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La Franca L, Rutigliani C, Checchin L, Lattanzio R, Bandello F, Cicinelli MV. Rate and Predictors of Misclassification of Active Diabetic Macular Edema as Detected by an Automated Retinal Image Analysis System. Ophthalmol Ther 2024; 13:1553-1567. [PMID: 38587776 PMCID: PMC11109071 DOI: 10.1007/s40123-024-00929-8] [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: 11/27/2023] [Accepted: 03/07/2024] [Indexed: 04/09/2024] Open
Abstract
INTRODUCTION The aim of this work is to estimate the sensitivity, specificity, and misclassification rate of an automated retinal image analysis system (ARIAS) in diagnosing active diabetic macular edema (DME) and to identify factors associated with true and false positives. METHODS We conducted a cross-sectional study of prospectively enrolled patients with diabetes mellitus (DM) referred to a tertiary medical retina center for screening or management of DME. All patients underwent two-field fundus photography (macula- and disc-centered) with a true-color confocal camera; images were processed by EyeArt V.2.1.0 (Woodland Hills, CA, USA). Active DME was defined as the presence of intraretinal or subretinal fluid on spectral-domain optical coherence tomography (SD-OCT). Sensitivity and specificity and their 95% confidence intervals (CIs) were calculated. Variables associated with true (i.e., DME labeled as present by ARIAS + fluid on SD-OCT) and false positives (i.e., DME labeled as present by ARIAS + no fluid on SD-OCT) of active DME were explored. RESULTS A total of 298 eyes were included; 92 eyes (31%) had active DME. ARIAS sensitivity and specificity were 82.61% (95% CI 72.37-89.60) and 84.47% (95% CI 78.34-89.10). The misclassification rate was 16%. Factors associated with true positives included younger age (p = 0.01), shorter DM duration (p = 0.006), presence of hard exudates (p = 0.005), and microaneurysms (p = 0.002). Factors associated with false positives included longer DM duration (p = 0.01), worse diabetic retinopathy severity (p = 0.008), history of inactivated DME (p < 0.001), and presence of hard exudates (p < 0.001), microaneurysms (p < 0.001), or epiretinal membrane (p = 0.06). CONCLUSIONS The sensitivity of ARIAS was diminished in older patients and those without DME-related fundus lesions, while the specificity was reduced in cases with a history of inactivated DME. ARIAS performed well in screening for naïve DME but is not effective in surveillance inactivated DME.
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Affiliation(s)
- Lamberto La Franca
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, IRCCS Ospedale San Raffaele, University Vita-Salute, Via Olgettina 60, 20132, Milan, Italy
| | - Carola Rutigliani
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Lisa Checchin
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, IRCCS Ospedale San Raffaele, University Vita-Salute, Via Olgettina 60, 20132, Milan, Italy
| | - Rosangela Lattanzio
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, IRCCS Ospedale San Raffaele, University Vita-Salute, Via Olgettina 60, 20132, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, IRCCS Ospedale San Raffaele, University Vita-Salute, Via Olgettina 60, 20132, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Vittoria Cicinelli
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, IRCCS Ospedale San Raffaele, University Vita-Salute, Via Olgettina 60, 20132, Milan, Italy.
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
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Shen L, Zheng Y, Gao Z, Li Q, Dai M, Yang W, Zhang Q, Li D, Hu Y, Yuan L. Efficacy and safety of intravitreal injection of conbercept for moderate to severe nonproliferative diabetic retinopathy. Front Med (Lausanne) 2024; 11:1394358. [PMID: 38846145 PMCID: PMC11153662 DOI: 10.3389/fmed.2024.1394358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/10/2024] [Indexed: 06/09/2024] Open
Abstract
Purpose This study aimed to assess the effectiveness and safety of intravitreal injection of conbercept (IVC) in treating moderate to severe nonproliferative diabetic retinopathy (NPDR), with or without accompanying diabetic macular edema. Methods In this longitudinal retrospective study, 35 patients (50 eyes) with moderate to severe NPDR and Diabetic Retinopathy Severity Scale (DRSS) scores between 43 and 53 were treated at the Department of Ophthalmology, First Affiliated Hospital of Kunming Medical University, from October 2018 to January 2023. Treatment protocol included three monthly IVC injections followed by a pro re nata (PRN) regimen over a two-year follow-up period. Outcome measures were best-corrected visual acuity (BCVA), intraocular pressure, central macular thickness (CMT), extent of hard exudate (HE), and changes in DRSS scores. DRSS scores before and after treatment were analyzed using the Wilcoxon rank-sum test. Both systemic and ocular adverse events were meticulously documented to ascertain safety. Results From baseline to the final follow-up, the mean BCVA improved from 0.41 ± 0.39 to 0.23 ± 0.20 logMAR (p<0.05). The mean CMT decreased from 306.22 ± 77.40 to 297.97 ± 88.15 μm (p = 0.385). At 24 months, DRSS scores improved by ≥1 stage in 40 eyes (80%), ≥ 2 stages in 28 eyes (56%), ≥3 stages in 10 eyes (20%), and remained stable in 6 eyes (12%). The DRSS scores at each follow-up interval demonstrated statistically significant improvement from baseline (p<0.05). In 15 of 27 eyes (55.56%) with diabetic macular edema (DME), there was a significant reduction in the mean area of HE from baseline (p<0.05). No serious systemic adverse events were observed. Conclusion IVC is an effective and safe treatment for moderate to severe NPDR, demonstrating significant improvements in DRSS scores.
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Affiliation(s)
- Lu Shen
- Department of Ophthalmology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yuxiang Zheng
- Department of Ophthalmology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zelan Gao
- Department of Ophthalmology, Yan’an Hospital of Kunming City, Kunming, China
| | - Qirui Li
- Department of Ophthalmology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Min Dai
- Department of Ophthalmology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Wenchang Yang
- Department of Ophthalmology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Qiying Zhang
- Department of Ophthalmology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Dongli Li
- Department of Ophthalmology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yijun Hu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Ling Yuan
- Department of Ophthalmology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
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Park D, Kim KL, Park SP, Kim YK. Comparison of quantification of intraretinal hard exudates between optical coherence tomography en face image versus fundus photography. Indian J Ophthalmol 2024; 72:S280-S296. [PMID: 38271424 DOI: 10.4103/ijo.ijo_1986_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/11/2023] [Indexed: 01/27/2024] Open
Abstract
PURPOSE To compare the quantification of intraretinal hard exudate (HE) using en face optical coherence tomography (OCT) and fundus photography. METHODS Consecutive en face images and corresponding fundus photographs from 13 eyes of 10 patients with macular edema associated with diabetic retinopathy or Coats' disease were analyzed using the machine-learning-based image analysis tool, "ilastik." RESULTS The overall measured HE area was greater with en face images than with fundus photos (en face: 0.49 ± 0.35 mm2 vs. fundus photo: 0.34 ± 0.34 mm2, P < 0.001). However, there was an excellent correlation between the two measurements (intraclass correlation coefficient [ICC] = 0.844). There was a negative correlation between HE area and central macular thickness (CMT) (r = -0.292, P = 0.001). However, HE area showed a positive correlation with CMT in the previous several months, especially in eyes treated with anti-vascular endothelial growth factor (VEGF) therapy (CMT 3 months before: r = 0.349, P = 0.001; CMT 4 months before: r = 0.287, P = 0.012). CONCLUSION Intraretinal HE can be reliably quantified from either en face OCT images or fundus photography with the aid of an interactive machine learning-based image analysis tool. HE area changes lagged several months behind CMT changes, especially in eyes treated with anti-VEGF injections.
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Affiliation(s)
- Donghee Park
- Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
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Carta V, Lixi F, Tatti F, Peiretti E. Effect of Intravitreal Brolucizumab in the Treatment of Polypoidal Choroidal Vasculopathy With Foveal Lipid Exudation. Cureus 2023; 15:e47942. [PMID: 38034243 PMCID: PMC10685085 DOI: 10.7759/cureus.47942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2023] [Indexed: 12/02/2023] Open
Abstract
A 71-year-old woman with a history of blurred vision in her right eye for nearly two months came to our attention. A complete ophthalmological evaluation, including best-corrected visual acuity measurement, fundus examination, spectral-domain optical coherence tomography, fluorescein angiography, and indocyanine green angiography, was performed. Multimodal imaging showed the presence of a polypoidal choroidal vasculopathy (PCV) lesion surrounded by diffuse hard exudates in the macular area. Our patient received three monthly intravitreal injections of brolucizumab during the loading phase, followed by an intravitreal injection every eight weeks for a total of 48 weeks of follow-up. The therapy appeared to be effective for improving both visual and anatomical outcomes revealing an important regression of the PCV and an almost complete reabsorption of lipid exudates. Intravitreal brolucizumab could be considered an effective treatment in the management of lipid exudation in PCV patients.
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Affiliation(s)
- Valentina Carta
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, ITA
| | - Filippo Lixi
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, ITA
| | - Filippo Tatti
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, ITA
| | - Enrico Peiretti
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, ITA
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Si M, Tao Y, Zhang Z, Zhao H, Cui W, Yang M, Wang H. Retinal vein changes in patients with high-risk proliferative diabetic retinopathy treated with conbercept and panretinal photocoagulation co-therapy: a cohort study. Front Endocrinol (Lausanne) 2023; 14:1218442. [PMID: 37693359 PMCID: PMC10485612 DOI: 10.3389/fendo.2023.1218442] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023] Open
Abstract
Objective This study aimed to observe and compare retinal vein diameter changes and other essential indicators in patients with high-risk proliferative diabetic retinopathy (PDR) treated with intravitreal injection of conbercept (IVC) combined with panretinal photocoagulation (PRP) versus PRP monotherapy. Methods A retrospective analysis was conducted on data from patients with high-risk PDR who received specific treatment and were followed up for 24 months. Among 82 patients with high-risk PDR, 50 eyes received PRP combined with IVC, whereas 32 eyes received PRP alone. During the 24-month follow-up period, changes in best-corrected visual acuity (BCVA), central foveal thickness (CFT), retinal vein diameter, number of microaneurysms (MA), neovascularization (NV) area, hard exudate (HE) area, size of the foveal avascular zone (FAZ), superficial capillary plexus (SCP) blood flow density, and adverse effects were recorded and compared between the two groups at baseline and at 6, 12, 18, and 24 months after treatment. The relationship between each observation index and vein diameter was also analyzed. Results During the 24-month follow up, significant improvements in the BCVA, CFT, retinal vein diameter, number of MAs, NV area, HE area, FAZ, and SCP were observed in the IVC+PRP group after treatment. The PRP group only showed significant reductions in NV and HE areas. The IVC+PRP group showed significant superiority over the PRP group in improving the vein diameter, number of MA, and HE area. However, no statistically significant difference in NV area reduction was found between the groups. Conclusion In the treatment of high-risk PDR, IVC+PRP therapy has a significant advantage over PRP monotherapy. IVC+PRP therapy may reverse diabetes-induced retinal vein changes, restoring morphology and function.
