Injection Of Vascular Endothelial Growth Factor Research Articles

(152) Efficiency Improvement Veno-Occlusive Surgeries for Treatment of Venous Leak with Autologous Stem Cell, VEGF and PRP

Abstract Introduction The venous leakage is one of the most often reason of erectile dysfunction (ED) in young and middle age men. The main reason of venous leakage or veno-occlusive Erectile Dysfunction (VOED) is the insufficiency venous obstruction under tunica albuginea of corpora cavernosa. Accordingly all types of veno-occlusive operations have particular and short term effect up to renovation of venous leakage in half year. Conservative treatment of VOED with PDE-5 has a low or mild effectiveness. Evermore young patients deny penile prosthesis implantation for psychological reason. Objective We want to stimulate growth of endothelial valves under tunica albuginea with injections autological mesenchymal stem cells (ASC) and autological VEGF (Vascular endothelial growth factor) and combine it with veno-occlusive surgeries. Methods 2012–2022 we treated 178 patients with VOED. The average patient age is 36.5 +4.1 years. Patients with prostatitis or depression/anxiety were excluded from the investigation or treated previously. We embolizated deep dorsal and Santorini plexus veins for patients with distal form of VOED–47 patients -Group 1. We ligated deep dorsal and penile veins for proximal form of VOED – 68 patients – Group 2. And we made both methods together for 65 patients –Group 3 with combination of proximal and distal leak. Patients with only surgical methods created subgroup A – 105 men. For improving of veno-occlusive mechanism for 73 patients (subgroup B) we injected to each corpus cavernosa 1 mln of autological stem cells 6 times (2 times before, during surgery and 3 times after surgery) each month and we performed 15 microinjections of VEGF each 10 days. Then we compared short (2 months) and long term (10 months) results. Results The efficacy of surgical treatment according to subjective data (questionnaires on IIEF-5) in 2 months was almost equal (16.7+3.1 and 16.9+3.0), but in 10 months significantly higher in SubGroup B(14.3+3.2 and 19.6+3.4). According to Doppler Penile Ultrasound in 10 months adding microinjections ASC and VEGF to surgery significantly improves Erectile function (absence of venous leakage) 56.4% - subgroup A and 87.4% - subgroup B. Only 6.8% patients subgroup B (opposite to 35.9% subgroup A) have to take PDE-5 inhibitors for maintain erectile function. Conclusions Half year injections of ASC and VEGF improve of veno-occlusive mechanism and increases effectiveness and long term result of veno-occlusive operations for treatment of VOED. Combine occlusive method (embolisation and ligation of veins) has the highest effectiveness and should be used in different types of leakage. Disclosure No.

Characteristics of macular edema associated with retinal vein occlusion showing poor anatomic response to three loading anti-vascular endothelial growth factor injections: an optical coherence tomography analysis

PurposeTo analyze the clinical features of refractory cystoid macular edema related to retinal vein occlusion associated with the response to three consecutive loading doses of anti–vascular endothelial growth factor.MethodsA retrospective chart review was performed on retinal vein occlusion patients treated by three anti–vascular endothelial growth factor injections. They were divided into a group according to resolution of macular edema in optical coherence tomography (Group 1) and with persistent macular edema (Group 2). We analyzed qualitative and quantitative morphologic features of optical coherence tomography.ResultsWe enrolled a total of 120 eyes from 120 patients (Group 1: n = 54, Group 2: n = 66). The baseline choroidal thickness differed significantly between groups 1 and 2 (290.70 ± 19.58 μm and 311.06 ± 17.87 μm P < 0.001). The presence of Hyperreflective foci (16.70% vs. 36.40% P < 0.001), Disorganization of the retinal inner layers (14.80% vs. 87.90%) and external limiting membrane disruption (16.60% vs. 39.3% P < 0.001) differed significantly. Logistic regression analysis showed that the initial central macular thickness (B = 0.012; P = 0.006), baseline choroidal thickness (B = 0.232; P = 0.016) and presence of hyperreflective foci (B = 1.050; P = 0.019), disorganization of the retinal inner layers (B = 1.132; P = 0.001) and external limiting membrane disruption (B = 1.575; P = 0.012) significantly affected the anti–vascular endothelial growth factor treatment response.ConclusionA thicker sub-fovea choroid and the presence of hyperreflective foci, disruption of the external limiting membrane and disorganization of the retinal inner layers associated with a poorer response to three loading anti–vascular endothelial growth factor injections in macular edema associated retinal vein occlusion.

