The management of neovascular age-related macular degeneration: A systematic literature review of patient-reported outcomes, patient mental health and caregiver burden

PURPOSE

The aim of this systematic literature review was to describe patient-reported outcomes, mental health and caregiver burden in patients with neovascular age-related macular degeneration (nAMD) treated with anti-vascular endothelial growth factor (VEGF) agents in routine clinical practice.

METHODS

Electronic searches were conducted in Embase and MEDLINE according to pre-defined criteria.

RESULTS

Of 856 records identified, 63 met inclusion criteria. Depression or depressive symptoms were reported in up to 42% of patients with nAMD. Of 25/63 (40%) studies evaluating quality of life (QoL) and using various tools, eight studies reported composite National Eye Institute Visual Functioning Questionnaire scores following anti-VEGF treatment. Of these, seven reported a statistically significant improvement at the earliest time point measured (Month 3-12) and approximately 50% reported sustained QoL benefits at 12 months. In studies comparing the attributed or different regimens, the most important factor from the patient's perspective was the likelihood that a particular regimen would maintain vision. There was a preference towards treat and extend, which was associated with a perceived reduction in patient and caregiver burden, compared to fixed dosing.

CONCLUSIONS

A coordinated holistic approach to patient care is key to optimizing patient well-being as well as visual outcomes. Further research regarding the patient-reported impact of nAMD management outside the trial setting (particularly international longitudinal studies) is warranted. Standardization of QoL studies would assist in establishing whether sustained QoL improvement, rather than prevention of QoL decline, should be a realistic expectation of treatment of nAMD in the longer term.

Optical coherence tomography angiography as predictor of visual outcomes in retinal vein occlusion treated with antiangiogenic therapy

PURPOSE

Evaluate optical coherence tomography angiography (OCT-A) features in retinal vein occlusions (RVO) associated with visual outcomes after anti-VEGF.

METHODS

Analytical observational study performed in eyes with macular edema secondary to RVO treated with anti-VEGF, with at least 6 months of follow-up. Bradley et al. classification of macular ischemia was used. Logistic regression analysis was used to investigate associations between final best-corrected visual acuity (BCVA) and OCT-A.

RESULTS

A total of 62 eyes, 61 subjects, mean age of 70 ± 12,6 years were included. Median follow up time 21,2 months (IQR 24.8), 53,2% had central retinal vein occlusion (CRVO) and 46,8% branch retinal vein occlusion (BRVO). Median BCVA pre-treatment was 0,84 logMAR (IQR 0,83) and post-treatment 0,47 logMAR (IQR 0,52). BCVA improved at the end of follow-up (p = 0,01), as well as central retinal thickness (CRT) (p = 0,02). Regarding capillary densities (CD), there was a decrease for both plexus, Superficial CD (p = 0,01) and Deep CD (p = 0,01), being more involved the superficial plexus. The lower the capillary density in both plexus, the worse BCVA, Superficial CD (r - 0,27, p = 0,03) and Deep CD (r - 0,29, p = 0,02). Media FAZ pre-treatment was 0,30 mm2 (IQR 0,23), with enlargement to 0,37 mm2 (IQR 0,32) (p = 0,01) post-treatment. Preservation of External Limiting Membrane/ Ellipsoid Zone (ELM/EZ) was seen in 60% of subjects (n = 37). The majority had grade 3 macular ischemia. Variables that best explain visual results were, baseline visual acuity (p = 0,01), pre-treatment CRT (p = 0,02) and pretreatment foveal superficial CD (p = 0,02).

CONCLUSIONS

Variables that best explain final vision after anti-VEGF were baseline visual acuity, CRT and foveal superficial CD.

Intravitreal aflibercept for the treatment of patients with diabetic macular edema in routine clinical practice in Latin America: the AQUILA study

BACKGROUND

AQUILA (NCT03470103) was a prospective, observational, 12-month cohort study to understand treatment patterns and to evaluate the clinical effectiveness and safety of intravitreal aflibercept (IVT-AFL) in patients from Latin America with diabetic macular edema (DME).

METHODS

Treatment-naïve and previously treated (switching to IVT-AFL) patients (aged ≥ 18 years) were enrolled from March 2018, with a primary completion date of September 2020, from Argentina, Colombia, Costa Rica and Mexico. Patients received IVT-AFL in a routine clinical practice setting.

RESULTS

Of 258 patients in the full analysis set, 181 were treatment-naïve and 77 had received previous treatment. The mean ± standard deviation number of IVT-AFL injections by Month 12 was 3.7 ± 1.8 (treatment-naïve) and 4.0 ± 2.2 (previously treated). The median duration from diagnosis to IVT-AFL treatment was 1.8 months (treatment-naïve) and 16.0 months (previously treated). Mean best-corrected visual acuity (Early Treatment Diabetic Retinopathy Study letters) improved from baseline to Month 12 by + 8.1 ± 17.7 (treatment-naïve; baseline: 54.5 ± 19.4) and + 4.6 ± 15.4 letters (previously treated; baseline: 52.9 ± 18.6).

CONCLUSION

AQUILA is the first study to assess the use of IVT-AFL in routine clinical practice in Latin America. Despite few patients being treated with the label-recommended regimen of 5 initial monthly doses or receiving ≥ 8 injections in 12 months, functional and anatomic visual outcomes improved during 12 months of treatment with IVT-AFL. Patients receiving the label-recommended number of injections had numerically greater improvements in visual acuity outcomes. Patients with DME treated regularly and more frequently with IVT-AFL therefore have the potential to achieve outcomes consistent with those observed in interventional studies. Trial registration Clinicaltrials.gov, NCT03470103. Registered February 5, 2018, https://clinicaltrials.gov/ct2/show/NCT03470103.

Smartphone Addiction and Cybercrime Victimization in the Context of Lifestyles Routine Activities and Self-Control Theories: The User's Dual Vulnerability Model of Cybercrime Victimization

(1) Background: This paper combines lifestyle-routine activities (L-RAT) and self-control (SCT) theories along with the literature on smartphone addiction in a joint model that addresses the multiple vulnerabilities that make the smartphone user a potential victim of cybercrime. This model, which we call the dual vulnerability model of cybercrime victimization, was subjected to empirical testing on a nationally representative sample of smartphone users. (2) Methods: Data from 2837 participants from a nationally representative sample of Spanish smartphone users were modeled using Mplus causal modeling software. (3) Results: The results of the study confirm the predictions of L-RAT and SCT in explaining cybercrime victimization (higher cybercrime victimization under conditions of high exposure, proximity, and suitability, relative absence of capable guardian, and low self-control). A significant effect of smartphone addiction on cybercrime victimization was also observed above and beyond L-RAT and SCT predictors. (4) Conclusions: The potential victim of cybercrime presents a double vulnerability, on the one hand, those identified by criminological theories such as L-RAT and SCT, and on the other hand, those derived from the deregulated-addicted use of the Internet access device (smartphone in our work).

