods:</i></b> Distribution of clinical variables (age, gender, laterality, tumor dimensions, tumor location, and presence of orange pigment, subretinal fluid, drusen, and retinal pigment epithelial [RPE] atrophy) between the groups was analyzed. Patient and disease characteristics were summarized as the median and interquartile range for continuous variables and the frequency and percentage for categorical variables. Comparisons were made using the Wilcoxon rank sum test for continuous variables and either Fisher’s exact test or the χ<sup>2</sup> test for categorical variables with a <i>p</i> value threshold of 0.05 for statistical significance. Growth rate (change in basal dimension/12 months) diagnostic of SCM was quantified. <b><i>Main Outcome Measures:</i></b> The primary aim of this study was to test the hypothesis that “growth” was diagnostic of SCM with the secondary aim of quantifying the malignant “growth rate” (growth rate of SCM). <b><i>Results:</i></b> The clinical characteristics among all 3 groups were similar except more patients with symptoms (68 vs. 20 vs. 42%, <i>p</i> = 0.004) and juxtapapillary location (<i>p</i> = 0.03) were in the pathology group than in the growth-confirmed group. Those in the combined and growth-confirmed groups had more patients with drusen (11 vs. 60 vs. 50%, <i>p</i> = 0.003) and RPE atrophy (11 vs. 23 vs. 67%, <i>p</i> = 0.003), respectively, than in the pathology group. The median time to detect growth was 9 months (range 3–26 months). The mean growth rate in basal dimension was 1.8 mm/12 months (range, 0.0–7.4 mm; [95% CI: 1.32–2.28]). <b><i>Conclusions and Relevance:</i></b> Choroidal melanocytic lesions exhibiting a defined growth rate can be clinically diagnosed as SCM without a need for biopsy.

scholarly journals Optical Coherence Tomography: An Adjunctive Tool for Differentiating between Choroidal Melanoma and Metastasis

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Vicktoria Vishnevskia-Dai ◽  
Dinah Zur ◽  
Shiran Yaacobi ◽  
Iris Moroz ◽  
Hadas Newman ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Retinal Thickness ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Choroidal Melanoma ◽  
Case Series ◽  
Subretinal Fluid ◽  
Optical Coherence ◽  
Choroidal Melanomas ◽  
Anterior Choroidal

Purpose.To investigate the value of optical coherence tomography (OCT) for differentiation between choroidal melanoma and metastasis based on characteristics of the anterior choroidal surface and the chorioretinal interface.Methods.This retrospective observational case series included 29 patients with untreated choroidal melanomas and 21 patients with untreated choroidal metastases. Regularity and lobularity characteristics of the anterior choroidal surface were evaluated in a masked manner. Retinal and retinal pigment epithelium (RPE) findings were documented as well.Results.OCT demonstrated a regular and smooth anterior choroidal surface in 89.7% of the eyes with melanoma and in 47.6% of the eyes with metastasis (p=0.002; sensitivity = 89.7%; specificity = 52.4%). The anterior choroidal contour was lobulated in 81.0% of the eyes with metastasis versus 17.2% of the eyes with melanoma (p<0.001; sensitivity = 82.8%; specificity = 81.0%). RPE thickness and neuroretinal characteristics (e.g., retinal thickness, the presence of cysts, and the presence of subretinal fluid) were similar in both choroidal tumors.Conclusion. OCT may serve as a noninvasive adjunctive tool for the differential diagnosis of choroidal tumors. Choroidal melanomas usually demonstrate regular surfaces on OCT, while choroidal metastases usually have an irregular and lobulated surface.

scholarly journals Regression patterns of choroidal melanoma: After palladium-103 (103Pd) plaque brachytherapy

2018 ◽  
Vol 28 (6) ◽  
pp. 722-730 ◽  
Author(s):  
Abhilasha Maheshwari ◽  
Paul T Finger
Keyword(s):  
Complete Resolution ◽  
Retinal Pigment Epithelial ◽  
Retinal Pigment ◽  
Choroidal Melanoma ◽  
Subretinal Fluid ◽  
Tumor Thickness ◽  
Tumor Vascularity ◽  
Orange Pigment ◽  
Pigment Epithelial ◽  
Plaque Brachytherapy