Retinopatia cukrzycowa proliferacyjna z obustronnym obrzękiem tarczy nerwu wzrokowego – wyrównanie glikemii jako złoty standard leczenia. Opis przypadku

IntroductionOne of the microvascular complications of diabetes mellitus is a diabetic retinopathy which turns out to be the main reason of newly developed blindness in individuals of reproductive age in developed countries.PurposeThe aim of this study was to report a case of 23-years old patient which was provided with intensive therapy with the goal of achieving near-normal glycemia. Improved blood-glucose levels lead to inhibition and regression of diabetic retinopathy and improvement of visual acuity.ResultsImprovement of best corrected visual acuity of both eyes (righteye 0.8, left eye 0.7) was achieved. We observed significant improvement in clinical manifestations of diabetic retinopathy including regression of microvasular abnormalities and considerable reduction of optic disc edema.ConclusionsBesides of invasive procedures such as laseroterapy, steroid or anti vascular endothelial growth factor injections and vitrecotmy, correct treatment of diabetes mellitus complications such as proliferative diabetic retinopathy should be mainly focused on maintaining normal blood-glucoselevels.

Analiza zmian parametrów angiografii optycznej koherentnej tomografii wykonanej u pacjentów z zakrzepem naczyń żylnych siatkówki przed leczeniem iniekcjami inhibitora czynnika wzrostu śródbłonka naczyniowego i po leczeniu

Optical coherence tomography angiography is a modern, non-invasive method for assessing hemodynamics in retinal and choroidal vessels. The study presents changes occurring in optical coherence tomography angiography examination in patients with retinal vein occlusion, before and after therapy with intravitreal anti vascular endothelial growth factor injections. Anti vascular endothelial growth factor therapy in patients with retinal vein occlusion reduces the non-perfusion area, improves retinal blood flow, reduces retinal ischemia, reduces cystoid macularedema, and improves visual acuity.

Knowledge, awareness and attitudes towards retinopathy of prematurity among Jordanian pediatricians: a cross sectional descriptive study

Abstract&#x0D; Background: Retinopathy of prematurity (ROP) is a preventable cause of childhood blindness. This study aims to measure knowledge, awareness and attitudes of Jordanian pediatricians towards ROP screening and treatment protocols, and to identify any barriers concerning referrals to specialized care.&#x0D; Methods: This is a cross-sectional non-interventional descriptive study. A self-administered semi- structured electronic questionnaire was designed to assess the knowledge, attitude and practice patterns of responders and was disseminated via social media and direct contact with pediatricians in governmental and private hospitals from all over the country and collected between June and November of 2022. The questionnaire included questions regarding demographics, level of education, practice details and knowledge regarding ROP.&#x0D; Results: A total of 85 responders from all levels completed the questionnaire. Most of the responders (78 (91.8%)) identified the main risk factors of ROP as low birth weight and gestational age and maintained that timely screening should be performed by an ophthalmologist. Fifty-nine pediatricians (69.4%) were sure that ROP is preventable and 62 (72.9%) identified both laser and anti- vascular endothelial growth factor injections as possible modalities of treatment. Thirty participants (35.3%) faced real limitations reaching ophthalmologists for a reliable ROP consultation. &#x0D; Conclusions: This study demonstrated a high level of awareness of ROP among Jordanian pediatricians of all levels, although some gaps pertaining to the accurate timing of screening still exist. There are identifiable limitations facing Jordanian pediatricians to reach a reliable ophthalmic service to screen and manage referred cases. A unified nation-wide ROP screening protocol with clear access to standardized ophthalmic care is necessary to reduce the challenges facing the screening and management process and by extension, the burden of this preventable disease.

Preparation of Chitosan Nanoparticles Loaded with Vascular Endothelial Growth Factor and Its Application in the Treatment of Skin Injury

This research was aimed to explore the application of chitosan (CS) nanoparticles (NPs) loaded with vascular endothelial growth factor (VEGF) in rat skin injury. Method: the VEGF-loaded CS NPs (VEGF/CS-NPs) were prepared, and a skin injury model on the back skin of rats was established. The VEGF/CS-NPs were applied to the injury model to observe the skin changes in the wound area of each group, compare the healing rate, the number of micro-vessels, and VEGF expression in each group of rats, so as to explore the intervention effect of VEGF/CS-NPs in skin injury. Results: the prepared VEGF/CS-NPs were spherical or quasi-spherical in morphology, uniformly dispersed, with smooth surfaces and relatively uniform size. The average particle size (PS) of the blank CS-NPs was 267.5 nm± 25.3 nm, while that of the drug-loaded CS-NPs was 298.6 nm ±44.7 nm, and the PS distribution was also very concentrated. The genipin cross-linked NPs could effectively prevent the degradation of the spherical wall and achieve the slow release of VEGF. After VEGF was applied to rats in the form of NPs, its healing rate and micro-vessel count were markedly superior to those of VEGF injection alone and blank group (P &lt; 0.05), and VEGF expression in skin injury tissues was also greatly increased (P &lt; 0.05). Conclusion: VEGF/CS-NPs could improve the bioavailability of VEGF and promote the healing of rat skin injuries.

