Macular Degeneration: Bakri SJ

Bakri SJ, Kaiser PK. · Cole Eye Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk i3, Cleveland, OH 44195, USA. · Expert Opin Investig Drugs. · Pubmed #16433595 No free full text.

Abstract: This manuscript reviews the pharmacotherapeutics of the novel, angiostatic cortisene, anecortave acetate suspension, for the treatment of age-related macular degeneration. The chemistry, pharmacokinetics and pharmacodynamics of anecortave acetate are discussed, and the results of the multi-centre, randomised, controlled clinical trials for the treatment of subfoveal choroidal neovascularisation in age-related macular degeneration summarised. It also discusses ongoing clinical trials involving anecortave acetate for dry and wet age-related macular degeneration.

Bakri SJ, Kaiser PK. · Cole Eye Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA. · Expert Opin Pharmacother. · Pubmed #14680447 No free full text.

Abstract: This article reviews the pharmacotherapeutics of verteporfin (Visudyne), Novartis Pharma AG) used in ocular photodynamic therapy. The chemistry, pharmacokinetics and pharmacodynamics of the drug are reviewed. The article highlights and summarises the results of the multi-centre, randomised, controlled clinical trials with verteporfin to treat subfoveal choroidal neovascularisation in age-related macular degeneration, ocular histoplasmosis syndrome and pathologic myopia. In addition, the safety profile and side effects of verteporfin are discussed.

Bakri SJ, Couch SM, McCannel CA, Edwards AO. · Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota 55905, USA. · Retina. · Pubmed #19430278 No free full text.

Abstract: PURPOSE: To report the results of same-day triple therapy with reduced fluence photodynamic therapy, intravitreal dexamethasone, and bevacizumab in patients with neovascular age-related macular degeneration. METHODS: Retrospective case series. Records of patients who received same-day triple therapy with reduced fluence photodynamic therapy (25 J/cm), intravitreal dexamethasone (200 microg), and intravitreal bevacizumab (1.25 mg) were reviewed. All patients had neovascular subfoveal age-related macular degeneration with at least 1 year of follow-up. Snellen visual acuity (VA), central macular thickness on optical coherence tomography, intraocular pressure, and endophthalmitis occurrence were recorded. RESULTS: The 31 patients were observed for a mean of 13.7 months. In all patients, mean baseline VA was 20/80 and vision at final follow-up was 20/60 (P = 0.69). In patients who received previous treatment for exudative age-related macular degeneration (n = 18), mean baseline VA was 20/100 and vision at final follow-up (mean, 13.7 months) was 20/100 (P = 0.31). In treatment-naïve patients (n = 13), mean baseline VA was 20/60 and vision at final follow-up (mean, 13.5 months) was 20/40 (P = 0.31). In all patients, mean central macular thickness was 293 mum at baseline and 245 mum at final follow-up (P = 0.053). In previously treated patients (n = 18), mean central macular thickness was 325 mum at baseline and 265 mum at final follow-up (P = 0.10). In treatment-naïve patients, mean central macular thickness was 249 mum at baseline (n = 13) and 218 mum at final follow-up (P = 0.34). Previously treated patients required more antivascular endothelial growth factor injections (mean = 3.6) than treatment-naïve patients (mean = 0.8), but the mean number of repeat triple therapy treatments was 0.3 in both groups. Changes in intraocular pressure and endophthalmitis were not observed during follow-up. CONCLUSION: Same-day triple therapy maintained VA and decreased macular thickness in patients with and without previous antivascular endothelial growth factor therapy. Triple therapy may reduce the number of antivascular endothelial growth factor injections in some patients and stabilize vision in some patients not responding to antivascular endothelial growth factor therapy.

Bakri SJ, Risco M, Edwards AO, Pulido JS. · Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota 55905, USA. · Am J Ophthalmol. · Pubmed #19403114 No free full text.