MANAGEMENT OF RETINAL PIGMENT EPITHELIUM TEAR DURING ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY

PURPOSE

This article aims to review current evidence on the development, diagnosis, and management of retinal pigment epithelium (RPE) tear during anti-vascular endothelial growth factor (VEGF) therapy.

METHODS

Literature searches were performed using MEDLINE/PubMed databases (cut-off date: August 2019).

RESULTS

Three key recommendations were made based on existing literature and clinical experience: 1) Multimodal imaging with color fundus photography, optical coherence tomography, near-infrared reflectance imaging, fundus autofluorescence imaging, optical coherence tomography-angiography, and/or fluorescein angiography are recommended to diagnose RPE tear and assess risk factors. Retinal pigment epithelium tears can be graded by size and foveal involvement. 2) Patients at high risk of developing RPE tear should be monitored after each anti-VEGF injection. If risk factors worsen, it is not yet definitively known whether anti-VEGF administration should be more frequent, or alternatively stopped in such patients. Prospective research into high-risk characteristics is needed. 3) After RPE tear develops, anti-VEGF treatment should be continued in patients with active disease (as indicated by presence of intraretinal or subretinal fluid), although cessation of therapy should be considered in eyes with multilobular tears.

CONCLUSION

Although evidence to support the assumption that anti-VEGF treatment contributes to development of RPE tear is not definitive, some data suggest this link.

Anti-VEGF intravitreal injections in the era of COVID-19: responding to different levels of epidemic pressure

Purpose

Following the first wave of the COVID-19 pandemic in early 2020, the easing of strict measures to reduce its spread has led to a resurgence of cases in many countries at both the national and local level. This article addresses how guidance for ophthalmologists on managing patients with retinal disease receiving intravitreal injections of anti-vascular endothelial growth factor (VEGF) during the pandemic should be adapted to the local epidemic pressure, with more or less stringent measures implemented according to the ebb and flow of the pandemic.

Methods

The Vision Academy’s membership of international retinal disease experts analyzed guidance for anti-VEGF intravitreal injections during the COVID-19 pandemic and graded the recommendations according to three levels of increasing epidemic pressure. The revised recommendations were discussed, refined, and voted on by the 14-member Vision Academy Steering Committee for consensus.

Results

Protocols to minimize the exposure of patients and healthcare staff to COVID-19, including use of personal protective equipment, physical distancing, and hygiene measures, should be routinely implemented and intensified according to local infection rates and pressure on the hospital/clinic or healthcare system. In areas with many COVID-19-positive clusters, additional measures including pre-screening of patients, postponement of non-urgent appointments, and simplification of complex intravitreal anti-VEGF regimens should be considered. Treatment prioritization for those at greatest risk of irreversible vision loss should be implemented in areas where COVID-19 cases are increasing exponentially and healthcare resources are strained.

Conclusion

Consistency in monitoring of local infection rates and adjustment of clinical practice accordingly will be required as we move forward through the COVID-19 era. Ophthalmologists must continue to carefully weigh the risk–benefits to minimize the exposure of patients and healthcare staff to COVID-19, ensure that patients receive sight-saving treatment, and avoid the potential long-term impact of prolonged treatment postponement.

Macular and choroidal thicknesses in a healthy Hispanic population evaluated by high-definition spectral-domain optical coherence tomography (SD-OCT)

Purpose

To report normal values of macular and choroidal thickness obtained from a healthy Hispanic population using Optovue (Optovue Inc, Freemont CA, USA) spectral domain optical coherence tomography (SD-OCT).

Design

Observational, cross-sectional, correlation study.

Methods

A total of 290 eyes (145 healthy subjects) were included; 69% of subjects were female. The median age was 39 ± 29 years (IQR), with a range between 18 and 89 years. The study sample was stratified into three age groups: Group 1, 18–40 years (50.3%), Group 2, 41–60 years (30.7%), and Group 3, older than 61 years (19%). Central macular, perifoveal (inner quadrants), and parafoveal (outer quadrants) thicknesses were estimated. In addition, central and peripheral choroidal thicknesses were estimated. Data analysis was performed to calculate the standardized mean difference according to the variance (Student’s t-test) and its differences with Epidat 4.1.

Results

Median macular central thickness was 250 ±30 µm (IQR) with Optovue. Median central choroidal thickness was 263 ± 48 µm (IQR). Median central choroidal thickness was greater than mean peripheral thickness. Macular evaluation showed a statistically significant difference in central, perifoveal, and parafoveal thicknesses, with lower values being recorded for the study sample compared with the manufacturer’s data.

Conclusions

SD-OCT has become a useful tool to obtain high-resolution images of the macula and choroid. This method allows precise assessment of the retinal and choroidal layers to diagnose and follow up posterior segment diseases. We are reporting normal cut-off values of macular and choroidal thicknesses in healthy Hispanic subjects evaluated with Optovue SD-OCT as new diagnostic normal parameters for research and clinical activities.

Guidance for anti-VEGF intravitreal injections during the COVID-19 pandemic

Purpose

There is an urgent need to address how to best provide ophthalmic care for patients with retinal disease receiving intravitreal injections with anti-vascular endothelial growth factor agents during the ongoing global COVID-19 pandemic. This article provides guidance for ophthalmologists on how to deliver the best possible care for patients while minimizing the risk of infection.

Methods

The Vision Academy’s Steering Committee of international retinal disease experts convened to discuss key considerations for managing patients with retinal disease during the COVID-19 pandemic. After reviewing the existing literature on the issue, members put forward recommendations that were systematically refined and voted on to develop this guidance.

Results

The considerations focus on the implementation of steps to minimize the exposure of patients and healthcare staff to COVID-19. These include the use of personal protective equipment, adherence to scrupulous hygiene and disinfection protocols, pre-screening to identify symptomatic patients, and reducing the number of people in waiting rooms. Other important measures include triaging of patients to identify those at the greatest risk of irreversible vision loss and prioritization of treatment visits over monitoring visits where possible. In order to limit patient exposure, ophthalmologists should refrain from using treatment regimens that require frequent monitoring.

