Cole Eye Institute

Cleveland, OH, United States

Cole Eye Institute

Cleveland, OH, United States

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Ehlers J.P.,Duke Eye Center | Ehlers J.P.,Cole Eye Institute | Decroos F.C.,Duke Eye Center | Fekrat S.,Duke Eye Center
Retina | Year: 2011

Purpose: To evaluate the effect of intravitreal bevacizumab on the visual and anatomical outcome in eyes with macular edema secondary to branch retinal vein occlusion. Methods: A retrospective, consecutive case series identified 53 consecutive patients with a branch retinal vein occlusion treated with intravitreal bevacizumab. Clinical variables were analyzed, including best-corrected visual acuity, angiographic characteristics, central foveal thickness, and complications. Results: Fifty-three eyes were identified with a mean initial best-corrected visual acuity of 20/137 and final best-corrected visual acuity of 20/96 (P = 0.05). The mean final line change was +1.6 lines (95% confidence interval, +0.7 to +2.3; +8 letters [95% confidence interval, +3.5 to 11.5]). At final follow-up, 28% gained ≥3 lines, whereas a loss of >3 lines was seen in 6% of eyes. The mean initial central foveal thickness of 425 μm decreased to 289 μm (P < 0.001). Mean number of injections was 2.5, and mean follow-up was 9 months. Eyes treated for ≤6 months after the onset of branch retinal vein occlusion showed improved functional outcomes (e.g., final best-corrected visual acuity, mean line change) as compared with those treated with >6 months of symptoms (P < 0.01). Conclusion: Intravitreal bevacizumab appears to be an effective treatment for macular edema secondary to branch retinal vein occlusion in many subjects. Eyes treated with intravitreal bevacizumab showed a significant reduction in central foveal thickness and improvement in visual acuity. Early treatment with intravitreal bevacizumab resulted in a greater improvement in visual acuity compared with delayed treatment. Copyright © Opthalmic Communications Society. Inc.


Choudhary M.M.,Cole Eye Institute | Hajj-Ali R.A.,Cleveland Clinic | Lowder C.Y.,Cole Eye Institute
Journal of Ophthalmology | Year: 2014

Ocular manifestations are present in many connective tissue diseases which are characterized by an immune system that is directed against self. In this paper, we review the ocular findings in various connective tissue diseases and systemic vasculitides and highlight gender differences in each disease. In rheumatoid arthritis, we find that dry eyes affect women nine times more than men. The other extra-articular manifestations of rheumatoid arthritis affect women three times more commonly than men. Systemic lupus erythematosus can involve all ocular structures and women are nine times more affected than men. Systemic sclerosis is a rare disease but, again, it is more common in women with a female to male ratio of 8: 1. Polymyositis and dermatomyositis also affect women more commonly than men but no gender differences have been found in the incidence or disease course in the systemic vasculitides associated with antineutrophil cytoplasmic antibody such as granulomatosis with polyangiitis (GPA, formerly known as Wegener's granulomatosis). Finally, Behcet's disease is more common in males, and male gender is a risk factor for Behcet's disease. There is a slight female preponderance in sarcoidosis with female gender carrying a worse prognosis in the outcome of ocular disease. © 2014 Maria M. Choudhary et al.


Cherfan C.G.,American University of Beirut | Traboulsi E.I.,Cole Eye Institute
Canadian Journal of Ophthalmology | Year: 2011

Slipped, severed, torn and lost extraocular muscles (EOM) are infrequently encountered in clinical practice but constitute significant complications of strabismus and other eye surgery and of orbital injuries. Knowledge of the clinical aspects of these various disease entities and their anatomical underpinnings are of utmost importance in providing effective recognition and treatment. These conditions share some common presenting signs, symptoms and clinical findings that are discussed in this review. The literature will be reviewed and management strategies will be presented. ©2011 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.


Englander M.,Cole Eye Institute | Kaiser P.K.,Cole Eye Institute
Current Opinion in Ophthalmology | Year: 2013

Using combination treatments that target other pathways involved in angiogenesis will hopefully improve on the results of current anti-VEGF agents and may result in greater visual improvement and more convenient dosing regimens. © 2013 Wolters Kluwer Health.


Xu D.,Cole Eye Institute | Kaiser P.K.,Cole Eye Institute
Immunotherapy | Year: 2013

Neovascular age-related macular degeneration (AMD) is the leading cause of legal blindness in patients over the age of 50 in the western world. Intravitreally administered anti-VEGF drugs have been developed to halt neovascular growth in AMD. Randomized trials have demonstrated the excellent safety profile and significant benefit of anti-VEGF therapy in maintaining vision. Aflibercept (Eylea®; Regeneron, NY, USA) is a soluble decoy receptor against VEGF that offers greater potency and binding affinity than other anti-VEGF drugs. Having received US FDA approval for neovascular AMD in November 2011, aflibercept given every 8 weeks after a loading dose was 'clinically equivalent' and statistically noninferior to the current FDA-approved therapy ranibizumab (Lucentis®; Genentech, CA, USA), given every 4 weeks. This article discusses the clinical background of AMD, development of aflibercept, results of the clinical trials and the future role of aflibercept in ocular neovascular diseases. © 2013 Future Medicine Ltd.


