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PHACOEMULSIFICATION CATARACT SURGERY WITH PROPHYLACTIC INTRAVITREAL BEVACIZUMAB FOR PATIENTS WITH COEXISTING DIABETIC RETINOPATHY: A Meta-Analysis.
Feng, Y, Zhu, S, Skiadaresi, E, McAlinden, C, Tu, R, Gao, R, Stephens, JW, Wang, Q, Huang, J
Retina (Philadelphia, Pa.). 2019;(9):1720-1731
Abstract
PURPOSE To evaluate the clinical effectiveness of intravitreal bevacizumab (IVB) injection combined with cataract surgery in the treatment of patients with cataract and coexisting diabetic retinopathy (DR). METHODS Pertinent comparative studies were identified through systemic searches of PubMed, EMBASE, and the Cochrane Controlled Trials Register up to March 1, 2016. Outcome measures included corrected distance vision acuity, central macular thickness, and progression of DR and maculopathy. A meta-analysis was performed using RevMan (Cochrane Collaboration, Oxford, United Kingdom). RESULTS Six studies describing a total of 283 eyes were identified. The meta-analysis results showed that corrected distance vision acuity measured at 1 month and 3 months after cataract surgery was significantly better in the IVB groups than in the control groups (P < 0.00001 and P = 0.01), whereas the corrected distance vision acuity at 6 months did not vary significantly between the 2 groups (P = 0.24). Similarly, the central macular thickness at 1, 3, and 6 months after surgery was significantly thinner in the IVB groups than in the control groups (P = 0.01, P = 0.0004, and P = 0.01, respectively). At 6 months, the progression of postoperative DR and maculopathy occurred more frequently in the control group than in the IVB group (P = 0.0001 and P < 0.0001, respectively). CONCLUSION Our meta-analysis indicates that cataract surgery combined with IVB seems to be an effective treatment in patients with coexisting DR in the short term (up to 6 months). More randomized, prospective, and large-sample-sized trials are needed to evaluate the long-term effects of IVB at the time of cataract surgery in patients with DR.
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2.
Medical and sclerosing agents in the treatment of orbital lymphatic malformations: what's new?
Lam, SC, Yuen, HKL
Current opinion in ophthalmology. 2019;(5):380-385
Abstract
PURPOSE OF REVIEW Currently, there is no ideal management for orbital lymphatic malformations. Significant advances have been made since the discovery of new agents in the treatment. The purpose of this manuscript is to review the recent evidence on new sclerotherapy agents and systemic medications. RECENT FINDINGS Traditional sclerosants are OK-432, sodium tetradecyl sulphate and ethanol. More recent developments are the use of doxycycline, bleomycin, and pingyangmycin. Sirolimus as a systemic medication has revolutionized the medical management of lymphatic malformations. Other oral drugs such as propranolol and sildenafil are controversial. Future treatment involves targeting lymphangiogenic pathways including inhibition of vascular endothelial growth factors and the phosphatidylinositol 4,5-bisphosphate 3-kinase catalytic subunit. SUMMARY The development of new agents allows multimodal management either as monotherapy or combined therapy to achieve better outcomes in this difficult to manage disease.
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3.
The Diabetic Retinopathy Clinical Research Network (DRCR.net) and Its Contributions to the Treatment of Diabetic Retinopathy.
Sun, JK, Jampol, LM
Ophthalmic research. 2019;(4):225-230
Abstract
Over the past two decades, the Diabetic Retinopathy Clinical Research Network (now known as the DRCR Retina Network) has contributed to multiple and substantial advances in the clinical care of diabetic eye disease. Network studies helped establish anti-vascular endothelial growth factor (VEGF) agents as an effective alternative to panretinal photocoagulation for eyes with proliferative diabetic retinopathy (PDR) and as first-line therapy for eyes with visual impairment for diabetic macular edema (DME), defined treatment algorithms for the use of intravitreal medications in these conditions, and provided critical data to understand how to better evaluate the diabetic eye using optical coherence tomography and other imaging modalities. Ongoing DRCR.net studies will address whether anti-VEGF therapy is effective at preventing vision-threatening complications in eyes with severe non-proliferative diabetic retinopathy, if photobiomodulation has a beneficial effect in eyes with DME, and whether initiation of DME treatment with bevacizumab and rescue with aflibercept can provide visual outcomes as good as those achieved with aflibercept alone. Future plans for the Network also include the expansion into non-diabetic eye disease in areas such as age-related macular degeneration.
