IVD Group Research Articles

A Comparison between Intravitreal Bevacizumab Injection and Placement of a Dexamethasone Implant to Treat Retinal Vein Occlusion Macular Edema

Purpose: We evaluated the macular, functional and structural features of patients with retinal vein occlusion and macular edema. We measured the best-corrected visual acuity (BCVA), central foveal thickness, and the area of the foveal avascular zone area after intravitreal bevacizumab (IVB) treatment and placement of a dexamethasone implant (IVD).Methods: We retrospectively reviewed 36 eyes of 36 patients with retinal vein occlusion and macular edema who underwent IVB treatment (20 eyes) and IVD placement (16 eyes). The parameters mentioned above were compared between the two treatment groups and the normal contralateral eyes after initial stabilization and 1 year later.Results: The BCVA was significantly higher in the IVB than the IVD group after initial stabilization and 1 year later. The intraocular pressure was lower at initial stabilization in the IVB than the IVD group, but no difference was apparent after 1 year. There was no significant between-group difference in the central foveal thickness at any time, but the IVD group required fewer injections during initial stabilization than the IVB group. In terms of the foveal avascular zone area, both the superficial and deep layers of the IVB group increased significantly during the initial stabilization period and then decreased to 1 year; no changes were seen in the IVD group.Conclusions: IVD treatment is associated with fewer injections than IVB treatment and a more stable retinal vasculature, but visual acuity may possibly decrease (because of cataract formation). Although IVB treatment improves visual acuity and reduces macular edema, this may be associated with an increased risk of macular ischemia given the need for repeated injections.

Comparing the effects of intravenous injection and intranasal atomisation of detomidine in sheep.

Detomidine is an α-2 agonist sedative drug which reduces the release of norepinephrine in nerves. Administering this drug through intranasal (IN) route could cause direct transmission to the central nervous system. Therefore, IN administration of detomidine would decrease the side effects and the onset of sedation. In this study, IN administration of detomidine in sheep through an atomiser was compared to its IV administration. Fifteen mature female sheep with an approximate weight of 49.53±1.72 kg were used. They were randomly divided into three groups: (1) atomising 10μg/kg (IND10 ); (2) IV 10μg/kg (IVD) and (3) atomising 30μg/kg (IND30 ). Following administration, vital signs, electrocardiographic components, sedative score and biochemistry profile were measured after 15, 30 and 60min, which were compared with the baseline measures. Bradycardia and the percentage of reduction from the baseline value in the respiratory rate were lower in the IND10 group compared to those in the IVD group. There was no significant difference in terms of the temperature and blood oxygen saturation (SpO2 ) among all the groups (p > 0.05). The level of cortisol declined in all the groups, and in the IND30 (60min), it was significantly different with the baseline value. The level of glucose increased in all the groups compared to the baseline, which was not significant. Insulin concentration was reduced in all the groups, and in the IND30 group, it changed significantly 60min after the drug administration. Sedation onset time was faster in the IV group. However, sedation scores between the two administration methods were not different, and only a dose-dependent increase was found in the sedation score in the atomisation group. Our findings revealed that IN atomisation of detomidine triggers similar sedation as its IV administration, which could be used as an alternative method.

One-Month Outcomes of Intravitreal Anti-VEGF vs. Dexamethasone Implant in the Treatment of Diabetic Macular Edema in Vitrectomized Eyes.

