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Zur D, Hod K, Trivizki O, Rabinovitch D, Schwartz S, Shulman S. ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR TREATMENT IN DIABETIC MACULAR EDEMA: RESULTS FROM A LARGE SINGLE-CENTER COHORT WITH BEVACIZUMAB AS FIRST-LINE THERAPY. Retina 2024; 44:1305-1313. [PMID: 38471038 DOI: 10.1097/iae.0000000000004096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
PURPOSE To explore visual acuity (VA) outcomes of anti-vascular endothelial growth factor (VEGF) intravitreal injections in treatment-naive eyes with diabetic macular edema (DME), with bevacizumab as first-line treatment. METHODS Retrospective single-center cohort study over a three-year follow-up. Overall, 1765 eyes from 1179 patients treated with intravitreal injections were evaluated. The cohort was divided according to the treatment given: (1) bevacizumab monotherapy, (2) eyes switched to a second-line agent, and (3) eyes switched to a third-line agent. RESULTS In total, 644 eyes of 444 patients met inclusion criteria. The mean age at presentation was 64.0 ± 11.1 years. The mean follow-up period was 24.6 ± 12.4 months. Furthermore, 67.1% of eyes were treated with bevacizumab monotherapy, 25.45% switched to a second-line agent, and 7.45% were switched to a third-line agent. The mean number of injections decreased significantly during each treatment year in the total cohort and within each treatment group ( P < 0.001). Mean VA for the total cohort and within each treatment group improved significantly throughout follow-up ( P < 0.001). No significant difference in VA was found between the groups ( P = 0.373). CONCLUSION This real-world study demonstrates robust and consistent VA gains over long-term follow-up in eyes with DME treated with either bevacizumab monotherapy or switching to alternative anti-VEGF agents in cases of suboptimal response.
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Affiliation(s)
- Dinah Zur
- Ophthalmology Division, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Keren Hod
- Department of Academy and Research, Assuta Medical Centers, affiliated to Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva
| | - Omer Trivizki
- Ophthalmology Division, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - David Rabinovitch
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and
| | - Shulamit Schwartz
- Ophthalmology Division, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shiri Shulman
- Ophthalmology Institute, Assuta Medical Centers, affiliated to Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva
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Vitiello L, Salerno G, Coppola A, De Pascale I, Abbinante G, Gagliardi V, Lixi F, Pellegrino A, Giannaccare G. Switching to an Intravitreal Dexamethasone Implant after Intravitreal Anti-VEGF Therapy for Diabetic Macular Edema: A Review. Life (Basel) 2024; 14:725. [PMID: 38929708 PMCID: PMC11204630 DOI: 10.3390/life14060725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 05/27/2024] [Accepted: 06/01/2024] [Indexed: 06/28/2024] Open
Abstract
Among working-age people, diabetic retinopathy and diabetic macular edema are currently considered the main causes of blindness. Nowadays, intravitreal injections are widely acknowledged as a significant milestone in ophthalmology, especially for the treatment of several retinal diseases, including diabetic macular edema. In particular, anti-vascular endothelial growth factor (VEGF) agents are typically the first line of treatment; however, monthly injections are required, at least, during the loading dosage. Notably, an intravitreal 0.7 mg dexamethasone (DEX) implant (Ozurdex®, AbbVie Inc., North Chicago, IL, USA) is considered a legitimate substitute treatment for diabetic eyes that have not responded to anti-VEGF treatment. In fact, clinical trials and real-life studies have demonstrated the effectiveness and safety of an intravitreal DEX implant in treating such conditions over a period of three to six months. For this reason, wisely selecting diabetic patients might be crucial to decreasing the load of injections in clinics and hospitals. The purpose of this review is to analyze the available scientific literature to highlight the benefits, efficacy, and clinical criteria for choosing whether to switch from intravitreal anti-VEGF therapy to an intravitreal DEX implant in diabetic macular edema.
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Affiliation(s)
- Livio Vitiello
- Eye Unit, “Luigi Curto” Hospital, Azienda Sanitaria Locale Salerno, 84035 Polla, SA, Italy; (G.S.); (A.C.); (I.D.P.); (G.A.); (V.G.); (A.P.)
| | - Giulio Salerno
- Eye Unit, “Luigi Curto” Hospital, Azienda Sanitaria Locale Salerno, 84035 Polla, SA, Italy; (G.S.); (A.C.); (I.D.P.); (G.A.); (V.G.); (A.P.)
| | - Alessia Coppola
- Eye Unit, “Luigi Curto” Hospital, Azienda Sanitaria Locale Salerno, 84035 Polla, SA, Italy; (G.S.); (A.C.); (I.D.P.); (G.A.); (V.G.); (A.P.)
| | - Ilaria De Pascale
- Eye Unit, “Luigi Curto” Hospital, Azienda Sanitaria Locale Salerno, 84035 Polla, SA, Italy; (G.S.); (A.C.); (I.D.P.); (G.A.); (V.G.); (A.P.)
| | - Giulia Abbinante
- Eye Unit, “Luigi Curto” Hospital, Azienda Sanitaria Locale Salerno, 84035 Polla, SA, Italy; (G.S.); (A.C.); (I.D.P.); (G.A.); (V.G.); (A.P.)
| | - Vincenzo Gagliardi
- Eye Unit, “Luigi Curto” Hospital, Azienda Sanitaria Locale Salerno, 84035 Polla, SA, Italy; (G.S.); (A.C.); (I.D.P.); (G.A.); (V.G.); (A.P.)
| | - Filippo Lixi
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, CA, Italy; (F.L.); (G.G.)
| | - Alfonso Pellegrino
- Eye Unit, “Luigi Curto” Hospital, Azienda Sanitaria Locale Salerno, 84035 Polla, SA, Italy; (G.S.); (A.C.); (I.D.P.); (G.A.); (V.G.); (A.P.)
| | - Giuseppe Giannaccare
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, CA, Italy; (F.L.); (G.G.)
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Sardana A, Singh K, Singh A, Singh VK. Optical coherence tomography biomarkers DROL, PROS, SND, hyperreflective walls of foveal cystoid spaces as predictors of central macular thickness and visual acuity in diabetic macular edema treated with intravitreal ranibizumab. Indian J Ophthalmol 2024; 72:722-727. [PMID: 38648434 PMCID: PMC11168529 DOI: 10.4103/ijo.ijo_903_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 10/22/2023] [Accepted: 10/28/2023] [Indexed: 04/25/2024] Open
Abstract
PURPOSE This study aims to establish DROL (disruption of retinal outer layers), PROS (photoreceptor outer segment length), SND (subfoveal neuroretinal detachment), and hyperreflective walls of foveal cystoid spaces (HRW) as optical coherence tomography (OCT) biomarkers and predictors of central macular thickness (CMT) and visual acuity in diabetic macular edema (DME) treated with intravitreal ranibizumab (IVR). METHODS In this prospective, interventional study performed at a tertiary care center over a span of 1 year from December 2021 to December 2022, 50 eyes of 46 patients of DME were included. Visual acuity and spectral domain OCT imaging were performed at baseline. Using inbuilt calipers on SD-OCT, the horizontal extent of DROL and the vertical extent of PROS were measured manually. SND and HRW were assessed qualitatively. IVR was administered and patients were followed up at 4, 8, and 12 weeks. RESULTS The eyes without DROL had statistically significant (P < 0.05) lesser CMT and better BCVA (best-corrected visual acuity) (P < 0.05) after pro re nata injection of IVR. There was a positive correlation between the extent of baseline DROL with final CMT (P < 0.05) and final logMAR BCVA (P > 0.05), whereas negative correlation with the extent of baseline PROS with final CMT (P < 0.05) and final logMAR BCVA (P > 0.05). The presence of HRW and SND predicted non-resolution of CMT and worse visual acuity after treatment with IVR in DME. CONCLUSION DROL, PROS, SND, and hyperreflective walls of foveal cystoid spaces may be utilized as qualitative as well as quantitative biomarkers to predict the post-treatment CMT and visual acuity in DME.
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Affiliation(s)
- Ayushi Sardana
- Department of Ophthalmology, Regional Institute of Ophthalmology, M.L.N. Medical College, Prayagraj, Uttar Pradesh, India
| | - Kamaljeet Singh
- Department of Ophthalmology, Regional Institute of Ophthalmology, M.L.N. Medical College, Prayagraj, Uttar Pradesh, India
| | - Arti Singh
- Department of Ophthalmology, Regional Institute of Ophthalmology, M.L.N. Medical College, Prayagraj, Uttar Pradesh, India
| | - Vinod K Singh
- Department of Ophthalmology, Regional Institute of Ophthalmology, M.L.N. Medical College, Prayagraj, Uttar Pradesh, India
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Camacho P, Ribeiro E, Pereira B, Varandas T, Nascimento J, Henriques J, Dutra-Medeiros M, Delgadinho M, Oliveira K, Silva C, Brito M. DNA methyltransferase expression (DNMT1, DNMT3a and DNMT3b) as a potential biomarker for anti-VEGF diabetic macular edema response. Eur J Ophthalmol 2023; 33:2267-2274. [PMID: 37082811 PMCID: PMC10590013 DOI: 10.1177/11206721231171623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 03/28/2023] [Indexed: 04/22/2023]
Abstract
PURPOSE DNA methylation is involved in Diabetic Retinopathy progression showing a metabolic memory mechanism. However, the association of DNA methyltransferase with diabetic macular edema is still unknown. We aimed to describe the differences in DNA methyltransferase gene expression in patients with different diabetic macular edema responses. METHODS A total of 27 diabetic patients, aged 59-90 years, were prospectively enrolled in this cross-sectional study. The participants were classified into control group (CG, n = 11), diabetic macular edema responders (rDME, n = 9) and non-responder diabetic macular edema (nrDME, n = 7) after anti-vascular endothelial growth factor (anti-VEGF) treatment. Only cases with a complete ophthalmological examination, digital 133° color fundus, and SD-OCT assessments were used. After RNA extraction and first-strand cDNA synthesis, quantitative real-time PCR was performed with specific primers on the CFX Connect™ Real-Time PCR Detection System to assess differential transcriptional expression patterns. RESULTS The DNMT1 gene showed a positive correlation (r = 0.617; p = 0.043) with Best Corrected Visual Acuity (BCVA) in CG, a positive correlation (r = 0.917; p = 0.010) with HbA1c in nrDME and a negative correlation (r = -0.659; p = 0.049) with GCL-IPL thickness in rDME. DNMT3A gene showed a positive correlation (r = -0.890; p = 0.001) with Sub-foveal Choroidal thickness in rDME whereas DNMT3b gene showed a negative correlation (r = -0.815; p = 0.007) with HbA1c and RNFL (r = -0.664; p = 0.026) in CG. CONCLUSIONS Patients with similar metabolic profile risk factors showed associated DNA methyltransferase transcriptional expression patterns differences fitting with the anti-VEGF diabetic macular edema response. Further studies are needed to clarify if these results (1) reflect disease evolution, (2) translate the therapeutic impact, (3) or can help to predict the therapeutic resistance profile.
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Affiliation(s)
- Pedro Camacho
- H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
- Ophtalmology Institute Dr. Gama Pinto, Lisbon, Portugal
- iNOVA4Health, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Edna Ribeiro
- H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Bruno Pereira
- iNOVA4Health, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisbon, Portugal
- Retina Institute of Lisbon, Lisbon, Portugal
| | | | - João Nascimento
- Retina Institute of Lisbon, Lisbon, Portugal
- Beatriz Ângelo Hospital, Lisbon, Portugal
| | | | - Marco Dutra-Medeiros
- iNOVA4Health, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisbon, Portugal
- Central Lisbon Hospital Center, Lisbon, Portugal
| | - Mariana Delgadinho
- H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Ketlyn Oliveira
- H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Carina Silva
- H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Miguel Brito
- H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
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Yu L, Hao X, Cheng J, Ling Y, Ren H, Mo B, Liu W. Predictive effect of TCED-HFV grading and imaging biomarkers on anti-VEGF therapy in diabetic macular edema. BMC Ophthalmol 2023; 23:232. [PMID: 37221461 DOI: 10.1186/s12886-023-02973-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 05/11/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND To evaluate the predictive effect of TCED-HFV grading and imaging biomarkers on anti-vascular endothelial growth factor (anti-VEGF) treatment in diabetic macular edema (DME). METHODS 81 eyes of 81 DME patients who were treated with anti-VEGF were included in this retrospective cohort study. All patients underwent a comprehensive ophthalmic examination at baseline and follow-up, including best-corrected visual acuity (BCVA), fundus photography, and spectral domain-optical coherence tomography (SD-OCT). Baseline imaging biomarkers were qualitatively and quantitatively graded according to the TCED-HFV classification protocol, and DME was divided into early stage, advanced stage, severe stage, and atrophy stage. RESULTS Six months post treatment, central subfield thickness (CST) in 49 eyes (60.5%) had decreased by 10% from baseline, 30 eyes (37.0%) had achieved CST < 300 μm, and 45 eyes (55.6%) had BCVA improved by more than five letters. Multivariate regression analysis revealed that eyes with baseline CST ≥ 390 μm had a higher probability of ≥ 10% reduction in CST from baseline, and eyes with abundant hyperreflective dots (HRD) had a lower probability of 10% reduction in CST (all P < 0.05). Eyes with vitreomacular traction (VMT) or epiretinal membrane (ERM) at baseline were less likely to reach the end point of CST < 300 μm (P < 0.05). BCVA increases of more than five letters were less likely in eyes with baseline BCVA ≥ 69 letters, complete or partial destruction of ellipsoid zone (EZ) at baseline (all P < 0.05). TCED-HFV staging was negatively correlated with BCVA at both baseline and 6 months (Kendall's tau-b=-0.39 and - 0.55, all P < 0.01). TCED-HFV staging was positively correlated with CST at 6 months (Kendall's tau-b = 0.19, P = 0.049) and negatively correlated with the reduction of CST (Kendall's tau-b=-0.32, P < 0.01). CONCLUSION The TCED-HFV grading protocol facilitates a comprehensive assessment of DME severity, standardizes the grading of multiple imaging biomarkers, and predicts the anatomical and functional outcomes of anti-VEGF treatment.
