New Clinical Treatment for Ocular Vascular Disease and Fundus Disease

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Ophthalmology".

Deadline for manuscript submissions: closed (31 March 2024) | Viewed by 9291

Special Issue Editors


E-Mail Website
Guest Editor
1. Clinical Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
2. Ophthalmology Department, Railway Hospital, 40-760 Katowice, Poland
Interests: corneal dystrophy; dry eye disease; cataract; retina; ocular imaging; optical coherence tomography
Special Issues, Collections and Topics in MDPI journals

E-Mail Website
Guest Editor
Eye Department (Ophthalmology), Tennent Institute of Ophthalmology, G12 0NA Glasgow, Scotland, UK
Interests: eyes; photoreceptor cells; OCT

E-Mail Website
Guest Editor
Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Katowice, Poland
Interests: retinal diseases; uveitis; ophthalmic genetics; imaging of the posterior segment of the eye
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue focuses on the latest advancements and clinical treatments for ocular vascular diseases and fundus disorders. Ocular vascular diseases, such as diabetic retinopathy, retinal vein occlusion, and age-related macular degeneration, are leading causes of vision loss and require effective therapeutic interventions. Similarly, fundus disorders, including retinal detachment, macular holes, and vitreomacular traction, pose significant challenges to ophthalmologists worldwide. This Special Issue presents cutting-edge research, innovative treatment strategies, and clinical trials aimed at improving the diagnosis, management, and outcomes of these ocular conditions. The articles cover a wide range of topics, including novel pharmacological interventions, surgical techniques, imaging modalities, and regenerative therapies. By providing a comprehensive overview of the latest clinical advancements, this Special Issue aims to foster collaboration and inspire further research in the field of ocular vascular diseases and fundus disorders.

Dr. Anna Karolina Nowińska
Dr. Shohista Saidkasimova
Dr. Slawomir Teper
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • ocular vascular diseases
  • fundus disorders
  • diabetic retinopathy
  • retinal vein occlusion
  • age-related macular degeneration
  • retinal detachment

Published Papers (11 papers)

Order results
Result details
Select all
Export citation of selected articles as:

Research

Jump to: Review

15 pages, 1174 KiB  
Article
Real-World Experience with Brolucizumab Compared to Aflibercept in Treatment-Naïve and Therapy-Refractory Patients with Diabetic Macular Edema
by Anne Rübsam, Leopold Hössl, Saskia Rau, Alexander Böker, Oliver Zeitz and Antonia M. Joussen
J. Clin. Med. 2024, 13(6), 1819; https://doi.org/10.3390/jcm13061819 - 21 Mar 2024
Viewed by 513
Abstract
Background: To report on the outcome of intravitreal brolucizumab compared to aflibercept in patients with diabetic macular edema (DME). Methods: Prospective, observational, study in 35 eyes of 24 patients with a loading dose of five injections of 6 mg brolucizumab every [...] Read more.
Background: To report on the outcome of intravitreal brolucizumab compared to aflibercept in patients with diabetic macular edema (DME). Methods: Prospective, observational, study in 35 eyes of 24 patients with a loading dose of five injections of 6 mg brolucizumab every 6 weeks (q6w, treatment-naïve eyes) or a minimum of two injections of brolucizumab q6w after the switch (recalcitrant DME eyes), followed by a treat and extend (T&E) regimen. The results were compared with 40 eyes of 31 DME patients who were treated with aflibercept. The data were obtained from the Berlin Macula Registry. The primary outcome measure was the change in best-corrected visual acuity (BCVA) at week 36. Secondary outcome measures were the change in central retinal thickness (CRT) and the treatment intervals until week 36. Results: BCVA increased significantly in treatment-naïve DME eyes treated with either brolucizumab (+0.12 logMAR, +6.4 letters, p = 0.03) or aflibercept (+0.19 logMAR, +9.5 letters, p = 0.001). In recalcitrant DME eyes, BCVA also increased significantly after switching to brolucizumab (+0.1 logMAR, +5 letters, p = 0.006) or aflibercept (+0.11 logMAR, +5.5 letters, p = 0.02). All treatment-naïve and recalcitrant DME eyes had a significant decrease in CRT after treatment with brolucizumab (p = 0.001 and p < 0.001) or aflibercept (p = 0.0002 and p = 0.03). At week 36, the mean treatment interval for brolucizumab was 11.3 weeks, while for aflibercept, it was 6.5 weeks for treatment-naïve eyes and 9.3 weeks vs. 5.3 weeks for pretreated eyes. Conclusions: In routine clinical practice, patients with treatment-naïve and recalcitrant DME showed a favorable response to brolucizumab and aflibercept therapy, with a reduced injection frequency after brolucizumab treatment. Full article
(This article belongs to the Special Issue New Clinical Treatment for Ocular Vascular Disease and Fundus Disease)
Show Figures

