Combination therapy in diabetic macular oedema and retinal vein occlusion – past and present

Koss, Michael; Naser, H; Şener, Aysun; Ackermann, Hanns; Al-Sarireh, F.; Singh, Pankaj; Koch, Frank

doi:10.1111/j.1755-3768.2010.01962.x

Cited by 28 publications

(18 citation statements)

References 62 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…No adverse events or serious side effects occurred and sampling vitreous fluids with either technique was revealed to be a safe procedure. Previous studies confirm those observations [12,13,14] although serious complications may occur and sampling aqueous humor was declared as a safer way to collect intraocular specimens [15,16]. Nevertheless, we decided to analyze vitreous samples instead of aqueous humor samples because intraocular plasminogen activity within the eye is low [17] and there is a substantial dilution effect between the anterior and posterior segments of the eye [11,18,19].…”

Section: Discussionmentioning

confidence: 55%

“…Thus, a minimum sample volume of 500 µl of central vitreous was aspirated from all patients. At the end of the limited core pars plana vitrectomy, subsequent isovolumetric substitution of balanced salt solution (BSS®, Alcon, Freiburg, Germany), 1.25 mg (100 µl) of bevacizumab (Avastin®, Genentech, San Francisco, Calif., USA) and 0.8 mg (200 µl) of dexamethasone (Dexaratiopharm®, Ulm, Germany) was injected in adherence with the principle of intravitreal combination therapy [12]. In the control group, 10 consecutive patients with an intact BRB [11] with different macular pathologies - macular hole (n = 2), macular pucker (n = 3) or vitreal floaters (n = 5) - were included, and undiluted samples of the central vitreous body were taken during standard 3-port vitrectomy performed for macular peeling due to idiopathic epiretinal membranes, macular hole surgery or vitreal floater removal.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Intravitreal Functional Plasminogen Is Elevated in Central Retinal Vein Occlusion

Bertelmann

Mennel²,

Sekundo³

et al. 2013

Ophthalmic Res

Self Cite

View full text Add to dashboard Cite

Purpose: To detect intravitreal functional plasminogen in vitreous samples of patients with recent onset of central retinal vein occlusion (CRVO) and to demonstrate significantly higher intravitreal plasminogen in CRVO patients in comparison to controls. Methods: Prospective clinical case series of 13 consecutive patients with recent onset of CRVO scheduled for core pars plana vitrectomy and 10 consecutive patients undergoing standard pars plana vitrectomy for routine macular surgery or vitreal floater removal. In all 23 cases, vitreous taps were extracted from the central vitreous body, and plasminogen was functionally determined in a new ultrasensitive p-nitroanilide reaction after activation with streptokinase (100% of normal, %N = functional plasminogen in pooled normal citrated plasma). Results: Plasminogen was detected in all analyzed samples (n = 23), and mean plasminogen was revealed to be 1.33 ± 1.73% (mean ± SD), with a range of 0.03-7.8%N. Patients with recent onset of CRVO exhibited significantly higher intravitreal plasminogen (2.19 ± 1.89%N) in comparison to controls (0.20 ± 0.21%N; p < 0.001, Mann-Whitney U test). Conclusion: Due to significantly increased intravitreal plasminogen in patients with recent onset of CRVO, intravitreally administered tissue plasminogen activator might be an option to induce posterior vitreous detachment (enzymatic vitreolysis) in CRVO patients.

show abstract

Section: Discussionmentioning

confidence: 55%

Section: Methodsmentioning

confidence: 99%

Intravitreal Functional Plasminogen Is Elevated in Central Retinal Vein Occlusion

Bertelmann

Mennel²,

Sekundo³

et al. 2013

Ophthalmic Res

Self Cite

View full text Add to dashboard Cite

show abstract

“…In literature, the combination of photo laser coagulation, intravitreal steroids or VEGF-inhibitors, or both, has shown early compelling evidence that some patients may benefit from less re-treatment compared to monotherapy [6]. As indicated in the RESTORE study, combined treatment was followed by grid/focal laser in this study [18].…”

Section: Discussionmentioning

confidence: 95%

“…Newer treatment options, namely intravitreal steroids and anti-VEGF agents, have been reported to give a chance of improvement rather than prevent visual loss in these patients [3][4][5]. There is an ongoing debate regarding the safety, efficiency, and economic concerns related to these intravitreal monotherapies, as they require frequent repetition to maintain the clinical effect [6]. There is still a selected group of patients with severe diffuse DME (DDME) refractory or resistant to intravitreal monotherapies.…”

Section: Introductionmentioning

confidence: 96%

The effect of combined treatment of bevacizumab and triamcinolone for diabetic macular edema refractory to previous intravitreal mono-injections