Dhoot D.S.,Cole Eye Institute | Kaiser P.K.,Cole Eye Institute
Expert Opinion on Biological Therapy | Year: 2012

Introduction: Age-related macular degeneration (AMD) is the leading cause of blindness in patients over 50 years in the developed world. The wet form of AMD is responsible for the majority of severe vision loss. VEGF-A is a key component in the development of wet AMD. Ranibizumab is an anti-VEGF agent that has established itself as the gold standard in the treatment of neovascular AMD. Herein, we review the pharmacology, pharmacokinetics, efficacy and safety of ranibizumab. Areas covered: Since its approval in 2006, ranibizumab has revolutionized the treatment of wet AMD. In two pivotal Phase III trials, MARINA and ANCHOR, ranibizumab (0.5 mg) prevented moderate visual loss in 90 and 96% of patients, respectively, and improved vision by 15 letters or more in 33 and 40% of patients, respectively. Fixed monthly dosing regimens were compared with quarterly dosing regimens in PIER and EXCITE studies and support the superiority of fixed monthly dosing. The CATT trial revealed that bevacizumab was not inferior to ranibizumab when dosed monthly. As-needed treatment regimens of ranibizumab were also found to be non-inferior to monthly ranibizumab after 1 year of follow-up. Expert opinion: Ranibizumab has positively altered the treatment of wet AMD and offers hope for millions of patients. © 2012 Informa UK, Ltd.


Yuan A.,Cole Eye Institute | Kaiser P.K.,Cole Eye Institute
Seminars in Ophthalmology | Year: 2011

Numerous drugs that show promise in the treatment of neovascular age related macular degeneration are currently being evaluated in early clinical trials. Some of these drugs target the vascular endothelial growth factor pathway while others act on different targets along the angiogenesis cascade. The mechanism of action of these novel therapeutics and the results of early clinical trials will be discussed along with a review of angiogenesis. © 2011 Informa Healthcare USA, Inc.


Traboulsi E.I.,Cole Eye Institute
Current Opinion in Ophthalmology | Year: 2012

PURPOSE OF REVIEW: Pigmented and depigmented ocular fundus lesions (de-POFLs) can be isolated and clinically insignificant, or they may be the hallmark of associated serious systemic disorders such as familial polyposis. The ophthalmologist is often called upon to look for these retinal lesions, or may encounter them in the course of routine examination when appropriate medical referral becomes essential. RECENT FINDINGS: The ophthalmoscopic and location differences between grouped pigmentation of the retinal pigment epithelium (bear tracks) and multiple POFLs associated with familial adenomatous polyposis is reviewed. The differential diagnosis, morphology and associations of de-POFLs are also listed and some of the associated genetic conditions are reviewed. SUMMARY: Familiarity with the morphologic and ophthalmoscopic features of pigmented and de-POFLs is essential for the ophthalmologist so that an exact diagnosis is made and the appropriate workup and referrals initiated. © 2012 Wolters Kluwer Health.


Crabb J.W.,Cole Eye Institute
Advances in Experimental Medicine and Biology | Year: 2010

Toward early detection of susceptibility to age-related macular degeneration (AMD), we quantified plasma carboxyethylpyrrole (CEP) oxidative protein modifications and CEP autoantibodies by ELISA in 916 AMD and 488 control donors. Mean CEP adduct and autoantibody levels were elevated in AMDplasma by ̃60 and ̃30%, respectively, and the odds ratio for both CEP markers elevated was ̃3-fold greater in AMD than in control patients. Genotyping was performed for AMD risk polymorphisms associated with age-related maculopathy susceptibility 2 (ARMS2), high-temperature requirement factor A1 (HTRA1), complement factor H (CFH), and complement C3. The AMD risk predicted for those exhibiting elevated CEP markers and risk genotypes was 2- to 3-fold greater than the risk based on genotype alone. AMD donors carrying the ARMS2 and HTRA1 risk alleles were the most likely to exhibit elevated CEP markers. Receiver operating characteristic curves suggest that CEP markers alone can discriminate between AMD and control plasma donors with ̃76% accuracy and in combination with genomic markers, provide up to ̃80% discrimination accuracy. CEP plasma biomarkers, particularly in combination with genomic markers, offer a potential early warning system for predicting susceptibility to this blinding disease. © Springer Science+Business Media, LLC 2010.


Smith A.G.,Cole Eye Institute | Kaiser P.K.,Cole Eye Institute
Expert Opinion on Emerging Drugs | Year: 2014

Introduction: Wet or exudative age-related macular degeneration (AMD) is the leading cause of blindness in the United States for individuals over the age of 65 years. Wet AMD is characterized by the formation of choroidal neovascularization, which can lead to edema, hemorrhage and scarring of the macula. This leads to metamorphopsia and vision loss. Without treatment, the loss of vision is permanent. The current gold standard treatment of wet AMD consists of intravitreal injections of anti-vascular endothelial growth factor (VEGF) medications. Areas covered: Numerous new therapies in the drug pipeline aim at addressing limitations of current treatments. Future therapies involve novel compounds that attack different parts of the VEGF cascade, novel delivery systems aimed at reducing the frequency of intraocular injections, combination therapies and the use of radiation in conjunction with intravitreal therapies. Expert opinion: Limitations of current treatments include the need for repeated injections, the high financial costs and treatment burdens of repeated injections, the risk of adverse ocular and systemic adverse events, and the inability to completely reverse the disease process of wet AMD. There are many new therapies and approaches in the pipeline which hold promise for improving the treatment of wet AMD. © Informa UK, Ltd.

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