Figure 1

13 pages, 2638 KiB  
Article
Impact of Brightness on Choroidal Vascularity Index
by Nicola Rosa, Marco Gioia, Rachele Orlando, Martina De Luca, Eleonora D’Aniello, Isabella Fioretto, Ciro Sannino and Maddalena De Bernardo
J. Clin. Med. 2024, 13(4), 1020; https://doi.org/10.3390/jcm13041020 - 10 Feb 2024
Viewed by 586
Abstract
The use of choroidal vascularization to diagnose and follow-up ocular and systemic pathologies has been consolidated in recent research. Unfortunately, the choroidal parameters can be different depending on the lighting settings of optical coherence tomography (OCT) images. The purpose of this study was [...] Read more.
The use of choroidal vascularization to diagnose and follow-up ocular and systemic pathologies has been consolidated in recent research. Unfortunately, the choroidal parameters can be different depending on the lighting settings of optical coherence tomography (OCT) images. The purpose of this study was to examine whether the brightness of OCT images could influence the measurements of choroidal parameters obtained by processing and analyzing scientific images with the ImageJ program. In this observational, prospective, non-randomized study, 148 eyes of 74 patients with a mean age of 30.7 ± 8.5 years (ranging from 23 to 61 years) were assessed. All patients underwent a complete ophthalmological examination including slit lamp, fundus oculi, ocular biometry, corneal tomography and spectral domain (SD) OCT evaluations of the foveal region in the enhanced depth imaging (EDI) mode. OCT images at two different brightness levels were obtained. The total choroidal area (TCA), choroidal vascularity index (CVI), stromal choroidal area (SCA) and luminal choroidal area (LCA) at both lower and higher brightness levels were measured. To avoid the bias of operator-dependent error, the lower and higher brightness TCAs were obtained using two methods: the manual tracking mode and fixed area. At the two different brightness levels, LCA, SCA and CVI measurements showed statistically significant changes (p < 0.05), whereas the TCA differences were not statistically significant (p > 0.05). According to the results of this study, highlighting that brightness could affect LCA, SCA and CVI parameters, care should be taken during OCT image acquisition. Full article
(This article belongs to the Special Issue New Clinical Treatment for Ocular Vascular Disease and Fundus Disease)
Show Figures

Figure 1

15 pages, 2193 KiB  
Article
Is Primary Open-Angle Glaucoma a Vascular Disease? Assessment of the Relationship between Retinal Arteriolar Morphology and Glaucoma Severity Using Adaptive Optics
by Alina Szewczuk, Zbigniew M. Wawrzyniak, Jacek P. Szaflik and Anna Zaleska-Żmijewska
J. Clin. Med. 2024, 13(2), 478; https://doi.org/10.3390/jcm13020478 - 15 Jan 2024
Viewed by 1340
Abstract
Background: Retinal vascular abnormalities may be associated with glaucomatous damage. Adaptive optics (AO) is a new technology that enables the analysis of retinal vasculature at the cellular level in vivo. The purpose of this study was to evaluate retinal arteriolar parameters using the [...] Read more.
Background: Retinal vascular abnormalities may be associated with glaucomatous damage. Adaptive optics (AO) is a new technology that enables the analysis of retinal vasculature at the cellular level in vivo. The purpose of this study was to evaluate retinal arteriolar parameters using the rtx1 adaptive optics fundus camera (AO-FC) in patients with primary open-angle glaucoma (POAG) at different stages and to investigate the relationship between these parameters and changes in spectral-domain optical coherence tomography (SD-OCT) and perimetry. Methods: Parameters of the retinal supratemporal and infratemporal arterioles (wall thickness (WT), lumen diameter (LD), total diameter (TD), wall-to-lumen ratio (WLR), and cross-sectional area of the vascular wall (WCSA)) were analysed with the rtx1 in 111 POAG eyes, which were divided into three groups according to the severity of the disease, and 70 healthy eyes. The associations between RTX1 values and the cup-to-disk ratio, SD-OCT parameters, and visual field parameters were assessed. Results: Compared with the control group, the POAG groups showed significantly smaller TD and LD values (p < 0.05) and significantly higher WLR and WT values (p < 0.05) for the supratemporal and infratemporal arterioles. TD was significantly positively correlated with the retinal nerve fibre layer (RNFL) and ganglion cell complex (GCC) (p < 0.05). LD was significantly positively correlated with the RNFL, GCC, and rim area (p < 0.05). The WLR was significantly negatively correlated with the RNFL, GCC, rim area, and MD (p < 0.05), while it was significantly positively correlated with the cup-to-disc ratio and PSD (p < 0.05). Conclusions: The results suggest that vascular dysfunction is present in POAG, even at a very early stage of glaucoma, and increases with the severity of the disease. Full article
(This article belongs to the Special Issue New Clinical Treatment for Ocular Vascular Disease and Fundus Disease)
Show Figures

