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Albert J Augustin

Publications and source records attributed to Albert J Augustin.

11 recordsLinked to original sources
PubMed2006

Verteporfin and intravitreal triamcinolone acetonide combination therapy for occult choroidal neovascularization in age-related macular degeneration.

PURPOSE: To evaluate the efficacy and safety of photodynamic therapy (PDT) with verteporfin combined with intravitreal triamcinolone (IVTA) in occult choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). DESIGN: Single center, nonrandomized interventional case series. METHODS: A prospective, noncomparative, interventional case series of 41 eyes of 41 patients with a two-year follow-up period. Verteporfin PDT was performed using the recommended standard procedure for approved forms of AMD. A solution containing 25 mg of crystalline triamcinolone acetonide was injected intravitreally 16 hours post PDT. The procedure was repeated after three months in case of persistent CNV leakage. RESULTS: The mean number of treatments needed was 1.8. Thirty-four eyes (82.9%) required one retreatment at three months. No additional retreatments were necessary. Visual acuity improved gradually in most of the patients with mean values of 20/133 and 20/115 at baseline and three months; 20/101 and 20/84 at six and twelve months; and 20/83 and 20/81 at eighteen and twenty-four months. Eleven of 41 treated study eyes (26.8%) underwent cataract surgery between six and fifteen months after the first treatment. Nine patients required local or systemic glaucoma therapy because of a transient steroid induced intraocular pressure increase. CONCLUSIONS: Verteporfin PDT combined with intravitreal triamcinolone may improve the outcome of standard verteporfin PDT in the treatment of occult CNV secondary to AMD. An improvement in visual acuity was observed in most of the treated patients and was maintained during a two-year follow-up period. Retreatment numbers were lower than expected from monotherapy trials.

Aged↗
PubMed2006

Emerging drugs for age-related macular degeneration.

Age-related macular degeneration (AMD) is a leading cause of blindness that until recently had no recognised drug treatment. In wet AMD, choroidal neovascularisation (CNV) causes a profound loss of central vision. CNV is a complex process in which tissue ischaemia and/or inflammation is thought to trigger production of angiogenic signal molecules. The release of VEGF appears to be particularly important. Verteporfin photodynamic therapy was the first drug therapy to be licensed for the treatment of some types of wet AMD. Other treatments directly targeting VEGF or other aspects of angiogenesis, such as pegaptanib, ranibizumab and anecortave acetate, have either recently been licensed or are in the advanced stages of development. These and other promising treatment options such as combination strategies are reviewed.

Aging↗
PubMed2005

Verteporfin therapy combined with intravitreal triamcinolone in all types of choroidal neovascularization due to age-related macular degeneration.

OBJECTIVE: To evaluate the efficacy and safety of photodynamic therapy with verteporfin combined with intravitreal triamcinolone in choroidal neovascularization secondary to age-related macular degeneration (AMD). DESIGN: Prospective, noncomparative, interventional case series. PARTICIPANTS: One hundred eighty-four patients undergoing treatment for neovascular AMD at one retinal referral center. METHODS: One hundred eighty-four eyes of 184 consecutive patients (63.6% female, 36.4% male) with a mean age of 76.5 years and a follow-up of a median of 38.8 weeks (range, 12-103) were included in a case series. One hundred forty-eight (80.4%) patients had subfoveal choroidal neovascularization, 19 patients (10.3%) had juxtafoveal choroidal neovascularization, and 17 patients (9.2%) had extrafoveal choroidal neovascularization. Verteporfin photodynamic therapy was performed using the recommended standard procedure. A solution containing 25 mg of triamcinolone was injected intravitreally 16 hours after photodynamic therapy in 184 patients. The combined therapy procedure was repeated at the 3-month follow-up visits whenever persistent choroidal neovascularization leakage was documented angiographically. MAIN OUTCOME MEASURES: Mean change in best-refracted visual acuity (VA) between baseline and the last visit, and number of treatments necessary to achieve absence of leakage. RESULTS: Visual acuity improved in the majority of patients (baseline VA, mean 20/125) by a mean increase of 1.22 Snellen lines and 1.43 lines using laser interferometry (P<0.01). The mean number of required treatments was 1.21. Twenty-three eyes (12.5%) required 2 treatments, 6 eyes (3.26%) required 3 treatments, and 1 eye (0.5%) required 4 treatments. The combination treatment including laser and intravitreal steroid administration was well tolerated. Forty-six patients (25%) required glaucoma therapy due to a transient steroid-induced intraocular pressure (IOP) increase. Twelve patients (6.5%) were on topical medication for preexisting glaucoma. Two patients (1%) whose IOP increase could not be controlled with topical therapy required surgery. CONCLUSIONS: Verteporfin photodynamic therapy combined with intravitreal triamcinolone may improve the outcome of standard verteporfin photodynamic therapy in the treatment of choroidal neovascularization secondary to AMD. A significant improvement in VA was observed in a majority of treated patients and was maintained during the maximum follow-up. In addition, retreatment rates were lower than anticipated.