Novel concepts in the management of angina in coronary artery disease.

Coronary artery disease remains a condition with high prevalence and detrimental effects on the quality of life of affected individuals. Its most frequent manifestation, stable angina pectoris, may be challenging to manage despite the available antianginal pharmacotherapy and adequate risk factor control, especially in subjects not amenable to revascularization. In the direction of refractory angina pectoris, several approaches have been developed over the years with varying degrees of success. Among the most recognized techniques in managing angina is enhanced external counterpulsation, which utilizes mechanical compression of the lower extremities to increase blood flow to the heart. Moving to coronary sinus reduction, it leads to an increase in coronary sinus backward pressure, ultimately augmenting myocardial blood flow redistribution to ischemic regions and ameliorating chronic angina. Clinical trial results of the above-mentioned techniques have been encouraging but are based on small sample sizes to justify their widespread application. Other interventional approaches, such as transmyocardial laser revascularization, extracorporeal shockwave myocardial revascularization, and spinal cord stimulation, have been met with either controversial or negative results, and their use is not recommended. Lastly, angiogenic therapy with targeted intramyocardial vascular endothelial growth factor injection or CD34+ cell therapy may be beneficial and warrants further investigation. In this review, we summarize the current knowledge in the field of angina management, highlighting the potential and the gaps in the existing evidence that ought to be addressed in future larger-scale, randomized studies before these techniques can be safely adapted in the clinical practice of patients with refractory angina pectoris.

Systemic Adverse Events Among Patients With Diabetes Treated With Intravitreal Anti–Vascular Endothelial Growth Factor Injections

Anti-vascular endothelial growth factor (VEGF) agents are currently the mainstay of treatment for diabetic retinopathy (DR). Although effective, data on their systemic safety remains inconclusive, particularly in high-risk patient groups. To explore the systemic safety of intravitreal anti-VEGF agents among patients with diabetes. This was a retrospective, longitudinal population-based analysis of the Corporate Data Warehouse, a large-scale database of patients within the US Veteran Health Affairs. All patients 18 years and older with type 2 diabetes who were seen at any Veterans Affairs health care facility in the US between January 1, 2011, and December 31, 2012, were identified. Data were then extracted on incident systemic adverse events among this patient cohort from January 1, 2013, to December 31, 2017. All individuals with diabetes who did and did not receive anti-VEGF injections were included. Patients with a history of prior systemic adverse events and those who received an intravitreal injection between January 1, 2011, and December 31, 2012, were excluded. Data were analyzed from October 2019 to March 2023. Anti-VEGF injection. Proportion of patients with any incident systemic adverse event, acute myocardial infarction, cardiovascular disease, or kidney disease at 1-, 3-, and 5-year follow-up. A total of 1 731 782 patients (mean [SD] age, 63.8 [12.3] years; 1 656 589 [95.7%] male) with type 2 diabetes were included. DR was present in 476 013 (27.5%), and 14 022 (0.8%) received anti-VEGF injections. Of the total number of patients with type 2 diabetes, 321 940 (18.6%) developed systemic adverse events between 2013 and 2017. The 5-year cumulative incidence of any systemic adverse event was 37.0% (5187/14 022) in the injection group vs 18.4% (316 753/1 717 760) in the noninjection group (P < .001). Anti-VEGF injections were independently associated with a higher likelihood of developing any systemic adverse event (odds ratio, 1.8; 95% CI, 1.7-1.9) when controlling for age, race, sex, ethnicity, tobacco use, severity of DR, Deyo-Charlson Comorbidity Index score, mean hemoglobin A1c, total number of injections, and statin use. In this study, intravitreal anti-VEGF injections were independently associated with a higher likelihood of systemic adverse events among patients with diabetes.