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Affiliation(s)
- Lu Yu
- Department of Ophthalmology, Beijing Tongren Hospital, Beijing Tongren Eye Center, Capital Medical University, 1 Dongjiaominxiang Road, Beijing, 100073, P.R. China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Capital Medical University, Beijing, 100073, P.R. China
- Department of Ophthalmology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, 100049, P.R. China
| | - Xiaolin Hao
- Department of Ophthalmology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, 100049, P.R. China
| | - Jie Cheng
- Department of Ophthalmology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, 100049, P.R. China
| | - Yu Ling
- Department of Ophthalmology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, 100049, P.R. China
| | - Hong Ren
- Department of Ophthalmology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, 100049, P.R. China
| | - Bin Mo
- Department of Ophthalmology, Beijing Tongren Hospital, Beijing Tongren Eye Center, Capital Medical University, 1 Dongjiaominxiang Road, Beijing, 100073, P.R. China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Capital Medical University, Beijing, 100073, P.R. China
| | - Wu Liu
- Department of Ophthalmology, Beijing Tongren Hospital, Beijing Tongren Eye Center, Capital Medical University, 1 Dongjiaominxiang Road, Beijing, 100073, P.R. China.
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Capital Medical University, Beijing, 100073, P.R. China.
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Prediction of OCT images of short-term response to anti-VEGF treatment for diabetic macular edema using different generative adversarial networks. Photodiagnosis Photodyn Ther 2023; 41:103272. [PMID: 36632873 DOI: 10.1016/j.pdpdt.2023.103272] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/03/2023] [Accepted: 01/03/2023] [Indexed: 01/11/2023]
Abstract
PURPOSE This study sought to assess the predictive performance of optical coherence tomography (OCT) images for the response of diabetic macular edema (DME) patients to anti-vascular endothelial growth factor (VEGF) therapy generated from baseline images using generative adversarial networks (GANs). METHODS Patient information, including clinical and imaging data, was obtained from inpatients at the Ophthalmology Department of Qilu Hospital. 715 and 103 pairs of pre-and post-treatment OCT images of DME patients were included in the training and validation sets, respectively. The post-treatment OCT images were used to assess the validity of the generated images. Six different GAN models (CycleGAN, PairGAN, Pix2pixHD, RegGAN, SPADE, UNIT) were applied to predict the efficacy of anti-VEGF treatment by generating OCT images. Independent screening and evaluation experiments were conducted to validate the quality and comparability of images generated by different GAN models. RESULTS OCT images generated f GAN models exhibited high comparability to the real images, especially for edema absorption. RegGAN exhibited the highest prediction accuracy over the CycleGAN, PairGAN, Pix2pixHD, SPADE, and UNIT models. Further analyses were conducted based on the RegGAN. Most post-therapeutic OCT images (95/103) were difficult to differentiate from the real OCT images by retinal specialists. A mean absolute error of 26.74 ± 21.28 μm was observed for central macular thickness (CMT) between the synthetic and real OCT images. CONCLUSION Different generative adversarial networks have different prognostic efficacy for DME, and RegGAN yielded the best performance in our study. Different GAN models yielded good accuracy in predicting the OCT-based response to anti-VEGF treatment at one month. Overall, the application of GAN models can assist clinicians in prognosis prediction of patients with DME to design better treatment strategies and follow-up schedules.
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Akbas YB, Alagoz C, Cakmak S, Demir G, Alagoz N, Artunay HO. Three year outcomes of intravitreal ranibizumab and aflibercept treatment of patients with diabetic macular edema: A comparative study. Ther Adv Ophthalmol 2023; 15:25158414231195174. [PMID: 37649968 PMCID: PMC10464826 DOI: 10.1177/25158414231195174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 07/31/2023] [Indexed: 09/01/2023] Open
Abstract
Background Diabetic macular edema (DME) is the most common cause of visual deterioration in patients with diabetes mellitus. Various treatment options have been used for DME, including intravitreal injection of steroids and anti-vascular endothelial growth factors. Objectives To evaluate and compare the functional and anatomical outcomes of intravitreal ranibizumab (IVR) and intravitreal aflibercept (IVA) treatments in patients with DME. Design Retrospective study. Methods Four hundred three eyes of 235 naïve patients who underwent IVR or IVA treatment for DME followed up to 36 months included in the study. Best corrected visual acuity (BCVA) and central macular thickness (CMT) were measured at baseline, year 1, 2 and 3. Primary endpoint of the study was the change in BCVA and CMT each year from baseline and requirement of additional treatment (laser/steroid injection). Results There were 198 eyes in IVR group and 205 eyes in IVA group. The changes in mean BCVA were 0.09 ± 0.32 versus 0.17 ± 0.41 Logarithm of the minimum angle of resolution (logMAR) (p = 0.042) at year 1, 0.09 ± 0.37 versus 0.12 ± 0.45 logMAR (p = 0.512) at year 2 and 0.13 ± 0.36 versus 0.15 ± 0.48 logMAR (p = 0.824) at year 3 in IVA and IVR groups, respectively. The baseline mean BCVA were lower (p = 0.004) in IVA group. The mean total number of injections was 7.93 ± 3.38 versus 7.42 ± 3.05 (p = 0.112). Conclusion At year 1, change in mean BCVA was statistically significantly higher in IVA group; however this difference did not persist at years 2 and 3. Although the mean total number of injections was similar between groups, the requirement for adjuvant steroid treatment was significantly higher in ranibizumab group, which may affect the number of visits and treatment costs. Both ranibizumab and aflibercept treatments achieved a good long-term visual and anatomical response in DME patients.
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Affiliation(s)
- Yusuf Berk Akbas
- University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Olimpiyat Bulvari Yolu, Basaksehir, Istanbul 34480, Turkey
| | - Cengiz Alagoz
- University of Health Sciences, Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey
| | - Semih Cakmak
- Department of Ophthalmology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Gokhan Demir
- Department of Ophthalmology, Westeye Hospital, Erbil, Iraq
| | - Nese Alagoz
- University of Health Sciences, Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey
| | - Halil Ozgur Artunay
- University of Health Sciences, Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey
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8
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Maatouk CM, Sastry R, Singh RP. Long term outcomes following anti-VEGF therapy for diabetic macular edema. EXPERT REVIEW OF OPHTHALMOLOGY 2022. [DOI: 10.1080/17469899.2022.2131539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Christopher M. Maatouk
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- The Cole Eye Center for Ophthalmic Bioinformatics, Cleveland, OH, USA
| | - Resya Sastry
- The Cole Eye Center for Ophthalmic Bioinformatics, Cleveland, OH, USA
- Creighton University School of Medicine, Omaha, NE, USA
| | - Rishi P. Singh
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Cleveland Clinic Martin Hospital, Stuart, FL, USA
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Malhi NK, Allen CL, Stewart E, Horton KL, Riu F, Batson J, Amoaku W, Morris JC, Arkill KP, Bates DO. Serine-arginine-rich protein kinase-1 inhibition for the treatment of diabetic retinopathy. Am J Physiol Heart Circ Physiol 2022; 322:H1014-H1027. [PMID: 35302878 PMCID: PMC9109797 DOI: 10.1152/ajpheart.00001.2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Angiogenic VEGF isoforms are upregulated in diabetic retinopathy (DR), driving pathological growth and fluid leakage. Serine-arginine-rich protein kinase-1 (SRPK1) regulates VEGF splicing, and its inhibition blocks angiogenesis. We tested the hypothesis that SRPK1 is activated in diabetes, and an SRPK1 inhibitor (SPHINX31) switches VEGF splicing in DR and prevents increased vascular permeability into the retina. SRPK1 was activated by high glucose (HG), in a PKC-dependent manner, and was blocked by SPHINX31. HG induced release of SRSF1 from the nuclear speckles, which was also SRPK1 dependent, and increased retinal pigment epithelial (RPE) monolayer admittance, which was reversed by SRPK1 inhibition (P < 0.05). Diabetes increased retinal permeability and thickness after 14 days which was blocked by treatment with SPHINX31 eye drops (P < 0.0001). These results show that SRPK1 inhibition, administered as an eye drop, protected the retinal barrier from hyperglycemia-associated loss of integrity in RPE cells in vitro and in diabetic rats in vivo. A clinical trial of another SRPK1 inhibitor has now been initiated in patients with diabetic macular edema.NEW & NOTEWORTHY VEGF-A165b splicing is induced by hyperglycemia through PKC-mediated activation of SRPK1 in RPE cells, increasing their permeability and angiogenic capability. SRPK1 inhibitors can be given as eye drops to reduce retinal permeability and edema in diabetic retinopathy.
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Affiliation(s)
- Naseeb K Malhi
- Tumour and Vascular Biology Laboratories, Division of Cancer and Stem Cells, Centre for Cancer Sciences, School of Medicine, Biodiscovery Institute, University of Nottingham, Nottingham, United Kingdom
| | - Claire L Allen
- Tumour and Vascular Biology Laboratories, Division of Cancer and Stem Cells, Centre for Cancer Sciences, School of Medicine, Biodiscovery Institute, University of Nottingham, Nottingham, United Kingdom
| | | | - Katherine L Horton
- Tumour and Vascular Biology Laboratories, Division of Cancer and Stem Cells, Centre for Cancer Sciences, School of Medicine, Biodiscovery Institute, University of Nottingham, Nottingham, United Kingdom
| | - Federica Riu
- Tumour and Vascular Biology Laboratories, Division of Cancer and Stem Cells, Centre for Cancer Sciences, School of Medicine, Biodiscovery Institute, University of Nottingham, Nottingham, United Kingdom
| | | | - Winfried Amoaku
- Division of Clinical Neuroscience, Department of Ophthalmology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Jonathan C Morris
- School of Chemistry, University of New South Wales, Sydney, New South Wales, Australia
| | - Kenton P Arkill
- Tumour and Vascular Biology Laboratories, Division of Cancer and Stem Cells, Centre for Cancer Sciences, School of Medicine, Biodiscovery Institute, University of Nottingham, Nottingham, United Kingdom
| | - David O Bates
- Tumour and Vascular Biology Laboratories, Division of Cancer and Stem Cells, Centre for Cancer Sciences, School of Medicine, Biodiscovery Institute, University of Nottingham, Nottingham, United Kingdom.,Exonate Limited, Duxford, United Kingdom.,COMPARE, University of Birmingham and University of Nottingham Midlands, Nottingham, United Kingdom
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Use of ziv-aflibercept in diabetic macular edema in a Ghanaian population. Eye (Lond) 2022; 36:40-44. [PMID: 35590054 PMCID: PMC9159049 DOI: 10.1038/s41433-022-02005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Aim To investigate the use of intravitreal ziv-aflibercept (IVZ) in Ghanaian patients with diabetic macular edema (DME). Methods A retrospective study of patients with DME, who had been treated with IVZ (1.25 mg/0.05 ml), as part of routine clinical practice, on pro re nata basis between 2016 and 2018 who had a minimum follow-up of 6 months was retrieved and analyzed. The primary outcome measure was change in best-corrected visual acuity (BCVA) at 6 months. Secondary outcome measures are change in BCVA at 12 months and at the last follow-up visit, adverse events and change in central macular thickness (CMT). Results Twenty-five eyes of 17 patients (11 males) were included in this study. Their mean age was 60.82 ± 7.70 years and the mean duration of follow-up was 9.52 ± 3.31 months. The mean baseline BCVA (logMAR) of 0.65 ± 0.3 improved to 0.34 ± 0.16 (p < 0.0001) and 0.22 ± 0.15 (p = 0.0004) at 6 and 12 months, respectively. Twelve (48%) eyes had a visual gain of at least three lines at 6 months and 4 of 12 eyes (33.3%) at 1 year. There was a significant reduction in the mean CMT at 6 and 12 months and at the last follow-up visit compared to baseline (p < 0.0001). The adverse events recorded were raised intraocular pressure (four eyes) at 3, 6, and 12 months post injection, increased blood pressure in a patient with known systemic hypertension and transient memory loss in one patient. Conclusion IVZ (1.25 mg) was associated with significant improvement in BCVA and reduction in CMT at 6 and 12 months in eyes with DME. A randomized clinical trial is warranted to assess this potentially cost-effective intervention for DME in low-resource settings.
