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Biomedical subjects

Philip J Ferrone

Publications and source records attributed to Philip J Ferrone.

11 recordsLinked to original sources
PubMed2006

Ranibizumab combined with verteporfin photodynamic therapy in neovascular age-related macular degeneration: year 1 results of the FOCUS Study.

OBJECTIVE: To investigate the safety and efficacy of intravitreal ranibizumab treatment combined with verteporfin photodynamic therapy (PDT) in patients with predominantly classic choroidal neovascularization secondary to age-related macular degeneration. METHODS: In this 2-year, phase I/II, multicenter, randomized, single-masked, controlled study, patients received monthly ranibizumab (0.5 mg) (n = 106) or sham (n = 56) injections. The PDT was performed 7 days before initial ranibizumab or sham treatment and then quarterly as needed. MAIN OUTCOMES MEASURES: Proportion of patients losing fewer than 15 letters from baseline visual acuity at 12 months (primary efficacy outcome) and the incidence and severity of adverse events. RESULTS: At 12 months, 90.5% of the ranibizumab-treated patients and 67.9% of the control patients had lost fewer than 15 letters (P<.001). The most frequent ranibizumab-associated serious ocular adverse events were intraocular inflammation (11.4%) and endophthalmitis (1.9%; 4.8% if including presumed cases). On average, patients with serious inflammation had better visual acuity outcomes at 12 months than did controls. Key serious nonocular adverse events included myocardial infarctions in the PDT-alone group (3.6%) and cerebrovascular accidents in the ranibizumab-treated group (3.8%). CONCLUSION/APPLICATION TO CLINICAL PRACTICE: Ranibizumab + PDT was more efficacious than PDT alone for treating neovascular age-related macular degeneration. Although ranibizumab treatment increased the risk of serious intraocular inflammation, affected patients, on average, still experienced visual acuity benefit.

Aged↗
PubMed2005

Near confluent laser photocoagulation for the treatment of threshold retinopathy of prematurity.

OBJECTIVE: To evaluate the effect of a near confluent pattern of indirect laser photocoagulation in reducing the rate of progression and re-treatment of threshold retinopathy of prematurity. METHODS: This study examined a noncomparative interventional case series. We performed a retrospective review of the medical records of patients who underwent peripheral laser ablation by 1 surgeon for threshold retinopathy of prematurity from 1997 to 2002. A total of 58 eyes from 31 patients were treated, and 44 eyes of 23 patients were included in the study. Ten eyes of 5 infants had zone 1 disease, and 34 eyes of 18 infants had zone 2 disease. Laser spots were placed in a near confluent pattern in the peripheral avascular retina between the ridge of extraretinal proliferation and the ora serrata. The mean +/- SD number of laser spots was 2534 +/- 455 for zone 1 (range, 2100-3378) and 1850 +/- 487 for zone 2 (range, 1030-2689). RESULTS: In 7 eyes of 4 infants with zone 1 disease, the retinopathy regressed and did not require any further treatment. Three eyes of 2 infants, however, progressed after laser treatment and required vitrectomy surgery. Progression was defined as the development of stage 4 or 5 disease. None of the patients with zone 2 disease had progression of retinopathy, and none of them needed more than 1 treatment. Patients tolerated the procedure well, and there were no complications at the time of the procedure or at follow-up visits. CONCLUSIONS: A near confluent pattern of laser photocoagulation may reduce the rate of progression of threshold retinopathy of prematurity in zone 2 (0%). The near confluent pattern of treatment may also reduce the re-treatment rate of the disease (0%). Larger studies are needed to confirm our findings.

Birth Weight↗
PubMed2004

Lens-sparing vitrectomy for progressive tractional retinal detachments associated with stage 4A retinopathy of prematurity.

OBJECTIVE: To describe the results of lens-sparing vitrectomy in infants with progressive, fovea-threatening, tractional retinal detachments associated with stage 4A retinopathy of prematurity. METHODS: In a retrospective, interventional, consecutive clinical case series, the records of patients with stage 4A retinopathy of prematurity who underwent lens-sparing vitrectomy for progressive retinal detachments were reviewed. Retinal attachment status, reversed or arrested retinal dragging, and visual acuity were assessed after the procedure. RESULTS: Thirty-two eyes of 29 patients underwent lens-sparing vitrectomy at a mean postconceptional age of 43 weeks. Thirty (94%) of 32 eyes had complete retinal reattachment and arrest or reversal of retinal dragging after 1 lens-sparing vitrectomy. Visual acuity of at least central, steady, and unmaintained was observed in 17 (81%) of the 21 eyes in which it was tested and at least central, steady, and maintained vision was measured in 13 (62%) of 21 eyes, with 1 eye achieving 20/40 visual acuity. CONCLUSIONS: Lens-sparing vitrectomy is a safe and effective procedure for the treatment of fovea-threatening retinal detachments in patients with stage 4A retinopathy of prematurity.