(428) Complex Treatment of Venous Leak with Embolisation and Autological Stem Cells Injections

Abstract Introduction The venous leakage is one of the most often reason of erectile dysfunction (ED) in young and middle age men. The main reason of veno-occlusive ED (VOED) is the insufficiency venous obstruction in corpora cavernosa under tunica albuginea that is why all types of veno-occlusive operations have particular and short term effect up to renovation of venous leakage in half year. Conservative treatment of VOED with PDE-5 has a low effectiveness. Evermore young patients deny Penile prosthesis implantation for psychological reason. Objective We want to stimulate growth of endothelial valves under tunica albuginea with injections autological mesenchymal stem cells (ASC) and autological VEGF (Vascular endothelial growth factor) and combine it with veno-occlusive surgeries (embolization and/or ligation). Methods On the basis of Andrology deratment in 2012-2022 we treated 184 patients with VOED. The average patient age is 36.1 +4.1 years. Patients with prostatitis or depression/anxiety were excluded from the investigation or treated previously. We embolizated deep dorsal and Santorini plexus veins for patients with distal form of VOED–47 patients -Group 1. We ligated deep dorsal and penile veins for proximal form of VOED – 68 patients – Group 2. And we made both methods together for 71 patients –Group 3 with combination of proximal and distal leak. Patients with only surgical methods created subgroup A – 106 men. For improving of veno-occlusive mechanism for 78 patients (subgroup B) we injected to each corpus cavernosa 1 mln of autological stem cells 5 times (2 times before and 3 times after surgery) each 1.5-2 months and we performed 15 microinjections of VEGF each 10 days. Then we compared short (2 months) and long term (10 months) results. Results The efficacy of surgical treatment according to subjective data (questionnaires on IIEF-5) in 2 months was almost equal (16.7+3.1 and 16.9+3.0), but in 10 months significantly higher in SubGroup B (14.3+3.2 and 19.7+3.4). According to Ultrasound and Cavernosography in 10 months adding microinjections ASC and VEGF to surgery significantly improves Erectile function (absence of venous leakage) 56.4% - subgroup A and 87.4% - subgroup B. Conclusions Half year injections of autological stem cells and VEGF improve of veno-occlusive mechanism and increases effectiveness and long term result of veno-occlusive operations for treatment of VOED. This method can be offer as second line therapy of ED for young patients with venous leak. Disclosure No

Two-year outcomes of patients presenting to Sydney Eye Hospital with neovascular glaucoma

BackgroundNeovascular glaucoma (NVG) is a sight-threatening condition that is often refractory to treatment. Current management principles are yet to be standardized due to lack of evidence. We studied the interventions used to treat NVG at Sydney Eye Hospital (SEH) and the two-year surgical outcomes.MethodsWe performed a retrospective audit of 67 eyes of 58 patients with NVG from January 1, 2013, to December 31, 2018. Intraocular pressure (IOP), best-corrected visual acuity (BCVA), number of medications, repeat surgery, recurrent neovascularization, loss of light perception and pain were studied.ResultsThe average age of the cohort was 59.67 years (SD 14.22). The most common etiologies were proliferative diabetic retinopathy (35 eyes; 52.2%), central retinal vein occlusion (18 eyes; 26.9%) and ocular ischemic syndrome (7 eyes; 10.4%). 70.1% of eyes (47) received vascular endothelial growth factor injections (VEGFI), 41.8% (28 eyes) received pan-retinal photocoagulation (PRP) and 37.3% (25 eyes) received both prior to or within the first week of presentation to SEH. The most common initial surgical interventions were trans-scleral cyclophotocoagulation (TSCPC) (36 eyes; 53.7%) and Baerveldt tube insertion (18 eyes; 26.9%). 62.7% of eyes (42 eyes) failed (IOP > 21 or < 6 mmHg for two consecutive reviews, further IOP-lowering surgery or loss of light perception) during follow-up. Initial TSCPC failed in 75.0% (27/36 eyes) compared with 44.4% (8/18 eyes) after Baerveldt tube insertion.ConclusionOur study reinforces the refractory nature of NVG, often despite intensive treatment and surgery. Improvements in patient outcomes may be achieved with earlier consideration of VEGFI and PRP. This study identifies the limitations of surgical interventions for NVG and highlights the need for a standardized management approach.