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Xu F, Liu S, Xiang Y, Hong J, Wang J, Shao Z, Zhang R, Zhao W, Yu X, Li Z, Yang X, Geng Y, Xiao C, Wei M, Zhai W, Zhang Y, Wang S, Li J. Prediction of the Short-Term Therapeutic Effect of Anti-VEGF Therapy for Diabetic Macular Edema Using a Generative Adversarial Network with OCT Images. J Clin Med 2022; 11:jcm11102878. [PMID: 35629007 PMCID: PMC9144043 DOI: 10.3390/jcm11102878] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/20/2022] [Accepted: 05/01/2022] [Indexed: 02/04/2023] Open
Abstract
Purpose: To generate and evaluate individualized post-therapeutic optical coherence tomography (OCT) images that could predict the short-term response of anti-vascular endothelial growth factor (VEGF) therapy for diabetic macular edema (DME) based on pre-therapeutic images using generative adversarial network (GAN). Methods: Real-world imaging data were collected at the Department of Ophthalmology, Qilu Hospital. A total of 561 pairs of pre-therapeutic and post-therapeutic OCT images of patients with DME were retrospectively included in the training set, 71 pre-therapeutic OCT images were included in the validation set, and their corresponding post-therapeutic OCT images were used to evaluate the synthetic images. A pix2pixHD method was adopted to predict post-therapeutic OCT images in DME patients that received anti-VEGF therapy. The quality and similarity of synthetic OCT images were evaluated independently by a screening experiment and an evaluation experiment. Results: The post-therapeutic OCT images generated by the GAN model based on big data were comparable to the actual images, and the response of edema resorption was also close to the ground truth. Most synthetic images (65/71) were difficult to differentiate from the actual OCT images by retinal specialists. The mean absolute error (MAE) of the central macular thickness (CMT) between the synthetic OCT images and the actual images was 24.51 ± 18.56 μm. Conclusions: The application of GAN can objectively demonstrate the individual short-term response of anti-VEGF therapy one month in advance based on OCT images with high accuracy, which could potentially help to improve treatment compliance of DME patients, identify patients who are not responding well to treatment and optimize the treatment program.
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Affiliation(s)
- Fabao Xu
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; (F.X.); (J.W.); (Z.S.); (R.Z.); (W.Z.); (X.Y.); (Z.L.); (X.Y.); (Y.G.); (C.X.); (M.W.); (W.Z.); (Y.Z.)
| | - Shaopeng Liu
- School of Computer Science, Guangdong Polytechnic Normal University, Guangzhou 510665, China;
| | - Yifan Xiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510085, China;
| | - Jiaming Hong
- School of Medical Information Engineering, Guangzhou University of Chinese Medicine, Guangzhou 510182, China;
| | - Jiawei Wang
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; (F.X.); (J.W.); (Z.S.); (R.Z.); (W.Z.); (X.Y.); (Z.L.); (X.Y.); (Y.G.); (C.X.); (M.W.); (W.Z.); (Y.Z.)
| | - Zheyi Shao
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; (F.X.); (J.W.); (Z.S.); (R.Z.); (W.Z.); (X.Y.); (Z.L.); (X.Y.); (Y.G.); (C.X.); (M.W.); (W.Z.); (Y.Z.)
| | - Rui Zhang
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; (F.X.); (J.W.); (Z.S.); (R.Z.); (W.Z.); (X.Y.); (Z.L.); (X.Y.); (Y.G.); (C.X.); (M.W.); (W.Z.); (Y.Z.)
| | - Wenjuan Zhao
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; (F.X.); (J.W.); (Z.S.); (R.Z.); (W.Z.); (X.Y.); (Z.L.); (X.Y.); (Y.G.); (C.X.); (M.W.); (W.Z.); (Y.Z.)
| | - Xuechen Yu
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; (F.X.); (J.W.); (Z.S.); (R.Z.); (W.Z.); (X.Y.); (Z.L.); (X.Y.); (Y.G.); (C.X.); (M.W.); (W.Z.); (Y.Z.)
| | - Zhiwen Li
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; (F.X.); (J.W.); (Z.S.); (R.Z.); (W.Z.); (X.Y.); (Z.L.); (X.Y.); (Y.G.); (C.X.); (M.W.); (W.Z.); (Y.Z.)
| | - Xueying Yang
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; (F.X.); (J.W.); (Z.S.); (R.Z.); (W.Z.); (X.Y.); (Z.L.); (X.Y.); (Y.G.); (C.X.); (M.W.); (W.Z.); (Y.Z.)
| | - Yanshuang Geng
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; (F.X.); (J.W.); (Z.S.); (R.Z.); (W.Z.); (X.Y.); (Z.L.); (X.Y.); (Y.G.); (C.X.); (M.W.); (W.Z.); (Y.Z.)
| | - Chunyan Xiao
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; (F.X.); (J.W.); (Z.S.); (R.Z.); (W.Z.); (X.Y.); (Z.L.); (X.Y.); (Y.G.); (C.X.); (M.W.); (W.Z.); (Y.Z.)
| | - Min Wei
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; (F.X.); (J.W.); (Z.S.); (R.Z.); (W.Z.); (X.Y.); (Z.L.); (X.Y.); (Y.G.); (C.X.); (M.W.); (W.Z.); (Y.Z.)
| | - Weibin Zhai
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; (F.X.); (J.W.); (Z.S.); (R.Z.); (W.Z.); (X.Y.); (Z.L.); (X.Y.); (Y.G.); (C.X.); (M.W.); (W.Z.); (Y.Z.)
| | - Ying Zhang
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; (F.X.); (J.W.); (Z.S.); (R.Z.); (W.Z.); (X.Y.); (Z.L.); (X.Y.); (Y.G.); (C.X.); (M.W.); (W.Z.); (Y.Z.)
| | - Shaopeng Wang
- Zibo Central Hospital, Binzhou Medical University, Zibo 256603, China;
| | - Jianqiao Li
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; (F.X.); (J.W.); (Z.S.); (R.Z.); (W.Z.); (X.Y.); (Z.L.); (X.Y.); (Y.G.); (C.X.); (M.W.); (W.Z.); (Y.Z.)
- Correspondence: ; Tel.: +86-020-185-6008-7118
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Kusuhara S, Shimura M, Kitano S, Sugimoto M, Muramatsu D, Fukushima H, Takamura Y, Matsumoto M, Kokado M, Kogo J, Sasaki M, Morizane Y, Utsumi T, Kotake O, Koto T, Terasaki H, Hirano T, Ishikawa H, Mitamura Y, Okamoto F, Kinoshita T, Kimura K, Yamashiro K, Suzuki Y, Hikichi T, Washio N, Sato T, Ohkoshi K, Tsujinaka H, Kondo M, Takagi H, Murata T, Sakamoto T. Treatment of diabetic macular edema in real-world clinical practice: the effect of aging. J Diabetes Investig 2022; 13:1339-1346. [PMID: 35389565 PMCID: PMC9340861 DOI: 10.1111/jdi.13801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/08/2022] [Accepted: 04/05/2022] [Indexed: 11/27/2022] Open
Abstract
Aims/Introduction In older patients, the management of diabetic macular edema (DME) can be complicated by comorbidities, geriatric syndrome, and socioeconomic status. This study aims to evaluate the effects of aging on the management of DME. Materials and Methods This is a real‐world clinical study including 1,552 patients with treatment‐naïve center‐involved DME. The patients were categorized into 4 categories by age at baseline (C1, <55; C2, 55–64; C3, 65–74; and C4, ≥75 years). The outcomes were the change in logarithm of the minimum angle of resolution best‐corrected visual acuity (logMAR BCVA) and central retinal thickness (CRT), and the number of treatments from baseline to 2 years. Results From baseline to 2 years, the mean changes in logMAR BCVA from baseline to 2 years were −0.01 in C1, −0.06 in C2, −0.07 in C3, and 0.01 in C4 (P = 0.016), and the mean changes in CRT were −136.2 μm in C1, −108.8 μm in C2, −100.6 μm in C3, and −89.5 μm in C4 (P = 0.008). Treatments applied in the 2 year period exhibited decreasing trends with increasing age category on the number of intravitreal injections of anti‐VEGF agents (P = 0.06), selecting local corticosteroid injection (P = 0.031), vitrectomy (P < 0.001), and laser photocoagulation outside the great vascular arcade (P < 0.001). Conclusions Compared with younger patients with DME, patients with DME aged ≥75 years showed less frequent treatment, a lower BCVA gain, and a smaller CRT decrease. The management and visual outcome in older patients with DME would be unsatisfactory in real‐world clinical practice.
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Affiliation(s)
- Sentaro Kusuhara
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masahiko Shimura
- Department of Ophthalmology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan
| | - Shigehiko Kitano
- Department of Ophthalmology, Diabetes Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Masahiko Sugimoto
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
| | | | - Harumi Fukushima
- Department of Ophthalmology, Diabetes Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoshihiro Takamura
- Department of Ophthalmology, School of Medical Sciences, University of Fukui, Yoshida, Japan
| | - Makiko Matsumoto
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Masahide Kokado
- Department of Ophthalmology, Wakayama Medical University, Wakayama, Japan
| | - Jiro Kogo
- Department of Ophthalmology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Mariko Sasaki
- Department of Ophthalmology, Tachikawa Hospital, Tachikawa, Japan.,Department of Ophthalmology, National Hospital Organisation Tokyo Medical Center, Meguro-ku, Tokyo, Japan
| | - Yuki Morizane
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takuya Utsumi
- Department of Ophthalmology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan
| | - Osamu Kotake
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
| | - Takashi Koto
- Kyorin Eye Center, Kyorin University School of Medicine, Mitaka, Japan
| | - Hiroto Terasaki
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Takao Hirano
- Deparment of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiroto Ishikawa
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yoshinori Mitamura
- Department of Ophthalmology, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
| | - Fumiki Okamoto
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takamasa Kinoshita
- Department of Ophthalmology, Sapporo City General Hospital, Sapporo, Japan
| | - Kazuhiro Kimura
- Departmet of Ophthalmology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Kenji Yamashiro
- Department of Ophthalmology, Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Yukihiko Suzuki
- Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | | | - Noriaki Washio
- Department of Ophthalmology, Showa General Hospital, Kodaira, Japan
| | - Tomohito Sato
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Japan
| | - Kishiko Ohkoshi
- Department of Ophthalmology, St. Luke's International Hospital, Tokyo, Japan
| | - Hiroki Tsujinaka
- Department of Ophthalmology, Nara Medical University Graduate School of Medicine, Kashihara, Japan
| | - Mineo Kondo
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hitoshi Takagi
- Department of Ophthalmology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Toshinori Murata
- Deparment of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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Peto T, Akerele T, Sagkriotis A, Zappacosta S, Clemens A, Chakravarthy U. Treatment patterns and persistence rates with anti-vascular endothelial growth factor treatment for diabetic macular oedema in the UK: A real-world study. Diabet Med 2022; 39:e14746. [PMID: 34796985 PMCID: PMC9299692 DOI: 10.1111/dme.14746] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 11/17/2021] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Anti-vascular endothelial growth factors (anti-VEGFs) are considered standard of care therapy for diabetic macular oedema (DME). This study examined treatment patterns and outcomes in patients with DME treated with anti-VEGF therapy. METHODS Using anonymized electronic medical record data collected from three UK sites, this retrospective cohort study assessed rates of anti-VEGF intravitreal injections in adults with treatment-naïve DME who received their first treatment between 1 September 2010 and 31 July 2018. The proportion of patients with at least one interval of at least 12 weeks between injections; the distribution of injection intervals; the discontinuation rates; and the number of anti-VEGF injection-, injection-free- and total visits were assessed during the first and second years of treatment. RESULTS Overall, 1606 patient eyes with DME were included, with no minimum follow-up. During the first and second year of treatment, 63.2% and 73.1% of eyes had at least one anti-VEGF injection interval of at least 12 weeks, respectively. In the first and second years of treatment, the mean (standard deviation) numbers of injections were 7.7 (1.9) and 5.6 (2.2), with 14.2 (5.7) and 13.4 (6.4) total clinic visits, and 6.6 (5.0) and 7.8 (5.8) injection-free visits, respectively. In total, 27.8% of patient eyes discontinued treatment during the first 2 years. CONCLUSIONS The high number of clinic visits and high discontinuation rates demonstrate a significant unmet need for a treatment to enable sustainable extended injection intervals, while maintaining visual acuity. This could improve patient adherence and health-related quality of life for patients with DME.
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Affiliation(s)
- Tunde Peto
- Centre for Public HealthQueen's University BelfastBelfastUK
| | | | | | | | - Andreas Clemens
- Novartis Pharma AGBaselSwitzerland
- Department of Cardiology and Angiology IFaculty of MedicineHeart Center Freiburg UniversityUniversity of FreiburgFreiburgGermany
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Deissler HL, Rehak M, Busch C, Wolf A. Blocking of VEGF-A is not sufficient to completely revert its long-term effects on the barrier formed by retinal endothelial cells. Exp Eye Res 2022; 216:108945. [PMID: 35038456 DOI: 10.1016/j.exer.2022.108945] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 12/20/2021] [Accepted: 01/10/2022] [Indexed: 12/27/2022]
Abstract
The VEGF-A-induced functional impairment of the barrier formed by retinal endothelial cells (REC) can be prevented and even - at least temporarily - reverted by trapping the growth factor in a complex with a VEGF-binding protein or by inhibiting the activity of the VEGF receptor 2 (VEGFR2). In an approach to emulate the clinically relevant situation of constant exposure to effectors, we investigated (1) whether prolonged exposure to VEGF-A165 for up to six days results in a different type of disturbance of the barrier formed by immortalized bovine REC (iBREC) and (2) whether alterations of the barrier induced by VEGF-A165 can indeed be sustainably reverted by subsequent treatment with the VEGF-A-binding proteins ranibizumab or brolucizumab. As a measure of barrier integrity, the cell index (CI) of iBREC cultivated on gold electrodes was monitored continuously. CI values declined shortly after addition of the growth factor and then remained low for more than six days over which considerable amounts of both extra- and intracellular VEGF-A were measured. Interestingly, the specific VEGFR2 inhibitor nintedanib normalized the lowered CI when added to iBREC pre-treated with VEGF-A165 for one day, but failed to do so when cells had been exposed to the growth factor for six days. Expression of the tight junction (TJ) protein claudin-5 was unchanged early after addition of VEGF-A165 but higher after prolonged treatment, whereas decreased amounts of the TJ-protein claudin-1 remained low, and increased expression of the plasmalemma vesicle-associated protein (PLVAP) remained high during further exposure. After two days, the characteristic even plasma membrane stainings of claudin-1 or claudin-5 appeared weaker or disordered, respectively. After six days the subcellular localization of claudin-5 was similar to that of control cells again, but claudin-1 remained relocated from the plasma membrane. To counteract these effects of VEGF-A165, brolucizumab or ranibizumab was added after one day, resulting in recovery of the then lowered CI to normal values within a few hours. However, despite the VEGF antagonist being present, the CI declined again two days later to values that were just slightly higher than without VEGF inhibition during further assessment for several days. At this stage, neither the supernatants nor whole cell extracts from iBREC treated with VEGF-A165 and its antagonists contained significant amounts of free VEGF-A. Treatment of VEGF-A165-challenged iBREC with ranibizumab or brolucizumab normalized expression of claudin-1 and claudin-5, but not completely that of PLVAP. Interestingly, the characteristic VEGF-A165-induced relocalization of claudin-1 from the plasma membrane was reverted within one day by any of the VEGF antagonists, but reappeared despite their presence after further exposure for several days. Taken together, barrier dysfunction induced by VEGF-A165 results from deregulated para- and transcellular flow but the precise nature or magnitude of underlying changes on a molecular level clearly depend on the time of exposure, evolving into a stage of VEGF-A165-independent barrier impairment. These findings also provide a plausible explanation for resistance to treatment with VEGF-A antagonists frequently observed in clinical practice.