Figure 1

13 pages, 3270 KiB  
Article
Ocular Surface Temperature Profile of Eyes with Retinal Vein Occlusion
by Shany Shperling, Tommy Mordo, Gabriel Katz, Amir Alhalel, Alon Skaat, Gal Yaakov Cohen, Ofira Zloto and Ari Leshno
J. Clin. Med. 2023, 12(23), 7479; https://doi.org/10.3390/jcm12237479 - 03 Dec 2023
Viewed by 692
Abstract
Retinal vein occlusion (RVO) results in ischemia followed by an inflammatory response. Both processes affect tissue temperature in opposite directions. Here, we evaluate the effect of RVO on the ocular surface temperature (OST) profile. Subjects with RVO were prospectively recruited. Healthy subjects without [...] Read more.
Retinal vein occlusion (RVO) results in ischemia followed by an inflammatory response. Both processes affect tissue temperature in opposite directions. Here, we evaluate the effect of RVO on the ocular surface temperature (OST) profile. Subjects with RVO were prospectively recruited. Healthy subjects without any ocular disease served as controls. The OST was determined using the Therm-App thermal imaging camera, and image processing software was employed to compute the mean temperature values of the medial canthus, lateral canthus, and cornea. We obtained thermographic images from 30 RVO subjects (30 eyes) and 148 controls (148 eyes). A univariate analysis found that eyes with RVO had significantly elevated OSTs compared to the controls (mean difference of 0.6 ± 0.3 Celsius, p < 0.05). However, this distinction between the groups lost statistical significance upon adjusting for possible confounders, including patient and environmental factors. These findings were confirmed with a post hoc case–control matched comparison. In conclusion, RVO does not seem to affect the OST. This might be due to the balance between inflammatory thermogenesis and heat constriction from ischemia in RVO. It is also possible that, in our cohort, the RVO pathophysiological processes involved were localized and did not extend to the anterior segment. Patient and environmental factors must be considered when interpreting the OST. Full article
(This article belongs to the Special Issue New Clinical Treatment for Ocular Vascular Disease and Fundus Disease)
Show Figures