Purpose: To describe the patterns of regression of choroidal melanoma after treatment with plaque brachytherapy. Methods: Retrospective interventional case series including 170 consecutive patients treated with 103Pd eye plaque radiation for choroidal melanoma. Outcome measures were changes in tumor thickness, surface characteristics, tumor vascularity, ultrasonography, fluorescein angiography, optical coherence tomography, and histopathology. Results: The mean initial tumor thickness was 3.9 mm (median 2.8 mm; range 2–11.3 mm) that decreased to 1.7 mm (median 1.2 mm; range 0–7.1 mm) after plaque brachytherapy. On imaging, tumors were pigmented in 51% ( n = 86/170), amelanotic in 10% ( n = 17/170), and variably pigmented in 39% ( n = 67/170). Tumor pigmentation increased in 64% ( n = 106/166), decreased in 18% ( n = 30/166), and was unchanged in 18% ( n = 30/166). Of the 120 that demonstrated intrinsic vascularity, 10% ( n = 12/120) had decreased tumor-related vascularity and 90% ( n = 108/120) showed complete resolution. Subretinal fluid was present in 34% ( n = 58/170) of eyes at presentation. Of them, 15% (9; n = 9/58) had persistent SRF at last follow-up. On ultrasound imaging, 88% ( n = 149/170) tumors presented with low to moderate internal reflectivity of which 61% ( n = 91/149) showed increased reflectivity on regression. We noted a crescendo–decrescendo fluctuation in the presence of orange pigment lipofuscin along with complete resolution of drusenoid retinal pigment epithelial detachments. In the entire series of 170 patients, there was 0.5% (1) failure of local control, 2% (4) secondary enucleations, and 6% (10) patients developing metastasis. Conclusion: Findings related to choroidal melanoma regression after 103Pd plaque brachytherapy included decreased intrinsic tumor vascularity, decreased tumor-related subretinal fluid, increased pigmentation, specific changes in orange pigment lipofuscin and resolution of drusenoid retinal pigment epithelial detachments, as well as decreased tumor thickness with an increase in internal reflectivity on ultrasound.

Abstract 15: Preoperative Transdural Collaterals in Moyamoya

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Cynthia Akagbosu ◽  
Armide Storey ◽  
Richard Robertson ◽  
R. Michael Scott ◽  
Edward Smith
Keyword(s):  
Advanced Disease ◽  
Case Series ◽  
Single Institution ◽  
Operative Complications ◽  
Surgical Field ◽  
Perioperative Complication ◽  
One Year ◽  
Age Range ◽  
The Brain

Introduction: The prevalence of angiographically evident pre-operative transdural collaterals to the brain in moyamoya is not well documented. Hypothesis: We hypothesized that presence of transdural collaterals would be associated with more advanced moyamoya disease at diagnosis, more frequent operative complications and better long-term angiographic results. Methods: Single institution case series reviewing all moyamoya patients with 6 vessel arteriograms treated surgically from 2005-2013. Results: 204 patients (n=121 (59%) F / 83 (41%) M) were diagnosed with moyamoya at 9.5 years of age (range 0.4-35 years). Presentation included ischemia (84% stroke or TIA), headache (36%), incidental (7%), chorea (3%) and hemorrhage (1%). Radiographically, 154 (75%) had bilateral disease for a total of 358 affected hemispheres, 152 (75%) had radiographic stroke and 190 (93%) had ivy sign on FLAIR MRI, indicating slow flow. Of the 358 hemispheres, 324 were treated operatively. On preoperative angiogram, 99 patients (49%) had transdural collaterals in 174 affected hemispheres (54%). Suzuki grades were higher in patients with collaterals (3.4 vs. 3.0, p=0.002). Of a total of 324 treated hemispheres, 84 (26%) had collaterals within the area of the surgical field. Complications included 12 strokes (3.7% stroke rate per hemisphere), with 5 (42%) directly attributable to interruption of a transdural collateral. In one-year postoperative arteriograms in 215 hemispheres, while not significant, Matsushima grades trended better in patients with preoperative collaterals, (1.6 vs. 1.8; A=1, B=2, C=3, p=0.09). Conclusions: In conclusion, transdural collaterals are present in nearly half of all moyamoya patients. They are more common in advanced disease, are associated with stroke as a perioperative complication and may suggest increased capacity to produce surgical collaterals postoperatively. These data support the utility of preoperative arteriograms.

Sign in / Sign up

Export Citation Format

Share Document