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Affiliation(s)
- Heidrun L Deissler
- Department of Ophthalmology, Ulm University Medical Center, Ulm, Germany.
| | - Matus Rehak
- Department of Ophthalmology, University Hospital Leipzig, Leipzig, Germany; Department of Ophthalmology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Catharina Busch
- Department of Ophthalmology, University Hospital Leipzig, Leipzig, Germany
| | - Armin Wolf
- Department of Ophthalmology, Ulm University Medical Center, Ulm, Germany
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Zhang Y, Xu F, Lin Z, Wang J, Huang C, Wei M, Zhai W, Li J. Prediction of Visual Acuity after anti-VEGF Therapy in Diabetic Macular Edema by Machine Learning. J Diabetes Res 2022; 2022:5779210. [PMID: 35493607 PMCID: PMC9042629 DOI: 10.1155/2022/5779210] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 12/05/2022] Open
Abstract
PURPOSE To predict visual acuity (VA) 1 month after anti-vascular endothelial growth factor (VEGF) therapy in patients with diabetic macular edema (DME) by using machine learning. METHODS This retrospective study included 281 eyes with DME receiving intravitreal anti-VEGF treatment from January 1, 2019, to April 1, 2021. Eighteen features from electronic medical records and measurements data from OCT images were extracted. The data obtained from January 1, 2019, to November 1, 2020, were used as the training set; the data obtained from November 1, 2020, to April 1, 2021, were used as the validation set. Six different machine learning algorithms were used to predict VA in patients after anti-VEGF therapy. After the initial detailed investigation, we designed an optimization model for convenient application. The VA predicted by machine learning was compared with the ground truth. RESULTS The ensemble algorithm (linear regression + random forest regressor) performed best in VA and VA variance predictions. In the validation set, the mean absolute errors (MAEs) of VA predictions were 0.137-0.153 logMAR (within 7-8 letters), and the mean square errors (MSEs) were 0.033-0.045 logMAR (within 2-3 letters) for the 1-month VA predictions, respectively. For the prediction of VA variance at 1 month, the MAEs were 0.164-0.169 logMAR (within 9 letters), and the MSEs were 0.056-0.059 logMAR (within 3 letters), respectively. CONCLUSIONS Our machine learning models could accurately predict VA and VA variance in DME patients receiving anti-VEGF therapy 1 month after, which would be much valuable to guide precise individualized interventions and manage expectations in clinical practice.
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Affiliation(s)
- Ying Zhang
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Occupational and Environmental Health, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- Shandong Qidu Pharmaceutical Co. Ltd., Shandong Provincial Key Laboratory of Neuroprotective Drugs, Zibo, China
| | - Fabao Xu
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zhenzhe Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Jiawei Wang
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Chao Huang
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Min Wei
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Weibin Zhai
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jianqiao Li
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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Touhami S, Dupas B, Bertaud S, Tadayoni R, Couturier A. Intravitreal dexamethasone in diabetic macular edema: a way of enhancing the response to anti VEGF in non or poor responders? Ophthalmologica 2021; 245:350-357. [PMID: 34587614 DOI: 10.1159/000519235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/12/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Sara Touhami
- Ophthalmology Department, Université de Paris, APHP, Hôpital Lariboisière, Paris, France
- Department of Ophthalmology, Reference Center in Rare Diseases, DHU Sight Restore, Hôpital Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - Bénédicte Dupas
- Ophthalmology Department, Université de Paris, APHP, Hôpital Lariboisière, Paris, France
| | - Samuel Bertaud
- Ophthalmology Department, Université de Paris, APHP, Hôpital Lariboisière, Paris, France
| | - Ramin Tadayoni
- Ophthalmology Department, Université de Paris, APHP, Hôpital Lariboisière, Paris, France
| | - Aude Couturier
- Ophthalmology Department, Université de Paris, APHP, Hôpital Lariboisière, Paris, France
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Kulkarni S, Ramachandran R, Sivaprasad S, Rani PK, Behera UC, Vignesh TP, Chawla G, Agarwal M, Mani SL, Ramasamy K, Raman R. Impact of treatment of diabetic macular edema on visual impairment in people with diabetes mellitus in India. Indian J Ophthalmol 2021; 69:671-676. [PMID: 33595499 PMCID: PMC7942112 DOI: 10.4103/ijo.ijo_2614_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose: The aim of this study was to report visual and anatomical outcomes following treatment for diabetic macular edema (DME) in clinical practice in India. Methods: Retrospective chart review of patients with DME who were initiated on treatment and followed up for at least 1 year at 9 tertiary eye care centers during 2016–2017 was performed. Data on demographics, systemic illnesses, visual acuity and anatomical characteristics of DME, treatment history were collated and analyzed for change in visual acuity level and central macular thickness at 1 year. Results: A total 1853 patients were diagnosed with treatable DME during study period, 1315 patients were treated and 556 patients (1019 eyes) followed up at one year. Although patients achieved significantly better anatomical outcome (central macular thickness of <300μ in 32.3% at baseline compared to 60.7% at 1 year, P < 0.001), visual impairment due to DME did not differ from baseline (mild visual impairment in 53.2% at baseline compared to 56% at 1 year, P = 0.7). Cystoid type of DME was the most common phenotype (432/1019, 42.4%) followed by spongy type (325, 31.9%) and cystoid plus spongy type (138, 13.5%). Bevacizumab monotherapy was the most common (388/1019, 38.1%) treatment followed by combination therapy (359, 35.2%). Mean number of anti-VEGF injections received per eye in a year was 2.1 (SD ± 0.9). Conclusion: Only about a third of treated DME patients complete one year follow up in India. Most patients receive suboptimal number of treatments. Treated DME cases largely show better anatomical outcome but not a better functional outcome.
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Affiliation(s)
- Sucheta Kulkarni
- Department of Retina, PBMA's H.V. Desai Eye Hospital, Pune, India
| | - Rajalakshmi Ramachandran
- Department of Ophthalmology, Dr. Mohan's Diabetes Specialties Centre and Madras Diabetes Research Foundation, Chennai, India
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, London and University College London, London, UK
| | - Padmaja Kumari Rani
- Smt. Kanuri Santhamma Retina Vitreous Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Umesh C Behera
- Department of Vitreo-Retina, L V Prasad Eye Institute, Bhubaneswar, India
| | - T P Vignesh
- Department of Retina-Vitreous, Aravind Eye Hospital, Madurai, India
| | - Gajendra Chawla
- Department of Retina, Vision Care & Research Centre, Bhopal, India
| | - Manisha Agarwal
- Department of Vitreoretina, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Sheena Liz Mani
- Department of Retina, Dr. Tony Fernandez Eye Hospital, Aluva, India
| | - Kim Ramasamy
- Department of Retina-Vitreous, Aravind Eye Hospital, Madurai, India
| | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India
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18
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Indicators of Visual Prognosis in Diabetic Macular Oedema. J Pers Med 2021; 11:jpm11060449. [PMID: 34067442 PMCID: PMC8224579 DOI: 10.3390/jpm11060449] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 11/26/2022] Open
Abstract
Diabetic macular oedema (DMO) is an important cause of moderate vision loss in people with diabetes. Advances in imaging technology have shown that a significant proportion of patients with DMO respond sub-optimally to existing treatment options. Identifying associations and predictors of response before treatment is initiated may help in explaining visual prognosis to patients and aid the development of personalized treatment strategies. Imaging features, such as central subfoveal thickness, photoreceptor integrity, disorganization of retinal inner layers, choroidal changes, and macular perfusion, have been reported to be prognostic factors of visual acuity (VA) in DMO. In this review we evaluated each risk factor to understand their relative importance in visual prognostication of DMO eyes post-treatment. Although individually, some of these factors may not be significant predictors, in combination they may form phenotypes that can inform visual prognosis. Stratification based on these phenotypes needs to be developed to progress to personalized medicine for DMO.
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19
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Nian S, Lo ACY, Mi Y, Ren K, Yang D. Neurovascular unit in diabetic retinopathy: pathophysiological roles and potential therapeutical targets. EYE AND VISION 2021; 8:15. [PMID: 33931128 PMCID: PMC8088070 DOI: 10.1186/s40662-021-00239-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 04/02/2021] [Indexed: 02/06/2023]
Abstract
Diabetic retinopathy (DR), one of the common complications of diabetes, is the leading cause of visual loss in working-age individuals in many industrialized countries. It has been traditionally regarded as a purely microvascular disease in the retina. However, an increasing number of studies have shown that DR is a complex neurovascular disorder that affects not only vascular structure but also neural tissue of the retina. Deterioration of neural retina could precede microvascular abnormalities in the DR, leading to microvascular changes. Furthermore, disruption of interactions among neurons, vascular cells, glia and local immune cells, which collectively form the neurovascular unit, is considered to be associated with the progression of DR early on in the disease. Therefore, it makes sense to develop new therapeutic strategies to prevent or reverse retinal neurodegeneration, neuroinflammation and impaired cell-cell interactions of the neurovascular unit in early stage DR. Here, we present current perspectives on the pathophysiology of DR as a neurovascular disease, especially at the early stage. Potential novel treatments for preventing or reversing neurovascular injuries in DR are discussed as well.
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Affiliation(s)
- Shen Nian
- Department of Pathology, Xi'an Medical University, Xi'an, Shaanxi Province, China.
| | - Amy C Y Lo
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Yajing Mi
- Institute of Basic Medicine Science, Xi'an Medical University, Xi'an, Shaanxi Province, China
| | - Kai Ren
- Department of Biochemistry and Molecular Biology, Xi'an Medical University, Xi'an, Shaanxi Province, China
| | - Di Yang
- Department of Ophthalmology, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, Yunnan Province, China.
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20
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GRAding of functional and anatomical response to DExamethasone implant in patients with Diabetic Macular Edema: GRADE-DME Study. Sci Rep 2021; 11:4738. [PMID: 33637772 PMCID: PMC7910444 DOI: 10.1038/s41598-020-79288-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/30/2020] [Indexed: 01/19/2023] Open
Abstract
To analyze functional and anatomical response patterns to dexamethasone (DEX) implant in diabetic macular edema (DME), to describe proportion of responders and non-responders, and to propose a new DME grading system. Retrospective, multicenter, observational cohort study. Naïve and non-naïve DME patients were treated with DEX, with visual acuity (VA) ≥ 0.2 logMAR and central subfield thickness (CST) of ≥ 300 µm. Functional and anatomical responses were graded after 2 and 4 months, and categorized as early and stable improvement, early and progressive improvement, pendular response, delayed improvement, and persistent non-response. 417 eyes were included (175 treatment naïve eyes). Compared to non-naïve eyes, naïve eyes showed a very good functional response (VA gain ≥ 10 letters) more frequently after 2 and 4 months (56% and 57% [naïve] vs. 33% and 28% [non-naïve], p < 0.001). A VA gain < 5 letters (non-response) after 2 and 4 months was seen in 18% and 16% of naïve eyes, and in 49% and 53% of non-naïve eyes (p < 0.001). A lack of anatomical response was rare in both groups, but more frequently in non-naïve eyes (12% vs. 4%, p = 0.003). Functionally and anatomically, naïve eyes showed most frequently an early and stable improvement (functionally: 77/175 44%; anatomically: 123/175 eyes, 70%). Most non-naïve eyes experienced no significant improvement functionally (97/242 eyes, 40%), despite a mostly early and stable improvement anatomical response pattern (102/242 eyes, 42%). Functional but not anatomical response patterns were influenced by baseline VA. Naïve and non-naïve eyes show different functional and anatomical response patterns to DEX implant. Functional non-responders are rare in naïve eyes, whereas anatomical non-response is unusual in both groups.
