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Ursula Schmidterfurth - One of the best experts on this subject based on the ideXlab platform.
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verteporfin plus ranibizumab for choroidal neovascularization in age related macular degeneration twelve month mont blanc study results
Ophthalmology, 2012Co-Authors: Michael Larsen, Ursula Schmidterfurth, Paolo Lanzetta, Sebastian Wolf, Christian Simader, Erika Tokaji, Stefan Pilz, Annemarie WeisbergerAbstract:Purpose To compare the efficacy and safety of same-day verteporfin photodynamic therapy (PDT) and intravitreal ranibizumab combination treatment versus ranibizumab monotherapy in neovascular age-related macular degeneration. Design Prospective, multicenter, double-masked, randomized, active-controlled trial. Participants We included 255 patients with all types of active subfoveal choroidal neovascularization. Methods Patients were randomized 1:1 to as-needed ( pro re nata; PRN) combination (standard-fluence verteporfin 6 mg/m 2 PDT and ranibizumab 0.5 mg) or PRN ranibizumab monotherapy (sham infusion [5% dextrose] PDT and ranibizumab 0.5 mg). Patients received 3 consecutive monthly injections followed by PRN Retreatments based on protocol-specific Retreatment criteria. Main Outcome Measures Mean change in best-corrected visual acuity (BCVA) from baseline to month 12, and the proportion of patients with treatment-free interval ≥3 months at any timepoint after month 2. Results The mean change in BCVA at month 12 was +2.5 and +4.4 letters in the combination and monotherapy groups, respectively ( P = 0.0048; difference: −1.9 letters [95% confidence interval, −5.76 to 1.86], for having achieved noninferiority with a margin of 7 letters). The proportion of patients with a treatment-free interval of ≥3 months at any timepoint after month 2 was high, but did not show a clinically relevant difference between the treatment groups. Secondary efficacy endpoints included the mean number of ranibizumab Retreatments after month 2 (1.9 and 2.2 with combination and monotherapy, respectively [ P = 0.1373]). The time to first ranibizumab Retreatment after month 2 was delayed by 34 days (about 1 monthly visit) with combination (month 6) versus monotherapy (month 5). At month 12, mean ± standard error central retinal thickness decreased by 115.3±9.04 μm in the combination group and 107.7±11.02 μm in the monotherapy group. The mean number of verteporfin/sham PDT treatments was comparable in the 2 groups (combination, 1.7; monotherapy, 1.9). The safety profiles of the 2 groups were comparable, with a low incidence of ocular serious adverse events. Conclusions The combination PRN treatment regimen with verteporfin PDT and ranibizumab was effective in achieving BCVA gain comparable with ranibizumab monotherapy; however, the study did not show benefits with respect to reducing the number of ranibizumab Retreatment over 12 months. The combination therapy was well tolerated. Financial Disclosure(s) Proprietary or commercial disclosures may be found after the references.
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verteporfin and intravitreal triamcinolone acetonide combination therapy for occult choroidal neovascularization in age related macular degeneration
American Journal of Ophthalmology, 2006Co-Authors: Albert J Augustin, Ursula SchmidterfurthAbstract: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.
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photodynamic therapy with verteporfin for choroidal neovascularization caused by age related macular degeneration
Evidence-based Eye Care, 2000Co-Authors: Joan W Miller, Ursula Schmidterfurth, M Sickenberg, Horst Laqua, Irene Barbazetto, L Zografos, Bertrand Piguet, Constantin J Pournaras, G Donati, Anne Marie LaneAbstract:Objectives: To evaluate safety and short-term visual acuity and fluorescein angiographic effects of photodynamic therapy (PDT) after Retreatments with verteporfin for choroidal neovascularization (CNV) in agerelated macular degeneration (AMD) that demonstrated fluorescein leakage after at least 1 course of PDT. Design: Nonrandomized, multicenter, open-label phase 1 and 2 clinical trial using 2 different Retreatment dosage regimens.