Conclusion

Management of patients with retinal disease receiving intravitreal injections during the COVID-19 pandemic will require adjustment to regular clinical practice to minimize the risk of exposure of patients and healthcare staff, and to prioritize those with the greatest medical need. The safety of patients and healthcare staff should be of paramount importance in all decision-making.

Enhancing violations of Leggett-Garg inequalities in nonequilibrium correlated many-body systems by interactions and decoherence

We identify different schemes to enhance the violation of Leggett-Garg inequalities in open many-body systems. Considering a nonequilibrium archetypical setup of quantum transport, we show that particle interactions control the direction and amplitude of maximal violation, and that in the strongly-interacting and strongly-driven regime bulk dephasing enhances the violation. Through an analytical study of a minimal model we unravel the basic ingredients to explain this decoherence-enhanced quantumness, illustrating that such an effect emerges in a wide variety of systems.

Social Navigation in a Cognitive Architecture Using Dynamic Proxemic Zones

Robots have begun to populate the everyday environments of human beings. These social robots must perform their tasks without disturbing the people with whom they share their environment. This paper proposes a navigation algorithm for robots that is acceptable to people. Robots will detect the personal areas of humans, to carry out their tasks, generating navigation routes that have less impact on human activities. The main novelty of this work is that the robot will perceive the moods of people to adjust the size of proxemic areas. This work will contribute to making the presence of robots in human-populated environments more acceptable. As a result, we have integrated this approach into a cognitive architecture designed to perform tasks in human-populated environments. The paper provides quantitative experimental results in two scenarios: controlled, including social navigation metrics in comparison with a traditional navigation method, and non-controlled, in robotic competitions where different studies of social robotics are measured.

Classification of diabetes-related retinal diseases using a deep learning approach in optical coherence tomography

BACKGROUND AND OBJECTIVES

Spectral Domain Optical Coherence Tomography (SD-OCT) is a volumetric imaging technique that allows measuring patterns between layers such as small amounts of fluid. Since 2012, automatic medical image analysis performance has steadily increased through the use of deep learning models that automatically learn relevant features for specific tasks, instead of designing visual features manually. Nevertheless, providing insights and interpretation of the predictions made by the model is still a challenge. This paper describes a deep learning model able to detect medically interpretable information in relevant images from a volume to classify diabetes-related retinal diseases.

METHODS

This article presents a new deep learning model, OCT-NET, which is a customized convolutional neural network for processing scans extracted from optical coherence tomography volumes. OCT-NET is applied to the classification of three conditions seen in SD-OCT volumes. Additionally, the proposed model includes a feedback stage that highlights the areas of the scans to support the interpretation of the results. This information is potentially useful for a medical specialist while assessing the prediction produced by the model.

RESULTS

The proposed model was tested on the public SERI-CUHK and A2A SD-OCT data sets containing healthy, diabetic retinopathy, diabetic macular edema and age-related macular degeneration. The experimental evaluation shows that the proposed method outperforms conventional convolutional deep learning models from the state of the art reported on the SERI+CUHK and A2A SD-OCT data sets with a precision of 93% and an area under the ROC curve (AUC) of 0.99 respectively.

CONCLUSIONS

The proposed method is able to classify the three studied retinal diseases with high accuracy. One advantage of the method is its ability to produce interpretable clinical information in the form of highlighting the regions of the image that most contribute to the classifier decision.

Antifungal and physicochemical properties of inclusion complexes based on β-cyclodextrin and essential oil derivatives

Inclusion complexes based on β-cyclodextrin (β-CD) and antimicrobial compounds, were prepared by co-precipitation method, and characterized by entrapment efficiency (EE), thermal analysis, X-ray diffraction, ¹H NMR spectroscopy, and water sorption. In addition, experiments associated to evaluate the effect of relative humidity on the release of active compounds and antifungal tests were performed. The analysis evidenced the encapsulation of active compounds into the β-CD structure with EE of 91 ± 4.1% and 66 ± 2.1% for β-CD/cinnamaldehyde and β-CD/eugenol complexes, respectively. Additionally, high relative humidities favored the release of active compounds from inclusion complexes. On the other hand, inclusion complexes were able to control the growth of B. cinerea, which was evidenced by a reduction of its mycelialradial growth. Finally, specific interactions between the active compounds and β-CD were evaluated through molecular dynamics simulation techniques. According to the obtained results, these complexes could be applied as additives in the design of antifungal packaging.

Synthetic bioresorbable poly-α-hydroxyesters as peripheral nerve guidance conduits; a review of material properties, design strategies and their efficacy to date

Implantable tubular devices known as nerve guidance conduits (NGCs) have drawn considerable interest as an alternative to autografting in the repair of peripheral nerve injuries.

Efficacy and safety of fluocinolone acetonide 0.025% otic solution in patients with otic eczema: a randomized, double-blind, placebo-controlled clinical trial

Objectives

To assess the efficacy and safety of fluocinolone acetonide 0.025% otic solution versus placebo in treating patients with otic eczema.

Methods

In this multicentre, randomized, double-blind, parallel-group phase 3 clinical trial, conducted at 12 Spanish centres between March 2012 and March 2013, patients received fluocinolone acetonide 0.025% or placebo otic solution twice daily for 7 days (days 1–7) with an 8-day follow-up (days 9–15). Outcome measures included change in itching from baseline (day 1) to study days 4–8 and 9–15, and change in otoscopic signs (erythema, oedema, and scaling) from baseline to the end of treatment (day 8) and end of follow-up (day 15).

Results

Patients treated with fluocinolone acetonide 0.025% (n = 66), as compared with placebo-treated patients (n = 69), showed significantly higher reductions in itching from baseline to study days 4–8 and 9–15, and in individual and global otoscopic signs from baseline to the end of treatment (day 8) and end of follow-up (day 15). Incidence and severity of adverse events was similar between the fluocinolone and placebo groups.

Conclusions

Fluocinolone acetonide 0.025% otic solution, administered twice daily for 7 days, is an effective and safe treatment for otic eczema.