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Affiliation(s)
- Mingwei Si
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, China
| | - Yuan Tao
- Department of Ophthalmology, The Second People’s Hospital of Jinan, Jinan, China
| | - Ziniu Zhang
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Hui Zhao
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, China
| | - Wenxuan Cui
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, China
| | - Mengyao Yang
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, China
| | - Hong Wang
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, China
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Yan Y, Yu L, Sun C, Zhao H, Zhang H, Wang Z. Retinal microvascular changes in diabetic patients with diabetic nephropathy. BMC Endocr Disord 2023; 23:101. [PMID: 37147636 PMCID: PMC10161482 DOI: 10.1186/s12902-022-01250-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/12/2022] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND To explore the characteristics of retina microvascular changes in patients with diabetic nephropathy (DN) and its risk factors. METHODS Retrospective, observational study. 145 patients with type 2 diabetic mellitus (DM) and DN were included in the study. Demographic and clinical parameters were obtained from medical records. Presence of diabetic retinopathy (DR), hard exudates (HEs) and diabetic macular edema (DME) were evaluated according to the color fundus images, optical coherence tomography (OCT) and fluorescence angiography (FFA). RESULTS DR accounted for 61.4% in type 2 DM patients with DN, of which proliferative diabetic retinopathy (PDR) accounted for 23.6% and sight threatening DR accounted for 35.7%. DR group had significantly higher levels of low-density lipoprotein cholesterol (LDL-C) (p = 0.004), HbA1c (P = 0.037), Urine albumin creatine ratio (ACR) (p < 0.001) and lower level of estimated glomerular filtration rate (eGFR) (P = 0.013). Logistic regression analysis showed DR was significantly associated with ACR stage (p = 0.011). Subjects with ACR stage3 had higher incidence of DR compared with subjects with ACR stage1 (OR = 24.15, 95%CI: 2.06-282.95). 138 eyes of 138 patients were analyzed for HEs and DME, of which 23.2% had HEs in posterior pole and 9.4% had DME. Visual acuity was worse in HEs group than in non-HEs group. There was significant difference in the LDL-C cholesterol level, total cholesterol (CHOL) level and ACR between HEs group and non-HEs group. CONCLUSIONS A relatively higher prevalence of DR was found in type 2 DM patients with DN. ACR stage could be recognized as a risk factor for DR in DN patients. Patients with DN needs ophthalmic examination more timely and more frequently.
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Affiliation(s)
- Yujie Yan
- Department of Ophthalmology, China-Japan, Friendship Hospital, Beijing, People's Republic of China
| | - Liping Yu
- Department of Endocrinology, China-Japan, Friendship Hospital, Beijing, People's Republic of China
| | - Chuan Sun
- Department of Ophthalmology, China-Japan, Friendship Hospital, Beijing, People's Republic of China
| | - Haipeng Zhao
- Department of Ophthalmology, China-Japan, Friendship Hospital, Beijing, People's Republic of China
| | - Hongsong Zhang
- Department of Ophthalmology, China-Japan, Friendship Hospital, Beijing, People's Republic of China.
| | - Zhijun Wang
- Department of Ophthalmology, China-Japan, Friendship Hospital, Beijing, People's Republic of China.
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Shen Y, Wang H, Fang J, Liu K, Xu X. Novel insights into the mechanisms of hard exudate in diabetic retinopathy: Findings of serum lipidomic and metabolomics profiling. Heliyon 2023; 9:e15123. [PMID: 37089301 PMCID: PMC10119565 DOI: 10.1016/j.heliyon.2023.e15123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
Objective Retinal hard exudates (HEs) result from lipoproteins leaking from capillaries into extracellular retinal space, and are related to decreased visual acuity in diabetic retinopathy (DR). This study aims to identify differential serum lipids and metabolites associated with HEs. Materials and methods A cross-sectional study was conducted Jul 2017 ∼ Mar 2021. We assessed the amount of HEs using standard ETDRS photographs for comparison. HEs severity was rated as "no or questionable", "moderate" or "severe". Serum samples were processed via high coverage pseudotargeted lipidomics analysis, and untargeted liquid chromatography coupled with time-of-flight mass spectrometry for metabolomics study, respectively. Weighted gene co-expression network analyses, partial least squares-discriminant analysis, and multi-receiver operating characteristic analysis were applied. Results A total of 167 patients were included. Discovery group: 116 eyes (116 patients). Validation group: 51 eyes (51 patients). 888 lipids were detected and divided into 18 modules (MEs), ME1 ∼ ME18. Lipids in ME1 significantly increased in patients with HEs in DR (NPDR and PDR combined), NPDR, and PDR, respectively. ME1 enriched to triglycerides (29%), ceramides (17%), and N-acylethanolamines (15%). A combined model of 20 lipids was the best to discriminate HEs, area under curve = 0.804, 95% confidence interval = 0.674-0.916. For metabolomics analysis, 19 metabolites and 13 pathways associated with HEs were identified. Taurine and hypotaurine metabolism, cysteine and methionine metabolism were closely related to HEs (P < 0.01). Conclusions The lipids and metabolites identified may serve as prediction biomarkers in the early stage of HEs in DR.
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Chou HD, Wu CH, Chiang WY, Chen NN, Hwang YS, Chen KJ, Lai CH, Wu PC, Chen YH, Yeung L, Shao SC, Lai CC, Wu WC. Optical coherence tomography and imaging biomarkers as outcome predictors in diabetic macular edema treated with dexamethasone implant. Sci Rep 2022; 12:3872. [PMID: 35264625 PMCID: PMC8907275 DOI: 10.1038/s41598-022-07604-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 02/17/2022] [Indexed: 11/09/2022] Open
Abstract
In this retrospective, multicenter study, we determined the predictive value of imaging biomarkers in diabetic macular edema (DME) outcomes following dexamethasone (DEX) implant(s). Sixty-seven eyes of 47 patients' best-corrected visual acuity (BCVA) and central foveal thickness (CFT) on optical coherence tomography (OCT) before and after intravitreal DEX implants were evaluated. Baseline imaging biomarkers were graded using fundus photography and OCT, and the predictive value of biomarkers for significant treatment effects at six months was analyzed. Six months after 2.0 ± 0.8 (mean ± SD) DEX implants, 35 (52%) and 16 (24%) eyes had CFT reduction ≥ 10% from baseline and decreased to < 300 µm, respectively. BCVA improved ≥ 3 lines in 15 (22%) and remained stable in 38 (57%) eyes. At six months, eyes with severe intraretinal cyst (IRC), abundant hyperreflective dots (HRD), and moderate or severe hard exudate had a significantly higher chance of CFT reduction ≥ 10%. Eyes with abundant HRD at baseline and those underwent three DEX implants were more likely to achieve CFT < 300 µm. Eyes with DME and severe IRC, abundant HRD, or moderate-to-severe hard exudate at baseline were more likely to show a significant reduction in CFT six months after DEX implant.
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Affiliation(s)
- Hung-Da Chou
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing St., Gueishan Dist., Taoyuan City, 333, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Cheng-Hsiu Wu
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, Keelung City, Taiwan
| | - Wei-Yu Chiang
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Nan-Ni Chen
- Department of Ophthalmology, Chiayi Chang Gung Memorial Hospital, Chiayi City, Taiwan
| | - Yih-Shiou Hwang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing St., Gueishan Dist., Taoyuan City, 333, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Department of Ophthalmology, Chang Gung Memorial Hospital, Xiamen Branch, Xiamen, China.,Department of Ophthalmology, Jen-Ai Hospital Dali Branch, Taichung, Taiwan
| | - Kuan-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing St., Gueishan Dist., Taoyuan City, 333, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Chien-Hsiung Lai
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Department of Ophthalmology, Chiayi Chang Gung Memorial Hospital, Chiayi City, Taiwan.,Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan.,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Pei-Chang Wu
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Yi-Hao Chen
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Ling Yeung
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, Keelung City, Taiwan
| | - Shih-Chieh Shao
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung City, Taiwan
| | - Chi-Chun Lai
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, Keelung City, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuxing St., Gueishan Dist., Taoyuan City, 333, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan City, Taiwan.