Computed Analysis of Retinal Vascular Growth After Bevacizumab Treatment of Retinopathy of Prematurity Until Age 3 Years

PurposePremature infants, after anti–vascular endothelial growth factor injections for retinopathy of prematurity, have persistent peripheral avascular retina (PAR). PAR is ablated with laser; however, physiologic growth of the retinal vasculature in the long term has not been measured. The purposes of this study were to measure retinal vessel growth after treatment with intravitreal bevacizumab (IVB) for retinopathy of prematurity, using serial fluorescein angiography (FA), until age 3 years, and to assess the timing for providing laser ablation in PAR. MethodsData from an observational, longitudinal clinical study were collected. Angiographic images of eyes treated with IVB were included; imaging data from laser photocoagulation were excluded. All eyes underwent initial examination under general anesthesia with FA and photographic imaging. The retinal vessel length was measured from the temporal margin of the optic disc passing through the foveal center, and the lengths at subsequent FA were compared. To compare the changes in retinal vessel length over time in individual eyes, a paired-sample t test was performed. FindingsFA images from 70 eyes (35 infants) treated with IVB were available. A total of 150 FA images were available for review; data from 125 images of good quality were used for analysis. The mean postmenstrual ages (PMAs) at first, second, third, and fourth FA were 66.2, 100.9, 135.1, and 180.7 weeks, respectively. The mean retinal vessel length was 14.177 mm at first FA and 13.199 mm at fourth FA (PMA range, 42...234 weeks). Retinal vascular lengths of individual eyes compared over time showed no statistically significant growth from the first FA to age 3 years. The changes in retinal vessel length from first to second FA were –0.117 ± 0.79 mm (p = 0.42; n = 30); from first to third FA, +0.060 ± 0.85 mm (p = 0.79; n = 15); and first to fourth FA, –0.404 ± 1.32 mm (p = 0.45; n = 7). ImplicationsBeyond 65 weeks' PMA, no meaningful retinal vascular growth occurred after IVB up to age 3 years, guiding the timing for physicians if laser photocoagulation is being considered. Future studies are needed to address retinal growth changes in the growing eyes of infants.

Efficacy of Intravitreal Anti Vascular Endothelial Growth Factor Injection Compared to Focal Therapy in Pediatric Patients with Coats Disease

Introduction: Coats disease is a retinal vascular disorder that may lead to progressive exudative retinal detachment. The standard regiment of treatment is focal therapy. However, its effectiveness may decrease when more than two quadrants of the retina exhibit vascular abnormalities. Thus, recent studies tried to use anti vascular endothelial growth factor (anti-VEGF) as therapy for the vascular problems. Aims: Comparing the efficacy between anti-VEGF injection and standard therapy regiment such as focal laser therapy. Methods: Literature searching was conducted through PubMed, ScienceDirect, Google Scholar, ProQuest, and SpringerLink. Search terms included "Coats’ Disease" and mesh terms of “Anti- VEGF". The efficacy is assessed based on Best-Corrected Visual Acuity (BCVA) and improvement in fundus manifestations. Results: All of the studies that conducted primary intravitreal anti-VEGF treatment were followed by necessary ablative treatment. These studies, such as by Yang Q and Zheng XX, et al. showed remarkable improvements in both visual acuity and anatomical outcomes. Laser therapy also gained satisfactory result in upgrading clinical stages, even though some complications including subretinal fibrosis, cataract, and vitreous hemorrhage were reported. A comparative study by Ray R, et al. noted that group undergoing anti-VEGF might require longer treatment sessions despite possible benefits. Conclusion: Anti-VEGF agents can be used as neoadjuvant in standard therapy. It did not reduce the time for full treatment, but the resolution of disease was seen in the most severe cases treated with combination therapy.

Risk, Prevalence, and Progression of Glaucoma in Eyes With Age-Related Macular Degeneration Treated With Intravitreal Anti–Vascular Endothelial Growth Factor Injections