Aged↗
PubMed2005

Comparison of the original Amsler grid with the modified Amsler grid: result for patients with age-related macular degeneration.

PURPOSE: To compare the sensitivity of the original Amsler grid presenting white lines on a black background with that of the modified standard version of the grid presenting black lines on a white background in the detection of visual disturbances. PATIENTS AND METHODS: One hundred eighty-two patients (182 eyes) with dry and exudative age-related macular degeneration and a history of metamorphopsia were instructed to use an Amsler grid. None of the patients were familiar with an Amsler grid or had used it previously. If the disease was present in both eyes, one eye was chosen as the study eye by randomization. Both grid types were presented and used for documentation of central visual field changes. The sequence of presentation of the respective grid was also chosen by randomization. Original Amsler grid questions were used for grading ("metamorphomas" and "scotomas"). Visual acuity of patients ranged from 0.1 to 0.7. Subgroup analysis was performed based on the visual acuity levels. RESULTS: For the overall study population, the original Amsler grid provided significantly better results than the modified version. Evaluation of data for the different subgroups showed no significant difference between patients with visual acuity ranging from 0.1 to 0.3. For patients with visual acuity of 0.5 or better, the original Amsler grid was significantly more informative and reliable than the modified version. CONCLUSION: For patients with macular diseases, use of the original Amsler grid (white lines on a black background) should be recommended. This is particularly important for patients with visual acuity of 0.5 or better.

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PubMed2004

Safety of posterior juxtascleral depot administration of the angiostatic cortisene anecortave acetate for treatment of subfoveal choroidal neovascularization in patients with age-related macular degeneration.

BACKGROUND: Anecortave acetate is a synthetic derivative of cortisol, but very specific and irreversible chemical modifications to the cortisol structure have resulted in the creation of a potent inhibitor of blood vessel growth with no evidence non-clinically or clinically of glucocorticoid receptor-mediated bioactivity. The clinical safety of Anecortave Acetate administered as a posterior juxtascleral depot every 6 months for up to 4 years is reviewed in this manuscript. METHODS: Clinical safety and efficacy of the novel angiostatic agent Anecortave Acetate for Depot Suspension was evaluated in patients with subfoveal exudative age-related macular degeneration (AMD) in a masked, randomized, dose-duration clinical trial completed in June 2003. This safety and efficacy study enrolled and treated 128 patients at 18 clinical sites in the US and EU. This was the first clinical trial of Anecortave Acetate for Depot Suspension administered as a posterior juxtascleral depot. Assessments of clinical safety were made with general physical examinations including electrocardiograms and hematology/serum chemistry/urinalysis, detailed ophthalmic evaluations with fluorescein/indocyanine green angiography and assessments of best-corrected logMAR visual acuity. All safety reports have been reviewed periodically by an Independent Safety Committee responsible for overseeing these activities. RESULTS: No clinically relevant safety issues related to either Anecortave Acetate for Depot Suspension or the administration procedure have been identified by an Independent Safety Committee. The most frequent safety issues reported were cataractous changes, decreased visual acuity, ptosis, ocular pain, abnormal vision and subconjunctival hemorrhage, but the majority of these were assessed as unrelated to treatment. CONCLUSIONS: Anecortave Acetate for Depot Suspension (3, 15 and 30 mg) is clinically safe following administration and re-administration at 6-month intervals as a posterior juxtascleral depot using a specially designed curved cannula.

Angiogenesis Inhibitors↗
PubMed2004

Oxidative tissue damage after phacoemulsification: influence of ophthalmic viscosurgical devices.