Figure 1

9 pages, 679 KiB  
Article
Anatomical and Functional Effects of an Oral Supplementation of Bromelain and Curcugreen in Patients with Focal Diabetic Macular Edema
by Adriano Carnevali, Sabrina Vaccaro, Massimiliano Borselli, Soufiane Bousyf, Luca Lamonica, Giorgio Randazzo, Giuseppe Giannaccare and Vincenzo Scorcia
J. Clin. Med. 2023, 12(23), 7318; https://doi.org/10.3390/jcm12237318 - 26 Nov 2023
Cited by 1 | Viewed by 711
Abstract
Diabetic retinopathy (DR) is one of the most severe diabetes-related complications, and macular edema stands as the primary contributor to the loss of central vision in individuals diagnosed with diabetes mellitus. The purpose of this study was to investigate the anatomical and functional [...] Read more.
Diabetic retinopathy (DR) is one of the most severe diabetes-related complications, and macular edema stands as the primary contributor to the loss of central vision in individuals diagnosed with diabetes mellitus. The purpose of this study was to investigate the anatomical and functional effects of the oral administration of bromelain and curcugreen in patients controlled by therapy with non-proliferative DR presenting focal edema. Patients were enrolled and divided into two groups: group A (n = 18) received two tablets a day of bromelain and curcugreen (Retinil Forte®) orally, and group B (n = 15) underwent observation. The protocol included four visits: the screening visit (T0) and follow-up checks every 3 months up to 12 months (T3–T6–T9–T12). Best-corrected visual acuity (BCVA), central macular thickness (CMT) measured by optical coherence tomography (OCT) and vascular perfusion (VP) in superficial capillary plexus (SCP) and the deep capillary plexus (DCP) measured by optical coherence tomography angiography (OCTA) were analyzed. A mixed-design ANOVA was calculated to determine whether the change in BCVA, CMT, VP in SCP and DCP over time differed according to the consumption of Retinil Forte®. The results indicated that the interaction between time and treatment on the CMT and VP in DCP were significant, with F (4, 124) = 6.866 (p < 0.0001) and F (4, 124) = 3.263 (p = 0.0140), respectively. Conversely, the interaction between time and treatment was not significant on BCVA and VP in SCP with F (4, 124) = 1.121 (p = 0.3496) and F (4, 124) = 1.473 (p = 0.2146), respectively. In conclusion, our results suggest a protective role of the oral administration of bromelain and curcugreen in patients with DR and focal edema, in terms of the improvement of baseline CMT and VP in DCP over time. Full article
(This article belongs to the Special Issue New Clinical Treatment for Ocular Vascular Disease and Fundus Disease)
Show Figures

Figure 1

17 pages, 4505 KiB  
Article
Pharmacological Modulation of β-Catenin Preserves Endothelial Barrier Integrity and Mitigates Retinal Vascular Permeability and Inflammation
by Madhuri Rudraraju, Shengshuai Shan, Fang Liu, Jennifer Tyler, Ruth B. Caldwell, Payaningal R. Somanath and S. Priya Narayanan
J. Clin. Med. 2023, 12(22), 7145; https://doi.org/10.3390/jcm12227145 - 17 Nov 2023
Viewed by 1201
Abstract
Compromised blood-retinal barrier (BRB) integrity is a significant factor in ocular diseases like uveitis and retinopathies, leading to pathological vascular permeability and retinal edema. Adherens and tight junction (AJ and TJ) dysregulation due to retinal inflammation plays a pivotal role in BRB disruption. [...] Read more.
Compromised blood-retinal barrier (BRB) integrity is a significant factor in ocular diseases like uveitis and retinopathies, leading to pathological vascular permeability and retinal edema. Adherens and tight junction (AJ and TJ) dysregulation due to retinal inflammation plays a pivotal role in BRB disruption. We investigated the potential of ICG001, which inhibits β-catenin-mediated transcription, in stabilizing cell junctions and preventing BRB leakage. In vitro studies using human retinal endothelial cells (HRECs) showed that ICG001 treatment improved β-Catenin distribution within AJs post lipopolysaccharide (LPS) treatment and enhanced monolayer barrier resistance. The in vivo experiments involved a mouse model of LPS-induced ocular inflammation. LPS treatment resulted in increased albumin leakage from retinal vessels, elevated vascular endothelial growth factor (VEGF) and Plasmalemmal Vesicle-Associated Protein (PLVAP) expression, as well as microglia and macroglia activation. ICG001 treatment (i.p.) effectively mitigated albumin leakage, reduced VEGF and PLVAP expression, and reduced the number of activated microglia/macrophages. Furthermore, ICG001 treatment suppressed the surge in inflammatory cytokine synthesis induced by LPS. These findings highlight the potential of interventions targeting β-Catenin to enhance cell junction stability and improve compromised barrier integrity in various ocular inflammatory diseases, offering hope for better management and treatment options. Full article
(This article belongs to the Special Issue New Clinical Treatment for Ocular Vascular Disease and Fundus Disease)
Show Figures