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4.
Angiogenesis Process in Osteosarcoma: An Updated Perspective of Pathophysiology and Therapeutics.
Li, YS, Liu, Q, Tian, J, He, HB, Luo, W
The American journal of the medical sciences. 2019;(4):280-288
Abstract
In this review, we discuss the pathologic mechanism of the angiogenesis process in osteosarcoma (OS) and the therapeutic use of angiogenesis inhibitors in OS treatment. The activation of endothelial cells by angiogenic factors leads to the production of proteolytic enzymes, which degrade the extracellular matrix. The degradation of the underlying basement membrane enables endothelial cells to proliferate and migrate to the surrounding tissue to form new vessels. These new vessels provide cancer cells with oxygen and nutrition and play an important role in cancer cell survival and metastasis. Thus, antiangiogenic therapies might be an interesting approach in OS therapeutics.
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The medical treatment of radioiodine-refractory differentiated thyroid cancers in 2019. A TUTHYREF® network review.
de la Fouchardiere, C, Alghuzlan, A, Bardet, S, Borget, I, Borson Chazot, F, Do Cao, C, Godbert, Y, Leenhardt, L, Zerdoud, S, Leboulleux, S
Bulletin du cancer. 2019;(9):812-819
Abstract
Patients with radioiodine-refractory (RAIR) differentiated thyroid carcinoma (DTC) represent a challenging subgroup of DTC because they are at higher risk of cancer-related death. Multidisciplinary discussions can assess the role and the nature of local treatments, but also determine the optimal timing for first-line antiangiogenic therapy as some of these patients can be followed for several months or years without any treatment. In this review, we will examine the definition of RAIR-DTC, the different treatment options and finally some of the most recent cancer research breakthroughs for RAIR-DTC.
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6.
Drug-Induced Hypertension.
Foy, MC, Vaishnav, J, Sperati, CJ
Endocrinology and metabolism clinics of North America. 2019;(4):859-873
Abstract
Untoward side effects of pharmaceuticals can result in considerable morbidity and expense to the health care system. There is likely a sizable fraction of the hypertensive population with disease either induced or exacerbated by polypharmacy. The elevation of blood pressure in drug-induced hypertension occurs through a variety of mechanisms, most notably, sodium and fluid retention, activation of the renin-angiotensin-aldosterone system, alteration of vascular tone, or a combination of these pathways. Recognition of common medications causing drug-induced hypertension is important to effectively control blood pressure. The epidemiology, pathophysiology, and management of these agents are discussed.
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First-line treatment algorithm and guidelines in center-involving diabetic macular edema.
Kodjikian, L, Bellocq, D, Bandello, F, Loewenstein, A, Chakravarthy, U, Koh, A, Augustin, A, de Smet, MD, Chhablani, J, Tufail, A, et al
European journal of ophthalmology. 2019;(6):573-584
Abstract
Management of center-involving diabetic macular edema represents a real therapeutic challenge. Diabetic macular edema is the leading cause of visual acuity impairment in diabetic patients. Since the advent of intravitreal drugs, management of diabetic macular edema has significantly evolved. The historical grid laser photocoagulation is no longer recommended as first-line treatment of diabetic macular edema owing to the findings of the pivotal randomized controlled trials, and anti-vascular endothelial growth factor therapy has emerged as first-line therapy. Steroids also represent a valid treatment option in the management of naïve diabetic macular edema and their efficacy has also been confirmed in several studies. The optimal treatment for diabetic macular edema should consider both general and ophthalmological comorbidities. Patient compliance and motivation should also be carefully evaluated as some treatments require monthly follow-up. Based on recent literature evidence, the present review provides clinicians with a first-line treatment algorithm for center-involving diabetic macular edema tailored to the patient's individual characteristics.