To examine the risk, prevalence, and progression of glaucoma development in age-related macular degeneration (AMD) eyes receiving intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections compared to controls. Retrospective clinical cohort study. Retrospective review of eyes receiving intravitreal anti-VEGF injections from January 1, 2004, to December 31, 2013, for exudative AMD. Age- and sex-matched control groups of eyes included eyes with nonexudative AMD (NEAMD) and no AMD. Eyes with a diagnosis of glaucoma or glaucoma suspect were reviewed for injection details, type and date of glaucoma diagnosis, glaucoma treatments, standard automated perimetry (SAP), and spectral domain optical coherence tomography (SD-OCT). Qualitative progression was determined by indication of glaucoma progression in provider notes. Quantitative progression was assessed based on change in mean deviation (MD) on SAP, retinal nerve fiber layer thickness on SD-OCT, and intraocular pressure (IOP). There were 707 eyes of 504 patients treated with anti-VEGF injections and 1008 eyes in the NEAMD and no-AMD cohorts. There was no difference in glaucoma or suspect prevalence at initial presentation between eyes treated with injections and NEAMD (6.9% vs 9.7%, P=.22) or no-AMD controls (vs 8.5%, P=.55). There was no difference in cumulative 5-year probability of new glaucoma diagnosis after anti-VEGF injections compared to NEAMD (1.9% vs 1.0%, P=.69) or no-AMD controls (vs 1.6%, P=.88). There was no difference in qualitative progression of glaucoma in the injection cohort vs NEAMD (P=.19) or no-AMD controls (P=.61). The rate of MD change in injection eyes was similar to NEAMD eyes (P=.74) but greater than no-AMD eyes (P=.02). Eyes receiving injections required more topical glaucoma medications compared with NEAMD (P=.03) and more glaucoma laser treatments compared with no-AMD controls (P=.009). Eyes receiving injections did not require more frequent incisional glaucoma surgery compared with NEAMD (21.0% vs 15.0%, P=.95) or no-AMD controls (vs 10.0%, P=.10). Eyes treated with intravitreal anti-VEGF injections for exudative AMD did not have increased risk of developing glaucoma compared with controls. Of those with a glaucoma diagnosis, exudative AMD eyes receiving injections required a greater number of topical glaucoma medications compared with NEAMD eyes and had a greater rate of MD loss than no-AMD controls.

Backlog in ophthalmic surgeries associated with the COVID-19 pandemic in Ontario 2020

ObjectifÉvaluer le volume de chirurgies ophtalmiques reportées en Ontario en lien avec la pandémie de COVID-19 entre mars et décembre 2020, proposer des stratégies pour traiter les dossiers en attente et calculer le délai nécessaire pour y arriver. NatureÉtude transversale. ParticipantsOntariens admissibles à l'Assurance-santé de l'Ontario entre 2017 et 2020. MéthodesOn a eu recours à des modèles de prévision de séries chronologiques et à la théorie des files d'attente pour estimer le nombre de dossiers en attente de chirurgies ophtalmiques en lien avec la pandémie de COVID-19 et calculer le délai nécessaire pour rattraper le retard. RésultatsOn estime à 92 150 (intervalle de prévision à 95 % : 71 288–112 841) le nombre de chirurgies ophtalmiques qui auraient dû être réalisées au bloc opératoire entre le 16 mars et le 31 décembre 2020. Quelque 90 % des interventions retardées visaient le traitement de cataractes, et un nombre inquiétant (4 %) comportaient un décollement de rétine. Près de la moitié des chirurgies en attente dans la province (48 %; 44 542 sur 92 150) touchaient des patients de Santé Ontario Ouest. De plus, on estime à 23 755 (intervalle de prévision à 95 % : 14 656–32 497) le nombre d'injections d'anti-VEGF (facteur de croissance endothélial vasculaire) qui n'ont pas été administrées. On estime à 248 semaines (intervalle de confiance à 95 % : 235–260) et à 128 semaines (intervalle de confiance à 95 % : 121–134) le délai pour rattraper ce retard à l’échelle provinciale si l'on ajoute 10 % et 20 %, respectivement, de temps de bloc opératoire par semaine, d'après le volume hebdomadaire des chirurgies ophtalmiques en 2019. ConclusionsLes données de l'Ontario révèlent que l'importance des retards au chapitre des chirurgies ophtalmiques pour l'année 2020 seule soulève de vives inquiétudes quant à la capacité de répondre aux besoins des patients à cet égard. À mesure que se poursuit la pandémie, les retards sont appelés à augmenter. Il est urgent de trouver une stratégie de compensation et de mettre en place des démarches pour mieux gérer les répercussions collatérales de la pandémie sur les retards en matière de chirurgie ophtalmique.

BRIDGE ARCH-SHAPED SUBRETINAL FLUID IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION: Evolution and Outcomes.

