Purpose: This work aimed to analyze the 100 most-cited articles on antivascular endothelial growth factor (anti-VEGF) inhibitors. Methods: A literature search for anti-VEGF inhibitors using the Web of Science was completed using the bibliographic databases for peer-reviewed literature published in Ophthalmology, the New England Journal of Medicine, Journal of the American Medical Association, and Lancet. Primary outcomes were the most frequently cited articles and journals with the most citations as well as the specific drug and disease process studied. Results: There were 42 696 cumulative citations among the top 100 articles. The articles were published between 2004 to 2016, with most articles published in 2006. Ophthalmology published the greatest number of articles among the top 100 at 48, whereas the New England Journal of Medicine has the most citations per publication at 1714. Ranibizumab was the medication researched in most articles at 56, followed by bevacizumab at 48, aflibercept at 10, and pegaptanib at 9. Forty-two articles investigated treatment of age-related macular degeneration, followed by 24 investigating diabetic macular edema, 10 for retinal vein occlusion, 8 for proliferative diabetic retinopathy, 2 for retinopathy of prematurity and polypoidal choroidal vasculopathy, and 1 for corneal neovascularization. Conclusions: As evidenced by the considerable number of citations accumulated over the past 20 years, anti-VEGF inhibitors have led to significant research in ophthalmology.
Victims of radiation events succumb to serious infections as a consequence of bacterial translocation and sepsis. Exacerbation of the risk of infection by radiation combined burn injury (RCBI) further heightens vulnerability. No suitable countermeasures for RCBI exist. We evaluated ODSH, an anticoagulant and anti‐inflammatory agent as a potential countermeasure to RCBI. Female mice (12‐week, B6D2F1/J) were subjected to 9.5 Gy (LD70/30 for RCBI) whole‐body bilateral 60Co gamma‐photon radiation (0.4 Gy/min), followed by dorsal skin burn injury under anesthesia (∼15% total‐body‐surface area burn). Mice were injected (S.C.) with ODSH (25 mg/kg every 12 h; days 1‐2 and 17.5 mg/kg every 12 h; days 3‐7) or vehicle for 7 days post‐injury and further administered topical gentamicin (0.1% cream; days 1‐10) and oral levofloxacin (100 mg/kg; days 3‐16). Mice were euthanized on day 30 following water consumption, body weight and survival analysis. Our data showed ODSH had no effect on radiation injury (RI)‐induced mortality (45% ODSH vs. 45% VEH; n = 20). Interestingly ODSH treatment significantly reduced survival after RCBI (12% ODSH vs. 41% VEH; n = 22). Furthermore, ODSH did not affect water consumption or body mass after RI or RCBI. ODSH also did not counteract the negative alterations in hematology, splenocytes, or bone marrow cell counts after RI or RCBI. These data illustrate that ODSH in combination with antibiotic treatments, may not be a mitigating countermeasure for RCBI. This work was supported by NIAID Grant G1B2265014.
Inflammation plays a key role in the pathogenesis of diabetic retinopathy (DR), leading to alterations in the blood-retinal barrier and increased vascular permeability. Many anti-VEGF medications are now available for the treatment of DR, but response to these medications is not as robust in patients with diabetic macular oedema. Newer biologic agents are currently under study to improve the treatment of DR. These have shown promising results to both decrease the treatment burden of intravitreal injections and improve visual outcomes for diabetic patients.
Purpose: Extracorporeal membrane oxygenation (ECMO) is an established treatment modality for critically ill patients with cardiopulmonary failure, yet little is known of the ocular pathology in this population. The aim of this study is to characterize the posterior segment findings of ECMO patients. Methods: This study is a retrospective analysis of 20 ECMO patients evaluated by ophthalmology from September 2012 to May 2019 at a level 1 trauma center. Comprehensive examinations assessed for intraocular pathology. Demographic data, exam findings, and mortality were analyzed. Results: The sample size consisted of 20 patients; a majority were male (75%), and mean age was 37.4 years (interquartile range, 26.75-50 years). All patients received ECMO for care of acute respiratory distress syndrome (ARDS). Average duration of ECMO therapy was 9.6 ± 6.5 days. Eleven (55%) patients had acute retinal pathology, including Purtscher-like retinopathy (20%), intraocular hemorrhage (50%), and septic chorioretinitis (bacterial or fungal, 10%). Location of hemorrhage included the retina (40%), vitreous (30%), and optic disc (15%). Sixty percent (n = 12) of patients were unable to provide a subjective history on initial assessment. Ultimately, 5 out of 20 patients (25%) died of systemic illness during their hospital stay. Conclusion: This study demonstrates high rates of retinal pathology, most commonly vitreous and/or retinal hemorrhage alongside a Purtscher-like retinopathy. This is likely secondary to complications of anticoagulation, microthrombi, septicemia, and hemodynamic instability. We found a mortality rate slightly lower than that of prior ECMO studies. Prospective studies with pre-ECMO and post-ECMO fundus photography is warranted for better understanding of these medically complex patients.
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