The role of OCT-A in retinal disease management

Optical coherence tomography angiography (OCT-A) is a non-invasive, non-dye-based imaging modality that has the potential to enhance our understanding of retinal diseases. While this rapidly advancing imaging modality offers great potential, there is a need for community-wide understanding of the range of technologies and methods for interpreting the images, as well as a need to enhance understanding of images from disease-free eyes for reference when screening for retinal diseases. Importantly, clinical trials have been designed without OCT-A-based endpoints; therefore, caution is required when making treatment decisions based on OCT-A imaging alone. With this in mind, a full understanding of the advantages and limitations of OCT-A will be vital for effective development of the technique within the field of ophthalmology. On behalf of the Vision Academy Steering Committee (sponsored by Bayer), this publication summarizes the views of the authors on the current use of OCT-A imaging and explores its potential for future applications in research and clinical practice.

Further observations on a bilateral IRVAN syndrome case

PURPOSE

Reporting clinical features of the late course of the disease after long-term follow-up in a bilaterally affected patient with idiopathic retinitis, vasculitis, retinal aneurysms and neuroretinitis (IRVAN) and new peripheral retinal findings on wide-field angiography and multimodal imaging.

METHODS

This was a retrospective observational study, based on current diagnostic studies including wide-field fluorescein angiography, optical coherence tomography (OCT) and treatment of aneurysms with argon laser photocoagulation.

RESULTS

A 21-year-old female with bilateral IRVAN syndrome-stage 2 in the right eye and stage 3 in the left eye-previously treated bilaterally with laser photocoagulation for retinal macroaneurysms and ischemic areas between 1985 and 1992. Follow-up interrupted on two occasions, with subsequent fundus re-examinations confirming the prevention of retinal neovascularization in both eyes, as recently evidenced on wide-field angiography.

CONCLUSIONS

A case of bilateral IRVAN disease with multiple retinal aneurysms, neuroretinitis and peripheral capillary nonperfusion successfully treated with laser photocoagulation, maintaining normal visual acuity in one eye and preventing retinal neovascular complications.

When Violence Can Appear With Different Male Partners: Identification of Resilient and Non-resilient Women in the European Union

Introduction: Little scholarly attention has been paid to the analysis of the history of intimate partner violence (IPV) against women with different male partners and how it could be related to levels of IPV with the current male partner. From this point of view, been a victim of IPV could increase the vulnerability of women and, therefore, exert a negative influence on the selection of partners over time, thus increasing the odds of potentially mating with abusive male partners. Alternatively, for some women victims of IPV in previous relationships, there may be additional resources that reduce their vulnerability to victimization by new partners.

Methodology: The present study analyzes levels of IPV in different partners of 2376 heterosexual women from the 28 countries of the European Union living together as a couple who had previously lived with a different male partner.

Analysis/Discussion: Multilevel regression results indicated that resilient women were younger, more satisfied with household income, and were involved in shorter relationships. As for their previous levels of victimization, they scored lower on child abuse and non-partner adult victimization. Also, their levels of victimization from previous partners were the same as those of the non-resilient women, with the exception of physical IPV victimization where resilient women scored higher than non-resilient women. Resilient women also informed the interviewer to have ended the abusive relationship because of the violence to a greater extent than non-resilient women and seemed to suffer fewer psychological difficulties due to previous violent relationships. Finally, countries scoring higher on human development index (HDI) showed a larger proportion of resilient women.

Conclusion: Resilient women are mostly characterized by fewer psychological difficulties and lower frequency of adverse situations (in childhood or in adulthood) when compared to non-resilient women. Although resilient women reported a higher physical IPV, they nevertheless show fewer psychological sequelae and a greater ability to end abusive relationships. In addition, the human development of the countries in which they live also seems to reinforce their resilience, which suggests combining intervention policies at the individual and contextual levels.

Yellow (577 nm) micropulse laser versus half-dose verteporfin photodynamic therapy in eyes with chronic central serous chorioretinopathy: results of the Pan-American Collaborative Retina Study (PACORES) Group

PURPOSE

To compare the functional and anatomical outcomes of eyes with chronic central serous chorioretinopathy treated with yellow micropulse (MP) laser versus half-dose verteporfin photodynamic therapy (PDT).

METHODS

This is a multicentre, retrospective comparative study of 92 eyes treated with yellow MP laser (duty cycle of 5%, zero spacing between spots, spot size varied from 100 to 200 µm, power varied from 320 to 660 mW, and the pulse burst duration was 200 ms) and 67 eyes treated with PDT (half-dose verteporfin (3 mg/m²) infused over 10 min), followed by laser activation for 83 s. Spot sizes varied from 400 to 2000 µm.

RESULTS

In the MP group, at 12 months of follow-up, the mean best corrected visual acuity (BCVA) improved from the logarithm of the minimum angle of resolution (logMAR) of 0.41±0.27 at baseline to 0.21±0.26 (P<0.0001), 48.9% (45/92) of eyes had an improvement of ≥3 lines of BCVA from baseline, 48.9% (45/92) of eyes remained within 2 lines of baseline BCVA, and only 2.2% (2/92) of eyes lost ≥3 lines of BCVA from baseline. In the PDT group, at 12 months of follow-up, the mean BCVA changed from logMAR of 0.50±0.34 at baseline to 0.47±0.34 (P=0.89), 19% (13/67) of eyes had an improvement of ≥3 lines of BCVA from baseline, 73% (49/67) of eyes remained within 2 lines of baseline BCVA, and 7% (5/67) of eyes lost ≥3 lines of BCVA from baseline. There were no adverse events attributable to the yellow MP laser treatment. One eye in the PDT group developed choroidal neovascularisation, which was treated with three intravitreal bevacizumab injections.

CONCLUSIONS

Both PDT and MP are effective in restoring the macular anatomy. In places where PDT is not available, yellow MP laser may be an adequate treatment alternative.

Spontaneous Separation in Idiopathic Vitreomacular Traction Syndrome Associated with Contralateral Full-Thickness Macular Hole

Purpose

Vitreomacular traction syndrome (VMTS) and full-thickness macular hole are two different well-known entities that on follow-up may be subjected to clinical modifications. Precisely, a spontaneous separation of idiopathic VMTS occurred in three eyes of three patients relieving in addition traction of the posterior hyaloid that had led also to a focal macular pigment epithelium detachment (RPE). An association to a full-thickness macular hole was observed in the contralateral eye of one of the patients.

Methods

This is a retrospective study of three patients evaluated with fluorescein angiography and documented with optical coherence tomography using the Stratus (OCT) model 3000, with scans analysis and protocols analysis, measuring the size and shape of vitreomacular adhesions, macular thickness changes before and after the spontaneous separation of the fractional posterior hyaloid adhesion. In addition, the vitreous was evaluated with contact lens slit lamp biomicroscopy and ultrasound. The associated contralateral macular hole in one of the patients was surgically treated.