To study factors leading to bridge arch-shaped subretinal fluid (SRF) on optical coherence tomography in wet age-related macular degeneration and evaluate its anatomical and functional outcomes. In this single-center, retrospective study, patients with bridge arch-shaped SRF and choroidal neovascular membrane (CNVM) were included. Overall, 623 eyes in 431 patients with chronic CNVM were identified, and 24 eyes (4%) in 21 patients showed bridge arch-shaped SRF. Mean age of patients was 69.19 ± 12.0 years. Type-1 CNVM was noted in 79% cases before development of bridge arch-shaped SRF. Mean early treatment diabetic retinopathy letters visual acuity was 53.93 ± 32.19. Time interval to develop bridge arch-shaped SRF was 21.9 ± 30.63 months. Mean number of intravitreal anti-vascular endothelial growth factor injections given before developing bridge arch-shaped SRF was 6.5 ± 7.09. During the development of bridge arch-shaped SRF, visual acuity reduced by -20.57 ± 31.13 letters (P = 0.033) and fibrotic Type-2 CNVM (n = 18, 75%) was noted. Retinal pigment epithelium tear was noted in 8 eyes (33%). At the final visit, further reduction in visual acuity of -7.136 ± 13.73 early treatment diabetic retinopathy letters (P = 0.011) after developing bridge arch-shaped SRF was seen. Mean number of injections given after developing bridge arch-shaped SRF was 4.76 ± 3.76. Bridge arch-shaped SRF is an uncommon finding seen in eyes with Type-2 chronic CNVMs. Presence of retinal pigment epithelium breach and tear and nonaggressive treatment regimen with intravitreal anti-vascular endothelial growth factor injections could be responsible for its pathogenesis. It is a marker of fibrotic enlargement, leading to poor visual outcomes despite showing favorable therapeutic response.

Combine treatment of veno-occlusive ED withveno-occlusive surgery, injections of stem cells and VEGF

ABSTRACT Introduction The venous leakage is one of the most often reason of erectile dysfunction (ED) in young and middle age men. The main reason of veno-occlusive ED (VOED) is the insufficiency venous obstruction in corpora cavernosa under tunica albuginea that is why all types of veno-occlusive operations have particular and short term effect up to renovation of venous leakage in half year. Conservative treatment of VOED with PDE-5 has a low effectiveness. Evermore young patients deny Penile prosthesis implantation for psychological reason. Objective We want to stimulate growth of endothelial valves under tunica albuginea with injections autological mesenchymal stem cells and autological VEGF (Vascular endothelial growth factor) and combine it with veno-occlusive surgery. Materials and Methods On the basis of the Kharkiv Regional Clinical Centre of Urology and Nephrology, Andrology deratment in 2012-2021 we carried out comprehensive examination and treatment of 174 patients with VOED. Most of them 142 (81.6%) have left side or bilateral varicocele. The average patient age is 36.5 +4.1 years. Patients with prostatitis or depression/anxiety were excluded from the investigation or treated previously. We provided embolization of deep dorsal and Santorini plexus veins for patients with distal form of VOED throw deep dorsal vein –46 patients -Group 1.We performed ligation of deep dorsal and penile veins with Marmar surgery from peno-pubical incision for proximal form of VOED – 68 patients – Group 2, And we made both methods together for 62 patients –Group 3 with combination of proximal and distal leak. Patients with only surgical methods created subgroup A – 105 men. For improving of veno-occlusive mechanism for 69 patients (subgroup B) we injected to each corpus cavernosa 1 mln of autological endothelial stem cells 5 times (2 times before and 3 times after surgery) each 1.5-2 months and we performed 15 microinjections of VEGF each 10 days. During occlusive operations we injected to ligated veins (deep dorsal and big penile veins) 2 mln of autological fibroblastic stem cells in retrograde direction. Then we compared short (2 months) and long term (10 months) result. Results The efficacy of surgical treatment according to subjective data (questionnaires on IIEF-5) in 2 months was almost equal (16.7±3.1 and 16.9±3.0), but in 10 months significantly higher in SubGroup B(14.3±3.2 and 19.6±3.4). According to objective data in 10 months adding microinjections of autological stem cells and VEGF to surgery significantly improves Erectile function (absence of venous leakage on Doppler Penile US with bemix) 56.4% - subgroup A and 91.4% - subgroup B. Conclusions Half year injections of autological stem cells and VEGF improve of veno-occlusive mechanism and increases effectiveness and long term result of veno-occlusive operations for treatment of VOED. Cavernosografy of combine form of VOED Disclosure Work supported by industry: no.

The Pandemic Is Not Associated with Endophthalmitis Decrease after Anti–Vascular Endothelial Growth Factor Injections

Based on an analysis of 4,206,234 anti-VEGF intravitreal injections in the IRIS Registry database, there was no observed difference in rates of presumed endophthalmitis after intravitreal injections pre-pandemic vs. during the pandemic in 2020.

VEGF Modulates Neurogenesis and Microvascular Remodeling in Epileptogenesis After Status Epilepticus in Immature Rats.