Birth Weight↗
PubMed2004

The effects of scleral buckling on young rabbit eyes.

OBJECTIVE: To evaluate the effects of scleral buckling surgery on the developing eye in an animal model. METHODS: Eleven young rabbits underwent scleral buckling surgery in one eye. In 6 rabbits, a 2.5 x 0.6-mm solid silicone encircling band (240 style) with a Watzke sleeve was used, and in 5 rabbits, a 2.0-mm silicone encircling sponge (502 style) with its ends abutting, but not connected, was used. After 3 months, both eyes of each animal were enucleated. Six eyes of an additional 3 rabbits served as baseline controls for determining initial globe volumes. RESULTS: Of the eyes buckled with a 240 band, 4 of 6 developed glaucoma compared with 0 of 5 eyes buckled with a 502 sponge (P =.06). Migration of the element occurred in all eyes with a 240 band (3 anterior, 3 posterior), while none of the 502 sponges migrated. There was no significant difference in the mean final corneal diameter between eyes with a 240 band (P =.94) and untreated fellow eyes or between eyes with a 502 sponge and untreated fellow eyes (P =.25). The mean axial length of eyes with a 240 band and untreated fellow eyes was 19.57 mm and 16.83 mm, respectively (P =.009). The mean axial length of eyes with a 502 sponge and untreated fellow eyes was 16.67 mm and 16.50 mm, respectively (P =.67). When comparing eyes with a 240 band with eyes with a 502 sponge, a significant difference was observed in the mean axial length (P =.006) and mean volume (P =.006) between the 2 scleral buckle groups. CONCLUSIONS: The use of a noninterrupted solid silicone encircling band appeared to have significant effects on the growth of young rabbit eyes. The use of an interrupted silicone sponge produced a buckling effect similar to the solid silicone band and did not migrate, adversely affect eye growth, or result in glaucoma. CLINICAL RELEVANCE: Noncontinuous encircling elements may prove to be as beneficial as continuous encircling elements in the treatment of tractional and rhegmatogenous retinal detachment in infant eyes without the potentially deleterious effects associated with a nondivided encircling band or the need for a second surgery to divide the encircling element.

Animals↗
PubMed2003

Management of macular holes that develop after retinal detachment repair.

PURPOSE: To study the characteristics and management of macular holes that develop after prior rhegmatogenous retinal detachment (RD) repair. DESIGN: Retrospective, interventional, consecutive case series. METHODS: The setting was a clinical practice. The case records of all of our patients (n = 12) who developed a new full-thickness macular hole after prior RD repair over an 8-year period were examined. Patients who developed a macular hole after prior RD repair were offered either surgical repair of the macular hole or continued observation. For eyes that underwent macular hole repair, main outcome measures included macular attachment status and postoperative visual acuity. RESULTS: Twelve full-thickness macular holes were detected in a series of 2,380 eyes (0.5% prevalence), which had undergone surgery for prior primary RD. Ten macular holes developed after scleral buckling surgery, two after pneumatic retinopexy, and none were seen after primary vitrectomy. The fovea had been detached in 11 of the 12 eyes at the time of RD. The median time to macular hole diagnosis after RD repair was 3.4 months (range, 0.3-161 months). Eight of the eight eyes (100%) undergoing surgical repair achieved macular reattachment with a median of 3.5 lines of visual improvement at a median of 14.8 months of follow-up. Seven of these eight eyes had an improvement in visual acuity of at least 3 Snellen lines, and four of the eight had at least 20/40 visual acuity postoperatively. Four eyes with macular holes were observed. CONCLUSIONS: Macular holes developed in less than 1% of eyes that had previously undergone repair of rhegmatogenous RD. In our series, these atypical holes were seen predominantly after macula-off detachments, most commonly occurring after scleral buckling procedures. They were effectively repaired using conventional pars plana vitrectomy with long-acting gas tamponade and a variety of adjuvant therapies. A good visual outcome is possible with this approach.