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photodynamic therapy with verteporfin for choroidal neovascularization caused by age related macular degeneration results of a single treatment in a phase 1 and 2 study
Archives of Ophthalmology, 1999Co-Authors: Ursula Schmidterfurth, Joan W Miller, M Sickenberg, Horst Laqua, Irene Barbazetto, Evangelos S Gragoudas, L Zografos, Bertrand Piguet, Constantin J Pournaras, G DonatiAbstract:OBJECTIVES: To evaluate safety and short-term visual acuity and fluorescein angiographic effects of photodynamic therapy (PDT) after Retreatments with verteporfin for choroidal neovascularization (CNV) in age-related macular degeneration (AMD) that demonstrated fluorescein leakage after at least 1 course of PDT. DESIGN: Nonrandomized, multicenter, open-label phase 1 and 2 clinical trial using 2 different Retreatment dosage regimens. SETTING: Four ophthalmic centers in Europe and North America providing retinal care. METHODS: Standardized protocol refraction, visual acuity testing, ophthalmic examinations, color photographs, and fluorescein angiograms were used to evaluate the results of multiple PDT treatments. Two regimens (regimens 2 and 4) for treatment and Retreatment were chosen from 5 used in a single-treatment study. Both regimens used a verteporfin dose of 6 mg/m2 infused for 10 minutes. However, regimen 2 used a light dose of 100 J/cm2 applied 20 minutes after the start of the verteporfin infusion, whereas regimen 4 used a light dose of 50, 75, or 100 J/cm2 applied 15 minutes after infusion commenced. Posttreatment evaluations were planned in 31 participants up to 3 months after up to 2 Retreatments given at 2- or 4-week intervals after initial PDT treatment. Similar posttreatment evaluations were planned after Retreatments in 5 additional participants who were reenrolled some time more than 12 weeks after an initial PDT treatment. RESULTS: The average visual acuity change for the 31 participants who had Retreatment within 2 to 4 weeks after the initial treatment and a follow-up examination 16 to 20 weeks after the initial treatment was 0.2 lines (range, -4 to 4 lines) in regimen 2 and -1.0 line (range, -5 to 3 lines) in regimen 4. Similar outcomes were noted in the 5 reenrolled participants. Cessation of fluorescein leakage from classic CNV for at least 1 to 4 weeks could be achieved without loss of visual acuity after at least 2 treatments in 2 (6.5%) of 31 patients. Similar to single-treatment effects, the disappearance of leakage was documented regularly at 1 week after each Retreatment. Fluorescein leakage reappeared by 4 to 12 weeks after a Retreatment in almost all cases. However, compared with baseline, leakage activity appeared to be reduced after multiple PDT courses. For the 31 patients who had follow-up for 3 months after the last Retreatment and had received Retreatment 2 to 4 weeks after the initial treatment, progression of CNV beyond the area identified before the Retreatment was noted in 10 (48%) of the 21 eyes with classic CNV in regimen 2 and 9 (90%) of 10 eyes in regimen 4. The rate and severity of ocular or systemic adverse events were not increased by multiple applications. CONCLUSIONS: Multiple applications of PDT with verteporfin achieve repetitive, short-term cessation of fluorescein leakage from CNV secondary to AMD, without loss of visual acuity. This strategy can be used in randomized clinical trials investigating the efficacy of verteporfin in PDT for recurrent fluorescein dye leakage from persistent or recurrent CNV, following an initial or subsequent PDT treatment, with maintenance of visual acuity. Retreatments may achieve progressive cessation of leakage and prevent further growth of CNV and subsequent visual loss.
Fang Qian - One of the best experts on this subject based on the ideXlab platform.