Abstract: PURPOSE: To report the outcomes and complications of bilateral simultaneous intravitreal injections performed in the office. DESIGN: Retrospective case series. METHODS: Records of 35 patients receiving simultaneous bilateral intravitreal injections between November 2007 and November 2008 were reviewed. Data collected included indication for injection, preinjection and postinjection intraocular pressure (IOP), preinjection and postinjection visual acuity (VA), and complications/complaints after each injection. RESULTS: A total of 208 injections were administered to 35 patients, with a mean of 5.9 injections per patient (range, 2 to 14; standard deviation [SD], 3.68). One hundred and thirty-three eyes received bevacizumab (Avastin; Genentech Inc, South San Francisco, California, USA) alone, 14 received bevacizumab plus preservative-free intravitreal triamcinolone or Triescence (Kenalog; Bristol-Myers Squibb Co, New York, New York, USA), 56 received ranibizumab (Lucentis; Genentech Inc), and 5 received bevacizumab plus dexamethasone (Decadron; Merck, Whitehouse Station, New Jersey, USA). Mean time of postinjection follow-up was 39 days. Postinjection VA follow-up measurements were available for 194 injections. The indication for initiating therapy was choroidal neovascularization from age-related macular degeneration (49 eyes), diabetic macular edema (ME) (13 eyes), proliferative diabetic retinopathy (4 eyes), ME attributable to retinal vein occlusion (2 eyes), and ME attributable to autoimmune retinopathy (2 eyes). The mean VA before each injection was 20/96 and at the next follow-up was 20/91 (P = .40). One patient had a painless, culture-negative endophthalmitis in 1 eye 3 days after bilateral bevacizumab; at 1 year VA improved from 20/400 to 20/80. CONCLUSIONS: Simultaneous bilateral intravitreal injections in the office are well tolerated. A separate povidone-iodine preparation, speculum, needle, and syringe were used for each eye. None of the patients requested alternating unilateral injections, after receiving bilateral injections. Patients should be counseled as to the risk of complications.

Fung AE, Palanki R, Bakri SJ, Depperschmidt E, Gibson A. · Pacific Eye Associates, California Pacific Medical Center, San Francisco, California 94115, USA. · Ophthalmology. · Pubmed #19091408 No free full text.

Abstract: PURPOSE: To evaluate the quality of reporting in the neovascular age-related macular degeneration (nvAMD) literature by applying the Consolidated Standards for Reporting Trials (CONSORT) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement writing standards. DESIGN: CONSORT and STROBE impact analysis; literature review. PARTICIPANTS: Phase III randomized controlled trials (RCTs) of verteporfin photodynamic therapy, pegaptanib, and ranibizumab, and interventional case studies of bevacizumab for nvAMD. METHODS: A literature search identified eligible articles published before October 31, 2007. We assessed the report quality of Phase III RCTs using the CONSORT statement and case series publications using the STROBE statement, both with indicators relevant to nvAMD. MAIN OUTCOME MEASURES: Presence or absence of CONSORT or STROBE statement indicators. RESULTS: Seven publications of Phase III RCTs and 29 publications on bevacizumab interventional case studies for nvAMD met our inclusion criteria. Of 37 possible CONSORT writing guideline items, the mean report quality for RCTs was 30.6 (83%), with a range from 23 to 35 (65%-95%). Of 35 possible STROBE writing guideline items, the mean report quality grade for intravitreal bevacizumab case series was 23 (70%), with a range from 16 to 31 (46%-94%). Among the bevacizumab studies, more than 90% reported scientific background, drug dose and administration, baseline characteristics, unadjusted results, and adverse events. Fewer than 20% reported study size calculations, handling of missing data, or a discussion of bias. CONCLUSIONS: Since the adoption of the CONSORT standards by Ophthalmology and other journals in 1996, the reporting quality for RCTs has further improved among this cohort of nvAMD articles. On the other hand, no reporting standards for case series have existed until the recent publication of the STROBE statement. In this first application of the STROBE standards to ophthalmology, we found that the small interventional studies in our series had an average reporting score lower than the RCTs, but also that some individual scores were higher than the RCTs. This outcome demonstrates that good, useful articles can be written about small studies. Although not a direct measure of the quality of a study, good reporting allows a reader to assess the validity and applicability of the study's findings. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Bakri SJ, Ekdawi NS. · Department of Ophthalmology, Vitreoretinal Diseases and Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA. · Retina. · Pubmed #18698303 No free full text.