ObjectivesTo compare short-term effect of intravitreal ranibizumab with dexamethasone implant for diabetic macular edema (DME) in vitrectomized eyes.MethodsSingle-center, prospective, randomized study of vitrectomized eyes with DME. Study eyes were divided into two groups, receiving ranibizumab (IVV group, n = 35 eyes) or dexamethasone implant (IVD group, n = 35 eyes) respectively. Patients were evaluated at baseline, Week 1 and Month 1. The main outcome measures included best-corrected visual acuity (BCVA), central retinal thickness (CRT) and intraocular pressure (IOP).ResultsBCVA and CRT were similar in the two groups at baseline. At Week 1, the CRT improvement was significant in two groups (P = 0.041 in IVV group, P = 0.030 in IVD group), but at Month 1, only IVD group had significant improvement in CRT (P < 0.001). And BCVA gains were significant at Week 1 (P = 0.029) and Month 1 (P = 0.001) in IVD group, whereas IVV group did not show significant BCVA gains (P = 0.056 at Week1, P = 0.166 at Month 1). The changes of BCVA and CRT were significantly higher in IVD group than IVV group at Month1, but the changes were not significant at Week1.ConclusionsComparing to anti-VEGF therapy, DEX implant is more effect in improving BCVA and reducing CRT in vitrectomized eyes at 1 month, which indicated DEX implant is a better strategy.

Intravitreal dexamethasone implant combined with bevacizumab versus intravitreal bevacizumab for diabetic macular edema

PurposeTo compare the visual and anatomical outcomes of intravitreal bevacizumab combined with the dexamethasone intravitreal implant and bevacizumab monotherapy in eyes with diabetic macular edemaMethodsWe retrospectively reviewed 41 eyes of 41 patients with diabetic macular edema who underwent either intravitreal bevacizumab (1.25 mg) (20 eyes, IVB group) injection alone or simultaneous injection of bevacizumab (1.25 mg) and dexamethasone implant (0.7 mg) (21 eyes, IVD group). The best‐corrected visual acuity, central macular thickness (CMT), intraocular pressure, and retreatment percentages were accessed for 1, 3, and 6 months after injectionResultsAt 3 and 6 months, best‐corrected visual acuity (BCVA) showed significant improvements in the IVD group compared to the baseline. No significant improvement of the BCVA was observed in the IVB group during the initial 3 months; however, BCVA in this group at 6 months was significantly improved compared to baseline. There was a significant improvement in CMT in IVD group compared to IVB group during the first 3 months. In IVD group, CMT was 264.39 ± 54.95 µm at 1 month after initial injection while that of IVB group was 349.00 ± 112.18 µm (p = 0.011). At 3 months, CMT in the IVD group significantly improved compared to that of IVB group (p &lt; 0.001). The average number of additional intravitreal injections during 6 months follow‐up period was 0.45 in the IVD group and 1.15 in the IVB group. In the IVD group, cortical (7%) and posterior subcapsular (15%) cataract developed by 2 grades or more during the follow‐up period in phakic eyes.ConclusionsIn patients with diabetic macular edema, simultaneous therapy combining a dexamethasone implant plus bevacizumab showed significant improvement in the visual acuity and CMT during the initial 3 months, and the number of additional intravitreal injections were less in combined treated group.

ASSESSMENT OF HYPERREFLECTIVE FOCI AFTER BEVACIZUMAB OR DEXAMETHASONE TREATMENT ACCORDING TO DURATION OF MACULAR EDEMA IN PATIENTS WITH BRANCH RETINAL VEIN OCCLUSION

To evaluate the association between hyperreflective foci (HRF) on spectral domain optical coherence tomography and therapeutic effect of intravitreal bevacizumab (IVB) or intravitreal dexamethasone implants (IVD) according to macular edema (ME) duration in branch retinal vein occlusion. Consecutive treatment-naive patients received IVB or IVD for at least 6 months. Each group was subdivided according to ME duration (<3 months vs. ≥3 months). Hyperreflective foci and best-corrected visual acuity were compared. Of 139 eyes (139 patients), 69 received IVB and 70 received IVD. At baseline, eyes with ME ≥ 3 months had more outer and total retinal HRF than eyes with ME < 3 months (P < 0.001 and P = 0.001). At 6 months, the IVD group exhibited a greater reduction in outer retinal HRF than the IVB group in both ME duration subgroups (P = 0.015 and P < 0.001). In the ME ≥ 3 months group, IVD resulted in greater best-corrected visual acuity improvement than IVB (P = 0.017). Increased outer retinal HRF at baseline in eyes with ME ≥ 3 months together with a greater reduction in HRF at 6 months and better visual outcomes after IVD suggests that the inflammatory aspect of disease should be considered in the treatment of ME. Thus, IVD injection could be more appropriate for patients with a longer ME duration after branch retinal vein occlusion.