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Should we still be performing macular laser for non-centre involving diabetic macular oedema? No. Eye (Lond) 2022; 36:485-486. [PMID: 34645965 PMCID: PMC8873404 DOI: 10.1038/s41433-021-01787-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 11/08/2022] Open
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Shi R, Guo Z, Yang X, Che X. Aggravation of retinal hard exudates after intravitreal anti-vascular endothelial growth factor therapy for cystoid macular edema and the risk factors: a retrospective study. BMC Ophthalmol 2022; 22:92. [PMID: 35197011 PMCID: PMC8867860 DOI: 10.1186/s12886-022-02315-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 01/27/2022] [Indexed: 12/03/2022] Open
Abstract
Background/aims To evaluate retinal hard exudates (HEs) progression in patients with cystoid macular edema (CME) secondary to diabetic retinopathy (DR) or branch retinal vascular occlusion (BRVO) after intravitreal injections of ranibizumab (IVR) treatment and identify the risk factors for the deterioration of HEs. Methods This retrospective study enrolled 288 eyes with center-involving CME secondary to DR or BRVO from 288 patients (one eye per patient). All patients were treated with three loading doses of ranibizumab intravitreally at a monthly interval. The morphologic features of HEs were observed, and the HEs areas were quantified using a semi-automatic method at baseline, 1 month after the first dose of IVR and 1 month after the third dose of IVR therapy. HEs progression was defined as having a > =2-grade increase in the HEs severity scale. The best-corrected vision acuity (BCVA) and alterations in HEs areas were compared between DR and BRVO groups. And logistic regression analyses were used to identify the risk factors for HEs exacerbation. Results Morphological changes of retinal HEs occurred in all eyes after IVR therapy, although HEs area was not significantly changed in some eyes. DR group has a higher percentage of eyes with progressed HEs area than the BRVO groups (34.9% vs. 21.8%, P = 0.019) 1 month after the first dose of IVR. Both DR and BRVO groups had a decreased percentage of enlarged HEs 1 month after the third injection, but the DR group is still higher than the BRVO group (17.1% vs. 8.4%, P = 0.027). At baseline, there was no correlation between VA and HEs areas. After the first and third doses of IVR, there still was no consistent correlation between HEs severity and change in VA over time. Furthermore, CME with subretinal fluid (SRF) is associated with a higher risk of HEs progression (P = 0.001). Long CME duration and high serum low-density lipoprotein cholesterol (LDL-C) level were identified as risk factors for HEs progression following IVR treatment in both univariable and multivariable regression analyses (Odds ratio (OR) = 1.88, P = 0.012 and OR = 1.14, P = 0.021, respectively). Conclusions Alterations in the area of retinal HEs are widely observed after IVR treatment for CME. The eyes with CME secondary to DR have a higher percentage of progressed HEs than the BRVO eyes. DME with SRF, extended duration of CME, and high LDL-C level are potential risk factors of deteriorated HEs after IVR treatment.
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Affiliation(s)
- Rui Shi
- Department of Ophthalmology, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - Zhonglan Guo
- Department of Ophthalmology, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - Xiangxiang Yang
- Department of Ophthalmology, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - Xuanyi Che
- Department of Ophthalmology, Shaanxi Provincial People's Hospital, Xi'an, 710068, China.
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Ebrahimi M, Balibegloo M, Rezaei N. Monoclonal antibodies in diabetic retinopathy. Expert Rev Clin Immunol 2022; 18:163-178. [PMID: 35105268 DOI: 10.1080/1744666x.2022.2037420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Diabetic retinopathy (DR), as one of the main complications of diabetes, is among the leading causes of blindness and visual impairment worldwide. AREAS COVERED Current clinical therapies include photocoagulation, vitrectomy, and anti-vascular endothelial growth factor (VEGF) therapies. Bevacizumab and ranibizumab are two monoclonal antibodies (mAbs) inhibiting angiogenesis. Intravitreal ranibizumab and bevacizumab can decrease the rate of blindness and retinal thickness, and improve visual acuity whether as monotherapy or combined with other treatments. They can increase the efficacy of other treatments and decrease their adverse events. Although administered intravitreally, they also might enter the circulation and cause systemic effects. This study is aimed to review our current knowledge about mAbs, bevacizumab and ranibizumab, in DR including superiorities, challenges, and limitations. Meanwhile, we tried to shed light on new ideas to overcome these limitations. Our latest search was done in April 2021 mainly through PubMed and Google Scholar. Relevant clinical studies were imported. EXPERT OPINION Future direction includes detection of more therapeutic targets considering other components of DR pathophysiology and shared pathogenesis of DR and neurodegenerative diseases such as Parkinson's disease and Alzheimer's disease, the treat-and-extend regimen, and new ways of drug delivery and other routes of ocular drug administration.
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Affiliation(s)
- Moein Ebrahimi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA),Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Maryam Balibegloo
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA),Universal Scientific Education and Research Network (USERN), Tehran, Iran.,Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Rezaei
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA),Universal Scientific Education and Research Network (USERN), Tehran, Iran.,Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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12
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Kwon JW, Kim B, Jee D, Cho YK. Aqueous humor analyses of diabetic macular edema patients with subretinal fluid. Sci Rep 2021; 11:20985. [PMID: 34697354 PMCID: PMC8546094 DOI: 10.1038/s41598-021-00442-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/12/2021] [Indexed: 12/14/2022] Open
Abstract
We identified treatment-naïve diabetic macular edema (DME) patients with or without subretinal fluid (SRF). We compared their baseline characteristics: aqueous concentrations of interleukin (IL)-1β, IL-2, IL-6, IL-8, IL-10, and IL-17, as well as tumor necrosis factor-α, vascular endothelial growth factor (VEGF), and placental growth factor (PlGF). We also compared fundus and optical coherence tomography (OCT) findings, and responsiveness to anti-VEGF treatments. Of 67 DME patients, 18 (26.87%) had SRF. Compared to the no SRF group, the SRF group had significantly higher levels of IL-6, IL-8, VEGF, and PlGF in aqueous humor. After grouping according to diabetic retinopathy stage, non-proliferative diabetic retinopathy (NPDR) patients with SRF had higher aqueous levels of IL-6 and IL-8, compared to NPDR patients without SRF. Moreover, proliferative diabetic retinopathy (PDR) patients with SRF had higher aqueous levels of VEGF and PlGF, compared to PDR patients without SRF. Fundus and OCT analyses revealed that the SRF group had a greater proportion of patients with succinate or patch-shaped hard exudates involving the macula, and greater central subfield thickness (CST) at baseline. After 6 months of anti-VEGF treatments, the SRF group showed better responsiveness in terms of CST; however, visual acuity was not correlated with responsiveness. Considering higher aqueous levels of VEGFs and pro-inflammatory cytokines, SRF could be a biomarker related to diabetic retinopathy activity. DME patients with SRF showed better anatomical responsiveness to anti-VEGF treatments, but did not show better functional improvement on short-term evaluation compared to those of DME patients without SRF.
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Affiliation(s)
- Jin-Woo Kwon
- Department of Ophthalmology and Visual Science, College of Medicine, St. Vincent's Hospital, Catholic University of Korea, #93 Jungbu-daero, Paldal-ku, Suwon, 16247, Kyunggi-do, Korea.
| | - Byungjin Kim
- Department of Ophthalmology and Visual Science, College of Medicine, St. Vincent's Hospital, Catholic University of Korea, #93 Jungbu-daero, Paldal-ku, Suwon, 16247, Kyunggi-do, Korea
| | - Donghyun Jee
- Department of Ophthalmology and Visual Science, College of Medicine, St. Vincent's Hospital, Catholic University of Korea, #93 Jungbu-daero, Paldal-ku, Suwon, 16247, Kyunggi-do, Korea
| | - Yang Kyung Cho
- Department of Ophthalmology and Visual Science, College of Medicine, St. Vincent's Hospital, Catholic University of Korea, #93 Jungbu-daero, Paldal-ku, Suwon, 16247, Kyunggi-do, Korea.
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13
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Gong R, Han R, Guo J, Liu W, Xu G. Quantitative evaluation of hard exudates in diabetic macular edema by multicolor imaging and their associations with serum lipid levels. Acta Diabetol 2021; 58:1161-1167. [PMID: 33811294 DOI: 10.1007/s00592-021-01697-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/26/2021] [Indexed: 10/21/2022]
Abstract
AIMS To quantify hard exudates (HEs) by multicolor imaging (MCI) and traditional color fundus photography (CFP) in diabetic macular edema (DME), and study their associations with serum lipid levels. METHODS Observational study. DME patients with HEs were recruited. The HE area and location both by MCI and CFP were measured by ImageJ software. Multivariate regression models were used to analyze the associations of serum lipid levels with the total HE area and HE location. RESULTS Sixty-two patients (74 eyes) were enrolled to quantify HEs in DME. The total HE area by MCI was larger than that by CFP (P = 0.004), and the distance between the fovea and the nearest HE by MCI was shorter than that by CFP (P = 0.003). The percentage of patients with HEs involving the central macula by MCI was significantly higher than that by CFP (P < 0.001). Furthermore, 62 eyes of 62 patients were included to analyze the associations of HE parameters with serum lipid levels. In both MCI and CFP, the HE areas were positively associated with triglyceride level (P = 0.016, P = 0.022, respectively). HEs involving the central macula were positively associated with triglyceride and low-density cholesterol levels in MCI (P = 0.028, P = 0.046, respectively), while no significant association was found between serum lipid levels and HE location in CFP. CONCLUSIONS MCI is superior to traditional CFP for the detection of HEs and the analysis of associations between HEs and serum lipid levels in DME.
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Affiliation(s)
- Ruowen Gong
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, People's Republic of China
| | - Ruyi Han
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, People's Republic of China
| | - Jingli Guo
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, People's Republic of China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, People's Republic of China
| | - Wei Liu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China.
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, People's Republic of China.
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, People's Republic of China.
| | - Gezhi Xu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China.
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, People's Republic of China.
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, People's Republic of China.
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Xu X, Essilfie J, Gong Y, Yu SQ, Freund KB. Resolution of Foveal Lipid Deposition in Adult-Onset Coats Disease With Combined Focal Laser Photocoagulation and Anti-VEGF Therapy. Ophthalmic Surg Lasers Imaging Retina 2021; 52:396-399. [PMID: 34309430 DOI: 10.3928/23258160-20210628-07] [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: 11/20/2022]
Abstract
A major cause of poor visual prognosis in Coats disease is the formation of fibrovascular changes following dense foveal lipid deposition. The authors document the multimodal imaging findings of a 38-year-old woman and a 23-year-old man with adult-onset Coats disease who presented with macular edema and foveal lipid accumulation. Thermal laser targeting individual capillary macroaneurysms combined with intravitreal anti-vascular endothelial growth factor (VEGF) therapy was performed. Although there was a subsequent increase in foveal lipid immediately following the resolution of macular edema, these lipids largely resolved, leaving behind no evidence macular neovascular fibrosis. This report highlights the potential protective effect of combination therapy with thermal laser and intravitreal anti-VEGF therapy for macular exudation associated with Coats disease. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:396-399.].