Yolcu

Sobacı

2014

Int Ophthalmol

View full text Add to dashboard Cite

The purpose of this study is to evaluate the efficiency of combined treatment of bevacizumab and triamcinolone in refractory diffuse DME (DDME). Twenty-five pseudophakic eyes with DDME refractory to previous successive intravitreal bevacizumab (IVB, 1.25 and 2.5 mg/0.1 ml) and triamcinolone (IVT, 4 mg and 10 mg/0.1 ml) injections were included. The average number of injections was two (1-4). The mean best corrected visual acuity (BCVA) was 0.8 (0.3-1.5) logMAR before enrollment, 0.6 (0.0-1.5) logMAR at 6 months and 0.6 (0-1.8) logMAR at 12 months (p = 0.0001, p = 0.003). The median central macular thickness (CMT) of all the eyes was 575 (502-1049) µm at baseline, 370 (179-983) µm at 6 months, and 410 (198-929) µm at 12 months (p = 0.0001; p = 0.0001). At 6 months, the VA of 13 (52 %) patients was stabilized (± 0.2 logMAR of initial BCVA) and 12 (48 %) patients showed visual improvement (>0.2 logMAR). At 12 months, 10 (40 %) patients had stabilized vision, 13 (52 %) showed visual improvement and 2 (8 %) showed visual loss. At 6 months, 18 (72 %) patients showed anatomic stabilization (a decrease of 10 % to 50 % in initial CMT) and 7 (28 %) anatomical success (a decrease in CMT more than 50 % or ≤250 µm at final visit). At 12 months, 13 (52 %) patients showed anatomic stabilization, 10 (40 %) anatomic success, and 2 (8 %) anatomical failure (decrease in CMT less than 10 %). The combined application of IVB and triamcinolone may improve vision and decrease CMT in severe DDME cases refractory to previous monotherapies.

show abstract

“…A minimum sample volume of 500 µl of central vitreous was thus obtained from all patients. At the end of the limited core ppV, a subsequent isovolumetric substitution of balanced salt solution (BSS®, Alcon, Freiburg, Germany), 1.25 mg (100 µl) of bevacizumab (Avastin®, Genentech, San Francisco, Calif., USA) and 0.8 mg (200 µl) of dexamethasone (Dexaratiopharm®, Ulm, Germany) was injected according to the intravitreal combination therapy principle [17]. In the control group, 10 consecutive patients with an intact BRB [15] were included and undiluted samples of the central vitreous body were drawn during ppV.…”

Section: Methodsmentioning

confidence: 99%

Intravitreal Functional Plasminogen in Eyes with Branch Retinal Vein Occlusion

et al. 2014

Self Cite

View full text Add to dashboard Cite

Purpose: To evaluate whether intravitreal functional plasminogen is elevated in eyes with branch retinal vein occlusion (BRVO) and to discover whether intravitreal plasminogen activities are correlated with the extent of blood-retina barrier (BRB) breakdown. Methods: Our study is a prospective case series of 20 consecutive patients with BRVO and 10 consecutive patients serving as controls. Vitreous taps were extracted from the central vitreous body and plasminogen was functionally determined in an innovative, ultrasensitive p-nitroanilide reaction after activation with streptokinase (100% of normal, %N = functional plasminogen in pooled normal citrated plasma). Intravitreal VEGF levels were assayed to estimate BRB breakdown. Results: Intravitreal functional plasminogen was detected in all analyzed samples (n = 30) and mean (±SD) plasminogen activities were found to be 0.97 ± 1.06%N (range: 0.03-3.9%N). Patients suffering from BRVO exhibited significantly higher intravitreal plasminogen (1.35 ± 1.11%N) in comparison with controls (0.20 ± 0.21%N, p < 0.001). Intravitreal VEGF concentrations in the BRVO group (576 ± 547 pg/ml) were significantly higher than these in controls (111 ± 120 pg/ml, p = 0.003). There was a significant correlation between intravitreal functional plasminogen and intravitreal VEGF levels (r = 0.519, p = 0.003). Conclusions: Intravitreal functional plasminogen is significantly elevated in eyes suffering from BRVO and correlates with the extent of BRB breakdown. The induction of posterior vitreous detachment by using intravitreally administered recombinant tissue plasminogen activator (enzymatic vitreolysis) should be explored in further investigations.

show abstract

Combination therapy in diabetic macular oedema and retinal vein occlusion – past and present

Cited by 28 publications

References 62 publications

Intravitreal Functional Plasminogen Is Elevated in Central Retinal Vein Occlusion

Intravitreal Functional Plasminogen Is Elevated in Central Retinal Vein Occlusion

The effect of combined treatment of bevacizumab and triamcinolone for diabetic macular edema refractory to previous intravitreal mono-injections

Intravitreal Functional Plasminogen in Eyes with Branch Retinal Vein Occlusion

Contact Info

Product

Resources

About