Dexamethasone Intravitreal Implant (Ozurdex) for Long-Term Macular Edema after Epiretinal Membrane Peeling Surgery.

Purpose To investigate the functional and anatomical outcome of the 0.7 mg dexamethasone (Ozurdex) intravitreal implant (IVD) in eyes with long-term macular edema after macular epiretinal membrane removal. Methods We enrolled 40 eyes with persistent macular edema at least 12 months after epiretinal membrane removal. Twenty eyes in the IVD group received IVD and the other 20 eyes were in the control group. The main outcome measures were change in best-corrected visual acuity (BCVA) and central foveal thickness (CFT). Results For eyes in the IVD group, the mean BCVA improved by 3.45 lines to 0.47 logMAR one month after IVD. However, the mean BCVA improved by only 0.14 lines to 0.74 logMAR at the same time in eyes in the control group. Six months later, the mean BCVA improved to 0.31 and 0.74 logMAR in the IVD and control groups, respectively. In the IVD group, the mean CFT decreased rapidly by 116.8 μm to 333.9 μm one month after IVD. Thereafter the CFT decreased at a slower pace. In the control group, the CFT remained static during the follow-up period. However, in the IVD group, 6 months after IVD, the CFT seemed to have a tendency to increase. Conclusions Single IVD could significantly decrease macular edema and improve visual outcome for eyes with persistent long-term macular edema after macular ERM removal and the effect can be sustained as long as 6 months after the initial injection. However, in order to maintain the visual and anatomical outcome, repeat IVD might be considered if macular edema recurs.

Intravitreal dexamethasone implant versus triamcinolone acetonide for macular oedema of central retinal vein occlusion: quantifying efficacy and safety

Purpose Among the retinal vascular diseases, burden of retinal vein occlusion is most common immediately after diabetic retinopathy. Intravitreal corticosteroids are gaining popularity in managing macular edema (ME) of RVO. Our study compares efficacy and safety of intravitreal triamcinolone (IVTA) and dexamethasone implant (IVD) over 6 months.MethodsThis comparative, prospective, randomized study on 40 patients of non-ischemic central RVO with significant ME (> 330 μm) of < 3 months duration. Study was done at Army Research Hospital between Sep-2012 and May-2014 in accordance to Helsinki Declaration. IVD group (n = 20) received Ozurdex® while IVTA group (n = 20) received triamcinolone-acetonide (4 mg/0.1 ml), followed up at day-1 and weeks 4, 8, 12, 24.ResultsAt 6 months, mean improvement in best corrected visual acuity and retinal thickness (CMT) in the IVD group was 0.43 logmar and 323 μm and in IVTA group was 0.49 logmar and 322 μm respectively. Proportion of patients achieving ≥ 15 letters was about 40% in both groups. IOP rise was significantly higher in IVTA group at 12 and 24 weeks. In IVTA group ≥ 10 mmHg IOP rise was seen in 60% of patients, 41.6% among them had > 35 mmHg and 66% needed combination treatment and failed to reach baseline line IOP at 6 months. In IVD group, 5 pts had IOP rise with all being < 26 mmHg and were easily managed with single agent with IOP reaching baseline by 6th month in all pts. Relative risk of IOP rise with IVTA is 2.4 times higher compared to IVD. Cataract progression and cataract surgeries were required at significantly higher rates in IVTA group. In IVTA group, cataract progression was seen in 35% patients, with 71.5% requiring cataract surgery at 6 months. IVD group, 10% patients had cataract progression while none required surgery at 6 months. Relative risk of cataract progression with IVTA is 3.5 times higher compared to IVD.ConclusionIntravitreal steroids are effective in managing macular edema of retinal vein occlusion, while newer formulation of sustained release dexamethasone implant is significantly safer than IVTA.