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21
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Brito PS, Costa JV, Barbosa-Matos C, Costa SM, Correia-Pinto J, Silva RM. ASSOCIATION OF SERUM VASOGENIC AND PROINFLAMMATORY FACTORS WITH CLINICAL RESPONSE TO ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR FOR DIABETIC MACULAR EDEMA. Retina 2021; 41:345-354. [PMID: 32453069 DOI: 10.1097/iae.0000000000002852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To study the role of serum biomarkers as prognostic factors for qualitative and quantitative response to anti-vascular endothelial growth factor injections for diabetic macular edema (DME). METHODS Sixty-seven eyes with DME were treated with intravitreal bevacizumab during a 12-month follow-up period. All cases underwent a baseline workup consisting of 12 inflammatory, metabolic and prothrombotic factors. The following outcomes were evaluated at 3-month intervals until 1 year of follow-up: visual acuity, central subfield thickness (CST), macular volume (MV), % of change from baseline in CST, occurrence of a CST change < 10%, a CST change >20%, and a CST <330 µm, achieving an improvement ≥2 lines of visual acuity, achieving visual acuity ≥20/40. RESULTS A significant improvement in CST and visual acuity was seen from third month onwards. Twenty-eight (48.1%) cases were classified as "early responders," 24 (35.8%) as "late responders", and 15 (22.4%) as "poor responders." Serum vascular endothelial growth factor-A levels were significantly lower in "poor responders" (P = 0.006). C-reactive protein (hsCRP) was associated with a limited anatomic response (<10% CST change) (P = 0.002, OR = 1.845, cutoff value of hsCRP = 1.84 mg/L). hsCRP was also negatively associated with obtaining a final CST <330 µm (P = 0.04, r2 = 0.112, OR = 0.643). Baseline visual acuity was significantly associated with 12th month visual acuity (P < 0.001, r2 = 0.602) and also with an improvement ≥2 visual acuity lines (P = 0.009, OR = 20.54). CONCLUSION Increased high-sensitivity C-reactive protein was associated with limited anatomic response to anti-vascular endothelial growth factor treatment and persistent DME. Poor responders had significantly lower values of serum vascular endothelial growth factor-A, suggesting an alternative pathogenic pathway for persisting DME.
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Affiliation(s)
- Pedro S Brito
- Department of Ophthalmology, Hospital de Braga, Braga, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus Gualtar, Braga, Portugal
| | - Jorge V Costa
- Department of Ophthalmology, Hospital de Braga, Braga, Portugal
| | - Catarina Barbosa-Matos
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus Gualtar, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga, Guimarães, Portugal
| | - Sandra M Costa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus Gualtar, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga, Guimarães, Portugal
| | - Jorge Correia-Pinto
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus Gualtar, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga, Guimarães, Portugal
| | - Rufino M Silva
- Department of Ophthalmology, Centro Hospitalar e Universitario de Coimbra (CHUC), Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra (iCBR- FMUC), Coimbra, Portugal; and
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
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22
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Cao J, You K, Jin K, Lou L, Wang Y, Chen M, Pan X, Shao J, Su Z, Wu J, Ye J. Prediction of response to anti-vascular endothelial growth factor treatment in diabetic macular oedema using an optical coherence tomography-based machine learning method. Acta Ophthalmol 2021; 99:e19-e27. [PMID: 32573116 DOI: 10.1111/aos.14514] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/24/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To predict the anti-vascular endothelial growth factor (VEGF) therapeutic response of diabetic macular oedema (DME) patients from optical coherence tomography (OCT) at the initiation stage of treatment using a machine learning-based self-explainable system. METHODS A total of 712 DME patients were included and classified into poor and good responder groups according to central macular thickness decrease after three consecutive injections. Machine learning models were constructed to make predictions based on related features extracted automatically using deep learning algorithms from OCT scans at baseline. Five-fold cross-validation was applied to optimize and evaluate the models. The model with the best performance was then compared with two ophthalmologists. Feature importance was further investigated, and a Wilcoxon rank-sum test was performed to assess the difference of a single feature between two groups. RESULTS Of 712 patients, 294 were poor responders and 418 were good responders. The best performance for the prediction task was achieved by random forest (RF), with sensitivity, specificity and area under the receiver operating characteristic curve of 0.900, 0.851 and 0.923. Ophthalmologist 1 and ophthalmologist 2 reached sensitivity of 0.775 and 0.750, and specificity of 0.716 and 0.821, respectively. The sum of hyperreflective dots was found to be the most relevant feature for prediction. CONCLUSION An RF classifier was constructed to predict the treatment response of anti-VEGF from OCT images of DME patients with high accuracy. The algorithm contributes to predicting treatment requirements in advance and provides an optimal individualized therapeutic regimen.
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Affiliation(s)
- Jing Cao
- Department of Ophthalmology College of Medicine The Second Affiliated Hospital of Zhejiang University Hangzhou China
| | - Kun You
- Hangzhou Truth Medical Technology Ltd Hangzhou China
| | - Kai Jin
- Department of Ophthalmology College of Medicine The Second Affiliated Hospital of Zhejiang University Hangzhou China
| | - Lixia Lou
- Department of Ophthalmology College of Medicine The Second Affiliated Hospital of Zhejiang University Hangzhou China
| | - Yao Wang
- Department of Ophthalmology College of Medicine The Second Affiliated Hospital of Zhejiang University Hangzhou China
| | - Menglu Chen
- Department of Ophthalmology College of Medicine The Second Affiliated Hospital of Zhejiang University Hangzhou China
| | - Xiangji Pan
- Department of Ophthalmology College of Medicine The Second Affiliated Hospital of Zhejiang University Hangzhou China
| | - Ji Shao
- Department of Ophthalmology College of Medicine The Second Affiliated Hospital of Zhejiang University Hangzhou China
| | - Zhaoan Su
- Department of Ophthalmology College of Medicine The Second Affiliated Hospital of Zhejiang University Hangzhou China
| | - Jian Wu
- College of Computer Science and Technology Zhejiang University Hangzhou China
| | - Juan Ye
- Department of Ophthalmology College of Medicine The Second Affiliated Hospital of Zhejiang University Hangzhou China
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23
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Veritti D, Sarao V, Soppelsa V, Lanzetta P. Managing Diabetic Macular Edema in Clinical Practice: Systematic Review and Meta-Analysis of Current Strategies and Treatment Options. Clin Ophthalmol 2021; 15:375-385. [PMID: 33551641 PMCID: PMC7856351 DOI: 10.2147/opth.s236423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/22/2021] [Indexed: 12/15/2022] Open
Abstract
Purpose This meta-analysis aims to summarize 12-month best-corrected visual acuity (BCVA) outcomes in response to anti-vascular endothelial growth factor (VEGF) therapy and dexamethasone implant for the treatment of diabetic macular edema (DME) and to identify factors affecting treatment response using evidence generated from meta-regression. Methods A systematic review of electronic databases was conducted to identify randomized controlled trials (RCTs) and real-life/observational studies that reported 12-month changes in BCVA in patients with DME on anti-VEGF or dexamethasone implant treatment in monotherapy. Study factors that were analyzed are baseline patient characteristics, study type, drug employed, number of injections and 12-month change in BCVA. Data were pooled in a random-effects meta-analysis with BCVA change as the main outcome. Meta-regression was conducted to assess the impact of multiple covariates. Results One-hundred-five heterogeneous study populations (45,032 eyes) were identified and included in the analysis. The use of anti-VEGFs and dexamethasone implant induced an overall increase of +8.13 ETDRS letters in BCVA at 12 months of follow-up. Meta-regression provided evidence that mean BCVA change using anti-VEGFs was not statistically higher for RCTs (p=0.35) compared to observational studies. Dexamethasone implant showed a trend for better results in observational studies over RCTs. Populations following a fixed aflibercept regimen performed better than those following a reactive treatment regimen. Mean BCVA gain was higher in younger populations (p<0.001), with lower baseline BCVA (p<0.0001) and longer diabetes duration (p<0.0001), receiving a higher number of injections (p<0.0001). Conclusion Intravitreal therapy with anti-VEGFs or dexamethasone implant produces a significant improvement in BCVA at 12 months in patients with DME. Meta-regression identified the modifiable covariates that can be targeted in order to maximize functional results.
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Affiliation(s)
- Daniele Veritti
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy
| | - Valentina Sarao
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy.,Istituto Europeo di Microchirurgia Oculare (IEMO), Udine, Italy
| | - Valentina Soppelsa
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy
| | - Paolo Lanzetta
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy.,Istituto Europeo di Microchirurgia Oculare (IEMO), Udine, Italy
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24
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Real-World Treatment Patterns and Vision Outcomes with Ranibizumab for Diabetic Macular Edema. J Ophthalmol 2021; 2021:8825082. [PMID: 33575038 PMCID: PMC7857902 DOI: 10.1155/2021/8825082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/29/2020] [Accepted: 01/02/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose To assess injection patterns and vision outcomes in patients receiving intravitreal ranibizumab injections for diabetic macular edema in a real-world clinical setting. Methods Retrospective chart review involving 74 eyes of 62 patients who started ranibizumab treatment for diabetic macular edema at the Hospital of the Lithuanian University of Health Sciences Kauno Klinikos. Data collected included follow-up visits, injections administered, and best-corrected visual acuity (BCVA). Results Median follow-up duration was 652.5 days (min 365; max 914). Over the first year, eyes received a median of 4 injections (min 1; max 10). Among eyes with 2-year follow-up and injections during the second year, there was a median of 3 injections (min 1; max 6) over the second year. The BCVA improved by a median of 5 letters 365 ± 60 days and 730 ± 60 days after baseline. At the first visit ≥365 days after baseline, 13.5% of eyes gained ≥15 letters from baseline while 6.8% of eyes lost ≥15 letters. For 74.3% of eyes, BCVA improved (gain of ≥5 letters) or remained stable (gain/loss of ≤4 letters). Conclusion Intravitreal ranibizumab for diabetic macular edema was effective in a real-world clinical setting, with most eyes gaining or maintaining vision. Compared with randomized prospective clinical trials, patients received less frequent injections and achieved lower vision gains.
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25
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Bonfiglio V, Platania CBM, Lazzara F, Conti F, Pizzo C, Reibaldi M, Russo A, Fallico M, Ortisi E, Pignatelli F, Longo A, Avitabile T, Drago F, Bucolo C. TGF-β Serum Levels in Diabetic Retinopathy Patients and the Role of Anti-VEGF Therapy. Int J Mol Sci 2020; 21:ijms21249558. [PMID: 33334029 PMCID: PMC7765505 DOI: 10.3390/ijms21249558] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/04/2020] [Accepted: 12/12/2020] [Indexed: 12/16/2022] Open
Abstract
Transforming growth factor β1 (TGFβ1) is a proinflammatory cytokine that has been implicated in the pathogenesis of diabetic retinopathy (DR), particularly in the late phase of disease. The aim of the present study was to validate serum TGFβ1 as a diagnostic and prognostic biomarker of DR stages. Thirty-eight subjects were enrolled and, after diagnosis and evaluation of inclusion and exclusion criteria, were assigned to six groups: (1) healthy age-matched control, (2) diabetic without DR, (3) non-proliferative diabetic retinopathy (NPDR) naïve to treatment, (4) NPDR treated with intravitreal (IVT) aflibercept, (5) proliferative diabetic retinopathy (PDR) naïve to treatment and (6) PDR treated with IVT aflibercept. Serum levels of vascular endothelial growth factor A (VEGF-A), placental growth factor (PlGF) and TGFβ1 were measured by means of enzyme-linked immunosorbent assay (ELISA). Foveal macular thickness (FMT) in enrolled subjects was evaluated by means of structural-optical coherence tomography (S-OCT). VEGF-A serum levels decreased in NPDR and PDR patients treated with aflibercept, compared to naïve DR patients. PlGF serum levels were modulated only in aflibercept-treated NPDR patients. Particularly, TGFβ1 serum levels were predictive of disease progression from NPDR to PDR. A Multivariate ANOVA analysis (M-ANOVA) was also carried out to assess the effects of fixed factors on glycated hemoglobin (HbA1c) levels, TGFβ1, and diabetes duration. In conclusion, our data have strengthened the hypothesis that TGFβ1 would be a biomarker and pharmacological target of diabetic retinopathy.
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Affiliation(s)
- Vincenza Bonfiglio
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section, University of Palermo, 90133 Palermo, Italy;
| | - Chiara Bianca Maria Platania
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, 95123 Catania, Italy; (C.B.M.P.); (F.L.); (F.C.); (F.D.)
| | - Francesca Lazzara
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, 95123 Catania, Italy; (C.B.M.P.); (F.L.); (F.C.); (F.D.)
| | - Federica Conti
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, 95123 Catania, Italy; (C.B.M.P.); (F.L.); (F.C.); (F.D.)
| | - Corrado Pizzo
- Department of Ophthalmology, University of Catania, 95123 Catania, Italy; (C.P.); (A.R.); (M.F.); (E.O.); (A.L.); (T.A.)
| | - Michele Reibaldi
- Department of Surgical Science, Eye Clinic, University of Torino, 10124 Torino, Italy;
| | - Andrea Russo
- Department of Ophthalmology, University of Catania, 95123 Catania, Italy; (C.P.); (A.R.); (M.F.); (E.O.); (A.L.); (T.A.)
| | - Matteo Fallico
- Department of Ophthalmology, University of Catania, 95123 Catania, Italy; (C.P.); (A.R.); (M.F.); (E.O.); (A.L.); (T.A.)
| | - Elina Ortisi
- Department of Ophthalmology, University of Catania, 95123 Catania, Italy; (C.P.); (A.R.); (M.F.); (E.O.); (A.L.); (T.A.)
| | | | - Antonio Longo
- Department of Ophthalmology, University of Catania, 95123 Catania, Italy; (C.P.); (A.R.); (M.F.); (E.O.); (A.L.); (T.A.)
| | - Teresio Avitabile
- Department of Ophthalmology, University of Catania, 95123 Catania, Italy; (C.P.); (A.R.); (M.F.); (E.O.); (A.L.); (T.A.)
| | - Filippo Drago
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, 95123 Catania, Italy; (C.B.M.P.); (F.L.); (F.C.); (F.D.)
- Center for Research in Ocular Pharmacology-CERFO, University of Catania, 95123 Catania, Italy
| | - Claudio Bucolo
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, 95123 Catania, Italy; (C.B.M.P.); (F.L.); (F.C.); (F.D.)