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the efficacy of the waveone reciprocating file system versus the protaper Retreatment system in endodontic Retreatment of two different obturating techniques
Journal of Endodontics, 2017Co-Authors: Ben Jorgensen, Anne E Williamson, Rene Chu, Fang QianAbstract:Abstract Introduction This ex vivo study aimed to evaluate the efficacy of retreating GuttaCore (Dentsply Tulsa Dental Specialties, Tulsa, OK) and warm vertically condensed gutta-percha in moderately curved canals with 2 different systems: ProTaper Universal Retreatment (Dentsply Tulsa Dental) and WaveOne (Dentsply Tulsa Dental). Methods Eighty mesial roots of mandibular molars were used in this study. The mesiobuccal canals in each sample were prepared to length with the WaveOne Primary file (Dentsply Tulsa Dental). The canals were obturated with either a warm vertical approach or with GuttaCore and divided into 4 Retreatment groups with the same mean root curvature: warm vertical retreated with ProTaper, warm vertical retreated with WaveOne, GuttaCore retreated with ProTaper, and GuttaCore retreated with WaveOne. The warm vertical groups were obturated using a continuous-wave technique of gutta-percha compaction, and the GuttaCore groups were obturated according to the manufacturer's instructions. After allowing sealer to set, each specimen was retreated with either the ProTaper Universal Retreatment files D1, D2, or D3 or with the WaveOne Primary file to the predetermined working length. The time taken to reach the working length was recorded. Instrument fatigue and failure were also evaluated. Results The post hoc 2-sample t tests showed that the overall mean total time taken to reach the working length for the warm vertical groups was significantly greater than that observed for the GuttaCore groups (mean = 87.11 vs 60.16 seconds, respectively), and the overall mean total time taken to reach the working length for WaveOne was significantly greater than that observed for ProTaper (99.09 vs 48.18 seconds, respectively). Two-way analysis of variance showed a significant main effect for both the type of experiment groups (F1,76 = 15.32, P = .0002) and the type of Retreatments (F1,76 = 54.67, P Conclusions The WaveOne Primary file underwent more separations and was unable to remove gutta-percha as efficiently as the ProTaper Universal Retreatment files. Also, canals obturated with GuttaCore were retreated more efficiently and with fewer file separations than the canals obturated using continuous wave of warm gutta-percha.
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time required to remove guttacore thermafil plus and thermoplasticized gutta percha from moderately curved root canals with protaper files
Journal of Endodontics, 2013Co-Authors: Robert T Beasley, Anne E Williamson, Bruce C Justman, Fang QianAbstract:Abstract Introduction A novel carrier-based obturation system, GuttaCore, was developed to facilitate more efficient nonsurgical Retreatments. This ex vivo study evaluated the time required for re-treating GuttaCore and 2 other common obturation materials in moderately curved canals with ProTaper Retreatment and ProTaper files. Methods Sixty mesial roots of mandibular molars with the same mean curvature were randomly divided into 3 experimental groups: warm vertical, Thermafil Plus, and GuttaCore. Ten teeth served as positive and negative controls. The mesiobuccal canal in each sample was prepared to ISO size 30 with 0.04 taper. The warm vertical group was obturated by using a continuous-wave technique of gutta-percha compaction, and the Thermafil Plus and GuttaCore groups were obturated according to manufacturers' instructions. After allowing sealer to set, each specimen was sequentially treated with ProTaper Retreatment files D1, D2, and D3 and ProTaper Universal file F3 to the predetermined working length. The time taken to reach working length (T1) and the time required for obturation material removal (T2) were recorded. Results One-way analysis of variance followed by post hoc Tukey-Kramer test indicated that the mean total time to remove filling material for the GuttaCore group was significantly shorter than those observed in the other groups (P Conclusions GuttaCore is removed in less time from moderately curved canals with ProTaper files than either thermoplasticized gutta-percha or Thermafil Plus materials.
Till Dammaschke - One of the best experts on this subject based on the ideXlab platform.
