Purpose To describe the characteristics and outcomes of patients with cytomega lovirus (CMV) retinitis in the absence of human immunodeficiency virus (HIV) inf ection. Design Retrospective cohort study. Methods Consec...Purpose To describe the characteristics and outcomes of patients with cytomega lovirus (CMV) retinitis in the absence of human immunodeficiency virus (HIV) inf ection. Design Retrospective cohort study. Methods Consecutive patients with CMV retinitis in the absence of HIV infection were identified at a university hospi tal. Demographic and clinical characteristics were noted at the time of CMV reti nitis. Outcomes were determined retrospectively. Main outcome measures were rate s of second eye involvement, vision loss, rhegmatogenous retinal detachment (RD) , immune recovery uveitis, progression of retinitis, and mortality. Results The clinical characteristics of CMV retinitis in 18 patients (30 eyes) without HIV i nfection diagnosed between January 1, 1984, and April 13, 2003, were similar to those of patients with HIV infection. The incidences of visual loss to the level s of 20/50 or worse and of 20/200 or worse were 17%per eye-year and 14%per ey e-year, respectively. The observed incidence of RD was 3.7%per eye-year, and the mortality rate was 23%per person-year. Following reduction of immunosuppre ssion, 10 patients (56%) who discontinued anti-CMV therapy remained free of re tinitis progression. The incidence of immune recovery uveitis was 13%per person year. Conclusions In our series, CMV retinitis in patients without HIV infectio n had a clinical course similar to that in patients with AIDS treated with highl y active antiretroviral therapy (HAART), except the incidence of RD was lower for patients without AIDS. A substantial number of patients no longer re quired long-term anti-CMV therapy after adjustment of immunomodulatory therapy .展开更多
Purpose: To investigate the effects of photodynamic therapy (PDT) on subfoveal choroidal neovascularization (CNV) in age-related macular degeneration (AMD) i n a Swedish patient material with smaller lesions than thos...Purpose: To investigate the effects of photodynamic therapy (PDT) on subfoveal choroidal neovascularization (CNV) in age-related macular degeneration (AMD) i n a Swedish patient material with smaller lesions than those investigated in the TAP (Treatment of Age-related Macular Degeneration with Photodynamic Therapy) and VIP (Verteporfin in Photodynamic Therapy) Studies. Methods: Photodynamic the rapy with verteporfin was performed according to the results and recommendations of the TAP and VIP Studies. The patients were followed up for 12 months and ret reatment was performed every 12 weeks when leakage from CNV was present. Of the 100 eyes in the first 100 patients with a follow-up period of 12 months, 59%ha d a predominantly classic lesion, 36%had an occult-only lesion and 5%had a mi nimally classic lesion. The greatest linear dimension (GLD) was ≤3 NIPS (Macula r Photocoagulation Study) disc diameters (DD) in 73%, 39%and 20%of lesions, r espectively, for the three groups. The actual lesion area was ≤3 MPS disc areas (DA) in 85%, 50%and 40%of lesions, respectively. There was a positive correl ation (P < 0.05) between the duration of symptoms and GLD, as well as between th e duration of symptoms and the lesion area (P < 0.02). Results: At 12 months, vi sual acuity had remained stable or increased by ≥3 lines (ETDRS) in 61%of pati ents with predominantly classic lesions, in 61%of patients with occult-only le sions and in 60%of patients with minimally classic lesions. Leakage had stopped after 2.9 ±0.9 treatments in 77%of the total group of patients. Conclusion: T he visual outcome was comparable to those of the TAP and VIP Studies (P > 0.3). Regarding the effect on leakage, however, our results are far better than those of the TAP and VIP Studies. The proportion of patients in which leakage had stop ped was almost three times that of the TAP (27%) and VIP (26%) Studies. It see ms likely that this difference was caused by the fact that the lesions in our st udy were much smaller, on average, than those in the TAP and VIP Studies.展开更多