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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: 9] [Impact Index Per Article: 3.0] [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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ASSESSMENT OF HYPERREFLECTIVE FOCI AFTER BEVACIZUMAB OR DEXAMETHASONE TREATMENT ACCORDING TO DURATION OF MACULAR EDEMA IN PATIENTS WITH BRANCH RETINAL VEIN OCCLUSION. Retina 2021; 41:355-365. [PMID: 32349101 DOI: 10.1097/iae.0000000000002826] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate the association between hyperreflective foci (HRF) on spectral domain optical coherence tomography and therapeutic effect of intravitreal bevacizumab (IVB) or intravitreal dexamethasone implants (IVD) according to macular edema (ME) duration in branch retinal vein occlusion. METHODS Consecutive treatment-naive patients received IVB or IVD for at least 6 months. Each group was subdivided according to ME duration (<3 months vs. ≥3 months). Hyperreflective foci and best-corrected visual acuity were compared. RESULTS Of 139 eyes (139 patients), 69 received IVB and 70 received IVD. At baseline, eyes with ME ≥ 3 months had more outer and total retinal HRF than eyes with ME < 3 months (P < 0.001 and P = 0.001). At 6 months, the IVD group exhibited a greater reduction in outer retinal HRF than the IVB group in both ME duration subgroups (P = 0.015 and P < 0.001). In the ME ≥ 3 months group, IVD resulted in greater best-corrected visual acuity improvement than IVB (P = 0.017). CONCLUSION Increased outer retinal HRF at baseline in eyes with ME ≥ 3 months together with a greater reduction in HRF at 6 months and better visual outcomes after IVD suggests that the inflammatory aspect of disease should be considered in the treatment of ME. Thus, IVD injection could be more appropriate for patients with a longer ME duration after branch retinal vein occlusion.
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Yoon CK, Sagong M, Shin JP, Lee SJ, Lee JE, Lee JE, Chung I, Jeong WJ, Pak KY, Kim HW. Title: efficacy of intravitreal dexamethasone implant on hard exudate in diabetic macular edema. BMC Ophthalmol 2021; 21:41. [PMID: 33451297 PMCID: PMC7811249 DOI: 10.1186/s12886-020-01786-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/21/2020] [Indexed: 11/28/2022] Open
Abstract
Background To investigate the effect of intravitreal dexamethasone implant (DEX implant) on hard exudate (HE) accompanying diabetic macular edema (DME). Methods This study was a non-comparative non-randomized 1-year prospective interventional study. Patients with DME and HE were treated using DEX implant two or three times. Color fundus photography and optical coherence tomography (OCT) were performed at every visit. HE area was measured semi-automatically from the fundus photographs. Results Thirty-five patients completed the study. Eleven patients (31.4%) received two injections, while the remaining received three times. HE area (primary outcome) significantly decreased from 1.404±2.094 mm2 (baseline) to 0.212±0.592 mm2 (last visit), which was 24% of the baseline HE area (P<0.001). HE1500 (HE within 1500 μm from the fovea) area also decreased significantly from 0.382±0.467 mm2 to 0.066±0.126 mm2 (P<0.001). Furthermore, anaverage best corrected visual acuity (BCVA) improvement of 4.4 Early Treatment Diabetic Retinopathy Study (ETDRS) letters was observed (from 49.9±18.3 to 54.3±20.4 letters) (P= 0.008). Central macular thickness (CMT) decreased from 455.8±23.6 μm to 366.8±31.1 μm (P=0.009). Repetitive measurements for entire study duration was analyzed using generalized estimating equations (GEE), where BCVA was related to age, CMT, and HE1500 area in multivariate analyses. Conclusion DEX implant could reduce and suppress HE in DME for one year with two or three injections. And centrally located HE area (HE1500 area) is related to vision. Trial registration ClinicalTrials.gov, NCT02399657, Registered 26 March 2015.
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Affiliation(s)
- Chang Ki Yoon
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Min Sagong
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Jae Pil Shin
- Department of Ophthalmology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sang Joon Lee
- Department of Ophthalmology, Kosin University college of medicine, Gospel Hospital, Busan, Korea
| | | | - Ji Eun Lee
- College of Medicine, Pusan National University, Yangsan, Korea
| | - Inyoung Chung
- Institute of Health Sciences, Gyeongsang National University Hospital, Gyeongsang National University, Jinju, Korea
| | | | - Kang Yeun Pak
- Inje Univertisy, Haeundae Paik hospital, 875, Haeun-daero, Haeundae-gu, 48108, Busan, Korea
| | - Hyun Woong Kim
- Inje Univertisy, Haeundae Paik hospital, 875, Haeun-daero, Haeundae-gu, 48108, Busan, Korea. .,Inje University Pusan Paik hospital, 875, Haeun-daero, Haeundae-gu, 48108, Busan, Korea.
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Wroblewski JJ, McChancy C, Pickel K, Buterbaugh H, Wieland T, Gonzalez A. Reproducibility of Fixed-luminance and Multi-luminance Flicker Electroretinography in Patients With Diabetic Retinopathy Using an Office-based Testing Paradigm. J Diabetes Sci Technol 2020; 14:1095-1103. [PMID: 31640411 PMCID: PMC7645135 DOI: 10.1177/1932296819882719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND We evaluated the reproducibility of office-based flicker electroretinography (ERG) in patients with nonproliferative diabetic retinopathy (NPDR). METHODS An observational study was conducted in which ultra-widefield fluorescein angiography (UWF-FA) was performed on 20 patients with mild-to-moderate NPDR; images were graded by the Fundus Photography Reading Center (Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, WI, USA). Fixed- and multi-luminance flicker ERG was repeated four times (greater than or equal to seven days apart). Recording consistency was assessed using intra-class correlation coefficients (ICCs), coefficients of variation, and Pearson correlations. RESULTS 82.5% and 17.5% of eyes had mild and moderate NPDR using UWF-FA; 90% of the angiograms were given a high confidence grade. Fixed-luminance phase values were highly reproducible (ICC: 0.949; P < .001). There was a significant negative correlation between fixed-luminance phase and log-corrected ischemic index values (-0.426; P = .015). CONCLUSIONS Office-based, fixed-luminance phase values are highly reproducible and negatively correlate with retinal ischemia in NPDR, suggesting that global retinal dysfunction may be reliably quantified early in patients with diabetes.
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Affiliation(s)
- John J. Wroblewski
- Cumberland Valley Retina Consultants, Hagerstown, MD, USA
- John J. Wroblewski, MD, Cumberland Valley Retina Consultants, 1150 Opal Court, Hagerstown, MD 21740, USA.
| | | | | | | | - Tyler Wieland
- Cumberland Valley Retina Consultants, Hagerstown, MD, USA
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Optical Coherence Tomography Parameters Related to Vision Impairment in Patients with Diabetic Macular Edema: A Quantitative Correlation Analysis. J Ophthalmol 2020; 2020:5639284. [PMID: 33062313 PMCID: PMC7537709 DOI: 10.1155/2020/5639284] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 07/10/2020] [Accepted: 07/31/2020] [Indexed: 11/20/2022] Open
Abstract
Purpose To quantitatively explore the correlation between optical coherence tomography (OCT) parameters and vision impairment in patients with diabetic macular edema (DME). Methods This study was a retrospective observational case series. One-hundred eyes from 66 patients with DME were retrospectively included. OCT parameters, including central macular thickness (CMT), height of intraretinal cystoid, subretinal fluid and sponge-like retinal swelling, density of hyperreflective foci (HRF), and integrity of the ellipsoidal zone (EZ), were assessed. Correlation analyses and multiple linear regression analysis were performed to quantitatively explore the relationship between best-corrected visual acuity (BCVA) and OCT parameters. Results Among all OCT parameters, CMT, height of intraretinal cystoid, height of sponge-like retinal swelling, and density of HRF and EZ integrity were significantly correlated with BCVA (r = −0.550, −0.526, −0.411, −0.277, and −0.501, respectively; P < 0.01). In multiple linear regression analysis, CMT, density of HRF, and EZ integrity fit a significant linear equation (β = 0.482, 0.184, and 0.447, respectively), with the adjusted R square reaching 0.522 (P < 0.001). In eyes without SRF, the height of intraretinal cystoid, density of HRF, and EZ integrity were included in the model and an adjusted R square of 0.605 (P < 0.001) was obtained. Conclusion In DME eyes, OCT parameters, including the density of HRF, the EZ integrity together with CMT, or the height of intraretinal cystoid, could explain 52.2% to 60.5% of the variation in BCVA and were weighted approximately 2 : 1 : 2, respectively.
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Chhablani J, Wong K, Tan GS, Sudhalkar A, Laude A, Cheung CMG, Zhao P, Uy H, Lim J, Valero S, Ngah NF, Koh A. Diabetic Macular Edema Management in Asian Population: Expert Panel Consensus Guidelines. Asia Pac J Ophthalmol (Phila) 2020; 9:426-434. [PMID: 32956188 DOI: 10.1097/apo.0000000000000312] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The aim of this consensus article was to provide comprehensive recommendations in the management of diabetic macular edema (DME) by reviewing recent clinical evidence. DESIGN A questionnaire containing 47 questions was developed which encompassed clinical scenarios such as treatment response to anti-vascular endothelial growth factor and steroid, treatment side effects, as well as cost and compliance/reimbursement in the management of DME using a Dephi questionnaire as guide. METHODS An expert panel of 12 retinal specialists from Singapore, Malaysia, Philippines, India and Vietnam responded to this questionnaire on two separate occasions. The first round responses were compiled, analyzed and discussed in a round table discussion where a consensus was sought through voting. Consensus was considered achieved, when 9 of the 12 panellists (75%) agreed on a recommendation. RESULTS The DME patients were initially profiled based on their response to treatment, and the terms target response, adequate response, nonresponse, and inadequate response were defined. The panellists arrived at a consensus on various aspects of DME treatment such as need for classification of patients before treatment, first-line treatment options, appropriate time to switch between treatment modalities, and steroid-related side effects based on which recommendations were derived, and a treatment algorithm was developed. CONCLUSIONS This consensus article provides comprehensive, evidence-based treatment guidelines in the management of DME in Asian population. In addition, it also provides recommendations on other aspects of DME management such as steroid treatment for stable glaucoma patients, management of intraocular pressure rise, and recommendations for cataract development.