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retreatability of three calcium silicate containing sealers and one epoxy resin based root canal sealer with four different root canal instruments
Clinical Oral Investigations, 2018Co-Authors: David Donnermeyer, Clarissa Bunne, Edgar Schafer, Till DammaschkeAbstract:The objective of the study was to compare the retreatability of three calcium silicate-containing sealers (BioRoot RCS, MTA Fillapex, Endo C.P.M.) and an epoxy resin-based sealer (AH Plus) with different root canal instruments (Hedstrom files, Reciproc R40, Mtwo Retreatment file R 25/.05 + Mtwo 40/.06, and F6 SkyTaper) concerning sealer remnants and Retreatment time. Root canals of 192 teeth were instrumented with Reciproc R40. All root canals were obturated using the single-cone technique with Reciproc R40 gutta-percha and one of the sealers (n = 48 per sealer). Two months later, Retreatment was performed using one of the mentioned instruments (n = 12 per instrument and sealer). The roots were split longitudinally, and both halves were investigated using light microscopy. The percentage of sealer remnants covering the root canal wall was evaluated using the software ImageJ. The time required for Retreatment was recorded. Statistical analysis was performed using two-way ANOVA and Student-Newman-Keuls post hoc test. Regarding the percentage of root canal filling remnants as well as Retreatment time, two-way ANOVA indicated that the results were significantly affected by the sealer (p < 0.001) and by the instrument used (p < 0.05). Overall, the use of AH Plus was associated with significantly more remnants compared to all other sealers (p < 0.001) and F6 SkyTaper instruments allowed significantly faster Retreatment than the other instruments (p < 0.05). The retreatability of calcium silicate-containing sealers was better compared to AH Plus as less sealer remnants and shorter Retreatment times were observed. Retreatment with engine-driven NiTi instruments was superior compared to hand instrumentation. Engine-driven NiTi instruments are better suited to remove root canal fillings than stainless steel Hedstrom files.
G Donati - One of the best experts on this subject based on the ideXlab platform.
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photodynamic therapy with verteporfin for choroidal neovascularization caused by age related macular degeneration
Evidence-based Eye Care, 2000Co-Authors: Joan W Miller, Ursula Schmidterfurth, M Sickenberg, Horst Laqua, Irene Barbazetto, L Zografos, Bertrand Piguet, Constantin J Pournaras, G Donati, Anne Marie LaneAbstract:Objectives: To evaluate safety and short-term visual acuity and fluorescein angiographic effects of photodynamic therapy (PDT) after Retreatments with verteporfin for choroidal neovascularization (CNV) in agerelated macular degeneration (AMD) that demonstrated fluorescein leakage after at least 1 course of PDT. Design: Nonrandomized, multicenter, open-label phase 1 and 2 clinical trial using 2 different Retreatment dosage regimens.
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photodynamic therapy with verteporfin for choroidal neovascularization caused by age related macular degeneration results of a single treatment in a phase 1 and 2 study
Archives of Ophthalmology, 1999Co-Authors: Ursula Schmidterfurth, Joan W Miller, M Sickenberg, Horst Laqua, Irene Barbazetto, Evangelos S Gragoudas, L Zografos, Bertrand Piguet, Constantin J Pournaras, G DonatiAbstract:OBJECTIVES: To evaluate safety and short-term visual acuity and fluorescein angiographic effects of photodynamic therapy (PDT) after Retreatments with verteporfin for choroidal neovascularization (CNV) in age-related macular degeneration (AMD) that demonstrated fluorescein leakage after at least 1 course of PDT. DESIGN: Nonrandomized, multicenter, open-label phase 1 and 2 clinical trial using 2 different Retreatment dosage regimens. SETTING: Four ophthalmic centers in Europe and North America providing retinal care. METHODS: Standardized protocol refraction, visual acuity testing, ophthalmic examinations, color photographs, and fluorescein angiograms were used to evaluate the results of multiple PDT treatments. Two regimens (regimens 2 and 4) for treatment and Retreatment were chosen from 5 used in a single-treatment study. Both regimens used a verteporfin dose of 6 mg/m2 infused for 10 minutes. However, regimen 2 used a light dose of 100 J/cm2 applied 20 minutes after the start of the