CFT is a sensitive and early predictor of VA deterioration. Four letters of acute VA loss seems to be a critical limit. VA loss of ≥ 4 letters appears to be associated with incomplete recovery. Eyes with <1 line of gain at the end of the loading phase should be considered for continuation of treatment at months 3 and 4. According to our calculations an average number of 8.4 injections/eye seems to be necessary to maintain stabilization of vision in the first year of treatment.
Treating CNV secondary to PM with ranibizumab during a follow-up of 36 months, we found considerable improvement of visual acuity. Compared to treatment of CNV secondary to exudative age-related macular degeneration, CNVs secondary to PM seem to respond faster to ranibizumab treatment and less injections are neccessary to reach stabilization.
The heterogeneity of available clinical data does not allow a definitive comparison of the 3 heavier-than-water endotampondes. The data so far available seem to indicate as a trend that Densiron 68 may provide advantages compared to other substances concerning the relative incidence of severe complications. On the background of relatively high rates of heavy silicone complications it seems reasonable to regard conventional "light" silicones as first choice if a silicone endotamponade is desired and no need for a gravity effect of the endotamponade is indicated.
The current standard treatment of choroidal neovascularisation (CNV) secondary to pathological myopia (PM) is intravitreal injection of VEGF antagonists. We now present our 6-year results after treating patients with CNV secondary to PM with ranibizumab. We retrospectively analysed 15 treatment-naive eyes of 13 patients (10 women, 3 men, mean age 59.2; standard deviation (SD) 11.1; range 41-78 years) with visual impairment related to CNV secondary to PM, who were treated with at least 1 injection of ranibizumab. Follow-up treatments were indicated according to our PRN (pro re nata) regimen. Re-treatment criteria were: reduction in visual acuity and/or activity in OCT or fluorescence angiography. Patients received a mean of 3.5 ranibizumab injections (SD 3.4; range 1-12) during a mean follow-up of 85 months (SD 6.6; range 76-102 months). Initial spherical equivalent was - 12.4 ± 4.0 dpt (range - 7.5 to 20.5 dpt). Baseline visual acuity was (log MAR) 0.65 ± 0.28. After one month, visual acuity improved to 0.43 ± 0.23 (p = 0.002), after 3 months to 0.38 ± 0.22 (p = 0.002), after 6 months to 0.34 ± 0.22 (p = 0.002) and after 9 months to 0.35 ± 0.23 (p = 0.002). After 1 year, visual acuity was 0.35 ± 0.24 (p = 0.001), after 2 years 2 0.35 ± 0.23 (p = 0.001), after 3 years 0.35 ± 0.23 (p = 0.002), after 4 years 0.37 ± 0.23 (p = 0.002), after 5 years 0.38 ± 0.23 (p = 0.002), and after 6 years 0.39 ± 0.26 (p = 0.016). After considerable initial improvement in visual acuity, the initial gain was maintained by a strict PRN regimen for the observation and treatment of patients with neovascular membranes secondary to pathological myopia. The number of injections needed to achieve stable visual acuity was lower than with other diseases that respond to anti-VEGF.
Inhibition of the angiotensin II-receptor(1) diminishes the deleterious effects of ischaemia and reperfusion on glomerular function and on the renal microcirculation. An involvement of the NO system could not be demonstrated.
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