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Affiliation(s)
- Jay Chhablani
- University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | | | - Gavin S Tan
- Surgical Retinal Department of the Singapore National Eye Centre; Clinician scientist, Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Aditya Sudhalkar
- Alphavision Augenzentrum Bremerhaven, Germany
- Sudhalkar Eye Hospital and Retina Centre in Baroda, India and Raghudeep Eye Hospital, Ahmedabad, India
| | - Augustinus Laude
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital; Adjunct associate professor, Lee Kong Chian School of Medicine Nanyang Technological University, Singapore
| | | | - Paul Zhao
- Department of Ophthalmology, National University Hospital; Chief, Alexandria Hospital Eye Surgery Center, Singapore
| | - Harvey Uy
- University of the Philippines and Medical Director, Peregrine Eye and Laser Institute in Makati, Philippines
| | - Jeffrey Lim
- Chong Hua Hospital, Cebu; Head, Retina section, Vicente Sotto Memorial Medical Center, Philippines
| | | | - Nor Fariza Ngah
- National Head, Ophthalmology Service, Ministry of Health Malaysia; Ophthalmology Service, Ministry of Health Malaysia; Head of Department, Ophthalmology Unit, Hospital Shah Alam, Malaysia
| | - Adrian Koh
- The Eye and Retina Surgeons, Camden Medical Center, Singapore
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Removal of foveal hard exudates by subretinal balanced salt solution injection using 38-gauge needle in diabetic patients. Graefes Arch Clin Exp Ophthalmol 2020; 258:1893-1899. [PMID: 32451607 DOI: 10.1007/s00417-020-04756-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/08/2020] [Accepted: 05/13/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To examine the anatomic and visual outcomes after removal of foveal hard exudates through a macular hole created by subretinal balanced salt solution (BSS) injection. METHODS This was a retrospective, consecutive, case series. Six patients (7 eyes) underwent vitrectomy with removal of foveal hard exudates. All patients were women and the mean age was 65 years (range from 55 to 71). All patients had a history of panretinal photocoagulation. Previous treatments included intravitreal anti-vascular endothelial growth factor injection in one eye and vitrectomy in both eyes of one patient. The geometric mean preoperative decimal visual acuity was 0.11 (range from 0.08 to 0.3). The mean postoperative follow-up period was 12 months (range from 6 to 19). The status of lens was two phakic and five pseudophakic. Surgical procedures included simultaneous cataract surgery if phakic, creation of posterior vitreous detachment if not present, internal limiting membrane (ILM) peeling and a gas or air tamponade. Manual subretinal BSS injection using 38-gauge needle was performed at ILM-peeled area. Removal of foveal hard exudates was conducted by the water flow through the macular hole created during subretinal BSS injection. RESULTS Foveal hard exudates decreased in all cases early after surgery. The geometric mean final decimal visual acuity was 0.31 (range from 0.1 to 0.9). Visual acuity improved more than 0.2 LogMAR units in six eyes and unchanged in one eye. There was no severe complication and recurrence of macular edema. CONCLUSION This procedure may be effective for foveal hard exudates in diabetic patients.
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22
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Srinivas S, Verma A, Nittala MG, Alagorie AR, Nassisi M, Gasperini J, Sadda SR. Effect of Intravitreal Ranibizumab on Intraretinal Hard Exudates in Eyes with Diabetic Macular Edema. Am J Ophthalmol 2020; 211:183-190. [PMID: 31758926 DOI: 10.1016/j.ajo.2019.11.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/06/2019] [Accepted: 11/11/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To study the effect of monthly 0.3-mg intravitreal ranibizumab injections on intraretinal hard exudates (HEs) and correlate the effect with macular thickness in eyes with diabetic macular edema (DME). DESIGN Randomized, controlled trial. METHODS Twenty-four eyes of 24 subjects with DME were included in this institutional review board-approved, prospective longitudinal study. Subjects were randomly assigned to receive monthly intravitreal ranibizumab injections either until macular edema resolved or until both macular edema and HEs resolved. All subjects underwent spectral-domain optical coherence tomography imaging (Cirrus OCT), at baseline and monthly for 12 months. Mean HE area and mean macular thickness at baseline and month 12 were compared using a paired t test and correlated with Pearson analysis. RESULTS The average age of the 24 subjects was 65 (±8.55) years. There was a significant decrease (P = .001) in mean HE area from baseline (0.48 ± 0.43 mm2) to month 12 (0.17 ± 0.19 mm2). There was a significant increase (P < .001) in best-corrected visual acuity from a letter score of 63.38 (±7.92) at baseline to 76.38 (±8.93) at month 12. There was no additional vision benefit for continuing to treat with monthly injections for persistent HE in the absence of macular thickening. CONCLUSION In eyes with DME, monthly intravitreal ranibizumab injections resulted in significant reduction in intraretinal HEs that paralleled reductions in macular thickness and volume. Baseline foveal HEs were associated with worse vision outcomes, and continued treatment for persistent HEs in the absence of edema did not result in better vision.
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Affiliation(s)
| | | | | | - Ahmed Roshdy Alagorie
- Doheny Eye Institute, Los Angeles, California; Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | | | - SriniVas R Sadda
- Doheny Eye Institute, Los Angeles, California; Department of Ophthalmology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California.
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Yu Q, Wang F, Zhou L, Yang J, Liu K, Xu X. Quantification of Diabetic Retinopathy Lesions in DME Patients With Intravitreal Conbercept Treatment Using Deep Learning. Ophthalmic Surg Lasers Imaging Retina 2020; 51:95-100. [PMID: 32084282 DOI: 10.3928/23258160-20200129-05] [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] [Received: 03/05/2019] [Accepted: 09/10/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVES To quantitatively evaluate diabetic retinopathy (DR) lesions using the authors' validated machine learning algorithms and provide physicians with an automated and precise method to follow the progression of DR and outcome of interventions. PATIENTS AND METHODS Retrospective analyses were conducted of 3,496 color fundus photography images from 19 patients with clinically significant diabetic macular edema receiving conbercept treatment. The modified seven-field fundus images were obtained at baseline and at the third, sixth, and twelfth month visit, whereas the modified two-field fundus images were obtained at the other monthly visits. The area of intraretinal hemorrhage and hard exudate lesions was traced by the authors' validated algorithms. RESULTS The mean central foveal thickness at baseline was 459.9 μm ± 127.5 μm. Mean central foveal thickness was 316.5 μm ± 53.0 μm at the twelfth month visit, which decreased by 143.4 μm when compared with the baseline optical coherence tomography. The mean total area of intraretinal hemorrhage in the study eye in seven fields was 5.656 ± 1.176 mm2 at baseline, 2.438 ± 0.976 mm2 at the third month, 2.901 ± 0.521 mm2 at the sixth month, and 2.122 ± 0.582 mm2 at the end of the study. The area of intraretinal hemorrhage was reduced by 62.49% from baseline to the end of study (P < .0001). The mean total area of hard exudates in the study eye was 2.549 ± 0.776 mm2 at baseline, 2.233 ± 0.576 mm2 at the third month, 2.710 ± 0.621 mm2 at the sixth month, and 1.473 ± 0.564 mm2 at the end of the study. The mean total area of hard exudates decreased by 41.1% at the twelfth month (P < .0001) compared with the first visit. Significant decrease was observed in the area of intraretinal hemorrhage during conbercept treatment. The hard exudates area fluctuated during loading then subsequently decreased at the twelfth month. CONCLUSIONS The present study quantitatively analyzed the change in the area change of intraretinal hemorrhage and hard exudate lesions during the course of conbercept treatment. The automated system is promising to be a precise and objective method for monitoring the progression of DR and outcomes of interventions in clinical settings. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:95-100.].
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Hyperreflective Foci in the Outer Retinal Layers as a Predictor of the Functional Efficacy of Ranibizumab for Diabetic Macular Edema. Sci Rep 2020; 10:873. [PMID: 31964970 PMCID: PMC6972781 DOI: 10.1038/s41598-020-57646-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 11/18/2019] [Indexed: 01/06/2023] Open
Abstract
Anti-VEGF drugs are as the first-line therapies for diabetic macular edema (DME). In this study, we investigated the association between hyperreflective foci in the outer retinal layers and functional efficacy in DME patients who received intravitreal ranibizumab (IVR) injections. We retrospectively reviewed 77 eyes of 71 patients with DME treated with pro re nata IVR injections for at least 12 months. We evaluated how baseline hyperreflective foci in the outer retinal layers on spectral domain optical coherence tomography images were associated with an improvement in logarithm of the minimum angle of resolution visual acuity (logMAR VA) at 12 months. Forty-three eyes with hyperreflective foci in the outer retinal layers had greater VA improvement than 34 eyes without such foci at 12 months. Multivariate analyses demonstrated that both logMAR VA and hyperreflective foci in the outer retinal layers at baseline were associated with VA improvement. Structural analyses revealed that the central subfield thickness was decreased and that the ellipsoid zone of photoreceptors was improved more significantly in eyes with hyperreflective foci in the outer layers than eyes without such lesions. Baseline hyperreflective foci in the outer retinal layers predict the functional efficacy of IVR injections for DME.
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Hu Y, Wu Q, Liu B, Huang M, Peng Q, Zhong P, Zeng X, Xiao Y, Li C, Fang Y, Li T, Yu H, Yang X. Restoration of Foveal Bulge after Resolution of Diabetic Macular Edema with Coexisting Serous Retinal Detachment. J Diabetes Res 2020; 2020:9705786. [PMID: 32626784 PMCID: PMC7313106 DOI: 10.1155/2020/9705786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/27/2020] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To evaluate the impact of restoration of foveal bulge (FB) in optical coherence tomography (OCT) images on visual acuity after resolution of diabetic macular edema with coexisting serous retinal detachment (SRD-DME). METHODS A total of 52 eyes with resolved SRD-DME and an intact ellipsoid zone at the central fovea were included. All eyes underwent best-corrected visual acuity (BCVA) examination and OCT scanning at baseline and follow-up visits (1, 3, and 6 months). The eyes were divided into two groups according to the presence of FB at 6 months. BCVA, central foveal thickness (CFT), height of SRD (SRDH), outer nuclear layer (ONL) thickness, photoreceptor inner segment (PIS), and outer segment (POS) length were compared between the two groups. RESULTS A FB was found in 25 of 52 (48%) eyes at 6 months. The FB (+) group had lower SRDH at baseline, and better BCVA, longer POS length at 6 months (all P < 0.05). There was no significant difference in the CFT, ONL thickness, and PIS length at 6 months between the two groups (all P > 0.05). More eyes in the FB (+) group had complete SRD resolution at 1 month (P = 0.009) and 3 months (P = 0.012). Eyes with complete SRD resolution at 1 month (P = 0.009) or 3 months (P = 0.012) were more likely to have a FB at 6 months. CONCLUSIONS The Presence of the FB is associated with better BCVA after resolution of SRD-DME. Eyes with lower baseline SRDH or faster SRD resolution are more likely to have a FB at 6 months.