Results

Two of the three eyes with spontaneous separation of the VMTS recovered 20/25 central visual acuity; the other eye maintained the initial 20/50 visual acuity. The treated macular hole recovered 20/100 corrected visual acuity.

Conclusions

Spontaneous separation of posterior hyaloid is a possible outcome during follow-up of idiopathic VMTS that can be well evaluated and documented with OCT while macular fluorescein angiography may be silent in cases like these presently reported. Central vision recovery can be excellent following the spontaneous separation, which releases anterior-posterior traction including on the retinal pigment epithelium and decreases macular thickness as measured with OCT. Therefore, regarding management, the indication for vitrectomy should be delayed awaiting the spontaneous release of vitreomacular traction in 4 to 6 months. The association between idiopathic VMTS in one eye and full-thickness macular hole in the opposite eye of one patient is an important pathophysiologic consideration.

Influence of preozonation on the adsorptivity of humic substances onto activated carbon

This research aims to study the influence of preozonation on the adsorptivity of humic substances onto activated carbon, which are usual stages in drinking water treatment. Three different types of humic substances were used in this study: natural fulvic and humic acids extracted from the Úzquiza Reservoir (Burgos, Spain) and a commercially supplied humic acid. The fractionation of the humic substances by ultrafiltration showed a very different molecular weight (MW) distribution for them: the lowest fraction of <1 kDa comprises the vast majority of the fulvic acids (around 86 %), whereas the main fraction for the commercial humic acids was the highest one of >30 kDa (around 40 %). The natural humic acids show an intermediate distribution between the two aforementioned humic substances. The 1-5-kDa fraction turned out to be the most reactive toward trihalomethane formation for the commercial humic acids. The adsorptive capacity of activated carbon for the humic substances was in the following order: natural fulvic acids > natural humic acids > commercial humic acids. The most adsorbable fraction was that of <1 kDa for the fulvic acids, whereas the 5-10-kDa fraction was the most adsorbable for both humic acids. Preozonation changes the MW distribution of the humic substances, decreasing the abundance of the high MW fractions and generating smaller molecules within the low to medium MW range. Adsorption isotherms show that preozonation has a beneficial effect on the adsorptivity of the commercial humic acids onto activated carbon, whereas no appreciable effect was observed for the case of the fulvic acids.

Acceptability of Partner Violence in 51 Societies: The Role of Sexism and Attitudes Toward Violence in Social Relationships

Sexist attitudes have been claimed to play an important role in acceptability of intimate partner violence (IPV). Empirical evidence suggests that sexist individuals are also more accepting of violence in social relationships than non-sexist individuals. Results from multilevel regression models of data from 72,730 respondents of 51 countries around the world showed that (a) both sexism and acceptability of general violence in social relationships were positively related to acceptability of IPV and (b) the highest levels of acceptability of IPV were found among those sexist individuals who also present positive attitudes toward the use of violence in social relationships.

Monitoring changes in the structure and properties of humic substances following ozonation using UV-Vis, FTIR and (1)H NMR techniques

The main objective of this work is to conduct a comprehensive structural characterization of humic substances using the following experimental techniques: FTIR, 1H NMR and several UV–Vis parameters (Specific UV Absorbance at 254 nm or SUVA254, SUVA280, A400, the absorbance ratios A210/254, A250/365, A254/203, A254/436, A265/465, A270/400, A280/350, A465/665, the Absorbance Slope Index (ASI), the spectral slopes S275–295, S350–400 and the slope ratio SR). These UV–Vis parameters have also been correlated with key properties of humic substances such as aromaticity, molecular weight (MW) and trihalomethane formation potential (THMFP). An additional objective of this work is also to evaluate the usefulness of these techniques to monitor structural changes in humic substances produced by the ozonation treatment. Four humic substances were studied in this work: three of them were provided by the International Humic Substances Society (Suwannee River Fulvic Acid Standard: SRFA, Suwannee River Humic Acid Standard: SRHA and Nordic Reservoir Fulvic Acid Reference: NLFA) and the other one was a terrestrial humic acid widely used as a surrogate for aquatic humic substances in various studies (Aldrich Humic Acid: AHA). The UV–Vis parameters showing the best correlations with aromaticity in this study were SUVA254, SUVA280, A280/A350 ratio and A250/A364 ratio. The best correlations with molecular weight were for SUVA254, SUVA280 and A280/A350 ratio. Finally, in the case of the THMFP it was STHMFP-per mol HS the parameter showing good correlations with most of the UV–Vis parameters studied (especially with A280/A350 ratio, A265/A465 ratio and A270/A400 ratio) whereas STHMFP-per mg C showed poor correlations in most cases. On the whole, the UV–Vis parameter showing the best results was A280/A350 ratio as it showed excellent correlations for the three properties studied (aromaticity, MW and THMFP). A decrease in aromaticity following ozonation of humic substances can be readily monitored by 1H NMR and FTIR; the latter technique also allows to monitor an increase in carboxylic acidity with ozone dosage. This organic matter originated following ozonation (more aliphatic in character and more polar) is expected to be recalcitrant to further oxidation. The terrestrial humic acid (AHA) showed some structural differences with the aquatic humic substances and its behavior upon ozonation also differed in some extent from that shown by them.

A comprehensive structural evaluation of humic substances using several fluorescence techniques before and after ozonation. Part I: structural characterization of humic substances

The main objective of this work (Part I) is to conduct a comprehensive structural characterization of humic substances, using all the current fluorescence techniques: emission scan fluorescence (ESF), synchronous fluorescence spectroscopy (SFS), total luminescence spectroscopy (TLS or EEM) through the use of both 2-D contour maps and 3-D plots, fluorescence index and the λ0.5 parameter. Four humic substances were studied in this work: three of them were provided by the International Humic Substances Society (Suwannee River Fulvic Acid Standard, Suwannee River Humic Acid Standard and Nordic Reservoir Fulvic Acid Reference) and the other one was a commercial humic acid widely used as a surrogate for aquatic humic substances in various studies (Aldrich Humic Acid: ALHA). The EEM spectra for the three natural aquatic substances were quite similar, showing two main peaks of maximum fluorescence intensity: one located in the ultraviolet region and centered at around Ex/Em values of 230/437 nm (peak A) and another one in the visible region, centered at around 335/460 nm (peak C); however, the EEM spectrum of ALHA is completely different to those of natural aquatic humic substances, presenting four poorly resolved main peaks with a high degree of spectral overlap, located at 260/462, 300/479, 365/483 and 450/524 nm. The synchronous spectra at Δλ=18 and 44 nm (especially at Δλ=18 nm) allowed the identification of a protein-like peak at λsyn around 290 nm, which was not detected in the EEM spectra; as it happened with EEM spectra, the synchronous spectra of ALHA are quite different from those of the aquatic humic substances, presenting a higher number of bands that suggest greater structural complexity and a higher degree of polydispersity. Good correlations were achieved between (13)C NMR aromaticity and both fluorescence index and λ0.5 parameter. The different spectra presented by ALHA compared to those shown by the natural aquatic humic substances for all the fluorescence techniques studied suggest an important structural difference between them, which cast doubt on the use of commercial humic acids as surrogates for natural humic substances.