Adult↗
PubMedDate not supplied

Retinal tears and retinal detachment as factors affecting visual outcome after cataract extraction complicated by posteriorly dislocated lens material.

PURPOSE: To evaluate the incidence and effect on visual acuity of complicating factors such as retinal tears (RTs) and rhegmatogenous retinal detachment (RRD) in eyes with posteriorly dislocated lens fragments after cataract extraction. METHODS: Retrospective consecutive series of patients presenting at a referral vitreoretinal practice with posteriorly dislocated lens material after cataract extraction over a period of 8 years. The presence of RT, RRD, endophthalmitis, and choroidal hemorrhage was noted, and their effect on visual outcome was studied. RESULTS: A total of 307 eyes with posteriorly dislocated lens material after cataract extraction were identified. Fifty-eight eyes (19%) were managed medically (Group I), whereas the other 249 eyes (81%) underwent pars plana vitrectomy for removal of the lens material (Group II). Indications for surgical management included uncontrolled inflammation, elevated intraocular pressure, and large lens fragments. No eyes in Group I developed RT or RRD. Of the 249 Group II eyes, 13 (5%) were found to have RT, and 25 (10%) developed RRD. In Group II, choroidal hemorrhage and endophthalmitis were noted in 12 (5%) and 4 (2%) eyes, respectively. Fifty-one (88%) of 58 eyes in Group I and 138 (55%) of 249 eyes in Group II achieved a final visual acuity of 20/40 or better. Seven (54%) of the 13 eyes with RT and 9 (36%) of the 25 eyes with RRD achieved a final visual acuity of 20/40 or better. In the RRD group, 9 (56%) of the 16 macula-on eyes achieved a final visual acuity of 20/40 or better, whereas none of the 9 macula-off eyes had a final visual acuity of 20/40 or better. None of the 4 eyes with endophthalmitis and only 1 (8%) of the 12 eyes with choroidal hemorrhage had a final visual acuity of 20/40 or better. Five (62%) of eight eyes with retinal detachment treated with pneumatic retinopexy needed further treatment with scleral buckle to achieve anatomical reattachment. CONCLUSION: A good visual outcome (20/40 or better) is possible in eyes with posteriorly dislocated lens fragments after cataract extraction, even when retinal tears or macula-on retinal detachment is present. The presence of a macula-off retinal detachment, however, has a significant adverse effect on the visual outcome. Pneumatic retinopexy is not associated with retinal reattachment in many cases and is not preferred.

Adult↗
PubMedDate not supplied

Valsalva-like retinopathy following hyperopic laser in situ keratomileusis.

A 50-year-old woman presented with unilateral acute loss of vision 15 hours after undergoing bilateral hyperopic laser in situ keratomileusis (LASIK). She denied "straining." Fluorescein angiography showed no retinal vascular abnormalities but demonstrated blocked fluorescence corresponding with subhyaloid, intraretinal, and subretinal hemorrhages seen clinically in the left eye. YAG laser vitreolysis was performed after noting posterior cortical vitreous thickening with a loculated subhyaloid hemorrhage. Best spectacle-corrected visual acuity was restored to 20/20 by the 2-month follow-up examination. Valsalva-like retinopathy, possibly the result of the rapid rise and fall of intraocular pressure during the microkeratome and suction ring operation, may occur following hyperopic LASIK surgery.

Diagnosis, Differential↗
PubMedDate not supplied

Indocyanine green angiography findings in sympathetic ophthalmia.

A 78-year-old woman with a recurrent retinal detachment in the right eye presented 2 years after her last surgery with clinical and fluorescein angiographic evidence of sympathetic ophthalmia in the left eye. Fluorescein angiography showed discrete multifocal areas of central hypofluorescence with a hyperfluorescent ring. After immunosuppressive therapy, fluorescein angiography displayed multiple hypofluorescent spots without the hyperfluorescent collar. Prior to systemic and periocular corticosteroid therapy, indocyanine green angiography (ICGA) revealed multifocal hypo-fluorescent spots that became more prominent as the study progressed. The early stages of the posttreatment ICGA appeared normal, but the hypofluorescent spots reappeared in the late stage of ICGA. ICGA is a useful diagnostic adjunct to fluorescein angiography and clinical examination in helping to secure the diagnosis and monitor the treatment progress of sympathetic ophthalmia.

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