- Center for Research in Ocular Pharmacology-CERFO, University of Catania, 95123 Catania, Italy
- Correspondence:
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26
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Choovuthayakorn J, Phinyo P, Tantraworasin A, Kunavisarut P, Patikulsila D, Chaikitmongkol V, Watanachai N, Pathanapitoon K. Intravitreal Anti-Vascular Endothelial Growth Factor Therapy for Diabetic Macular Edema in Clinical Practice of Single Center: Three-Year Outcomes. Ophthalmic Res 2020; 64:483-493. [PMID: 33053556 DOI: 10.1159/000512300] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/10/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The objective of this study was to explore visual and anatomical outcomes in patients who underwent intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection for visual impairment from center-involved diabetic macular edema (CI-DME) in clinical practice. METHODS Medical records of consecutive CI-DME patients who initiated treatment with intravitreal bevacizumab injection between January 2012 and December 2016 and were followed for at least 12 months were retrospectively reviewed. Visual and anatomical changes after treatment over a 36-month period were evaluated. RESULTS There were 286 patients (423 eyes) with a mean (standard deviation, SD) age of 56.8 (8.5) years included in this study. One hundred and forty-six (51%) patients were female, and 137 (47.9%) patients received bilateral eye treatment. Mean (SD) presenting visual acuity (VA) of overall eyes was 50.2 (19.6) letter scores. Stratified by baseline vision, eyes with initial VA worse than 20/40 achieved a statistically significant VA improvement, compared to baseline, by +8.4, +6.9, and +5.4 letters at 12, 24, and 36 months, respectively, with all p values <0.001. However, when initial VA was 20/40 and better, a non-statistically significant change in mean VA by +2.0, -3.5, and -3.6 letters were noted at the same time point (p value between 0.078 and 0.273). Unlike visual changes, a statistically significant decline in central subfield thickness compared to baseline was noted at the end of months 12, 24, and 36 in both initial VA subgroups (all p values <0.001). Nevertheless, even though the median number of given injections considerably decreased from 6 in the first 12 months to 2 in the second 12-month period and 1 in the final 12-month interval, required ophthalmic clinic visits decreased in frequency with median numbers of 10, 7, and 6 appointments in each consecutive 12-month duration. CONCLUSION This study supports the benefits of practical intravitreal anti-VEGF utilization to manage CI-DME in real-world settings. The improvement of vision in eyes presenting with poor baseline VA and maintenance of vision in eyes with better baseline VA were demonstrated through the 3-year review of each case. However, the burden of frequent monitoring warrants further evaluation of long-term compliance and efficacy.
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Affiliation(s)
- Janejit Choovuthayakorn
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Phichayut Phinyo
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Clinical Epidemiology and Clinical Statistics Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Apichat Tantraworasin
- Clinical Epidemiology and Clinical Statistics Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Paradee Kunavisarut
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Direk Patikulsila
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Voraporn Chaikitmongkol
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nawat Watanachai
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kessara Pathanapitoon
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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An open-source data set of anti-VEGF therapy in diabetic macular oedema patients over 4 years and their visual acuity outcomes. Eye (Lond) 2020; 35:1354-1364. [PMID: 32591734 DOI: 10.1038/s41433-020-1048-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 06/10/2020] [Accepted: 06/16/2020] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES The objective of this paper is to evaluate visual acuity (VA) outcomes of intravitreal anti-vascular endothelial growth factor (VEGF) in diabetic macular oedema (DMO). METHODS In this retrospective cohort study, electronic medical records for all patients undergoing intravitreal injections in a tertiary referral centre between March 2013 and October 2018 were analysed. Treatment response in terms of VA outcomes was reported for all eyes over a 4-year observation period. RESULTS Our cohort includes 2614 DMO eyes of 1964 patients over 48 months. Cox proportional-hazards modelling identified injection number (hazard ratio (HR) = 1.18), male gender (HR = 1.13) and baseline VA (HR = 1.09) as independent predictors to reach a favourable visual outcome of more than 70 Early Treatment Diabetic Retinopathy Study letters. Half of our cohort reached 70 letters 1.9 months after starting anti-VEGF therapy. Of those that reached 70 letters, 50% fell below 70 letters by 14.7 months. CONCLUSION To date, this is the largest single centre cohort study and over the longest observation period reporting on real-life outcomes of anti-VEGF in DMO. We have made an anonymised version of our data set available on an open-source data repository as a resource for clinical researchers globally.
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Tessier M, Meillon C, Creuzot-Garcher C, Bron AM, Nguyen P. Efficacy and follow-up of anti-VEGF injections in diabetic macular edema in real-life practice at the Dijon university medical centre through the Save Sight Registries. J Fr Ophtalmol 2020; 43:618-625. [PMID: 32473741 DOI: 10.1016/j.jfo.2019.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 10/18/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE To evaluate the efficacy of intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections (IVT) in diabetic macular edema (DME) in real-life practice using the Save Sight Registries (SSR). MATERIAL AND METHODS We conducted an observational, single-centre, retrospective study in the department of ophthalmology of the Dijon University Hospital. We included treatment-naive patients who presented with DME between January 2016 and December 2017. Demographic and clinical data, follow-up visits, and treatments administered were entered into the SSR, an international online ophthalmic registry. Primary endpoints were the change in best-corrected visual acuity (BCVA) and central subfield thickness (CST) from baseline to 12 and 24 months. RESULTS Fifty-eight eyes of 43 patients with a mean [standard deviation (SD)] age of 67.1 [9.5] years were included. Forty-one eyes completed 12 months of follow-up, and 17 eyes completed 24 months of follow up. Median [SD] baseline BCVA was 56.1 [22.9] ETDRS letters and the median [95% confidence interval (95% CI)] baseline CST was 447.9 [161.0] micrometers (μm). Median [95% CI] improvement in BCVA from baseline to months 12 and 24 were respectively, +5.6 [+0.5; +10.7] ETDRS letters and +7.7 [-2.8; +18.2] ETDRS letters. The median [95% CI] decrease in CST from baseline to months 12 and 24 were respectively, -110.9 [-154.5; -67.3] μm and -125.5 [-198.0; -53.0] μm. CONCLUSION Our clinical practice can be evaluated easily with the SSR system. In real life, anti-VEGF IVT are an effective treatment for DME, which result in improved BCVA and decreased CST.
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Affiliation(s)
- M Tessier
- Service d'ophtalmologie, CHU de Dijon, Dijon, France.
| | - C Meillon
- Service d'ophtalmologie, CHU de Dijon, Dijon, France
| | - C Creuzot-Garcher
- Service d'ophtalmologie, CHU de Dijon, Dijon, France; Eye and Nutrition Research Group, CSGA, UMR1324 INRA, 6265 CNRS, Université Bourgogne Franche-Comté, Dijon, France
| | - A M Bron
- Service d'ophtalmologie, CHU de Dijon, Dijon, France; Eye and Nutrition Research Group, CSGA, UMR1324 INRA, 6265 CNRS, Université Bourgogne Franche-Comté, Dijon, France
| | - P Nguyen
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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The Area and Number of Intraretinal Cystoid Spaces Predict the Visual Outcome after Ranibizumab Monotherapy in Diabetic Macular Edema. J Clin Med 2020; 9:jcm9051391. [PMID: 32397232 PMCID: PMC7290842 DOI: 10.3390/jcm9051391] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/03/2020] [Accepted: 05/07/2020] [Indexed: 02/06/2023] Open
Abstract
Visual outcomes in diabetic macular edema (DME) after anti-vascular endothelial growth factor therapy vary across individuals. We retrospectively reviewed the clinical records for 46 treatment-naive eyes of 46 patients with DME who underwent intravitreal ranibizumab (IVR) monotherapy with a pro re nata regimen for 12 months. Overall, mean best-corrected visual acuity (BCVA) improved. Multivariate analyses adjusted for age and baseline BCVA showed that the area ratio, compared with the retinal area, and the number of intraretinal cystoid spaces evaluated on OCT (optical coherence tomography) images at baseline positively correlated with LogMAR BCVA and the extents of ellipsoid zone and external limiting membrane disruption at 12 months, and negatively correlated with central retinal thickness at the time of edema resolution. Therefore, a high area ratio and large number of intraretinal cystoid spaces resulted in a disorganized outer retinal structure at 12 months, a thin and atrophic retina after edema resolution, and a worse visual outcome. The area ratio and number of intraretinal cystoid spaces on initial OCT images were predictors of the visual outcome after IVR therapy in DME irrespective of baseline age and BCVA. The factors were related to retinal neurodegenerative changes in DME and could help in obtaining proper informed consent before treatment.
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Shimura M, Kitano S, Muramatsu D, Fukushima H, Takamura Y, Matsumoto M, Kokado M, Kogo J, Sasaki M, Morizane Y, Utsumi T, Koto T, Sonoda S, Hirano T, Ishikawa H, Mitamura Y, Okamoto F, Kinoshita T, Kimura K, Sugimoto M, Yamashiro K, Suzuki Y, Hikichi T, Washio N, Sato T, Ohkoshi K, Tsujinaka H, Kusuhara S, Kondo M, Takagi H, Murata T, Sakamoto T. Real-world management of treatment-naïve diabetic macular oedema: 2-year visual outcome focusing on the starting year of intervention from STREAT-DMO study. Br J Ophthalmol 2020; 104:1755-1761. [PMID: 32169861 PMCID: PMC7785163 DOI: 10.1136/bjophthalmol-2019-315726] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/17/2020] [Accepted: 02/20/2020] [Indexed: 12/19/2022]
Abstract
Background/aims To investigate the yearly change of real-world outcomes for best corrected visual acuity (BCVA) after 2-year clinical intervention for treatment-naïve diabetic macular oedema (DMO). Methods Retrospective analysis of aggregated, longitudinal medical records obtained from 27 retina specialised institutions in Japan from Survey of Treatment for DMO database. A total of 2049 treatment-naïve centre involving DMO eyes of which the initial intervention started between 2010 and 2015, and had been followed for 2 years, were eligible. As interventions, antivascular endothelial growth factor (VEGF) agents, local corticosteroids, macular photocoagulation and vitrectomy were defined. In each eye, baseline and final BCVA, the number of each intervention for 2 years was extracted. Each eye was classified by starting year of interventional treatment. Results Although baseline BCVA did not change by year, 2-year improvement of BCVA had been increased, and reached to +6.5 letters in the latest term. There is little difference among starting year about proportions of eyes which BCVA gained >15 letters, in contrast to those which lost >15 letters were decreased by year. The proportion of eyes receiving anti-VEGF therapy was dramatically increased, while those receiving the other therapies were gradually decreased. The proportion of eyes which maintained socially good vision of BCVA>20/40 has been increased and reached to 59.0% in the latest term. Conclusion For recent years, treatment patterns for DMO have been gradually but certainly changed; as a result, better visual gain, suppression of worsened eyes and better final BCVA have been obtained. Anti-VEGF therapy has become the first-line therapy and its injection frequency has been increasing.
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Affiliation(s)
- Masahiko Shimura
- Department of Ophthalmology, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Shigehiko Kitano
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Daisuke Muramatsu
- Department of Ophthalmology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Harumi Fukushima
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | | | - Makiko Matsumoto
- Department of Ophthalmology, Nagasaki University School of Medicine Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masahide Kokado
- Department of Ophthalmology, Wakayama Medical University, Wakayama, Japan
| | - Jiro Kogo
- Department of Ophthalmology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Mariko Sasaki
- Department of Ophthalmology, Tachikawa Hospital, Tachikawa, Japan.,Department of Ophthalmology, National Hospital Organisation Tokyo Medical Center, Meguro-ku, Tokyo, Japan
| | - Yuki Morizane
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takuya Utsumi
- Department of Ophthalmology, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Takashi Koto
- Kyorin Eye Center, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Shozo Sonoda
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Takao Hirano
- Deparment of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Hiroto Ishikawa
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Yoshinori Mitamura
- Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Tokushima, Japan
| | - Fumiki Okamoto
- Department of Ophthalmology, University of Tsukuba Faculty of Medicine, Tsukuba, Ibaraki, Japan
| | - Takamasa Kinoshita
- Department of Ophthalmology, Sapporo City General Hospital, Sapporo, Japan
| | - Kazuhiro Kimura
- Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Masahiko Sugimoto
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Kenji Yamashiro
- Department of Ophthalmology, Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Yukihiko Suzuki
- Department of Ophthalmology, Hirosaki University School of Medicine Graduate School of Medicine, Hirosaki, Aomori, Japan
| | | | - Noriaki Washio
- Department of Ophthalmology, Showa General Hospital, Kodaira, Tokyo, Japan
| | - Tomohito Sato
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Kishiko Ohkoshi
- Department of Ophthalmology, St. Luke's International Hospital, Tokyo, Japan
| | - Hiroki Tsujinaka
- Department of Ophthalmology, Nara Medical University, Kashihara, Nara, Japan
| | - Sentaro Kusuhara
- Department of Surgery Related, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Mineo Kondo
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Hitoshi Takagi
- Department of Ophthalmology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Toshinori Murata
- Deparment of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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Kern C, Schiefelbein J, Fu DJ, Schworm B, Sim D, Herold T, Priglinger S, Kortuem K. Two Year Visual Acuity and Structural Outcomes in Patients with Diabetic Macular Oedema Treated with Intravitreal Aflibercept - A Retrospective Cohort Study. Clin Ophthalmol 2020; 14:533-541. [PMID: 32161438 PMCID: PMC7049742 DOI: 10.2147/opth.s237586] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/24/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess visual and anatomical outcomes of intravitreal aflibercept for clinically significant diabetic macular oedema (DME). Methods For this retrospective single-center cohort study at a tertiary referral center, we performed a data warehouse query to identify 117 treatment-naive patients (139 eyes) undergoing intravitreal treatment with aflibercept for DME between January 2014 and May 2018. Changes in best-corrected visual acuity (BCVA) values (as measured with ETDRS letters), central retinal thickness (CRT) and total macular volume (TVOL) are reported over a two-year period at various time-points. Results The total number of injections per study eye was 5.5 ± 1.4 after one and 8.7 ± 2.2 injections after two years. Baseline visual acuity (VA) was 60.1 ± 14.5 letters. A gain of 4.8 and 9.2 letters from baseline was observed after one and two years, respectively (both p ≤ 0.01). In comparison to the mean CRT at baseline (419 ± 174 µm), a CRT decrease was observed after one and two years of treatment (298 ± 115 µm and 319 ± 119 µm, respectively; both p ≤ 0.01). Similarly, TVOL decreased from 10.12 ± 2.05 mm3 to 8.96 ± 0.96 mm3 and 9.01 ± 1.29 mm3 (both p ≤ 0.01). Conclusion This study demonstrates that treating DME with intravitreal aflibercept yields positive functional and structural outcomes over a two-year period. However, we observed fewer injection numbers, along with inferior VA and structural outcomes than has been reported in randomized clinical trials. Our results show similar results as in patients treated with ranibizumab due to DME in real-life settings.