Figure 1

13 pages, 2714 KiB  
Article
Structural and Functional Retinal Changes in Patients with Mild Cognitive Impairment with and without Diabetes
by Álvaro Santos-Ortega, Carmen Alba-Linero, Facundo Urbinati, Carlos Rocha-de-Lossada, Rafael Orti, José Antonio Reyes-Bueno, Francisco Javier Garzón-Maldonado, Vicente Serrano, Carmen de Rojas-Leal, Carlos de la Cruz-Cosme, Manuela España-Contreras, Marina Rodríguez-Calvo-de-Mora and Natalia García-Casares
J. Clin. Med. 2023, 12(22), 7035; https://doi.org/10.3390/jcm12227035 - 10 Nov 2023
Viewed by 675
Abstract
Our objective is to analyze retinal changes using optical coherence tomography angiography (OCT-A) in patients with mild cognitive impairment (MCI) to characterize structural and vascular alterations. This cross-sectional study involved 117 eyes: 39 eyes from patients with MCI plus diabetes (DM-MCI), 39 eyes [...] Read more.
Our objective is to analyze retinal changes using optical coherence tomography angiography (OCT-A) in patients with mild cognitive impairment (MCI) to characterize structural and vascular alterations. This cross-sectional study involved 117 eyes: 39 eyes from patients with MCI plus diabetes (DM-MCI), 39 eyes from patients with MCI but no diabetes (MCI); and 39 healthy control eyes (C). All patients underwent a visual acuity measurement, a structural OCT, an OCT-A, and a neuropsychological examination. Our study showed a thinning of retinal nerve fiber layer thickness (RNFL) and a decrease in macular thickness when comparing the MCI-DM group to the C group (p = 0.008 and p = 0.016, respectively). In addition, an increase in arteriolar thickness (p = 0.016), a reduction in superficial capillary plexus density (p = 0.002), and a decrease in ganglion cell thickness (p = 0.027) were found when comparing the MCI-DM group with the MCI group. Diabetes may exacerbate retinal vascular changes when combined with mild cognitive impairment. Full article
(This article belongs to the Special Issue New Clinical Treatment for Ocular Vascular Disease and Fundus Disease)
Show Figures

Figure 1

10 pages, 2182 KiB  
Article
The Correlation between Retinal and Choroidal Thickness with Age-Related White Matter Hyperintensities in Progressive Supranuclear Palsy
by Maddalena De Bernardo, Francesco Diana, Marco Gioia, Martina De Luca, Maria Francesca Tepedino, Maria Teresa Pellecchia, Nicola Rosa, Paolo Barone and Marina Picillo
J. Clin. Med. 2023, 12(20), 6671; https://doi.org/10.3390/jcm12206671 - 22 Oct 2023
Viewed by 803
Abstract
Progressive supranuclear palsy (PSP) is a rare neurodegenerative disease. Recently, several retinal layers in PSP compared to healthy controls. were found to be thinner. However, no studies evaluating the correlation between retinal layers and cerebral white matter changes, nor eventual choroidal changes in [...] Read more.
Progressive supranuclear palsy (PSP) is a rare neurodegenerative disease. Recently, several retinal layers in PSP compared to healthy controls. were found to be thinner. However, no studies evaluating the correlation between retinal layers and cerebral white matter changes, nor eventual choroidal changes in PSP, have been conducted so far. The goals of the present study were to explore potential differences in choroidal structure between PSP and healthy controls, and to describe the relationship between retinal layers’ thickness and volume, using spectral-domain optical coherence tomography (SD-OCT) and age-related white matter change scores (ARWMC) using magnetic resonance imaging (MRI) of the brain. Choroidal structures of 26 PSP patients and 26 healthy controls using standard SD-OCT with an enhanced depth imaging (EDI) approach were analyzed; then, retinal the structures of 16 of these PSP patients using standard SD-OCT were examined; finally, the same patients underwent brain MRI, and their cerebral white matter changes were calculated. Non-statistically significant differences between PSP patients’ and healthy controls’ choroidal structure were found. On the contrary, PSP patients’ inner retinal layers (INR), retinal pigmented epithelium (RPE) and all retinal layers’ thicknesses in the macular region were found to be significantly correlated with ARWMC, independently from age and axial length (AL). PSP patients’ neurological alterations go hand in hand with retinal ones, independently from age and axial length. Our results suggest a mutual relationship between cerebral and retinal structure pathological alterations. On the other hand, no significant differences in the choroidal evaluation compared to healthy controls have been found. Full article
(This article belongs to the Special Issue New Clinical Treatment for Ocular Vascular Disease and Fundus Disease)
Show Figures