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Affiliation(s)
- Yijun Hu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences/the Second School of Clinical Medicine, Southern Medical University, Guangzhou 510080, China
- Aier Institute of Refractive Surgery, Refractive Surgery Center, Guangzhou Aier Eye Hospital, Guangzhou 510199, China
- Aier School of Ophthalmology, Central South University, Changsha 410021, China
| | - Qiaowei Wu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences/the Second School of Clinical Medicine, Southern Medical University, Guangzhou 510080, China
| | - Baoyi Liu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences/the Second School of Clinical Medicine, Southern Medical University, Guangzhou 510080, China
| | - Manqing Huang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences/the Second School of Clinical Medicine, Southern Medical University, Guangzhou 510080, China
| | - Qingsheng Peng
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences/the Second School of Clinical Medicine, Southern Medical University, Guangzhou 510080, China
- Shantou University Medical College, Shantou 515041, China
| | - Pingting Zhong
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences/the Second School of Clinical Medicine, Southern Medical University, Guangzhou 510080, China
- Shantou University Medical College, Shantou 515041, China
| | - Xiaomin Zeng
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences/the Second School of Clinical Medicine, Southern Medical University, Guangzhou 510080, China
| | - Yu Xiao
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences/the Second School of Clinical Medicine, Southern Medical University, Guangzhou 510080, China
| | - Cong Li
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences/the Second School of Clinical Medicine, Southern Medical University, Guangzhou 510080, China
| | - Ying Fang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences/the Second School of Clinical Medicine, Southern Medical University, Guangzhou 510080, China
| | - Tao Li
- State Key Laboratory of Ophthalmology, Clinical Research Center for Ocular Disease, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou 510060, China
| | - Honghua Yu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences/the Second School of Clinical Medicine, Southern Medical University, Guangzhou 510080, China
| | - Xiaohong Yang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences/the Second School of Clinical Medicine, Southern Medical University, Guangzhou 510080, China
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Karst SG, Schuster M, Mitsch C, Meyer EL, Kundi M, Scholda C, Schmidt‐Erfurth UM. Atrophy of the central neuroretina in patients treated for diabetic macular edema. Acta Ophthalmol 2019; 97:e1054-e1061. [PMID: 31228332 PMCID: PMC6900069 DOI: 10.1111/aos.14173] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 05/28/2019] [Indexed: 01/28/2023]
Abstract
Purpose To examine the prevalence of central retinal atrophy in patients treated for diabetic macular edema (DME) in a clinical setting. Methods Retrospective data analysis of patients with DME, focusing on those who developed central retinal thinning after DME treatment at the Department of Ophthalmology, Medical University Vienna. Patient characteristics and clinical data including best‐corrected visual acuity (BCVA), spectral domain optical coherence tomography and fluorescence angiography images were reviewed and DME treatment strategies analysed using descriptive statistics. The correlation between visual acuity and ocular, systemic or DME treatment factors was calculated using linear regression models and ancovas. Results A total of 6684 outpatient visits by 1437 patients with diabetes were analysed. Out of 149 patients, who had had a central subfield thickness (CST) below 200 μm, 32 (36 eyes) had previously been diagnosed with a centre involving DME with an average CST of 473 ± 103 μm and average visual acuity of 0.62 ± 0.44 logMAR at first presentation. At the time of central atrophy, 29 (81%) out of 36 eyes had a history of laser treatment, 11 (31%) a vitrectomy, 32 (88%) repeated intravitreal injections of anti‐vascular endothelial growth factor (VEGF; mean 5.3 ± 3.8) and 22 (61%) intravitreal corticosteroid injections (mean 2.5 ± 2.7). Visual function (0.67 ± 0.43 logMAR) at the time of atrophy was not significantly correlated to central retinal thickness (191 ± 7 μm) or any other ocular, systemic or treatment factors. Conclusions Only 4% of patients treated for DME developed central retinal thinning in our observation period. On average, our atrophy patients had higher CST and lower BCVA when they first presented with DME compared to the overall DME cohort, and they received a combination of intravitreal injections and laser for DME treatment. Central retinal atrophy might not be attributed to excessive use of intravitreally applied anti‐VEGF or any other DME therapy alone.
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Affiliation(s)
- Sonja G. Karst
- Department of Ophthalmology and Optometry Medical University Vienna Vienna Austria
| | - Magdalena Schuster
- Department of Ophthalmology and Optometry Medical University Vienna Vienna Austria
| | - Christoph Mitsch
- Department of Ophthalmology and Optometry Medical University Vienna Vienna Austria
| | - Elias L. Meyer
- Section for Medical Statistics Center for Medical Statistics, Informatics, and Intelligent Systems Medical University Vienna Vienna Austria
| | - Michael Kundi
- Institute of Environmental Health Medical University Vienna Vienna Austria
| | - Christoph Scholda
- Department of Ophthalmology and Optometry Medical University Vienna Vienna Austria
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Augustin AJ, Feltgen N, Haritoglou C, Hoerauf H, Maier MM, Mardin CY, Schargus M. [Clinical Decision Making for Treatment of Diabetic Macular Oedema with DEX Implant: a Consensus Paper]. Klin Monbl Augenheilkd 2019; 238:73-84. [PMID: 31770786 DOI: 10.1055/a-1024-4089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Currently two intravitreally applied corticosteroids (dexamethasone and fluocinolone) are licensed in Germany for treatment of diabetic macular oedema (DME). The use of DEX implant for DME in daily clinical practice has not been defined in detail. Following a Delphi panel survey, a group of retina experts set out to come up with a consensus for use of the DEX implant in DME. MATERIAL AND METHODS International and national treatment recommendations were identified from the literature. A steering group generated a catalogue of 72 statements on the aetiology and pathogenesis of DME, therapy with DEX implant, use of DEX implant in patients previously treated with VEGF-inhibitors, use of DEX implant in combination therapy, safety of DME therapies as well as patients' burden of treatment. Twenty-two ophthalmologists from private practice and 6 hospital ophthalmologists participated in the Delphi panel via Survey Monkey. Consensus was reached if at least 75% of participants agreed or disagreed with a statement. Statements for which consensus was not reached were discussed once more during the expert consensus meeting and a vote was taken. Based on these results a treatment algorithm for foveal DME was proposed. RESULTS If a patient does not show sufficient response after 3 - 6 months of anti-VEGF treatment (visual acuity gain of < 5 ETDRS letters or reduction of central retinal thickness ≤ 20%), a switch to DEX implant should take place. DEX implant is also suitable in eyes with longer presentation of DME, showing e.g. massive lipid exudates. DEX implant is suitable as first-line therapy especially in pseudophakic patients, patients unwilling or able to comply with tight anti-VEGF injection intervals or patients with known vascular diseases. With fixed control visits every 4 - 8 weeks, use of DEX implant is flexible and individual. Decision parameters for repeated use should be visual acuity, retinal thickness and intraocular pressure. Treatment of both eyes on the same day should not take place. CONCLUSION The algorithm presented reflects survey as well as expert discussion results and may differ from recommendations issued by the German professional society. The consensus recommendations for the treatment of DME generated during the survey and meeting of retina experts are intended to guide use of DEX implant in daily practice.
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Affiliation(s)
| | | | | | | | | | | | - Marc Schargus
- Augenklinik, Asklepios Kliniken GmbH, Hamburg.,Universitäts-Augenklinik, Heinrich-Heine-Universität, Düsseldorf
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Kim HR, Yoon CK, Kim HW, Pak KY. New Method of Quantitative Analysis of Hard Exudate Using Optical Coherence Tomography: Application in Diabetic Macular Edema. KOREAN JOURNAL OF OPHTHALMOLOGY 2019; 33:399-405. [PMID: 31612649 PMCID: PMC6791946 DOI: 10.3341/kjo.2019.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/04/2019] [Accepted: 06/12/2019] [Indexed: 11/23/2022] Open
Abstract
PURPOSE In the present study, the volume of hard exudates (HEs) was quantitatively measured using optical coherence tomography (OCT) and the agreement and correlation with area of HEs in fundus photography were analyzed. METHODS The medical records of patients with diabetic macular edema who underwent focal laser treatment and were followed up more than 3 months were retrospectively evaluated. An automated customized program designed for measuring HE volume was used. The HEs in each OCT B-scan binary image were measured using 512 × 128 pixels, 6 mm × 6 mm OCT cube scans. The volume was measured by summing the segmented HEs in each 128 B-scan image. The area was measured in 6 mm x 6 mm fundus photography. The volume and area were measured before and 3 months after the treatment. The agreement of increase and decrease in HEs, and the correlation of volume and area of HEs were analyzed. RESULTS A total of 35 patients (39 eyes) were included in the study. The volume was significantly reduced from 0.07978 to 0.02565 mm³ at 3 months (p < 0.001). The area was also significantly reduced from 15.35 to 8.60 mm² at 3 months (p < 0.001). The volume was decreased in 34 eyes and increased in 5 eyes. The area was decreased in 37 eyes and increased in 2 eyes. A significant correlation between volume and area was found (p < 0.001) as well as agreement between increase and decrease in volume and area. CONCLUSIONS In the 3-dimensional quantitative volumetric analysis, the volume and area of HEs were correlated and the direction of increase and decrease was concordant. Considering the distribution of HEs in multiple layers of the retina, volumetric analysis could be considered a substitute for the analysis of HE area.