Injectable and self-healing dynamic hydrogel as efficient nucleus pulposus replacement for intervertebral disc repair

Event Abstract Back to Event Injectable and self-healing dynamic hydrogel as efficient nucleus pulposus replacement for intervertebral disc repair Adrián Pérez-San Vicente1, Marianna Peroglio2, Manuela Ernst2, Pablo Casuso1, Damien Dupin1, Germán Cabañero1, Hans J. Grande1, David Eglin2, Mauro Alini2 and Iraida Loinaz1 1 Fundación CIDETEC, Material Division, Spain 2 AO Research Institute Davos, Switzerland Introduction: This study propose a novel dynamic hydrogel based on Gold-thiolate/disulfide (Au-S/SS) exchange with unique features like self-healing and shear thickening[1],[2] as an efficient biomaterial for nucleus pulposus (NP) replacement. To do so, the rheological behaviour of the dynamic hydrogel and the corresponding covalent hydrogel were compared and mechanical test coupled with imaging techniques were performed on partially nucleotomized IVDs restored with both hydrogels (n=28). Materials and Methods: Hydrogel preparation: 30% w/v thiol terminated 4-arm poly(ethylene glycol) was mixed with HAuCl4 in the presence of 20 wt.% of barium sulfate as contrast agent. For covalent hydrogels, a 30% w/v thiol terminated 4-arm PEG was reacted with poly(ethylene glycol) diacrylate (PEGDA). Rheological characterization: Shear storage and loss moduli (G' and G'', respectively) were obtained at constant deformation (1%) with increasing frequency (from 0.01 to 50 Hz). Compression test consisted of 5 sinusoidal cycles at 10, 100 and 1000 mm/sec. Hydrogel delivery to spine motion segments: Bovine tails (n=28) were isolated and a partial nucleotomy (5 mm diameter) was made through the center of the upper vertebra. A preformed dynamic or covalent hydrogel (~150 µl) was injected. Computed tomography imaging: Hydrogels were tracked before and after mechanical test by high-resolution peripheral quantitative tomography (XtremeCT, Scanco Medical) (resolution: 82 µm, 60 kVp, integration time: 200 ms). Biomechanical testing: The testing protocol consisted of 5 sinusoidal cycles from 60 N compression to 45 N tension performed successively at 0.1, 1 and 5 Hz, followed by a creep test at -30 N for 1 hr. The fifth cycle at each frequency was used for data analysis. Results and Discussion: Rehological properties of the dynamic hydrogel exhibited frequency dependent stifness with an increase of the dynamic moduli with frequency (4500 Pa to 78000 Pa). This peculiar mechanical behavior was attributed to the permanent exchange between Au-S species and disulfide bonds which is readily occurring in water at physiological conditions.[2] In contrast, the corresponding covalent hydrogel exhibited constant values of G´and G´´ (Figure 1b-c). A similar behavior was observed under unconfined compression (Figure 1 d-e). X-ray imaging demonstrated that the cavity was perfectly filled after and before mechanical testing (Figure 2 a). NZ stiffness value for the NP-nucleotomized IVD group decreased by 85% compared to the intact IVD group, while for dynamic hydrogel its value did not differ more than 17.33%. Covalently cross-linked hydrogel did not appear to affect positively the mechanical properties of the nucleotomized IVD. Interestingly, the NZ stiffness values showed a slight increase with increasing frequencies for both, the intact IVD and the group of IVD containing the dynamic hydrogel only demonstrated that the frequency-dependent properties allowed the original mechanical properties of the native NP to be recovered. On the contrary, this trend was not observed for NP-nucleotomized IVD and the specimen containing the covalently cross-linked hydrogel. Conclusion: In this work, we have shown a novel dynamic hydrogel with self-healing ability and frequency-dependent as a potential biomaterial suitable as NP replacement to treat IVD degeneration. To the best of our knowledge, this material represents the first example of frequency-dependent dynamic hydrogel into motion segments that increases the stiffness of the native disc and thus represents convincing potential alternative as NP substitute for IVD repair. The authors acknowledge COST Action STSM (MP1005-NAMABIO) and SNF international short visit grant (IZKOZ3-161639).

