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Song J.,Long Beach Memorial Medical Center | Castellarin A.,Long Beach Memorial Medical Center | Song M.,California Retina Consultants and Research Foundation | Song A.,Long Beach Memorial Medical Center
Journal of Medical Case Reports

Introduction. Malignant glaucoma occurs when the intraocular pressure elevates in the setting of a shallow anterior chamber and patent iridectomy. We describe a case in which malignant glaucoma that was refractory to conventional treatment and complete vitrectomy was successfully managed by rerouting the glaucoma tubes into the pars plana. Case presentation. A 47-year-old Latino man had a history of neovascular glaucoma and subsequent peripheral anterior synechiae. He was status post-two glaucoma drainage devices. He developed pupillary block. Laser iridotomy was performed without complications. He subsequently developed malignant glaucoma that was refractory to yttrium aluminum garnet capsulohyaloidotomy of the anterior hyaloid. He underwent pars plana vitrectomy with successful control of his intraocular pressure. After 2 weeks, the malignant glaucoma recurred. He underwent repositioning of the tubes into the pars plana with successful control of his intraocular pressure. Conclusion: In rare cases of malignant glaucoma refractive to yttrium aluminum garnet hyaloidotomy and vitrectomy, placement of glaucoma drainage devices is a reasonable alternative. © 2013 Song et al.; licensee BioMed Central Ltd. Source

Do D.V.,Wilmer Eye Institute | Pieramici D.J.,California Retina Consultants and Research Foundation | Van Lookeren Campagne M.,Genentech | Beres T.,Genentech | And 3 more authors.

PURPOSE: Multicenter, open-label, single-dose, dose-escalation Phase Ia study to determine the safety, tolerability, maximum tolerated dose, and immunogenicity of FCFD4514S, an antigen-binding fragment from a humanized monoclonal antibody directed against complement factor D, in patients with geographic atrophy. METHODS: Eighteen patients with geographic atrophy (lesion size: ≥0.75 disk areas; best-corrected visual acuity: 20/125-20/400 Snellen equivalent) were sequentially enrolled and received 1 of 6 escalating doses of intravitreal FCFD4514S subject to dose-limiting toxicity criteria. Follow-up assessments (clinical examination, best-corrected visual acuity, intraocular pressure) were conducted at postadministration Days 1, 3, 7, 14, 30, 60, and 90. Serum pharmacokinetics, immunogenicity, and complement activity were also evaluated. RESULTS: All patients completed the study with no reported FCFD4514S-related dose-limiting toxicities or ocular or systemic adverse events. The maximum tolerated dose for this study was 10 mg, the highest dose tested. No antitherapeutic antibody response or adverse effects on systemic complement activity were observed. Time to maximum serum concentration was 1 day to 3 days postdosing; serum terminal half-life was 5.9 days. CONCLUSION: Single-dose intravitreal FCFD4514S administrations were safe and well tolerated and not associated with any study drug-related ocular or systemic adverse events. These data support a multidose safety and tolerability assessment of FCFD4514S in geographic atrophy. Copyright © by Ophthalmic Communications Society, Inc. Source

Chiang A.,Wills Eye Institute | Kaiser R.S.,Wills Eye Institute | Avery R.L.,California Retina Consultants and Research Foundation | Dugel P.U.,Retinal Consultants of Arizona | And 11 more authors.

Purpose: To assess whether performing an air or gas exchange at the conclusion of a microincision vitrectomy procedure is beneficial regarding the rate of endophthalmitis. Methods: This was a collaborative, multicenter, retrospective chart review of 2,336 eyes that underwent microincision sutureless vitrectomy (23 or 25 gauge) with either SF6 or C3F8 gas endotamponade for macular hole between January 2008 and December 2009. For all eyes, the search methodology was structured to identify the main outcome measure, which was the occurrence of acute postoperative endophthalmitis (<6 weeks after pars plana vitrectomy). Results: Of the cumulative 2,336 consecutive cases over a 2-year period, only 1 (0.04%) had postoperative endophthalmitis. All eyes had near-complete gas-fluid exchange at the end of surgery; C3F8 was the most common endotamponade agent. The majority of cases were performed with 23-gauge vitrectomy. No other complications were noted. Conclusion: Endophthalmitis was a rare occurrence in this large series of gas-filled eyes after macular hole surgery (0.04%). Gas endotamponade after microincision sutureless vitrectomy may be beneficial in reducing the risk of postoperative endophthalmitis; however, additional studies are necessary to make a definitive recommendation. Copyright © by Ophthalmic Communications Society, Inc. Source