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8.
Treatment of Diabetic Macular Edema.
Kim, EJ, Lin, WV, Rodriguez, SM, Chen, A, Loya, A, Weng, CY
Current diabetes reports. 2019;(9):68
Abstract
PURPOSE OF REVIEW Diabetes mellitus is a global epidemic which is growing in prevalence, and diabetic macular edema (DME) is a leading cause of visual impairment among patients affected by this disease. Our objective is to review current and upcoming therapeutic approaches to DME. RECENT FINDINGS Once considered the gold standard in treatment of DME, focal/grid laser is now reserved mostly for non-center-involving DME, while anti-vascular endothelial growth factor (anti-VEGF) therapy has become the first-line treatment. However, suboptimal responders to anti-VEGF and the burden of frequent injections have stimulated the development of novel approaches. Corticosteroids can be effective in treating DME, but adverse effects such as intraocular pressure elevation and cataract formation must be considered. Emerging therapeutics and drug delivery systems in the pipeline offer exciting potential solutions to this vision-threatening disease. Multiple types of therapeutics targeting various pathways implicated in the pathogenesis of DME may help lessen the global burden of vision loss from diabetes.
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9.
[Focus: Drug-related osteonecrosis of the jaw].
Schmouchkovitch, A, Remaud, M, Simon, H, Herry, H, Le Toux, G, Boisramé, S
Presse medicale (Paris, France : 1983). 2018;(1):19-33
Abstract
Antiresorptives and antiangiogenics are treatments that have proven effective in oncology and the treatment of osteoporosis and they are increasingly prescribed. The care of these patients requires collaboration between the prescriber and the oral health professional to establish an optimized treatment plan. Therapeutic education of the patient is essential for him to understand the issues of good oral health and the adverse effects that can be caused by these treatments. The management is essentially based on the individual benefit/risk balance resulting from the general, local and inherent of the molecule risk factors. Management of drug-related osteonecrosis of the jaw should be as early as possible.
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10.
Recent clinically relevant highlights from the Diabetic Retinopathy Clinical Research Network.
Krick, TW, Bressler, NM
Current opinion in ophthalmology. 2018;(3):199-205
Abstract
PURPOSE OF REVIEW To present some recent clinically relevant results from Diabetic Retinopathy Clinical Research (DRCR) Network trials that may guide management of diabetic macular edema (DME) or proliferative diabetic retinopathy (PDR). RECENT FINDINGS Among eyes with DME and visual acuity 20/50 or worse, aflibercept, on average, had greater improvement in visual acuity over 2 years compared with bevacizumab or ranibizumab. Aflibercept is associated with higher rates of improvements in diabetic retinopathy severity among eyes with PDR and vision-impairing DME at baseline compared with bevacizumab or ranibizumab. Among eyes with persistent central-involved DME after at least six antivascular endothelial growth factor (anti-VEGF) injections, no difference in mean visual acuity improvement was observed between eyes that received continued ranibizumab and sham injections versus ranibizumab and intravitreous sustained dexamethasone drug-delivery system, especially for phakic eyes. For eyes with PDR, ranibizumab was associated with lower rates of developing PDR-worsening events compared with panretinal photocoagulation, especially among eyes that did not receive ranibizumab for central-involved DME at baseline. Ranibizumab is cost-effective for PDR for eyes with, not without, vision-impairing central-involved DME, highlighting challenges when safety and efficacy results are at odds with cost-effectiveness results. SUMMARY Aflibercept for DME, in certain circumstances, is more likely to have superior visual acuity and anatomical outcomes compared with bevacizumab or ranibizumab. No vision benefits are apparent, especially for phakic eyes, by adding intravitreous corticosteroids for persistent DME following anti-VEGF injections.