A comprehensive structural evaluation of humic substances using several fluorescence techniques before and after ozonation. Part II: evaluation of structural changes following ozonation

The main objective of this work (Part II) is to evaluate the usefulness of fluorescence techniques to monitor structural changes in humic substances produced by the ozonation treatment, using all the current fluorescence techniques: Emission scan fluorescence (ESF), synchronous fluorescence spectroscopy (SFS), total luminescence spectroscopy (TLS or EEM) through the use of both 2-D contour maps and 3-D plots, fluorescence index and the λ0.5 parameter. Four humic substances were studied in this work: three of them were provided by the International Humic Substances Society (Suwannee River Fulvic Acid Standard: SUFA, Suwannee River Humic Acid Standard: SUHA and Nordic Reservoir Fulvic Acid Reference: NOFA) and the other one was a commercial humic acid widely used as a surrogate for aquatic humic substances in various studies (Aldrich Humic Acid: ALHA). The lowest ozone dosage tested (0.25mg O3/mg TOC) caused no appreciable change in the different types of fluorescence spectra under study, therefore the structural change produced in the humic macromolecules may be considered of little significance. Concerning EEM and synchronous spectra, the two natural fulvic acids (SUFA and NOFA) showed a decrease in fluorescence intensity as ozone dosage increased, but the natural humic acid (SUHA) showed a different behaviour: an initial increase in fluorescence intensity at medium ozone dosages (1.5 mg O3/mg TOC) followed by an intensity decrease for the higher ozone dose (7.5 mg O3/mg TOC). Regarding synchronous spectra, the moderate dosage of 1.5 mg O3/mg TOC led to an increase in the fluorescence of the protein-like peak at λsyn=285 nm for the natural humic substances. The results obtained for the fluorescence index and λ0.5 may suggest that the greatest degradation of aromatic structures within the humic macromolecule occurs at high ozone dosages, whereas the predominant effect at moderate dosages would be the break-up of the humic macromolecule into lower molecular weight fragments. The behaviour of the commercial humic acid (ALHA) upon ozonation was very different from that of the natural humic substances (SUFA, SUHA and NOFA), a result that was confirmed with all the fluorescence techniques used in this study and that would cast doubt on the use of commercial humic acids as surrogates for natural humic substances.

New dynamical scaling universality for quantum networks across adiabatic quantum phase transitions

We reveal universal dynamical scaling behavior across adiabatic quantum phase transitions in networks ranging from traditional spatial systems (Ising model) to fully connected ones (Dicke and Lipkin-Meshkov-Glick models). Our findings, which lie beyond traditional critical exponent analysis and adiabatic perturbation approximations, are applicable even where excitations have not yet stabilized and, hence, provide a time-resolved understanding of quantum phase transitions encompassing a wide range of adiabatic regimes. We show explicitly that even though two systems may traditionally belong to the same universality class, they can have very different adiabatic evolutions. This implies that more stringent conditions need to be imposed than at present, both for quantum simulations where one system is used to simulate the other and for adiabatic quantum computing schemes.

Novel electro-fenton approach for regeneration of activated carbon

An electro-Fenton-based method was used to promote the regeneration of granular activated carbon (GAC) previously adsorbed with toluene. Electrochemical regeneration experiments were carried out using a standard laboratory electrochemical cell with carbon paste electrodes and a batch electrochemical reactor. For each system, a comparison was made using FeSO4 as a precursor salt in solution (homogeneous system) and an Fe-loaded ion-exchange resin (Purolite C-100, heterogeneous system), both in combination with electrogenerated H2O2 at the GAC cathode. In the two cases, high regeneration efficiencies were obtained in the presence of iron using appropriate conditions of applied potential and adsorption-polarization time. Consecutive loading and regeneration cycles of GAC were performed in the reactor without great loss of the adsorption properties, only reducing the regeneration efficiency by 1% per cycle during 10 cycles of treatment. Considering that, in the proposed resin-containing process, the use of Fe salts is avoided and that GAC cathodic polarization results in efficient cleaning and regeneration of the adsorbent material, this novel electro-Fenton approach could constitute an excellent alternative for regenerating activated carbon when compared to conventional methods.

Confirming the validity of the CONUT system for early detection and monitoring of clinical undernutrition: comparison with two logistic regression models developed using SGA as the gold standard

AIM

To ratify previous validations of the CONUT nutritional screening tool by the development of two probabilistic models using the parameters included in the CONUT, to see if the CONUT´s effectiveness could be improved.

METHODS

It is a two step prospective study. In Step 1, 101 patients were randomly selected, and SGA and CONUT was made. With data obtained an unconditional logistic regression model was developed, and two variants of CONUT were constructed: Model 1 was made by a method of logistic regression. Model 2 was made by dividing the probabilities of undernutrition obtained in model 1 in seven regular intervals. In step 2, 60 patients were selected and underwent the SGA, the original CONUT and the new models developed. The diagnostic efficacy of the original CONUT and the new models was tested by means of ROC curves. Both samples 1 and 2 were put together to measure the agreement degree between the original CONUT and SGA, and diagnostic efficacy parameters were calculated.

RESULTS

No statistically significant differences were found between sample 1 and 2, regarding age, sex and medical/surgical distribution and undernutrition rates were similar (over 40%). The AUC for the ROC curves were 0.862 for the original CONUT, and 0.839 and 0.874, for model 1 and 2 respectively. The kappa index for the CONUT and SGA was 0.680.

CONCLUSIONS

The CONUT, with the original scores assigned by the authors is equally good than mathematical models and thus is a valuable tool, highly useful and efficient for the purpose of Clinical Undernutrition screening.