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Affiliation(s)
- Christoph Kern
- Department of Ophthalmology, University Hospital LMU, Munich, Germany.,Moorfields Eye Hospital, London, UK
| | | | | | - Benedikt Schworm
- Department of Ophthalmology, University Hospital LMU, Munich, Germany
| | - Dawn Sim
- Moorfields Eye Hospital, London, UK
| | - Tina Herold
- Department of Ophthalmology, University Hospital LMU, Munich, Germany
| | | | - Karsten Kortuem
- Department of Ophthalmology, University Hospital LMU, Munich, Germany.,Moorfields Eye Hospital, London, UK
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Intravitreal Injections for Macular Edema Secondary to Retinal Vein Occlusion: Long-Term Functional and Anatomic Outcomes. J Ophthalmol 2020; 2020:7817542. [PMID: 32104597 PMCID: PMC7040414 DOI: 10.1155/2020/7817542] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/13/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose To report the long-term visual and anatomic outcomes of intravitreal injections for macular edema (ME) secondary to retinal vein occlusion (RVO) in a real-life clinical setting. Design Retrospective interventional case series. Methods A total of 223 consecutive eyes with ME secondary to RVO, treated with the first three intravitreal Ranibizumab or dexamethasone injections between August 2008 and September 2018, were enrolled in the study. Subsequent retreatment was guided by best-corrected visual acuity (BCVA) and central macular thickness (CMT) measurements, aimed at achieving macular fluid regression and BCVA stability. BCVA and CMT were recorded at baseline and at subsequent annual time points. The mean number of injections administered each year and the incidence of adverse events were recorded. Results The mean BCVA and CMT at baseline were 0.79 logMar (SD 0.71) and 615.7 μm (SD 257.5), respectively. The mean follow-up (FU) period was 47.8 months (min 12–max 120). At 12 months, the mean BCVA and CMT had significantly improved to 0.62 logMar (SD 0.68; p < 0.0001) and 401.04 μm (SD 257.5), respectively. The mean follow-up (FU) period was 47.8 months (min 12–max 120). At 12 months, the mean BCVA and CMT had significantly improved to 0.62 logMar (SD 0.68; p < 0.0001) and 401.04 Conclusion Intravitreal Ranibizumab and/or dexamethasone injections were found to be effective at inducing a long-lasting improvement of BCVA and CMT in a real-life clinical setting. A safety profile similar to that already well-established in Ranibizumab and dexamethasone treatment was observed, as well as a steady decrease in the number of intraocular injections required. The results support intravitreal treatments for BRVO and CRVO in patient populations with similar characteristics in similar settings.
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Cavalleri M, Cicinelli MV, Parravano M, Varano M, De Geronimo D, Sacconi R, Bandello F, Querques G. Prognostic role of optical coherence tomography after switch to dexamethasone in diabetic macular edema. Acta Diabetol 2020; 57:163-171. [PMID: 31375899 DOI: 10.1007/s00592-019-01389-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 07/23/2019] [Indexed: 12/16/2022]
Abstract
AIMS To analyze the visual outcome after early switch to dexamethasone (DEX) in eyes with diabetic macular edema previously treated with ranibizumab (RNB), based on structural spectral-domain optical coherence tomography (SD-OCT) features. METHODS Retrospective study of data from 28 eyes which underwent a loading dose of three monthly RNB injections and were then shifted to DEX implant injection. SD-OCT analysis was performed before switch to DEX (week 12, 12W) according to the presence of integrity of ellipsoid zone (EZ) and external limiting membrane (ELM), disorganization of retinal inner layers (DRIL), and quantity of hyper-reflective spots (HRS). Best-corrected visual acuity (BCVA) changes at different time points after DEX (month 1, 1M; 4 months, 4M; and 12 months, 12M) were compared among groups. RESULTS Significantly better BCVA was achieved at 1M in eyes with intact EZ (84.2 ± 12.3 letters; p = 0.04), with intact ELM (83.2 ± 11.5 letters; p < 0.01), and with fewer HRS (84.6 ± 12.5 letters; p = 0.03). However, the greatest percentage visual increase was achieved in eyes with disrupted EZ (+ 11.4%; p < 0.01), with disrupted ELM (+ 17.2%; p < 0.01), without DRIL (+ 12.5%; p < 0.01), and with more HRS (+ 14.3%; p = 0.04). After 12 months, a significant BCVA gain was observed only in eyes with intact retinal inner layers (+ 14.2%; p = 0.03). CONCLUSIONS Greater percentage BCVA improvement at 1M after switch to DEX was associated with EZ disruption, ELM disruption, intact retinal inner layers, and higher quantity of HRS. A switch to DEX therapy would be useful in patients with these SD-OCT features.
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Affiliation(s)
- Michele Cavalleri
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Maria Vittoria Cicinelli
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | | | | | | | - Riccardo Sacconi
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy.
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Busch C, Fraser-Bell S, Iglicki M, Lupidi M, Couturier A, Chaikitmongkol V, Giancipoli E, Rodríguez-Valdés PJ, Gabrielle PH, Laíns I, Santos AR, Cebeci Z, Amphornphruet A, Degenhardt V, Unterlauft JD, Cagini C, Mané-Tauty V, D'Amico Ricci G, Hindi I, Agrawal K, Chhablani J, Loewenstein A, Zur D, Rehak M. Real-world outcomes of non-responding diabetic macular edema treated with continued anti-VEGF therapy versus early switch to dexamethasone implant: 2-year results. Acta Diabetol 2019; 56:1341-1350. [PMID: 31541334 DOI: 10.1007/s00592-019-01416-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 08/27/2019] [Indexed: 01/12/2023]
Abstract
AIMS To provide 2-year follow-up data on eyes with diabetic macular edema (DME) that were non-responsive after three initial anti-vascular endothelial growth factor (VEGF) injections, comparing functional and anatomical outcomes under continued anti-VEGF therapy versus dexamethasone (DEX) implant. METHODS Multicenter, retrospective chart review comparing eyes with treatment-naïve DME and a suboptimal response to a loading phase of anti-VEGF therapy (3 injections given monthly) which were then treated with (a) further anti-VEGF (n = 72) or (b) initially switched to DEX implant (n = 38). Main outcome measures were change in visual acuity (VA) and central subfield thickness (CST) from the end of the loading phase to 24 months. RESULTS In 79% of the 12-month study population (87/110 eyes), 24-month data were available. One quarter of eyes in each group switched treatments during the second year. Eyes that were switched early to DEX implant maintained the functional and anatomical improvements at 24 months which were seen in the first year (from month 3: + 8.9 letters, - 214 µm). Eyes that were switched from anti-VEGF therapy to steroids in the second year improved VA and reduced CST at 24 months (from month 12: + 6.8 letters, p = 0.023; - 226 µm, p = 0.004). In eyes continued on anti-VEGF therapy, VA and CST were stable at 24 months (from month 3: + 2.8 letters, p = 0.254; - 24 µm, p = 0.243). Eyes that were non-responsive to anti-VEGF therapy for 12 months had similar chances to experience a VA gain from further therapy as eyes that were non-responsive for 3 months only (23.8 vs. 31.0%, p = 0.344). CONCLUSIONS The beneficial effect of an early switch to DEX implant in DME non-responders seen at month 12 was maintained during the second year. A later switch from anti-VEGF to steroids still provided significant improvement. Eyes continued on anti-VEGF over a period of 24 months maintained vision. A quarter of eyes, which had not improved vision at 12 months, exhibited a delayed response to treatment.
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Affiliation(s)
- Catharina Busch
- Department of Ophthalmology, University Hospital Leipzig, Liebigstr. 10-14, 04103, Leipzig, Germany.
| | | | - Matias Iglicki
- Private Retina Service, University of Buenos Aires, Buenos Aires, Argentina
| | - Marco Lupidi
- Department of Biomedical and Surgical Sciences, Section of Ophthalmology, University of Perugia, Perugia, Italy
| | - Aude Couturier
- Department of Ophthalmology, Hôpital Lariboisière, AP-HP, Université Paris, 7 - Sorbonne Paris Cité, Paris, France
| | - Voraporn Chaikitmongkol
- Retina Division, Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Ermete Giancipoli
- Department of Surgical, Microsurgical and Medical Sciences, Eye Clinic, University of Sassari, Sassari, Italy
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Patricio J Rodríguez-Valdés
- Instituto de Oftalmología y Ciencias Visuales, Escuela de Medicina, Tecnológico de Monterrey, Monterrey, Mexico
| | - Pierre-Henry Gabrielle
- Department of Ophthalmology, Dijon University Hospital, Dijon, France
- UMR1324, INRA, Center for Taste and Feeding Behaviour, Dijon, France
| | - Inês Laíns
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
- Massachusetts Eye and Ear, Harvard Medical School, Boston, USA
| | - Ana Rita Santos
- Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
- School of Allied Health Technologies, Polytechnic Institute of Porto, Porto, Portugal
| | - Zafer Cebeci
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Atchara Amphornphruet
- Department of Ophthalmology, Faculty of Medicine, Rajavithi Hospital, Rangsit University, Bangkok, Thailand
| | - Valentin Degenhardt
- Department of Ophthalmology, University Hospital Leipzig, Liebigstr. 10-14, 04103, Leipzig, Germany
- Department of Ophthalmology, University Hospital Heidelberg, Heidelberg, Germany
| | - Jan-Darius Unterlauft
- Department of Ophthalmology, University Hospital Leipzig, Liebigstr. 10-14, 04103, Leipzig, Germany
| | - Carlo Cagini
- Department of Biomedical and Surgical Sciences, Section of Ophthalmology, University of Perugia, Perugia, Italy
| | - Valérie Mané-Tauty
- Department of Ophthalmology, Hôpital Lariboisière, AP-HP, Université Paris, 7 - Sorbonne Paris Cité, Paris, France
| | - Giuseppe D'Amico Ricci
- Department of Surgical, Microsurgical and Medical Sciences, Eye Clinic, University of Sassari, Sassari, Italy
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Isaac Hindi
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Jay Chhablani
- UPMC Eye Center, University of Pittsburgh, Pittsburgh, USA
- L.V. Prasad Eye Institute, Banjara Hills, Hyderabad, India
| | - Anat Loewenstein
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Incumbent, Sydney A. Fox Chair in Ophthalmology, Tel Aviv University, Tel Aviv, Israel
| | - Dinah Zur
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Matus Rehak
- Department of Ophthalmology, University Hospital Leipzig, Liebigstr. 10-14, 04103, Leipzig, Germany
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35
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Shimura M, Kitano S, Muramatsu D, Fukushima H, Takamura Y, Matsumoto M, Kokado M, Kogo J, Sasaki M, Morizane Y, Kotake O, Koto T, Sonoda S, Hirano T, Ishikawa H, Mitamura Y, Okamoto F, Kinoshita T, Kimura K, Sugimoto M, Yamashiro K, Suzuki Y, Hikichi T, Washio N, Sato T, Ohkoshi K, Tsujinaka H, Kusuhara S, Kondo M, Takagi H, Murata T, Sakamoto T. Real-world management of treatment-naïve diabetic macular oedema in Japan: two-year visual outcomes with and without anti-VEGF therapy in the STREAT-DME study. Br J Ophthalmol 2019; 104:1209-1215. [PMID: 31784500 PMCID: PMC7577088 DOI: 10.1136/bjophthalmol-2019-315199] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/12/2019] [Accepted: 11/16/2019] [Indexed: 12/04/2022]
Abstract
Background/Aims To investigate real-world outcomes for best-corrected visual acuity (BCVA) after 2-year clinical intervention for treatment-naïve, centr-involving diabetic macular oedema (DME). Methods Retrospective analysis of longitudinal medical records obtained from 27 institutions specialising in retinal diseases in Japan. A total of 2049 eyes with treatment-naïve DME commencing intervention between 2010 and 2015 who were followed for 2 years were eligible. Interventions for DME included anti-vascular endothelial growth factor (VEGF) therapy, local corticosteroid therapy, macular photocoagulation and vitrectomy. Baseline and final BCVA (logMAR) were assessed. Eyes were classified by the treatment pattern, depending on whether anti-VEGF therapy was used, into an anti-VEGF monotherapy group (group A), a combination therapy group (group B) and a group without anti-VEGF therapy (group C). Results The mean 2-year improvement of BCVA was −0.04±0.40 and final BCVA of >20/40 was obtained in 46.3% of eyes. Based on the treatment pattern, there were 427 eyes (20.9%) in group A, 807 eyes (39.4%) in group B and 815 eyes (39.8%) in group C. Mean improvement of BCVA was −0.09±0.39, –0.02±0.40 and −0.05±0.39, and the percentage of eyes with final BCVA of >20/40 was 49.4%, 38.9%, and 52.0%, respectively. Conclusion Following 2-year real-world management of treatment-naïve DME in Japan, BCVA improved by 2 letters. Eyes treated by anti-VEGF monotherapy showed a better visual prognosis than eyes receiving combination therapy. Despite treatment for DME being selected by specialists in consideration of medical and social factors, a satisfactory visual prognosis was not obtained, but final BCVA remained >20/40 in half of all eyes.