Neurogenesis and angiogenesis are widely recognized to occur during epileptogenesis and important in brain development. Because vascular endothelial growth factor (VEGF) is a critical neurovascular target in neurological diseases, its effect on neurogenesis, microvascular remodeling and epileptogenesis in the immature brain after lithium-pilocarpine-induced status epilepticus (SE) was investigated. The dynamic changes in and the correlation between hippocampal neurogenesis and microvascular remodeling after SE and the influence of VEGF or SU5416 injection into the lateral ventricles at different stages after SE on neurogenesis and microvascular remodeling through regulation of VEGF expression were assessed by immunofluorescence and immunohistochemistry. Western blot analysis revealed that the VEGFR2 signaling pathway promotes phosphorylated ERK and phosphorylated AKT expression. The effects of VEGF expression regulation at different stages after SE on pathological changes in hippocampal structure and spontaneous recurrent seizures (SRS) were evaluated by Nissl staining and electroencephalography (EEG). The results showed that hippocampal neurogenesis after SE is related to microvascular regeneration. VEGF promotion in the acute period and inhibition in the latent period after SE alleviates loss of hippocampal neuron, abnormal vascular regeneration and inhibits neural stem cells (NSCs) ectopic migration, which may effectively alleviate SRS severity. Interfering with VEGF via the AKT and ERK pathways in different phases after SE may be a promising strategy for treating and preventing epilepsy in children.

Trends in Retinopathy of Prematurity Screening and Treatment: 2008-2018.

Retinopathy of prematurity (ROP) is the leading avoidable and treatable cause of childhood blindness in the United States. The objective of this study was to evaluate trends of ROP screening, incidence, and treatment in US NICUs over the last 11 years. Using standardized data submitted by NICUs from US Vermont Oxford Network member hospitals from 2008 to 2018 on very low birth weight infants hospitalized at the recommended age for ROP screening, we assessed trends in the proportion of eligible infants who received ROP screening, incidence, and treatment of ROP using logistic regression models. This study included 381 065 very low birth weight infants at 819 US NICUs participating in Vermont Oxford Network. Over time, more eligible infants received ROP screening (89% in 2008 to 91% in 2018, trend P < .001). Among those screened, overall ROP (stages 1-5, 37% in 2008 to 32% in 2018), severe ROP (stages 3-5, 8% in 2008 to 6% in 2018), and retinal ablation (6% in 2008 to 2% in 2018) declined and anti-vascular endothelial growth factor injections (1% in 2012 to 2% in 2018) increased (all trend P < .001). Among US hospitals from 2008 to 2018, the proportion of ROP screening among infants hospitalized at the recommended age increased, less overall and severe ROP were reported, less retinal ablation was performed, and more anti-vascular endothelial growth factor treatment was used. Despite increased ROP screening over time, 10% of infants were not screened, representing an opportunity for improvement in health care delivery.

Outcomes of Patients With Active Diabetic Macular Edema at the Time of Cataract Surgery Managed With Intravitreal Anti–Vascular Endothelial Growth Factor Injections

To investigate the outcomes of cataract surgery in patients with active diabetic macular edema (DME) who are receiving active treatment with intravitreal anti-vascular endothelial growth factor (VEGF) injections in the perioperative period. Retrospective clinical cohort study. We reviewed all patients who underwent cataract surgery and were receiving intravitreal anti-VEGF injections from January 1, 2012 through December 31, 2017. Thirty-seven eyes underwent cataract surgery and received ≥1 intravitreal anti-VEGF injection for a diagnosis of DME within 6 months before surgery. Outcome measures included the development of subretinal or intraretinal fluid in the 6 months after surgery, timing of injections, number of injections, best-corrected visual acuity, and central subfield thickness. There was a significant improvement between pre- and postoperative best-corrected visual acuity when comparing all eyes (Ps < .0001) and no significant difference in central subfield thickness before and after surgery (P > .05). There were 30 eyes (81.1%) that had fluid on the preoperative optical coherence tomography scan. Seventeen eyes (45.9%) developed new or worsening postoperative DME. Comparing the eyes that did or did not develop worsening DME, there were no differences in postoperative visual acuities (P > .05). Eyes that did develop new fluid had significant increases in postoperative central subfield thickness at both 1 month (350 vs 320 μm, P=.036) and 6 months (342 vs 305 μm, P=.013). In a real-world setting, patients with cataracts and actively treated DME may undergo cataract surgery but may see a worsening of DME not immediately affecting the best-corrected visual acuity.