Figure 1

11 pages, 2662 KiB  
Article
Evaluation of Tropicamide–Phenylephrine Mydriatic Eye Drop Instillation on Choroidal Thickness
by Marco Gioia, Maddalena De Bernardo, Sergio Pagliarulo, Ferdinando Cione, Francesco Ferdinando Mottola, Aniello La Marca, Ilaria De Pascale, Giovanni Albano and Nicola Rosa
J. Clin. Med. 2023, 12(19), 6355; https://doi.org/10.3390/jcm12196355 - 04 Oct 2023
Cited by 2 | Viewed by 763
Abstract
The purpose of this study is to evaluate choroidal thickness (ChT) at the subfoveal and peripheral level after the instillation of 0.5% tropicamide + 10% phenylephrine 9 hydrochloride eye drops by using OCT scans in enhanced depth image (EDI) mode. In total, 53 [...] Read more.
The purpose of this study is to evaluate choroidal thickness (ChT) at the subfoveal and peripheral level after the instillation of 0.5% tropicamide + 10% phenylephrine 9 hydrochloride eye drops by using OCT scans in enhanced depth image (EDI) mode. In total, 53 patients (30 males and 23 females) were involved, and the mean age was 25.62 ± 2.41 (age range: 23–36). The dominant eye was treated with tropicamide + phenylephrine (Visumidriatic Fenil 100 mg/mL + 5 mg/mL, Visufarma) while the nondominant eye was used as the control. An OCT analysis was performed on both eyes before and 30 min after the instillation of a drop of mydriatic in the dominant eye. The ChT was measured by using the OCT software measurement tool (Spectralis; Heidelberg Engineering; Heidelberg, Germany, version 6.0). The results showed a statistically significant ChT decrease (p = 0.009) in the temporal sector after the treatment with tropicamide + phenylephrine. In the subfoveal and nasal sectors, no statistically significant ChT changes were detected (p = 0.94; p = 0.85) following the administration of the mydriatic eye drops. The ChT thinning in the temporal sector following the instillation of the tropicamide + phenylephrine eye drops suggests that in the case of ChT studies, mydriatic administration should be avoided. Full article
(This article belongs to the Special Issue New Clinical Treatment for Ocular Vascular Disease and Fundus Disease)
Show Figures

Figure 1

13 pages, 965 KiB  
Article
Pre-Operative Ocular Findings and Long-Term Follow-Up in a Large Cohort of Non-Syndromic Unicoronal Craniosynostosis
by Parinaz Rostamzad, Yasmin S. Esser, Emily T. C. Tan, Marjolein H. G. Dremmen, Mieke M. Pleumeekers and Sjoukje E. Loudon
J. Clin. Med. 2023, 12(19), 6224; https://doi.org/10.3390/jcm12196224 - 27 Sep 2023
Viewed by 595
Abstract
(1) Background: Non-syndromic unicoronal craniosynostosis (UCS) is associated with a high prevalence of ocular anomalies. Currently, the etiology of this association remains obscure, however, it is presumed to be primarily attributed to their orbital malformations and/or secondary to craniofacial surgery. We assessed pre-operative [...] Read more.
(1) Background: Non-syndromic unicoronal craniosynostosis (UCS) is associated with a high prevalence of ocular anomalies. Currently, the etiology of this association remains obscure, however, it is presumed to be primarily attributed to their orbital malformations and/or secondary to craniofacial surgery. We assessed pre-operative ophthalmological examinations of non-syndromic UCS patients and compared them with their postoperative outcomes and long-term follow-up. (2) Methods: A retrospective case series was conducted on medical records of patients with non-syndromic UCS at Sophia Children’s Hospital, Rotterdam. Ophthalmologic examinations were collected at different time periods: T1 (first visit), T2 (<1 year after cranioplasty), and T3 (long-term follow-up at last visit). The McNemar’s test was used for statistical analysis. (3) Results: A total of 101 patients were included, for whom examinations were available at T1 and T3. Patients had a mean age of 2.8 years (±2.7) and 9.5 (±4.9) at T1 and T3, respectively. At T1, 52 patients (51.5%) were diagnosed with strabismus, and 61 patients (60.4%) at T3. Vertical strabismus increased significantly from 23 patients (22.8%) at T1 to 36 patients (35.6%) at T3 (p = 0.011). Followed by astigmatism, which increased significantly from 38 (37.6%) at T1 to 59 (58.4%) patients at T3 (p = 0.001). T1 was available in 20 patients prior to fronto-orbital advancement (FOA), therefore, a sub-analysis was conducted on these patients, which was followed shortly after FOA at T2. Prior to FOA, strabismus was present in 11 patients (55.0%) and in 12 patients (60.0%) at T2. After FOA, strabismus worsened in two patients. (4) Conclusions: This study showed the high prevalence of ocular anomalies in patients with non-syndromic UCS before and after cranioplasty and at long-term follow-up. The findings of this study show that ophthalmic and orthoptic examinations are an important part of the optimal treatment of patients with non-syndromic UCS. Full article
(This article belongs to the Special Issue New Clinical Treatment for Ocular Vascular Disease and Fundus Disease)
Show Figures