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Affiliation(s)
- Masahiko Shimura
- Department of Ophthalmology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan
| | - Shigehiko Kitano
- Department of Ophthalmology, Diabetes Center, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Harumi Fukushima
- Department of Ophthalmology, Diabetes Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoshihiro Takamura
- Department of Ophthalmology, School of Medical Sciences, University of Fukui, Yoshida, Japan
| | - Makiko Matsumoto
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Masahide Kokado
- Department of Ophthalmology, Wakayama Medical University, Wakayama, Japan
| | - Jiro Kogo
- Department of Ophthalmology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Mariko Sasaki
- Department of Ophthalmology, Tachikawa Hospital, Tachikawa, Japan
| | - Yuki Morizane
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Osamu Kotake
- Department of Ophthalmology, Hachioji Medical Center, Tokyo Medical University, Tokyo, Japan
| | - Takashi Koto
- Kyorin Eye Center, Kyorin University School of Medicine, Mitaka, Japan
| | - Shozo Sonoda
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Takao Hirano
- Deparment of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiroto Ishikawa
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yoshinori Mitamura
- Department of Ophthalmology, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
| | - Fumiki Okamoto
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takamasa Kinoshita
- Department of Ophthalmology, Sapporo City General Hospital, Sapporo, Japan
| | - Kazuhiro Kimura
- Departmet of Ophthalmology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Masahiko Sugimoto
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Kenji Yamashiro
- Department of Ophthalmology, Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Yukihiko Suzuki
- Department of Ophthalmology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | | | - Noriaki Washio
- Department of Ophthalmology, Showa General Hospital, Kodaira, Japan
| | - Tomohito Sato
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Japan
| | - Kishiko Ohkoshi
- Department of Ophthalmology, St. Luke's International Hospital, Tokyo, Japan
| | - Hiroki Tsujinaka
- Department of Ophthalmology, Nara Medical University Graduate School of Medicine, Kashihara, Japan
| | - Sentaro Kusuhara
- Department of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Mineo Kondo
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hitoshi Takagi
- Department of Ophthalmology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Toshinori Murata
- Deparment of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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Plaza-Ramos P, Borque E, García-Layana A. Evaluation of ranibizumab and aflibercept for the treatment of diabetic macular edema in daily clinical practice. PLoS One 2019; 14:e0223793. [PMID: 31644594 PMCID: PMC6808425 DOI: 10.1371/journal.pone.0223793] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/27/2019] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of ranibizumab and aflibercept in the treatment of diabetic macular edema in a real world study, and to compare the two treatments with each other. METHODS Retrospective observational study of 213 eyes from 141 patients with diabetic macular edema was completed between June 2014 and June 2016. 122 were treated with ranibizumab intravitreal injection and 91 with aflibercept intravitreal injection, with a loading phase of 3 injections and a Pro Re Nata protocol. The drug was selected by the physician and fluorescein angiography was performed by physician`s criteria. Re-treatment was performed when a decline in BCVA, an increase of central macular thickness or an increase or persistence of intraretinal fluid in OCT was observed. The primary outcome was the mean change in best corrected visual acuity at 1 year, while central macular thickness, central macular volume, the number of injections and visits were evaluated as secondary outcomes. The correlation between BCVA at 4th month visit and BCVA at 12th month visit was also evaluated. RESULTS The mean baseline best corrected visual acuity for the eyes treated with ranibizumab was 0.55 (+/- 0.35) logMAR, and with aflibercept it was 0.48 (+/- 0.29) (P = 0.109). Best corrected visual acuity improved in both groups, and at the end of the follow-up was 0.40 (+/- 0.35) in the ranibizumab group and 0.40 (+/- 0.29) in the aflibercept group (P = 0.864). Best corrected visual acuity at 4th month visit is correlated at a high value (R = 0.789) with the one at the end of the study. No differences were found in central macular thickness, central macular volume and glycosylated hemoglobin when adjusting with baseline values. The overall number of injections was 5.77 (+/- 2.01), being 5.56 (+/- 2.0) in the ranibizumab group and 6.07 (+/- 1.99) in the aflibercept group (P = 0.069). The main outcome determining final best corrected visual acuity was the baseline best corrected visual acuity (P<0.001). CONCLUSION There are no differences in efficacy between ranibizumab and aflibercept in diabetic macular edema treatment in this real world study.
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Affiliation(s)
- Pablo Plaza-Ramos
- Ophthalmology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
- * E-mail:
| | - Enrique Borque
- Ophthalmology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
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Battaglia Parodi M, Romano F, Arrigo A, Sacchi R, Scanzi G, Ferri C, Bandello F. Real-life anti-vascular endothelial growth factor treatment for age-related macular degeneration and diabetic macular edema in an Italian tertiary referral hospital. Eur J Ophthalmol 2019; 30:1461-1466. [PMID: 31617403 DOI: 10.1177/1120672119880386] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To study the real-life outcomes of intravitreal anti-vascular endothelial growth factor treatment in patients affected by age-related macular degeneration and diabetic macular edema in an Italian tertiary referral hospital over a 2-year follow-up. METHODS Patients with confirmed diagnosis of age-related macular degeneration or diabetic macular edema and 2 years of follow-up were retrospectively analyzed. They underwent a loading dose of three monthly anti-vascular endothelial growth factor injections, with re-treatment performed following a "pro-re-nata" regimen. Best-corrected visual acuity and central retinal thickness were collected and statistically analyzed. RESULTS In total, 167 diabetic macular edema eyes and 108 age-related macular degeneration eyes were included. Mean age was 63.4 ± 11.8 years for diabetic macular edema and 75.6 ± 8.4 years for age-related macular degeneration. For diabetic macular edema patients, mean number of injections was 5.0 ± 1.7 at 1 year and 2.8 ± 1.8 at 2 years. Mean best-corrected visual acuity improved from 60 Early Treatment for Diabetic Retinopathy Study letters to 66.7 letters at 1 year, and to 70 letters at 2 years (p < 0.001). Mean central retinal thickness decreased from 459 ± 148 µm to 327 ± 163 µm and 261 ± 89 µm, respectively, at the first and the second year (p < 0.001).With respect to age-related macular degeneration patients, mean number of injections was 5.3 ± 2.2 at 1 year and 3.3 ± 1.5 at 2 years. Mean best-corrected visual acuity improved from 63 Early Treatment for Diabetic Retinopathy Study letters to 68 letters at 1 year and to 70 letters at 2 years (p < 0.001). Mean central retinal thickness was 411 ± 146 µm, decreasing to 271 ± 93 µm at 1 year and 260 ± 68 µm at 2 years (p < 0.001). CONCLUSIONS Our study described the 2-year real-life outcome of anti-vascular endothelial growth factor treatment of diabetic macular edema and age-related macular degeneration.
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Affiliation(s)
| | - Francesco Romano
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco University Hospital, Milan, Italy
| | - Alessandro Arrigo
- Department of Ophthalmology and IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | - Raffaele Sacchi
- Department of Ophthalmology and IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | - Gianluca Scanzi
- Department of Ophthalmology and IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | - Camilla Ferri
- Department of Pharmacy, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology and IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
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Iglicki M, Loewenstein A, Barak A, Schwartz S, Zur D. Outer retinal hyperreflective deposits (ORYD): a new OCT feature in naïve diabetic macular oedema after PPV with ILM peeling. Br J Ophthalmol 2019; 104:666-671. [PMID: 31391181 DOI: 10.1136/bjophthalmol-2019-314523] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/06/2019] [Accepted: 07/24/2019] [Indexed: 01/17/2023]
Abstract
AIMS We aimed to investigate a novel optical coherence tomography (OCT) finding of outer retinal hyperreflective deposits (ORYDs) in patients with naïve diabetic macular oedema (DMO) seen after small gauge pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling. Furthermore, we evaluated the predictive value of ORYD for visual outcome over 24 months follow-up. METHODS Retrospective cohort study including 111 eyes from 111 patients with naïve DMO treated by PPV and ILM peeling with a follow-up of 24 months. OCT scans were analysed for the presence of ORYD 1 week and 1, 6, 12, 18 and 24 months after surgery. Change in baseline best-corrected visual acuity (BCVA) and central subfoveal thickness (CST) after surgery were measured over the follow-up period. Presence of ORYD was correlated with baseline characteristics and BCVA after 24 months. RESULTS Hundred and eleven eyes from 111 patients were included (mean age 67.5±14.8 years). ORYD was identified in the outer plexiform layer as hyperreflective deposits in 92 patients (82.8%) 7 days after surgery but it was not present before surgery. There was a significant reduction in the presence of ORYD. After 24 months ORYD disappeared in all cases (p<0.001). CONCLUSIONS We describe a novel OCT feature of ORYD present in the early postoperative phase in the majority of patients after PPV with ILM peeling for naïve DMO, disappearing over the postoperative course. These deposits might be a result of sudden desinflammation and could shed new light on the process of DMO resolution after operative intervention.
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Affiliation(s)
- Matias Iglicki
- Ophthalmology Department, Private Retina Service, University of Buenos Aires, Buenos Aires, Argentina
| | - Anat Loewenstein
- Ophthalmology Division, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adiel Barak
- Ophthalmology Division, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shulamit Schwartz
- Ophthalmology Division, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dinah Zur
- Ophthalmology Division, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Maggio E, Sartore M, Attanasio M, Maraone G, Guerriero M, Polito A, Pertile G. Reply. Am J Ophthalmol 2019; 199:256-257. [PMID: 30583794 DOI: 10.1016/j.ajo.2018.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 10/09/2018] [Indexed: 10/27/2022]
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Gandhi JS. Anti-Vascular Endothelial Growth Factor Treatment for Diabetic Macular Edema in a Real-World Clinical Setting. Am J Ophthalmol 2019; 199:255-256. [PMID: 30580839 DOI: 10.1016/j.ajo.2018.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 09/28/2018] [Accepted: 10/01/2018] [Indexed: 10/27/2022]
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Călugăru D, Călugăru M. Anti-VEGF Treatment for Diabetic Macular Edema in a Real-World Clinical Setting. Am J Ophthalmol 2018; 196:208-209. [PMID: 30269874 DOI: 10.1016/j.ajo.2018.08.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 08/15/2018] [Accepted: 08/24/2018] [Indexed: 11/25/2022]
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Maggio E, Sartore M, Attanasio M, Maraone G, Guerriero M, Polito A, Pertile G. Reply. Am J Ophthalmol 2018; 196:209-210. [PMID: 30278874 DOI: 10.1016/j.ajo.2018.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 08/25/2018] [Indexed: 11/28/2022]
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Schreur V, Altay L, van Asten F, Groenewoud JMM, Fauser S, Klevering BJ, Hoyng CB, de Jong EK. Hyperreflective foci on optical coherence tomography associate with treatment outcome for anti-VEGF in patients with diabetic macular edema. PLoS One 2018; 13:e0206482. [PMID: 30379920 PMCID: PMC6209345 DOI: 10.1371/journal.pone.0206482] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/12/2018] [Indexed: 12/02/2022] Open
Abstract
Purpose To investigate the relationship between baseline number of hyperreflective foci (HF) on spectral domain optical coherence tomography (SD-OCT) in patients with diabetic macular edema (DME), as well as the dynamics of HF during treatment with anti-vascular endothelial growth factor (VEGF), and treatment response. Methods We evaluated patients diagnosed with DME scheduled for treatment with intravitreal bevacizumab. Eyes were classified as adequate or insufficient treatment responders based on logMAR visual acuity improvement and central retinal thickness (CRT) decrease after three consecutive injections. Associations between number of HF at baseline and treatment response, the change in HF over the course of treatment, and the distribution of HF within the retinal layers were evaluated. Results In 54 eyes of 41 patients, mean number of HF and CRT decreased after intravitreal treatment with bevacizumab (p = 0.002 and p<0.001 respectively). Decrease in CRT after 3 months was independently associated with a higher number of HF at baseline (estimated effect -2.61, 95% CI [-4.42–-0.31], p = 0.006). Eyes with adequate treatment response presented with more HF at baseline (OR 1.106, 95% CI [1.012–1.210], p = 0.030) than eyes with insufficient treatment response. Most HF were located within the inner retinal layers, and decrease of HF was mostly due to a decrease of inner retinal HF. Conclusions In patients with DME treated with anti-VEGF, higher baseline numbers of HF have predictive value for treatment response in terms of visual acuity improvement and CRT decrease after 3 months. In addition, HF were responsive to anti-VEGF therapy.
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Affiliation(s)
- Vivian Schreur
- Department of Ophthalmology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lebriz Altay
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany
| | - Freekje van Asten
- Department of Ophthalmology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Sascha Fauser
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany
| | - B. Jeroen Klevering
- Department of Ophthalmology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carel B. Hoyng
- Department of Ophthalmology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eiko K. de Jong
- Department of Ophthalmology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- * E-mail:
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