Prospective Pilot Study: Efficacy of Intravitreal Dexamethasone and Bevacizumab Injections in the Treatment of Macular Oedema Associated with Branch Retinal Vein Occlusion

Background/Aims: To compare the efficacy of intravitreal injections of dexamethasone implants (IVD) with those of bevacizumab (IVB) for the treatment of macular oedema associated with branch retinal vein occlusion. Methods: A total of 19 patients (19 eyes) were included in this prospective pilot study. Initially, 8 eyes received three IVBs (group 1) and 11 received one IVD (group 2). All the patients underwent a 1-, 3-, 4- and 6-month follow-up visit. A repeated IVB (group 1) or IVD (group 2) was proposed at 4 months when necessary. Results: The mean visual acuity was significantly better 1 month after treatment in group 2, while the mean central macular thickness was also significantly lower in group 2. However, there was no longer any difference between the two groups at 3, 4 and 6 months, neither in terms of visual acuity nor in terms of retinal thickness. More than three IVBs were needed in 3 of 10 patients in group 1 while two IVDs were required in 10 of 11 patients in group 2. Conclusion: There was no significant difference between the two treatment regimens at the 6-month follow-up visit. A more rapid functional and anatomical efficacy was noted with IVD during the first month; however, reinjection at 4 months seemed more frequent with IVD than with IVB treatment.

Error Analysis of the Nine-Word California Verbal Learning Test (CVLT-9) Among Older Adults With and Without Dementia

The nine-word California Verbal Learning Test (CVLT-9; Libon et al., 1996; Spreen & Strauss, 1998) is a verbal list learning task used to assess declarative memory impairment among dementia patients. The present study sought to investigate the neuro-cognitive mechanisms that underlie the production of intrusions and perseverations on the list A, free recall learning trials, and the false positive responses made on the delayed recognition condition. Patients with probable Alzheimer's disease (AD), Ischaemic Vascular Dementia associated with periventricular and deep white matter changes (IVD), and individuals without dementia (NC) were studied. Between-group analyses showed that AD participants produced more initial intrusion errors, and perseverated on those same intrusion errors across list A learning trials than IVD or NC participants. Also, as participants with dementia produced initial free recall intrusion errors, the semantic organization of their responses on the ‘animal’ word list generation task declined (Giovannetti-Carew, Lamar, Cloud, Grossman, & Libon, 1997). On the delayed recognition test condition, within-group analyses revealed that the IVD group endorsed more list B interference foils, than other errors. AD participants endorsed semantically related foils and list B interference foils. In addition, as participants with dementia endorsed more list B interference foils, more perseverations were produced on the Graphical Sequence Test – Dementia Version (Lamar et al., 1997). These results were interpreted within the context of the semantic knowledge, and executive functions deficits that typify AD and IVD, respectively.

Psychological impact of emergency Cesarean section in comparison with elective Cesarean section, instrumental and normal vaginal delivery

The purpose of the study was to compare the psychological reactions of women after emergency Cesarean section (EmCS), elective Cesarean section (ElCS), instrumental vaginal delivery (ND) and normal vaginal delivery (NVD). The participants (EmCS n = 71, ElCS, n = 70, IVD, n = 89, and NVD, n = 96) answered questionnaires a few days postpartum and 1 month postpartum. The EmCS group reported the most negative delivery experience at both times, followed by the IVD group. At a few days postpartum the EmCS group experienced more general mental distress than the NVD group, but not when compared with the ElCS or the IVD groups. At 1 month postpartum the EmCS group showed more symptoms of post-traumatic stress than the ElCS and NVD groups, but not when compared to the IVD group. An unplanned instrumental delivery (EmCS or IVD) should be regarded as a pointer with respect to possible post-traumatic stress.