Figure 1

Review

Jump to: Research

45 pages, 761 KiB  
Review
The Treatment of Diabetic Retinal Edema with Intravitreal Steroids: How and When
by Maria Letizia Salvetat, Francesco Pellegrini, Leopoldo Spadea, Carlo Salati, Mutali Musa, Caterina Gagliano and Marco Zeppieri
J. Clin. Med. 2024, 13(5), 1327; https://doi.org/10.3390/jcm13051327 - 26 Feb 2024
Viewed by 701
Abstract
Diabetic macular edema (DME) is a common complication of diabetes mellitus and a leading cause of visual impairment worldwide. It is defined as the diabetes-related accumulation of fluid, proteins, and lipids, with retinal thickening, within the macular area. DME affects a significant proportion [...] Read more.
Diabetic macular edema (DME) is a common complication of diabetes mellitus and a leading cause of visual impairment worldwide. It is defined as the diabetes-related accumulation of fluid, proteins, and lipids, with retinal thickening, within the macular area. DME affects a significant proportion of individuals with diabetes, with the prevalence increasing with disease duration and severity. It is estimated that approximately 25–30% of diabetic patients will develop DME during their lifetime. Poor glycemic control, hypertension, hyperlipidemia, diabetes duration, and genetic predisposition are recognized as risk factors for the development and progression of DME. Although the exact pathophysiology is still not completely understood, it has been demonstrated that chronic hyperglycemia triggers a cascade of biochemical processes, including increased oxidative stress, inflammation, activation of vascular endothelial growth factor (VEGF), cellular dysfunction, and apoptosis, with breakdown of the blood-retinal barriers and fluid accumulation within the macular area. Early diagnosis and appropriate management of DME are crucial for improving visual outcomes. Although the control of systemic risk factors still remains the most important strategy in DME treatment, intravitreal pharmacotherapy with anti-VEGF molecules or steroids is currently considered the first-line approach in DME patients, whereas macular laser photocoagulation and pars plana vitrectomy may be useful in selected cases. Available intravitreal steroids, including triamcinolone acetonide injections and dexamethasone and fluocinolone acetonide implants, exert their therapeutic effect by reducing inflammation, inhibiting VEGF expression, stabilizing the blood-retinal barrier and thus reducing vascular permeability. They have been demonstrated to be effective in reducing macular edema and improving visual outcomes in DME patients but are associated with a high risk of intraocular pressure elevation and cataract development, so their use requires an accurate patient selection. This manuscript aims to provide a comprehensive overview of the pathology, epidemiology, risk factors, physiopathology, clinical features, treatment mechanisms of actions, treatment options, prognosis, and ongoing clinical studies related to the treatment of DME, with particular consideration of intravitreal steroids therapy. Full article
(This article belongs to the Special Issue New Clinical Treatment for Ocular Vascular Disease and Fundus Disease)
Show Figures

Figure A1

Back to TopTop