Avery R.L.,California Retina Consultants and Research Foundation | Bakri S.J.,Mayo Medical School | Blumenkranz M.S.,Stanford University | Brucker A.J.,University of Pennsylvania | And 16 more authors.

Purpose: To review evidence and provide updated guidelines on intravitreal (IVT) injection technique and monitoring. Methods: A review of the published literature on IVT injection from 2004 to 2014 formed the basis for round table deliberations by an expert panel of ophthalmologists. Results: The dramatic increase in the number of IVT injections has been accompanied by a comparable increase in evidence surrounding IVT practice patterns and techniques. The expert panel identified a number of areas that have evolved since publication of the original IVT injection guidelines in 2004, the most notable of which were a lack of evidence to support the routine use of pre-, peri-, and postinjection antibiotics to reduce the risk of endophthalmitis, and the role of aerosolized droplets containing oral contaminants from the patient and/or providers as a potential source of infection. The panel emphasized the continued importance of applying povidone-iodine to and avoiding eyelid contact with the intended injection site and needle. Conclusion: Updated guidelines on IVT injection technique and monitoring are proposed based on a review of published literature and expert panel deliberations. Source

Williams P.D.,Texas Retina Associates | Callanan D.,Texas Retina Associates | Solley W.,Texas Retina Associates | Avery R.L.,California Retina Consultants and Research Foundation | And 2 more authors.
Clinical Ophthalmology

Purpose: This prospective multi-center pilot study compares the use of half-fluence photodynamic therapy combined with ranibizumab with ranibizumab monotherapy for the treatment of neovascular age-related macular degeneration. Methods: All patients presenting with untreated subfoveal neovascular age-related macular degeneration were considered for inclusion. Patients were randomized to receive either ranibizumab with half-fluence photodynamic therapy or ranibizumab alone. Patients in the ranibizumab alone group were given three consecutive monthly ranibizumab injections and were followed monthly. They were treated with ranibizumab as needed, based on clinical discretion, using vision and optical coherence tomography. Patients in the combined group were given one same-day combined ranibizumab and half-fluence (25 j/cm 2) photodynamic therapy treatment and were treated monthly as needed. Outcomes included changes in standardized visual acuity, optical coherence tomography foveal thickness, and percentage of as-needed injections to maintenance examinations. Results: Fifty-six out of 60 enrolled patients completed the twelve month primary outcome visit; this consisted of 27 patients receiving ranibizumab alone and 29 receiving combined treatment. The average age was 79.1 for the ranibizumab alone group and 79.3 for the combined group. The mean visual acuity in the ranibizumab alone group improved from 52.9 Early Treatment of Diabetic Retinopathy letters initially to 62.8 letters at twelve months. The mean visual acuity in the combined group improved from 49.2 letters to 51.8 letters at twelve months. The differences in visual acuity improvements were not statistically significant based on a two-tailed t-test (P = 0.2). Due to the presence of outliers in each group, a Mann-Whitney U test was performed to confirm the results (U = 325; P = 0.28). The mean optical coherence tomography foveal thickness improved 92.5 microns and 106.7 microns in the ranibizumab alone and the combined group, respectively. The difference was not significant based on a two-tailed t-test (P = 0.6). The ranibizumab alone group received an average of 6.8 injections, while the combined group received an average of three injections. This difference was not significant based on a chi-square test (P = 0.11). Conclusion: The groups appeared similar based on statistical analysis, but larger studies are needed to determine possible small differences between combination therapy and monotherapy. © 2012 Williams et al, publisher and licensee Dove Medical Press Ltd. Source

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