Confirming the validity of the CONUT system for early detection and monitoring of clinical undernutrition: comparison with two logistic regression models developed using SGA as the gold standard

AIM

To ratify previous validations of the CONUT nutritional screening tool by the development of two probabilistic models using the parameters included in the CONUT, to see if the CONUT´s effectiveness could be improved.

METHODS

It is a two step prospective study. In Step 1, 101 patients were randomly selected, and SGA and CONUT was made. With data obtained an unconditional logistic regression model was developed, and two variants of CONUT were constructed: Model 1 was made by a method of logistic regression. Model 2 was made by dividing the probabilities of undernutrition obtained in model 1 in seven regular intervals. In step 2, 60 patients were selected and underwent the SGA, the original CONUT and the new models developed. The diagnostic efficacy of the original CONUT and the new models was tested by means of ROC curves. Both samples 1 and 2 were put together to measure the agreement degree between the original CONUT and SGA, and diagnostic efficacy parameters were calculated.

RESULTS

No statistically significant differences were found between sample 1 and 2, regarding age, sex and medical/surgical distribution and undernutrition rates were similar (over 40%). The AUC for the ROC curves were 0.862 for the original CONUT, and 0.839 and 0.874, for model 1 and 2 respectively. The kappa index for the CONUT and SGA was 0.680.

CONCLUSIONS

The CONUT, with the original scores assigned by the authors is equally good than mathematical models and thus is a valuable tool, highly useful and efficient for the purpose of Clinical Undernutrition screening.

Quantum-correlated two-photon transitions to excitons in semiconductor quantum wells

The dependence of the excitonic two-photon absorption on the quantum correlations (entanglement) of exciting biphotons by a semiconductor quantum well is studied. We show that entangled photon absorption can display very unusual features depending on space-time-polarization biphoton parameters and absorber density of states for both bound exciton states as well as for unbound electron-hole pairs. We report on the connection between biphoton entanglement, as quantified by the Schmidt number, and absorption by a semiconductor quantum well. Comparison between frequency-anti-correlated, unentangled and frequency-correlated biphoton absorption is addressed. We found that exciton oscillator strengths are highly increased when photons arrive almost simultaneously in an entangled state. Two-photon-absorption becomes a highly sensitive probe of photon quantum correlations when narrow semiconductor quantum wells are used as two-photon absorbers.

The use of biochemical and immunological parameters in nutritional screening and assessment

OBJECTIVE

To evaluate the relationship between serum albumin, total cholesterol and total lymphocyte count with two nutritional assessment methods, to verify if their use is justified in nutritional screening tools.

METHODS

101 patients admitted to medical/surgical wards underwent the SGA and the Full Nutritional Assessment (FNA). Blood test which included serum albumin, total cholesterol and total lymphocyte count (TLC), were made. Percentage of weight loss and BMI were calculated. An Anova test was done to measure the differences in the mean levels of the three parameters for the nutritional status evaluated by SGA and FNA. The probability of a patient being malnourished in the four ranges established for each parameter was calculated, as well as the relationship between the ranges and the percentage of weight loss and BMI. Sensitivity and specificity were calculated and the corresponding ROC curves, using SGA as gold standard.

RESULTS

Prevalence of undernutrition is 43.6% and 44.6% for SGA and FNA respectively. Mean levels of the three parameters decrease as the undernutrition degree increases (p < 0.005 for all cases). The probability of a patient being malnourished gets higher as parameter lowers (p = 0.000 for all cases). Total cholesterol shows a relationship with BMI < 18.5 and presence/absence of weight loss (p = 0.074 and p = 0.002 respectively). The area under ROC curves are albumin (0.823), cholesterol (0.790) and TLC (0.758) respectively.

CONCLUSIONS

The analytical parameters analyzed show a statistically significant relationship with the nutritional status. Therefore, they are suitable for use in nutritional screening.

Observation of speckle pattern formation in transparent nonlinear random media

We report on the experimental observation of speckle formation from a transparent crystal formed by a random distribution of nonlinear domains. The angular distribution of second-harmonic light generated by a transparent strontium barium niobate crystal is measured for different diameters of the fundamental beam and crystal thicknesses. Distinct manifestations of speckle pattern formation are found in these experiments. By using a theoretical Green's function formalism, we explain the reported observations as a result of the linear interference among the second-harmonic waves generated in all directions by each of the nonlinear domains forming the nonlinear crystal.

Intravitreal bevacizumab for subfoveal choroidal neovascularization in age-related macular degeneration at twenty-four months: the Pan-American Collaborative Retina Study

PURPOSE

To report the 24-month anatomic and Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA) response after primary intravitreal bevacizumab (IVB) (Avastin; Genentech Inc., San Francisco, CA) (1.25 or 2.5 mg) in patients with subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD).

DESIGN

Retrospective, multicenter, interventional, comparative case series.

PARTICIPANTS

We reviewed the clinical records of 180 consecutive patients (207 eyes) with subfoveal CNV secondary to AMD at 9 centers from 8 countries.

METHODS

Patients were treated with at least 1 injection of IVB 1.25 mg (124 eyes [59.9%]) or 2.5 mg (83 eyes [40.1%]). Patients underwent ETDRS BCVA testing, ophthalmoscopic examination, optical coherence tomography (OCT), and fluorescein angiography (FA) at baseline and 1-, 3-, 6-, 12-, and 24-month visits.

MAIN OUTCOME MEASURES

Changes in BCVA and OCT.

RESULTS

The mean age of our patients was 74.3±7.5 years. The mean number of IVB injections per eye was 5.1 (range, 1-24 injections). In the 1.25 mg group, baseline BCVA improved from 20/235 (logarithm of the minimum angle of resolution [logMAR] 1.07) to 20/172 (logMAR 0.92) at 24 months (P<0.0001). Similar BCVA changes were observed in the 2.5 mg group. At baseline, the mean central macular thickness (CMT) by OCT in the 1.25 mg group was 308.4±127.52 μm, which was reduced to 269.35±97.92 μm, 262.1±94.81 μm, 264.03±97.06 μm, 245.91±89.52 μm, and 249.27±89.14 μm at 1, 3, 6, 12, and 24 months, respectively (P<0.0001). Similar changes were observed in the 2.5 mg group. In the 2.5 mg group, systemic complications included 2 new cases (2.6%) of arterial hypertension, 1 case (1.3%) of stroke, and 1 case (1.3%) of death.

CONCLUSIONS

Primary IVB at a dose of 1.25 or 2.5 mg seems to provide stability or improvement in BCVA, OCT, and FA in subfoveal CNV secondary to AMD at 24 months. Our results show no significant difference regarding BCVA with IVB at doses of 1.25 or 2.5 mg.