Abstract: PURPOSE: To present the finding of tiny silicone oil droplets in 15 eyes of 15 patients after intravitreal injections of an anti-vascular endothelial growth factor agent or triamcinolone acetonide and to discuss the likely source of silicone oil. METHODS: In an observational case series, charts of patients who had undergone intravitreal injections by one surgeon were reviewed retrospectively. The finding of intravitreal silicone oil droplets was noted. The following information was also documented: number and type of injections before the appearance of silicone oil droplets, symptoms and evidence of ocular inflammation, visual acuity before and after silicone oil droplets, length of follow-up, and visual acuity at the last examination. RESULTS: Fifteen eyes of 15 patients were found to have silicone oil droplets documented after a various number of injections (range, 1-16). Patients were asymptomatic, and there were no adverse side effects associated with the presence of silicone oil droplets at examination. CONCLUSIONS: Silicone oil droplets may occur in the vitreous cavity after intravitreal drug injections. There were no adverse effects found associated with silicone oil in the vitreous after injections of anti-vascular endothelial growth factor agents or triamcinolone acetonide. The likely source of silicone oil is the needles and syringes used for the injections.

Bakri SJ, McCannel CA, Edwards AO, Moshfeghi DM. · Department of Ophthalmology, Mayo Clinic, Rochester, MN 55905, USA. · Graefes Arch Clin Exp Ophthalmol. · Pubmed #18425523 No free full text.

Abstract: BACKGROUND: To describe the occurrence of ocular hypertension in four patients following injection of ranibizumab intravitreally. METHODS: Case series. RESULTS: Four patients had high intraocular pressure after intravitreal ranibizumab 0.5 mg. Ocular hypertension occurred 1 month after the second ranibizumab injection in patients 1 and 3, and 1 month after the first ranibizumab in patient 2. In patient 4, it occurred several hours after the first ranibizumab injection. In all patients, the IOP increase was sustained across several visits, requiring control with topical glaucoma therapy, and in two cases the addition of a systemic carbonic anhydrase inhibitor. None of the patients had a previous history of glaucoma, ocular hypertension or IOP asymmetry and the IOP was as high as 30, 34, 46, and 50 mmHg in the four patients. CONCLUSION: Severe and sustained ocular hypertension may occur after intravitreal ranibizumab. Although the mechanism of the pressure rise is unknown, all eyes in our series were controlled with medical therapy.

Gündüz K, Bakri SJ. · Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA. · Eye. · Pubmed #18344969 No free full text.

Abstract: PURPOSE: To report short-term results of intravitreal bevacizumab (IVB) injection for macular oedema (ME) associated with branch retinal vein occlusion (BRVO). METHODS: Retrospective interventional case series of 12 eyes of 12 consecutive patients. IVB injections (1.25 mg/0.05 ml) were given as needed based on the presence of ME on optical coherence tomography. Changes in Snellen visual acuity (VA) and central macular thickness (CMT) were analysed using the Student's paired t-test. RESULTS: At a mean follow-up of 9.8 months (range: 6-17 months), the mean number of IVB injections given was 4 (range: 1-6). No ocular or systemic side effects were noted. The differences in logMAR VA between baseline and 1 month, between baseline and 6 months, and between baseline and final follow-up were statistically significant (P<0.05). The differences in CMT between baseline and 1 month, baseline and 6 months, and between baseline and final follow-up were also statistically significant (P<0.05). CONCLUSION: Short-term results indicate that IVB is useful in decreasing ME and improving VA in eyes with BRVO.

Bakri SJ, Larson TA, Edwards AO. · Department of Ophthalmology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. · Graefes Arch Clin Exp Ophthalmol. · Pubmed #18204851 No free full text.

Abstract: BACKGROUND: Injection of drugs into the vitreous can lead to intraocular inflammation through infectious and non-infectious processes. Failure to recognize an eye with anterior chamber and vitreous cell as sterile inflammation can lead to unnecessary treatment for endophthalmitis. METHODS: Four cases of uveitis following intravitreal bevacizumab (Avastin) for exudative age-related macular degeneration are described followed by review of the literature. RESULTS: Four patients presented with uveitis. Two patients presented with pain and red eye associated with iritis and two patients with vitritis, several days following intravitreal injection of bevacizumab. No paracentesis was performed and no corneal epithelial defect was created. Both patients with iritis were presumed to have sterile intraocular inflammation since the anterior chamber cell was much greater than the vitreous cell and resolved with cycloplegic and topical corticosteroid therapy. The third patient presented only with vitreous cell which resolved without therapy. The fourth patient had anterior chamber cell and vitreous cell with clumps, which resolved with topical prednisolone acetate. The inflammation resolved in all cases within 1 to 2 weeks. CONCLUSION: There are few published cases of uveitis following bevacizumab. With its rising use, it is important to be aware of its potential to be associated with intraocular inflammation.