Introduction: The aim of this study was to analyse 1-and 2-year outcomes aft er photodynamic therapy (PDT) in clinical routine outside of the TAP [treatment of age-related macular degeneration (AMD) with PDT] study. W...Introduction: The aim of this study was to analyse 1-and 2-year outcomes aft er photodynamic therapy (PDT) in clinical routine outside of the TAP [treatment of age-related macular degeneration (AMD) with PDT] study. We analysed the func tional results, possible influencing factors and the rate of side effects. Metho ds: We analysed the medical records of 210 consecutive patients between 50 and 9 3 years of age (73±9 years) who had been treated with PDT for active ≥50%clas sic CNV resulting from AMD. Only patients with a minimum follow-up of 1 year (1 27) were included; 52 patients completed 2 years of follow-up. Juxta-and extra foveal CNV were also analysed. Treatment was given in accordance with TAP parame ters and regular follow-up examinations were performed with standardised ETDRS visual acuity (VA) measurements and fluorescein angiography. Results: In the sub foveal group, in 63.6%(70/110) a loss of VA ≥3 lines could be prevented after 1 year, and in 51.1%(23/45) after 2 years. An improvement of ≥1 line was found in 31.8%(1 year) and in 22.2%of eyes (2 years). Severe VA loss of ≥6 lines o ccurred in 10.9%of cases after 1 year and in 15.6%after 2 years. Themean chang e of VA was-1.7±3.4 lines (1 year) and-2.5±3.9 lines (2 years). For the grou p ofCNV with juxta-/extrafoveal localisation, themean change ofVAwas +0.8±2.5 lines after 1 year and +1.0±4.2 lines after 2 years. With regard to different CNV localisations, the results for juxta-/extrafoveal CNV are statistical sign ificantly better (p=0.005 and p=0.035 after 1 and 2 years, respectively). A mean of 2.6 treatments were performed in the first year and 0.5 in the second year. Conclusions: The results obtained in a single institution compare favourably wit h the results of the TAP study. The results regarding functional visual outcome could be obtained with a lower number of treatments in clinical practice. Juxta -and extrafoveal CNV showed significantly better results than a subfoveal local isation of the CNV. In this subgroup a mean improvement of VA could be obtained after 1 or 2 years.展开更多
Background: Diabetic macular oedema is a frequent cause of visual loss in pati ents with diabetic retinopathy. The purpose of this study was to assess the effi cacy of intravitreal triamcinolone acetonide in reducing ...Background: Diabetic macular oedema is a frequent cause of visual loss in pati ents with diabetic retinopathy. The purpose of this study was to assess the effi cacy of intravitreal triamcinolone acetonide in reducing diabetic macular oedema and improving visual acuity. Methods: In this prospective study 12 eyes of 12 p atients with diabetic macular oedema unresponsive to prior laser treatment recei ved an intravitreal injection of 4 mg triamcinolone acetonide. Examinations were performed 1 day preoperatively and at 1 week and 1, 3, 6, and 9 months after su rgery and included slit-lamp examination, measurement of IOP, assessment of dis tance as well as reading visual acuity and assessment of macular thickness using optical coherence tomography (OCT). Results: Mean age of the patients (mean±SD ) was 66.6±8.6 years. Mean best-corrected visual acuity (BCVA) for distance (L ogMAR using ETDRS charts) improved from 1.0±0.4 preoperatively to 0.9±0.4 (p=0 .01) 1 week and to 0.9±0.4 (p=0.02) 1month postoperatively. Mean BCVA for readi ng vision (LogRAD using Radner Reading Charts) improved from 1.1±0.4 preoperati vely to 0.9±0.4 (p=0.002) 1 month postoperatively. Mean macular thickness decre ased from 450±190 (μm) preoperatively to 305±153 (p=0.02) 1 month postoperati vely. No significant improvement in VA and no significant reduction of macular thickness could be observed 3, 6 , and 9 months postoperatively. Mean intraocular pressure significantly increase d from 14.7±2.7mmHg preoperatively to 16.9±3.0 mmHg at 1 month (p=0.02). Concl usion: A single intravitreal injection of triamcinolone acetonide led to a signi ficant improvement in mean VA in patients with diabetic macular oedema. However, the significant effect was not permanent and persisted for only 1 month.展开更多