Dementia associated with periventricular and deep white matter alterations: A subtype of subcortical dementia

This research examined the neuropsychological functioning of demented patients with periventricular and deep white matter alterations. Thirty-three outpatients with NINCDS-ADRDA probable Alzheimer's disease (AD) and 27 outpatients with probable/ possible ischaemic vascular dementia (IVD, Chui et al., 1992) associated with periventricular and deep white matter alterations matched for age, education, level of dementia, and functional disability were studied. White matter alterations were measured using a 40-poin scale previously described by Junque et al. (1990). Subjects with cortical CVAs were excluded. On executive control tests, IVD subjects made more perseverations on tests of mental control and response set, and produced fewer responses on phonemic controlled oral word association tests (letters: F,A,S). IVD subjects also made more perseverations and graphomotor errors on clock drawings. On the California Verbal Learning Test the IVD group performed better than AD subjects on the short delay free recall test condition, the recognition discriminability index, and made fewer intrusion errors on both free and cued recall conditions. We conclude that neuropsychological assessment can differentiate AD from IVD associated with white matter alterations, and that the neuropsychological profile of demented subjects with significant periventricular and deep white matter alterations is similar to other subcortical dementing illnesses.

Dementia associated with periventricular and deep white matter alterations: A subtype of subcortical dementia

This research examined the neuropsychological functioning of demented patients with periventricular and deep white matter alterations. Thirty-three outpatients with NINCDS-ADRDA probable Alzheimer's disease (AD) and 27 outpatients with probable/ possible ischaemic vascular dementia (IVD, Chui et al., 1992) associated with periventricular and deep white matter alterations matched for age, education, level of dementia, and functional disability were studied. White matter alterations were measured using a 40-point scale previously described by Junque et al. (1990). Subjects with cortical CVAs were excluded. On executive control tests, IVD subjects made more preservations on tests of mental control and response set, and produced fewer responses on phonemic controlled oral word association tests (letters: F,A,S). IVD subjects also made more preservations and graphomotor errors on clock drawings. On the California Verbal Learning Test the IVD group performed better than AD subjects on the short delay free recall test condition, the recognition discriminability index, and made fewer intrusion errors on both free and cued recall conditions. We conclude that neuropsychological assessment can differentiate AD from IVD associated with white matter alterations, and that the neuropsychological profile of demented subjects with significant periventricular and deep white matter alterations is similar to other subcortical dementing illnesses.

COMPARATIVE STUDY OF THE INFECTION RATES OF BROVIAC/HICKMAN CATHETERS (BHC) AND TOTALLY IMPLANTABLE VENOUS DEVICES (IVD) IN PEDIATRIC ONCOLOGY PATIENTS

We reviewed the records of 30 patients with 37 venous access catheters who were prospectively identified at time of placement to compare complications of BHC (Broviac or Hickman, n=20) and IVD (Mediport or Infusaport, n=17). Choice of catheter type (BHC or IVD) was fay parental discretion. The groups were comparable with respect to age [BHC: mean 5.4y(0.3y-19.0y); IVD: 6.2y(0.7y-19.0y)], sex, diagnoses, days in place (mean=164d, BHC group; 154d IVD group), percent time neutropenic, percent inpatient days, and percent days accessed (BHC: 30% vs IVD: 28% of days). There were 10 catheter-associated infections in the BHC group (3282 days at risk), 3 local and 7 with bacteremia; 4 required catheter removal. There were 9 catheter-associated infections in the IVD group during 2618 days at risk (5 local, 4 with bacteremia); only 1 required catheter removal. All infections requiring catheter removal occurred in patients < 2 years of age. Pathogens included S. epidermidis (8), S. aureus (3), enterococcus (2), E. coli (1), and C. albicans (1). Noninfectious complications occurred in 14 BHC (5 resulting in catheter removal) and 11 IVD (5 resulting in catheter removal). Overall infection rate per 100 catheter days was 0.34 and 0.30 for the IVD and BHC groups respectively. Mechanical complication rate per 100 catheter days was 0.42 for both groups. Thus the incidence of infectious and noninfectious complications was comparable for both types of catheters.