Solano JM, Bakri SJ, Pulido JS. · Mayo Clinic, Rochester, MN 55905, USA. · Can J Ophthalmol. · Pubmed #17823640 links to  free full text

Abstract: CASE REPORT: A 59-year-old patient with a coexisting primary choroidal melanoma and colorectal cancer was treated with external beam radiation (EBR) of his choroidal melanoma and systemic chemotherapy with leukovorin/5 fluorouracil (FU) for treatment of his metastatic colorectal cancer. Eight months following EBR, he showed evidence of radiation retinopathy with macular edema. Optical coherence tomography (OCT) showed macular edema and subretinal fluid. Subsequently, systemic bevacizumab (5 mg/kg) was added to his leukovorin/5FU chemotherapy. After the addition of bevacizumab, OCT showed complete resolution of the macular edema and subretinal fluid. COMMENTS: Bevacizumab may have a role in the treatment of radiation retinopathy, but further investigation is needed before any definitive conclusions can be made.

Amselem L, Montero J, Diaz-Llopis M, Pulido JS, Bakri SJ, Palomares P, Garcia-Delpech S. · Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA. · Am J Ophthalmol. · Pubmed #17601432 No free full text.

Abstract: PURPOSE: To determine whether bevacizumab may improve anatomic and visual outcomes in patients with ocular ischemic syndrome (OIS). DESIGN: Interventional case reports. METHODS: Two patients with OIS presenting with unilateral ocular pain, iris neovascularization, and macular edema. Intravitreal injection of bevacizumab (1.25 mg). The main outcome measures were postinjection best-corrected visual acuity (BCVA), intraocular pressure (IOP), angiographic findings, and optical coherence tomography (OCT) findings and complications. RESULTS: One week after treatment, both patients demonstrated regression of the iris neovascularization and improvement of the macular edema, with no changes in BCVA and IOP. One eye was reinjected at four months. After three and seven months, no significant or systemic adverse events were observed, and no signs of new iris neovascularization were present. CONCLUSIONS: Intravitreal bevacizumab may be useful for the treatment of eyes with iris neovascularization and macular edema secondary to OIS.

Bakri SJ, Kitzmann AS. · Department of Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. · Am J Ophthalmol. · Pubmed #17317396 No free full text.

Abstract: PURPOSE: To report two cases of a retinal pigment epithelial (RPE) tear after intravitreal injection of 0.05 mg ranibizumab. DESIGN: Observational case report. METHODS: Two patients with choroidal neovascularization (CNV) resulting from age-related macular degeneration (AMD) were treated with an intravitreal injection of ranibizumab. RESULTS: Both patients were found to have a RPE tear on follow-up visits at one month, confirmed by optical coherence tomography (OCT) and by fluorescein or indocyanine green angiography. CONCLUSIONS: RPE tears may occur after intravitreal injection of ranibizumab. Further study is needed to determine whether CNV membranes associated with pigment epithelial detachments (PED) are more likely to develop RPE tears after treatment with anti-vascular endothelial growth factor (anti-VEGF) agents.

Bakri SJ, Nickel J, Yoganathan P, Beer PM. · Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA. · Ophthalmic Surg Lasers Imaging. · Pubmed #16898387 No free full text.