文摘Purpose To describe the characteristics and outcomes of patients with cytomega lovirus (CMV) retinitis in the absence of human immunodeficiency virus (HIV) inf ection. Design Retrospective cohort study. Methods Consecutive patients with CMV retinitis in the absence of HIV infection were identified at a university hospi tal. Demographic and clinical characteristics were noted at the time of CMV reti nitis. Outcomes were determined retrospectively. Main outcome measures were rate s of second eye involvement, vision loss, rhegmatogenous retinal detachment (RD) , immune recovery uveitis, progression of retinitis, and mortality. Results The clinical characteristics of CMV retinitis in 18 patients (30 eyes) without HIV i nfection diagnosed between January 1, 1984, and April 13, 2003, were similar to those of patients with HIV infection. The incidences of visual loss to the level s of 20/50 or worse and of 20/200 or worse were 17%per eye-year and 14%per ey e-year, respectively. The observed incidence of RD was 3.7%per eye-year, and the mortality rate was 23%per person-year. Following reduction of immunosuppre ssion, 10 patients (56%) who discontinued anti-CMV therapy remained free of re tinitis progression. The incidence of immune recovery uveitis was 13%per person year. Conclusions In our series, CMV retinitis in patients without HIV infectio n had a clinical course similar to that in patients with AIDS treated with highl y active antiretroviral therapy (HAART), except the incidence of RD was lower for patients without AIDS. A substantial number of patients no longer re quired long-term anti-CMV therapy after adjustment of immunomodulatory therapy .
文摘Purpose: To investigate the effects of photodynamic therapy (PDT) on subfoveal choroidal neovascularization (CNV) in age-related macular degeneration (AMD) i n a Swedish patient material with smaller lesions than those investigated in the TAP (Treatment of Age-related Macular Degeneration with Photodynamic Therapy) and VIP (Verteporfin in Photodynamic Therapy) Studies. Methods: Photodynamic the rapy with verteporfin was performed according to the results and recommendations of the TAP and VIP Studies. The patients were followed up for 12 months and ret reatment was performed every 12 weeks when leakage from CNV was present. Of the 100 eyes in the first 100 patients with a follow-up period of 12 months, 59%ha d a predominantly classic lesion, 36%had an occult-only lesion and 5%had a mi nimally classic lesion. The greatest linear dimension (GLD) was ≤3 NIPS (Macula r Photocoagulation Study) disc diameters (DD) in 73%, 39%and 20%of lesions, r espectively, for the three groups. The actual lesion area was ≤3 MPS disc areas (DA) in 85%, 50%and 40%of lesions, respectively. There was a positive correl ation (P < 0.05) between the duration of symptoms and GLD, as well as between th e duration of symptoms and the lesion area (P < 0.02). Results: At 12 months, vi sual acuity had remained stable or increased by ≥3 lines (ETDRS) in 61%of pati ents with predominantly classic lesions, in 61%of patients with occult-only le sions and in 60%of patients with minimally classic lesions. Leakage had stopped after 2.9 ±0.9 treatments in 77%of the total group of patients. Conclusion: T he visual outcome was comparable to those of the TAP and VIP Studies (P > 0.3). Regarding the effect on leakage, however, our results are far better than those of the TAP and VIP Studies. The proportion of patients in which leakage had stop ped was almost three times that of the TAP (27%) and VIP (26%) Studies. It see ms likely that this difference was caused by the fact that the lesions in our st udy were much smaller, on average, than those in the TAP and VIP Studies.