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Affiliation(s)
- Hae Rang Kim
- Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Chang Ki Yoon
- Department of Ophthalmology, Hallym University Kangnam Sacred Hospital, Seoul, Korea
| | - Hyun Woong Kim
- Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Kang Yeun Pak
- Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
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Test-retest repeatability of the pattern electroretinogram and flicker electroretinogram. Doc Ophthalmol 2019; 139:185-195. [PMID: 31312944 DOI: 10.1007/s10633-019-09707-5] [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] [Received: 10/18/2018] [Accepted: 06/27/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the repeatability of the steady-state pattern electroretinogram (PERG) and full-field flicker electroretinogram (Flicker ERG) protocols, delivered by the office-based Neuro Optic Vision Assessment (NOVA)™ testing platform, in healthy subjects. METHODS Healthy individuals underwent PERG (16° and 24°) and Flicker ERG [fixed luminance (FL) and multi-luminance (ML)] testing protocols. Test-retest repeatability of protocols was calculated using intra-class correlation coefficients (ICC). Reference values of the parameters of the aforementioned tests were also calculated. RESULTS The ICCs for the PERG parameters ranged from 0.793 to 0.911 (p < 0.001). The ICCs for the Flicker ERG parameters ranged from 0.968 to 0.994 (p < 0.001). A linear regression analysis was applied to assess the impact of age on ERG responses. Age had a significant impact on all PERG parameters (16° or 24°). The phase response of the FL Flicker ERG significantly decreased with age (β = - 0.837, p ≤ 0.001). The FL Flicker ERG Magnitude was also impacted with a significant quadratic effect of age (β = - 0.0047, p = 0.0004). Similarly, the Phase Area Under the Curve (Phase AUC) of the ML Flicker ERG significantly declined with age (β = - 0.007, p = 0.009), and the impact on the Magnitude AUC was significant as well, with a negative quadratic age effect. CONCLUSIONS The PERG and Flicker ERG protocols, delivered by an office-based testing platform, were shown to have good-to-excellent test-retest repeatability when tests were performed in the same order and in immediate succession.
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Kodjikian L, Bellocq D, Bandello F, Loewenstein A, Chakravarthy U, Koh A, Augustin A, de Smet MD, Chhablani J, Tufail A, García-Layana A, Sudhalkar A, Mathis T. First-line treatment algorithm and guidelines in center-involving diabetic macular edema. Eur J Ophthalmol 2019; 29:573-584. [DOI: 10.1177/1120672119857511] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Management of center-involving diabetic macular edema represents a real therapeutic challenge. Diabetic macular edema is the leading cause of visual acuity impairment in diabetic patients. Since the advent of intravitreal drugs, management of diabetic macular edema has significantly evolved. The historical grid laser photocoagulation is no longer recommended as first-line treatment of diabetic macular edema owing to the findings of the pivotal randomized controlled trials, and anti-vascular endothelial growth factor therapy has emerged as first-line therapy. Steroids also represent a valid treatment option in the management of naïve diabetic macular edema and their efficacy has also been confirmed in several studies. The optimal treatment for diabetic macular edema should consider both general and ophthalmological comorbidities. Patient compliance and motivation should also be carefully evaluated as some treatments require monthly follow-up. Based on recent literature evidence, the present review provides clinicians with a first-line treatment algorithm for center-involving diabetic macular edema tailored to the patient’s individual characteristics.
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Affiliation(s)
- Laurent Kodjikian
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
- CNRS UMR Mateis, Villeurbanne, France
| | - David Bellocq
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Anat Loewenstein
- Division of Ophthalmology, Tel Aviv Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sydney A. Fox chair of ophthalmology, Tel Aviv University, Tel Aviv, Israel
| | - Usha Chakravarthy
- Department of Ophthalmology, Queen’s University Belfast, Belfast, Northern Ireland
| | - Adrian Koh
- Eye and Retina Surgeons, Singapore, Singapore
- Singapore National Eye Centre, Singapore, Singapore
| | | | | | - Jay Chhablani
- Smt Kanuri Santhamma Centre for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, India
| | - Adnan Tufail
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | | | - Aditya Sudhalkar
- Raghudeep Eye Hospital, Iladevi Cataract Centre, Ahmedabad, India
| | - Thibaud Mathis
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
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Moon SW, Shin YU, Cho H, Bae SH, Kim HK. Effect of grape seed proanthocyanidin extract on hard exudates in patients with non-proliferative diabetic retinopathy. Medicine (Baltimore) 2019; 98:e15515. [PMID: 31124931 PMCID: PMC6571433 DOI: 10.1097/md.0000000000015515] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of orally administered grape seed proanthocyanidin extract (GSPE) in patients with non-proliferative diabetic retinopathy (NPDR). METHODS In this randomized (1:2:2), multicentre, double-blind trial, patients (n = 124; age: 40-78 years) were administered placebo, calcium dobesilate (CD; 750 mg/d), or GSPE (150 mg/d) orally for up to 12 months. All patients had retinal thickening with hard exudates (HEs) that met predefined criteria; the median best-corrected visual acuity was 0.8, as assessed using the Snellen visual acuity card. The main outcome measure was an improvement in HEs by at least 1 grade on a 10-grade severity scale. This was evaluated using fundus photography over 1 year. RESULTS The rate of improvement in the HE severity was higher in the GSPE group than in the CD group. No statistically significant difference existed among the study groups in optical coherence tomography parameters, such as central subfield macular thickness and total macular volume (TMV). However, in the GSPE group, TMV after 9 months of treatment was significantly decreased compared with that at baseline. The GSPE group showed a significantly greater improvement in HE severity than did the placebo or CD group. Four cases in the GSPE group and 2 in the CD group were determined to have developed potential treatment-related adverse reactions, which were all gastrointestinal in nature. CONCLUSIONS Oral GSPE therapy for 1 year improved HEs in patients with NPDR. The efficacy of GSPE for HEs was higher than that of oral CD in the study patients.
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Affiliation(s)
- Sang Woong Moon
- Department of Ophthalmology, Kyung Hee University College of Medicine
| | - Yong Un Shin
- Department of Ophthalmology, Hanyang University College of Medicine
| | - Heeyoon Cho
- Department of Ophthalmology, Hanyang University College of Medicine
| | - So Hyun Bae
- Department of Ophthalmology, Hanllym University College of Medicine, Seoul, Korea
| | - Ha Kyoung Kim
- Department of Ophthalmology, Hanllym University College of Medicine, Seoul, Korea
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Yoshitake T, Murakami T, Yoshitake S, Suzuma K, Dodo Y, Fujimoto M, Tsujikawa A. Anti-Fumarase Antibody as a Predictor of Functional Efficacy of Anti-VEGF Therapy for Diabetic Macular Edema. Invest Ophthalmol Vis Sci 2019; 60:787-794. [PMID: 30807637 DOI: 10.1167/iovs.18-26209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose To evaluate whether baseline titers of anti-fumarase antibody are associated with visual prognosis after anti-VEGF treatment for diabetic macular edema (DME). Methods In this retrospective study, we investigated 52 eyes of 52 DME patients who received intravitreal injections of anti-VEGF drugs (ranibizumab or aflibercept) after blood sampling at baseline. Optical coherence tomography (OCT) images were obtained at every monthly visit. The serum titer of anti-fumarase antibody at baseline was measured using ELISA. We evaluated the relationship between the titer of anti-fumarase antibody at baseline and visual acuity (VA) improvement at 12 months. Results The serum titer of anti-fumarase IgG was related to the logMAR visual acuity (VA; R = 0.329, P = 0.017) and the disrupted ellipsoid zone (EZ; R = 0.364, P = 0.008) at baseline. The titer of this autoantibody was not associated with logMAR VA (R = -0.007, P = 0.980) but was associated with VA improvement (R = 0.465, P < 0.001) at 12 months upon anti-VEGF treatment. The transverse length of the disrupted EZ line was shortened at 12 months (P < 0.001), and restoration of the EZ line was correlated to the autoantibody titer (R = 0.396, P = 0.004) compared with the decrease in central subfield (CSF) thickness. Multivariate analysis showed that pretreatment logMAR VA (β = 0.296, P = 0.045) and the autoantibody titer (β = 0.328, P = 0.017) were associated with VA improvement after anti-VEGF treatment. In contrast, the titer was not associated with logMAR VA at 12 months. Conclusions Anti-fumarase antibody is a novel serum biomarker predicting better functional efficacy of anti-VEGF treatment for DME.
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Affiliation(s)
- Tatsuya Yoshitake
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tomaoki Murakami
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shin Yoshitake
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kiyoshi Suzuma
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoko Dodo
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masahiro Fujimoto
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Loganadane P, Delbosc B, Saleh M. Short-Term Progression of Diabetic Hard Exudates Monitored with High-Resolution Camera. Ophthalmic Res 2018; 61:3-9. [PMID: 30466082 DOI: 10.1159/000493858] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 09/17/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess the progression of diabetic hard exudates over an 8-week period, using a high-resolution adaptive optics camera. DESIGN Prospective observational study. METHODS Five eyes of three patients presenting diabetic maculopathy with hard exudates were studied. An area of clinically visible exudates was imaged sequentially using SD-OCT and high-resolution flood illumination adaptive optics for 2 months, on a weekly basis. A time-lapse video was obtained for each eye studied. Changes in terms of surface, number of free elements (foci), and central macular thickness were recorded. RESULTS Short-term modifications in terms of disposition, size, and number of exudates were observed. Two patterns of progression were identified: two eyes showed exudate dislocation concomitant with the regression of the underlying macular edema, with hard exudates being progressively replaced by a multitude of smaller foci. These exudates were labeled resorption exudates. In three other eyes with persistent diabetic macular edema, foci aggregated into larger exudates. CONCLUSION Diabetic hard exudate changes occurred over a short period of time but were not assessable clinically. Adaptive optics was able to document these subtle changes precisely. Further studies using this imaging modality may improve our understanding of the natural history of exudates and eventually help assess the efficacy of the various treatments available such as lipid-lowering drugs and anti-VEGFs injections.