Abstract: BACKGROUND AND OBJECTIVE: To describe visual acuity results after photodynamic therapy (PDT) with verteporfin for choroidal neovascularization in age-related macular degeneration (AMD) associated with large submacular hemorrhage (SMH). PATIENTS AND METHODS: Eyes that had AMD, at least 12 months' follow-up, and SMH of at least 2.5 mm2, and had received no other treatment modality in conjunction with PDT, were divided into two groups: eyes with spontaneous SMH that was treated with PDT and eyes with SMH that occurred following PDT treatment. The presence of SMH did not preclude the patients from undergoing further PDT. RESULTS: Mean acuity of the spontaneous SMH group was 20/294 initially and 20/252 after 12 months. Mean acuity of the post-PDT SMH group was 20/336 initially and 20/406 after 12 months. Initial and 12-month acuities in both groups were not statistically different. Mean size of the hemorrhage was 11.5 mm2 in the spontaneous SMH group and 17.8 mm2 in the post-PDT SMH group. Subgroup analysis showed no statistically significant difference between initial and final visual acuities, regardless of the presence of blood under the fovea. Analysis by size of the SMH showed only the spontaneous SMH group with hemorrhages over 10 mm2 to have a statistically significant difference in visual acuity at 12 months (P= .0001; initial acuity, 20/230; 12-month acuity, 20/456). CONCLUSION: Eyes treated with PDT for choroidal neovascularization associated with submacular hemorrhage and AMD maintained stable vision over 12 months.

Bakri SJ, Sears JE, Lewis H. · Department of Ophthalmology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. · Graefes Arch Clin Exp Ophthalmol. · Pubmed #16871381 No free full text.

Abstract: BACKGROUND: To report the management of patients with a macular hole and submacular hemorrhage in the same eye. METHODS: Case reports of two eyes of two patients undergoing pars plana vitrectomy (PPV), subretinal injection of tissue plasminogen activator (t-PA) and air-fluid exchange to displace a submacular hemorrhage. In one eye with a submacular hemorrhage due to age-related macular degeneration, a macular hole formed during subretinal t-PA injection. In another patient with a submacular hemorrhage due to a ruptured retinal arterial macroaneurysm (RAM), a sub-internal limiting membrane (ILM) hemorrhage was noted, and a macular hole was found after peeling the ILM, overlying the subretinal hemorrhage. RESULTS: In the first case, after 45 min was allowed for the subretinal clot to liquefy, the macular hole was noted to be closed. A partial air-fluid exchange was performed and the patient was positioned upright, to displace the submacular hemorrhage and tamponade the macular hole. Two weeks later, visual acuity had improved from 20/400 with eccentric viewing to 20/100, the macular hole was closed by optical coherence tomography, and the patient subsequently underwent two sessions of verteporfin photodynamic therapy (PDT) to treat choroidal neovascularization detected by fluorescein angiography. At last follow-up 7 months after surgery, vision was 20/200, the CNV was active angiographically, and another session of PDT was performed. In the second case, PPV was combined with phacoemulsification and intraocular lens implantation. An 80% air-fluid exchange was performed after injecting the subretinal t-PA, the air was exchanged for 14% perfluoropropane gas, and the patient was positioned upright. Visual acuity improved from 20/400 to 20/200 at last follow-up 4 months after surgery, with the RAM spontaneously sclerosed and the macular hole closed clinically and angiographically. CONCLUSIONS: Intraoperative evacuation of subretinal hemorrhage is not necessary in cases with coexisting macular hole and submacular hemorrhage. The submacular hemorrhage can be displaced using air or gas, and the bubble can be used to tamponade the macular hole.

Bakri SJ, Beer PM. · Lions Eye Institute, Albany Medical College, 35 Hackett Boulevard, Albany, NY 12208, USA. · Int Ophthalmol. · Pubmed #15847312 No free full text.

Abstract: PURPOSE: To report the successful surgical outcome of two patients with a serous macular detachment and cystoid macular edema associated with a congenital optic nerve pit. METHOD: Case reports. Two patients with a serous macular detachment associated with a congenital optic nerve pit were treated with 360 degrees peripapillary endophotocoagulation during vitrectomy, attempted internal subretinal fluid drainage, and fluid-gas exchange. RESULTS: In both cases, the retina remained attached during a follow-up period of 6 months, and the patient's vision improved dramatically. One patient improved from the counting finger level to 20/70, and the other improved from 20/200 to 20/70. CONCLUSION: The use of 360 degrees peripapillary endophotocoagulation after pars plana vitrectomy for the treatment of optic nerve pit associated retinal detachment resulted in excellent visual acuity and anatomic reattachment. Attempted internal subretinal fluid drainage was unsuccessful and did not contribute to the success of the case.