PURPOSE: To quantify the oxidative tissue damage after phacoemulsification, correlate the damage to the energy applied, and investigate the influence of ophthalmic viscosurgical devices (OVDs). SETTING: Department of Ophthalmology, University of Mainz, Mainz, Germany. METHODS: The study comprised 130 eyes operated on by 1 surgeon using the same phacoemulsification machine. Some eyes received an OVD before phacoemulsification and some did not. Energy values were expressed as phaco time; that is, ultrasound (US) time (seconds) after conversion to 100% phaco power. Patients were grouped as follows: Group 1, phaco time less than 20 seconds and no OVD; Group 2, phaco time 20 to 40 seconds and no OVD; Group 3, phaco time more than 40 seconds and no OVD; Group 4, phaco time 20 to 40 seconds and hydroxypropyl methylcellulose 2% (HPMC); Group 5, phaco time 20 to 40 seconds and sodium hyaluronate 1%. Aqueous humor from pseudophakic eyes served as a control. At the end of surgery, anterior chamber fluid was analyzed for lipid peroxides using the thiobarbituric acid method. RESULTS: Lipid peroxides were detected in all groups. The values were significantly higher in Group 2 than in Group 1 (P<.01) and in Group 3 than in Groups 1 and 2 (P<.01). The differences in lipid peroxide values between all phaco groups and the control group were statistically significant. Sodium hyaluronate 1% and HPMC 2% produced significantly lower lipid peroxide values than in the respective phaco groups that did not receive an OVD (both P<.01). CONCLUSIONS: Oxidative tissue damage occurred during phacoemulsification. The damage, which correlated with the US energy applied, can be reduced by the use of OVDs.

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PubMed2002

Photodynamic therapy for symptomatic choroidal hemangioma: visual and anatomic results.

OBJECTIVE: To document the anatomic and functional outcome of photodynamic therapy (PDT) in symptomatic choroidal hemangioma DESIGN: Prospective, noncomparative, interventional case series. PARTICIPANTS: Fifteen patients with circumscribed choroidal hemangioma of the posterior pole presenting with progressive vision loss caused by exudation into the macular area. INTERVENTION: PDT using 6 mg/m(2) body surface area verteporfin and a light dose of 100 J/cm(2) at 692 nm was performed. One to four treatments with a single laser spot were applied in 6-week intervals. A standardized evaluation was provided before and at 6-week intervals after each treatment, at 3, 6, and 12 months, and a mean follow-up 19 months after the last application. MAIN OUTCOME MEASURES: Functional tests included best-refracted visual acuity (Early Treatment of Diabetic Retinopathy Study criteria) and scanning laser scotometry. Anatomic results were documented by ophthalmoscopy, fluorescein/indocyanine green angiography, and ultrasonography. RESULTS: A complete regression of the vascular mass was achieved in all eyes after the last course of one to four consecutive treatments. Tumors (mean height, 3.8 mm) responded with a reproducible decrease in size to each treatment, with the most intensive effect seen after the first application. Progressive occlusion of the angiomatous net without recanalization was documented angiographically. Two patients had stable vision with resolution of metamorphopsia; 13 patients demonstrated visual recovery. An overall visual acuity (VA) improvement of an average of 3 lines was documented, with a mean VA level of 20/125 before treatment and 20/80 after therapy. Visual fields showed withdrawal of central scotomas from the macula. No recurrence was seen during a follow-up for up to 50 months. CONCLUSIONS: PDT using verteporfin offers a safe and effective option to treat choroidal hemangiomas. Complete anatomic regression with persistent absence of leakage is associated with substantial improvements in vision.

Adult↗
PubMed2002

[The significance of oxidative mechanisms in diseases of the retina].

The eye is at high risk to be damaged by oxidative mechanisms. One major reason is the exposure to light throughout life. Anterior segment structures are mostly exposed to UV light. Visible blue light is believed to be a significant damaging mechanism for the retina. The biochemical composition of the posterior segment structures (unsaturated fatty acids) is an important factor making the eye more susceptible than other organs. Damaging mechanisms such as xanthin oxidase mechanisms are responsible for damage occurring in ischaemic diseases. These mechanisms are well known from diseases of other organs. Ischaemic processes are no longer believed to be the primary damaging mechanisms in diabetic retinopathy. Here, advanced glycation end products (AGE's) and related products may induce oxidative reactions and the expression of growth factors. In age-related macular degeneration photodynamic processes occurring already in childhood are believed to be a major factor contributing to the pathogenesis of the disease process. In addition, the expression of growth factors and new vessel growth can be initiated via inflammatory reactions or oxidative metabolites. In this manuscript we give an overview on oxidative mechanisms involved in the pathogenesis of retinal diseases. Different therapeutical and preventive approaches such as the results of the ARED-Study and possible side effects are discussed.

Adult↗