verteporfin infusion, whereas regimen 4 used a light dose of 50, 75, or 100 J/cm2 applied 15 minutes after infusion commenced. Posttreatment evaluations were planned in 31 participants up to 3 months after up to 2 Retreatments given at 2- or 4-week intervals after initial PDT treatment. Similar posttreatment evaluations were planned after Retreatments in 5 additional participants who were reenrolled some time more than 12 weeks after an initial PDT treatment. RESULTS: The average visual acuity change for the 31 participants who had Retreatment within 2 to 4 weeks after the initial treatment and a follow-up examination 16 to 20 weeks after the initial treatment was 0.2 lines (range, -4 to 4 lines) in regimen 2 and -1.0 line (range, -5 to 3 lines) in regimen 4. Similar outcomes were noted in the 5 reenrolled participants. Cessation of fluorescein leakage from classic CNV for at least 1 to 4 weeks could be achieved without loss of visual acuity after at least 2 treatments in 2 (6.5%) of 31 patients. Similar to single-treatment effects, the disappearance of leakage was documented regularly at 1 week after each Retreatment. Fluorescein leakage reappeared by 4 to 12 weeks after a Retreatment in almost all cases. However, compared with baseline, leakage activity appeared to be reduced after multiple PDT courses. For the 31 patients who had follow-up for 3 months after the last Retreatment and had received Retreatment 2 to 4 weeks after the initial treatment, progression of CNV beyond the area identified before the Retreatment was noted in 10 (48%) of the 21 eyes with classic CNV in regimen 2 and 9 (90%) of 10 eyes in regimen 4. The rate and severity of ocular or systemic adverse events were not increased by multiple applications. CONCLUSIONS: Multiple applications of PDT with verteporfin achieve repetitive, short-term cessation of fluorescein leakage from CNV secondary to AMD, without loss of visual acuity. This strategy can be used in randomized clinical trials investigating the efficacy of verteporfin in PDT for recurrent fluorescein dye leakage from persistent or recurrent CNV, following an initial or subsequent PDT treatment, with maintenance of visual acuity. Retreatments may achieve progressive cessation of leakage and prevent further growth of CNV and subsequent visual loss.
Oznur Tuncay - One of the best experts on this subject based on the ideXlab platform.
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incidence of apical crack initiation and propagation during the removal of root canal filling material with protaper and mtwo rotary nickel titanium Retreatment instruments and hand files
Journal of Endodontics, 2014Co-Authors: Huseyin Sinan Topcuoglu, Salih Duzgun, Bertan Kesim, Oznur TuncayAbstract:Abstract Introduction The aim of this study was to determine the incidence of crack initiation and propagation in apical root dentin after Retreatment procedures performed by using 2 rotary Retreatment systems and hand files with additional instrumentation. Methods Eighty extracted mandibular premolars with single canals were selected. One millimeter from the apex of each tooth was ground perpendicular to the long axis of the tooth, and the apical surface was polished. Twenty teeth served as the control group, and no preparation was performed. The remaining 60 teeth were prepared to size 35 with rotary files and filled with gutta-percha and AH Plus sealer. Specimens were then divided into 3 groups ( n = 20), and Retreatment procedures were performed with the following devices and techniques: ProTaper Universal Retreatment files, Mtwo Retreatment files, and hand files. After Retreatment, the additional instrumentation was performed by using size 40 ProTaper, Mtwo, and hand files. Digital images of the apical root surface were recorded before preparation, after instrumentation, after filling, after Retreatment, and after additional instrumentation. The images were then inspected for the presence of any new apical cracks and propagation. Data were analyzed with the logistic regression and Fisher exact tests. Results All experimental groups caused crack initiation and propagation after use of Retreatment instruments. The ProTaper and Mtwo Retreatment groups caused greater crack initiation and propagation than the hand instrument group ( P P Conclusions This study showed that Retreatment procedures and additional instrumentation after the use of Retreatment files may cause crack initiation and propagation in apical dentin.