Bakri SJ, Kaiser PK. · Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio 4195, USA. · Am J Ophthalmol. · Pubmed #15733990 No free full text.

Abstract: PURPOSE: To evaluate posterior subtenon injection of triamcinolone acetonide for refractory diabetic macular edema (DME). DESIGN: Retrospective, interventional, case series. METHODS: SETTING: Clinical practice. PATIENT POPULATION: Patients with persistent clinically significant DME involving the center of the fovea 3 or more months after one or more treatments of focal macular photocoagulation were included. Exclusion criteria were a history of corticosteroid-responsive intraocular pressure (IOP) rise, intraocular surgery within 3 months, and any laser treatment within 1 month. PROCEDURE: All patients received an ophthalmic history and examination including best-corrected Snellen visual acuity, IOP measurement, anterior segment examination including evaluation of lens status with LOCS II criteria, dilated fundus examination, and a posterior subtenon injection of 40 mg triamcinolone acetonide at baseline. Patients were reevaluated at 1, 3, 6, and 12 months after injection. RESULTS: Seventy-three injections were performed in 63 eyes of 50 patients. The mean baseline visual acuity was 20/80. Mean visual acuity significantly improved to 20/50 at 1 month, then stabilized to 20/65 at 3 months, 20/68 at 6 months, and 20/63 at 12 months. Complications were rare, with a transient significant rise in intraocular pressure at the 3-month evaluation and ptosis in two patients. CONCLUSIONS: Visual acuities remained stable or improved over a 12-month period after posterior subtenon triamcinolone injections for refractory DME. There was a statistically significant improvement in visual acuity at 1 month.

Bakri SJ, Beer PM. · Lions Eye Institute, Albany Medical College, Albany, NY 12208, USA. · Can J Ophthalmol. · Pubmed #15696765 No free full text.

Abstract: BACKGROUND: A significant number of eyes with diabetic macular edema remain refractory to treatment despite numerous attempts at photocoagulation. Triamcinolone acetonide, a minimally water soluble steroid injected in suspension form, has been reported to be a well-tolerated agent for intravitreal injection, prompting a decrease in diabetic macular edema on optical coherence tomography. We report our experience with this treatment in 19 eyes with persistent diabetic macular edema. METHODS: We reviewed the charts of 16 patients (19 eyes) from a clinical practice with diabetic macular edema persistent after focal or grid laser photocoagulation. All eyes had received 4 mg of triamcinolone, injected into the vitreous cavity 3.5 mm posterior to the limbus. Fluorescein angiography was performed before and about 2 weeks after the injection. Snellen visual acuity and intraocular pressure (as determined with Goldmann applanation tonometry) were also measured before and after the injection. RESULTS: Fluorescein angiography showed marked improvement of macular edema in 4 eyes (21.0%), mild improvement in 10 eyes (52.6%) and no change in 5 eyes (26.3%); no patient had worsening of macular edema. Visual acuity improved by at least 1 line in 13 eyes (68.4%), by 2 or more lines in 5 eyes (26.3%), by 3 or more lines in 2 eyes (10.5%) and by 4 lines in 1 eye (5.3%); visual acuity remained unchanged in 5 eyes (26.3%) and deteriorated by 1 line in 1 eye (5.3%). Intraocular pressure elevation of 10 mm Hg or greater occurred in two eyes (10.5%) and was successfully treated with topical administration of 0.15% brimonidine.The triamcinolone was well tolerated, and there were no other ocular complications. INTERPRETATION: Intravitreal injection of triamcinolone has potential in the treatment of diabetic macular edema and warrants investigation in a randomized prospective clinical trial.

Bakri SJ, Beer PM. · Retina Division, Lions Eye Institute, Albany Medical College, Albany, NY 12208, USA. · Eye. · Pubmed #15359269 No free full text.