文摘Introduction: The aim of this study was to analyse 1-and 2-year outcomes aft er photodynamic therapy (PDT) in clinical routine outside of the TAP [treatment of age-related macular degeneration (AMD) with PDT] study. We analysed the func tional results, possible influencing factors and the rate of side effects. Metho ds: We analysed the medical records of 210 consecutive patients between 50 and 9 3 years of age (73±9 years) who had been treated with PDT for active ≥50%clas sic CNV resulting from AMD. Only patients with a minimum follow-up of 1 year (1 27) were included; 52 patients completed 2 years of follow-up. Juxta-and extra foveal CNV were also analysed. Treatment was given in accordance with TAP parame ters and regular follow-up examinations were performed with standardised ETDRS visual acuity (VA) measurements and fluorescein angiography. Results: In the sub foveal group, in 63.6%(70/110) a loss of VA ≥3 lines could be prevented after 1 year, and in 51.1%(23/45) after 2 years. An improvement of ≥1 line was found in 31.8%(1 year) and in 22.2%of eyes (2 years). Severe VA loss of ≥6 lines o ccurred in 10.9%of cases after 1 year and in 15.6%after 2 years. Themean chang e of VA was-1.7±3.4 lines (1 year) and-2.5±3.9 lines (2 years). For the grou p ofCNV with juxta-/extrafoveal localisation, themean change ofVAwas +0.8±2.5 lines after 1 year and +1.0±4.2 lines after 2 years. With regard to different CNV localisations, the results for juxta-/extrafoveal CNV are statistical sign ificantly better (p=0.005 and p=0.035 after 1 and 2 years, respectively). A mean of 2.6 treatments were performed in the first year and 0.5 in the second year. Conclusions: The results obtained in a single institution compare favourably wit h the results of the TAP study. The results regarding functional visual outcome could be obtained with a lower number of treatments in clinical practice. Juxta -and extrafoveal CNV showed significantly better results than a subfoveal local isation of the CNV. In this subgroup a mean improvement of VA could be obtained after 1 or 2 years.
文摘Background: Diabetic macular oedema is a frequent cause of visual loss in pati ents with diabetic retinopathy. The purpose of this study was to assess the effi cacy of intravitreal triamcinolone acetonide in reducing diabetic macular oedema and improving visual acuity. Methods: In this prospective study 12 eyes of 12 p atients with diabetic macular oedema unresponsive to prior laser treatment recei ved an intravitreal injection of 4 mg triamcinolone acetonide. Examinations were performed 1 day preoperatively and at 1 week and 1, 3, 6, and 9 months after su rgery and included slit-lamp examination, measurement of IOP, assessment of dis tance as well as reading visual acuity and assessment of macular thickness using optical coherence tomography (OCT). Results: Mean age of the patients (mean±SD ) was 66.6±8.6 years. Mean best-corrected visual acuity (BCVA) for distance (L ogMAR using ETDRS charts) improved from 1.0±0.4 preoperatively to 0.9±0.4 (p=0 .01) 1 week and to 0.9±0.4 (p=0.02) 1month postoperatively. Mean BCVA for readi ng vision (LogRAD using Radner Reading Charts) improved from 1.1±0.4 preoperati vely to 0.9±0.4 (p=0.002) 1 month postoperatively. Mean macular thickness decre ased from 450±190 (μm) preoperatively to 305±153 (p=0.02) 1 month postoperati vely. No significant improvement in VA and no significant reduction of macular thickness could be observed 3, 6 , and 9 months postoperatively. Mean intraocular pressure significantly increase d from 14.7±2.7mmHg preoperatively to 16.9±3.0 mmHg at 1 month (p=0.02). Concl usion: A single intravitreal injection of triamcinolone acetonide led to a signi ficant improvement in mean VA in patients with diabetic macular oedema. However, the significant effect was not permanent and persisted for only 1 month.