Development of a TiO2 modified optical fiber electrode and its incorporation into a photoelectrochemical reactor for wastewater treatment

Electrochemical advanced oxidation processes (EAOPs) are used to chemically burn non biodegradable complex organic compounds that are present in polluted effluents. A common approach involves the use of TiO2 semiconductor substrates as either photocatalytic or photoelectrocatalytic materials in reactors that produce a powerful oxidant (hydroxyl radical) that reacts with pollutant species. In this context, the purpose of this work is to develop a new TiO2 based photoanode using an optic fiber support. The novel arrangement of a TiO2 layer positioned on top of a surface modified optical fiber substrate, allowed the construction of a photoelectrochemical reactor that works on the basis of an internally illuminated approach. In this way, a semi-conductive optical fiber modified surface was prepared using 30 microm thickness SnO2:Sb films on which the photoactive TiO2 layer was electrophoretically deposited. UV light transmission experiments were conducted to evaluate the transmittance along the optical fiber covered with SnO2:Sb and TiO2 showing that 43% of UV light reached the optical fiber tip. With different illumination configurations (external or internal), it was possible to get an increase in the amount of photo-generated H(2)O(2) close to 50% as compared to different types of TiO2 films. Finally, the electro-Fenton photoelectrocatalytic Oxidation process studied in this work was able to achieve total color removal of Azo orange II dye (15 mg L(-1)) and a 57% removal of total organic carbon (TOC) within 60 min of degradation time.

Primary intravitreal bevacizumab for diffuse diabetic macular edema: the Pan-American Collaborative Retina Study Group at 24 months

PURPOSE

To report the 24-month anatomic and Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA) response after primary intravitreal bevacizumab (Avastin; Genentech, Inc., San Francisco, CA; 1.25 or 2.5 mg) in patients with diffuse diabetic macular edema (DDME). In addition, a comparison of the 2 different doses of intravitreal bevacizumab (IVB) used is presented.

DESIGN

Retrospective, multicenter, interventional, comparative case series.

PARTICIPANTS

The clinical records of 115 consecutive patients (139 eyes) with DDME at 11 centers from 8 countries were reviewed.

METHODS

Patients were treated with at least 1 intravitreal injection of 1.25 or 2.5 mg of bevacizumab. All patients were followed up for 24 months. Patients underwent ETDRS BCVA testing, ophthalmoscopic examination, optical coherence tomography (OCT), and fluorescein angiography (FA) at the baseline, 1-, 3-, 6-, 12-, and 24-month visits.

MAIN OUTCOME MEASURES

Changes in BCVA and OCT results.

RESULTS

The mean age of the patients was 59.4+/-11.1 years. The mean number of IVB injections per eye was 5.8 (range, 1-15 injections). In the 1.25-mg group at 1 month, BCVA improved from 20/150 (0.88 logarithm of the minimum angle of resolution [logMAR] units) to 20/107, 0.76 logMAR units (P<0.0001). The mean BCVA at 24 months was 20/75 (0.57 logMAR units; P<0.0001). Similar BCVA changes were observed in the 2.5-mg group: at 1 month, BCVA improved from 20/168 (0.92 logMAR units) to 20/118 (0.78 logMAR units; P = 0.02). The mean BCVA at 24 months was 20/114 (0.76 logMAR units; P<0.0001). In the 1.25-mg group, the mean central macular thickness (CMT) decreased from 466.5+/-145.2 microm at baseline to 332.2+/-129.6 microm at 1 month and 286.6+/-81.5 microm at 24 months (P<0.0001). Similar results were obtained in the 2.5-mg group.

CONCLUSIONS

Primary IVB at doses of 1.25 to 2.5 mg seem to provide stability or improvement in BCVA, OCT, and FA in DDME at 24 months. The results show no evident difference between IVB at doses of 1.25 or 2.5 mg.

Comparison of two doses of primary intravitreal bevacizumab (Avastin) for diffuse diabetic macular edema: results from the Pan-American Collaborative Retina Study Group (PACORES) at 12-month follow-up

BACKGROUND

To report the 12-month anatomic and ETDRS best-corrected visual acuity (BCVA) response after primary intravitreal bevacizumab (Avastin) (1.25 mg or 2.5 mg) in patients with diffuse diabetic macular edema (DDME). In addition, a comparison of the two different doses of intravitreal bevacizumab (IVB) utilized was made.

METHODS

We reviewed the clinical records of 82 consecutive patients (101 eyes) with DDME in this interventional retrospective multicenter study. All patients with a minimum follow-up of 12 months (mean 57.6 +/- 8.4 weeks) were included in this analysis. Patients underwent ETDRS best-corrected visual acuity (BCVA) testing, ophthalmoscopic examination, optical coherence tomography (OCT), and fluorescein angiography (FA) at baseline and follow-up visits.

RESULTS

The mean age of our patients was 59.7 +/- 9.3 years. The mean number of IVB injections per eye was three (range: one to six injections) at a mean interval of 14.1 +/- 10.5 weeks. In the 1.25 mg group at 1 month BCVA improved from 20/190, logMAR = 0.97 to 20/85, logMAR 0.62, a difference that was statistically significant (p = 0.0001). This improvement was maintained throughout the 3-, 6-, and 12-month follow-up. The mean final BCVA at 12 months was 20/76, logMAR = 0.58 (p < 0.001), a statistically significant difference from baseline BCVA. Similar BCVA changes were observed in the 2.5 mg group. In the 1.25 mg group, the mean central macular thickness (CMT) decreased from 419.1 +/- 201.1 microm at baseline to 295.11 +/- 91.5 microm at 1 month, 302.1 +/- 124.2 microm at 3 months, 313.4.1 +/- 96.3 microm at 6 months, and 268.2 +/- 95.5 microm at 12 months (p < 0.0001). Similar CMT changes were observed in the 2.5 mg group. Adverse events included transient high blood pressure in one patient (1.2%), transient increased intraocular pressure in one eye (1%), and tractional retinal detachment in one eye (1%).

CONCLUSIONS

Primary IVB at doses of 1.25 to 2.5 mg seem to provide stability or improvement in BCVA, OCT, and FA in DDME at 12 months. There seems to be no difference in our results between intravitreal bevacizumab at doses of 1.25 mg or 2.5 mg. In addition, our results suggest the need for at least three injections a year to maintain the BCVA results.