Abstract: BACKGROUND/AIMS: To describe the clinical outcomes of four eyes with macular oedema due to radiation retinopathy treated with verteporfin photodynamic therapy (PDT). METHODS: Interventional Case Series. Four charts of four patients who underwent PDT for macular oedema due to radiation retinopathy were reviewed. Snellen visual acuities, clinical examination and fundus photographs were performed before and after PDT. Main outcome measures were visual acuity, clinical examination before and after PDT. RESULTS: All four eyes had a marked reduction in hard exudates. Three of four eyes had an improvement in vision following the PDT. CONCLUSION: PDT may have a role in the treatment of macular oedema due to radiation retinopathy.

Bakri SJ, Shah A, Falk NS, Beer PM. · Lions Eye Institute, Albany Medical College, Albany, New York, USA. · Eye. · Pubmed #15332099 No free full text.

Abstract: PURPOSE: To report the use of commercially available preservative-free intravitreal triamcinolone acetonide for the treatment of macular oedema due to retinal vascular diseases. DESIGN: Retrospective interventional case series. METHODS: Charts of eyes that received 4 mg preservative-free intravitreal triamcinolone acetonide for the treatment of persistent macular oedema due to retinal vascular diseases were reviewed. Patients were included if they had a follow-up of at least 3 months. Visual acuity, intraocular pressure, presence of an anterior chamber reaction, and mean macular thickness on optical coherence tomography (OCT) were recorded. RESULTS: A total of 10 eyes of 10 patients were identified. Visual acuity improved by a mean of 1.1 Snellen lines at 1 month and 1.3 lines at 3 months. Macular thickness on OCT decreased by a mean of 183.5 microm at 1 month (P<0.0001). Intraocular pressure increased from a mean of 13.5 mmHg at baseline to 15.3 at 1 month, and 14.5 at 3 months. Only the 1-month change in intraocular pressure was statistically significant (P=0.0274). There were no cases of endophthalmitis, anterior chamber reaction, or retinal detachment. CONCLUSION: In this small retrospective, noncomparative series, commercially available preservative-free intravitreal triamcinolone acetonide had no adverse outcomes. Macular oedema was noted to decrease following treatment.

Beer PM, Bakri SJ, Singh RJ, Liu W, Peters GB, Miller M. · Department of Ophthalmology, Lions Eye Institute, Albany Medical College, Albany, New York, USA. · Ophthalmology. · Pubmed #12689886 No free full text.

Abstract: PURPOSE: To describe the pharmacokinetics occurring after the direct injection of triamcinolone acetonide into the vitreous humor of humans. DESIGN: Interventional case series. PARTICIPANTS: Five patients who received a single 4-mg intravitreal injection of triamcinolone acetonide. METHODS: An aqueous humor sample was obtained from 5 eyes via an anterior chamber paracentesis at days 1, 3, 10, 17, and 31 after injection. At each visit, visual acuity and intraocular pressure were measured and indirect ophthalmoscopy was performed. A fluorescein angiogram was carried out at day 10. Concentrations were determined using high performance liquid chromatography; pharmacokinetic analysis was carried out using PK Analyst, an iterative, nonlinear, weighted, least-squares regression program. MAIN OUTCOME MEASURES: Intraocular concentrations of triamcinolone were measured and population pharmacokinetic parameters were calculated. RESULTS: Pharmacokinetic data followed a two-compartment model. Peak aqueous humor concentrations ranged from 2151 to 7202 ng/ml, half-lives from 76 to 635 hours, and the integral of the area under the concentration-time curve (AUC(0-t)) from 231 to 1911 ng/h per milliliter. After a single intravitreal injection of triamcinolone, the mean elimination half-life was 18.6 days in nonvitrectomized patients. The half-life in a patient who had undergone a vitrectomy was shorter at 3.2 days. CONCLUSIONS: There was considerable intrasubject variation among peak concentration, AUC(0-t) values, and elimination half-lives. After intravitreal injection, measurable concentrations of triamcinolone would be expected to last for approximately 3 months (93 +/- 28 days) in the absence of a vitrectomy. Because triamcinolone pharmacokinetics were characterized only in elderly patients with macular edema, the results cannot be extrapolated to other patient populations.

Ekdawi NS, Bakri SJ. · No affiliation provided · Eye. · Pubmed #17585312 No free full text.

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Bakri SJ, Patel SP. · No affiliation provided · Eye. · Pubmed #17187026 No free full text.

This publication has no abstract.