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Affiliation(s)
- Prisca Loganadane
- Department of Ophthalmology, Besançon University Hospital, Besançon, France
| | - Bernard Delbosc
- Department of Ophthalmology, Besançon University Hospital, Besançon, France
| | - Maher Saleh
- Department of Ophthalmology, Besançon University Hospital, Besançon, France,
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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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Chhablani J, Jhingan M, Goud A, Vupparaboina KK, Das T. Macular edema resolution assessment with implantable dexamethasone in diabetic retinopathy (MERIT): a pilot study. Clin Ophthalmol 2018; 12:1205-1211. [PMID: 30013313 PMCID: PMC6038870 DOI: 10.2147/opth.s163681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose This study aimed to evaluate the effect of dexamethasone implantation on the hard exudates (HEX) in patients with diabetic macular edema (DME). Study design This was a nonrandomized open-label single-center prospective trial. Methods This study included 15 eyes of 11 subjects with DME. Key inclusion criteria were naïve eyes with DME with HEX within 3 mm of fovea with center-involving DME; central macular thickness (CMT) >250 μm at baseline; best-corrected visual acuity (BCVA) between 20/400 and 20/40. Key exclusion criteria were previous intraocular surgery and history of panretinal photocoagulation (PRP) in past 4 months. The primary outcome measure was change in total HEX area at the macula (in mm2) measured by semiautomated algorithm. Secondary outcome measures were change in visual acuity, low-contrast visual acuity (LCVA), retinal sensitivity (RS) on macular microperimetry, and CMT. Results The total HEX area reduced from 1.5 mm2 (±1.46 mm2) at baseline to 0.89 mm2 (±1.062 mm2) at the final visit (p=0.185). The CMT improved significantly (p=0.03) from 488.67 μm (±240.66 μm) to 326.93 μm (±135.84 μm) at the final visit. Mean BCVA remained stable (p=0.95) (50.93±16.65 at baseline and 50.6±18.95 at final visit). The mean LCVA and RS showed insignificant improvement (p=0.31 and p=0.28, respectively). Conclusion Our pilot study demonstrated an improving trend in reduction of total HEX area and other anatomical outcomes, with limited functional outcomes. Larger randomized studies with a larger sample size with a control group are warranted to establish management protocols for DME with significant subfoveal HEX.
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Affiliation(s)
- Jay Chhablani
- Smt Kanuri Santhamma Retina Vitreous Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India,
| | - Mahima Jhingan
- Smt Kanuri Santhamma Retina Vitreous Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India,
| | - Abhilash Goud
- Smt Kanuri Santhamma Retina Vitreous Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India,
| | - Kiran Kumar Vupparaboina
- Smt Kanuri Santhamma Retina Vitreous Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India,
| | - Taraprasad Das
- Smt Kanuri Santhamma Retina Vitreous Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India,
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QUANTIFICATION OF INTRARETINAL HARD EXUDATES IN EYES WITH DIABETIC RETINOPATHY BY OPTICAL COHERENCE TOMOGRAPHY. Retina 2018; 38:231-236. [PMID: 28196059 DOI: 10.1097/iae.0000000000001545] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the reproducibility of intraretinal hard exudate (HE) quantification from spectral domain optical coherence tomography (SD-OCT) images of eyes with diabetic retinopathy (DR). METHODS Cases with diabetic macular edema were enrolled. The area of HE obtained by B-scan segmentation was compared with the area obtained by en face segmentation. RESULTS The mean ± SD for the HE area was 1.78 ± 1.37 mm with B-scan segmentation and 0.72 ± 0.82 mm with the automated en face analysis tool; the absolute difference was 1.01 ± 0.64 mm. There was excellent correlation in total HE area between the two methods (r = 0.95, P < 0.0001). The HE volume was 0.06 ± 0.07 mm. The correlation between HE volume and en face HE area was high (r = 0.95, P < 0.001). Intergrader reproducibility yielded excellent agreement with an intraclass correlation coefficient value of 0.99 (95% CI 0.994-0.999) for the en face approach and 0.99 (95% CI 0.977-0.997) for manual segmentation. CONCLUSION Quantification of HE in eyes with diabetic retinopathy can be performed reliably using en face segmentation and, though the en face results are consistently lower, correlates well with HE measurements obtained by exhaustive segmentation of all B-scans in dense volume optical coherence tomography (OCT).
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Lai TT, Yang CM, Yang CH, Ho TC, Hsieh YT. Treatment outcomes and predicting factors for diabetic macular edema treated with ranibizumab - One-year real-life results in Taiwan. J Formos Med Assoc 2018; 118:194-202. [PMID: 29609918 DOI: 10.1016/j.jfma.2018.03.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/12/2018] [Accepted: 03/14/2018] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To report the one-year outcomes of diabetic macular edema (DME) treated with ranibizumab under a real-life setting in Taiwan, and to identify the prognostic factors. METHODS Between July 2013 and January 2015, 119 eyes receiving intravitreal ranibizumab for DME were retrospectively recruited. Best-corrected visual acuity (BCVA) and central foveal thickness (CFT) measured with optical coherence tomography were collected at baseline and at Month 3, 6, and 12. Linear regression was used to identify the predicting factors for changes in BCVA and CFT at Month 12. RESULTS The average number of ranibizumab given within one year was 4.36 ± 1.87. The BCVA (logMAR) improved from 0.74 ± 0.30 at baseline to 0.64 ± 0.37 at Month 12 (p = 0.002). A better improvement in BCVA at Month 3 was significantly correlated with a better visual improvement at Month 12 (p < 0.001). The existence of subretinal fluid at baseline (p = 0.02) and a greater reduction in CFT at Month 3 (p < 0.001) were both correlated with a greater reduction in CFT at Month 12. Previous subtenon injection of triamcinolone acetonide was associated with fewer additional IVR after Month 3 (odds ratio = 0.35, 95% CI = 0.14-0.89). CONCLUSION Compared with existing prospective studies, the one-year real-life data in Taiwan showed fewer ranibizumab injections for DME and a less prominent yet still significant visual improvement. Both visual and anatomical improvements at Month 3 were correlated with the level of improvements at Month 12. Previous subtenon steroid injection might reduce the need of additional ranibizumab injections.
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Affiliation(s)
- Tso-Ting Lai
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chang-Hao Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Tzyy-Chang Ho
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Ting Hsieh
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.
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Murakami T, Suzuma K, Uji A, Yoshitake S, Dodo Y, Fujimoto M, Yoshitake T, Miwa Y, Yoshimura N. Association between characteristics of foveal cystoid spaces and short-term responsiveness to ranibizumab for diabetic macular edema. Jpn J Ophthalmol 2018; 62:292-301. [PMID: 29460019 DOI: 10.1007/s10384-018-0575-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 01/21/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate the association between the characteristics of foveal cystoid spaces and short-term responsiveness to ranibizumab treatment for diabetic macular edema (DME) at 3 months from the initial injection. METHODS We retrospectively reviewed 66 eyes of 61 patients with center-involved DME who received three consecutive ranibizumab injections and following as-needed administrations. We evaluated the relationship between visual improvement at 3 months and the preoperative optical coherence tomography (OCT) parameters including hyperreflective foci, heterogeneous OCT reflectivity, mean levels of OCT reflectivity and height of foveal cystoid spaces. RESULTS Twenty-three eyes without preoperative hyperreflective foci in the foveal cystoid spaces had significantly greater improvement in the logarithm of the minimum angle of resolution visual acuity (logMAR VA) at 3 months than 43 eyes with foci (P = 0.006). That was similar to the greater reduction in CSF thickness in eyes without lesions after treatment at the same time point (P < 0.001). VA improvement at 3 months was not associated with the height (R = 0.215, P = 0.083) or the reflectivity levels (R = -0.079, P = 0.538) of foveal cystoid spaces. There were no differences in VA changes between eyes with and without heterogeneous reflectivity in foveal cystoid spaces (P = 0.297). Multivariate analyses showed that logMAR VA and the absence of hyperreflective foci in foveal cystoid spaces were associated with VA improvement at 3 months. CONCLUSION Hyperreflective foci in foveal cystoid spaces at baseline predict poorer short-term responsiveness to ranibizumab injections for DME.
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Affiliation(s)
- Tomoaki Murakami
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaracho, Sakyo, Kyoto, 606-8507, Japan.
| | - Kiyoshi Suzuma
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaracho, Sakyo, Kyoto, 606-8507, Japan
| | - Akihito Uji
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaracho, Sakyo, Kyoto, 606-8507, Japan
| | - Shin Yoshitake
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaracho, Sakyo, Kyoto, 606-8507, Japan
| | - Yoko Dodo
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaracho, Sakyo, Kyoto, 606-8507, Japan
| | - Masahiro Fujimoto
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaracho, Sakyo, Kyoto, 606-8507, Japan
| | - Tatsuya Yoshitake
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaracho, Sakyo, Kyoto, 606-8507, Japan
| | - Yuko Miwa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaracho, Sakyo, Kyoto, 606-8507, Japan
| | - Nagahisa Yoshimura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaracho, Sakyo, Kyoto, 606-8507, Japan
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Shin YU, Hong EH, Lim HW, Kang MH, Seong M, Cho H. Quantitative evaluation of hard exudates in diabetic macular edema after short-term intravitreal triamcinolone, dexamethasone implant or bevacizumab injections. BMC Ophthalmol 2017; 17:182. [PMID: 28974211 PMCID: PMC5627478 DOI: 10.1186/s12886-017-0578-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 09/25/2017] [Indexed: 12/28/2022] Open
Abstract
Background To quantitatively compare short-term hard exudates (HEs) alteration in patients with diabetic macular edema (DME) after intravitreal triamcinolone, dexamethasone implant or bevacizumab injections. Methods This retrospective study enrolled DME eyes with HEs that underwent a single-dose intravitreal injection of triamcinolone (25 eyes), dexamethasone implant (20 eyes), or three monthly injections of bevacizumab (25 eyes) and completed at least three months of follow-up. All patients were examined before and after 1, 2 and 3 months of injections. Using color fundus photographs, the amount of HEs was quantified by two masked graders. The difference in HEs area between baseline and each follow-up visit was compared among the three groups. Results After three months, HEs area was reduced to 52.9 ± 4.21% (P < 0.001) in the triamcinolone group, 63.6 ± 6.08% (P = 0.002) in the dexamethasone implant group, and 85.2 ± 5.07% (P = 0.198) in the bevacizumab group. A significant reduction in HEs appeared at one month in the triamcinolone group (53.5 ± 4.91%, P < 0.001) and at two months in the dexamethasone implant group (70.1 ± 5.21%, P = 0.039). Conclusions Our study suggests intravitreal steroids (triamcinolone, dexamethasone implants) significantly reduce HEs in DME patients on short-term follow-up, whereas intravitreal bevacizumab does not. Therefore, intravitreal steroids may be useful in DME with HEs in the fovea.
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Affiliation(s)
- Yong Un Shin
- Department of Ophthalmology, Hanyang University College of Medicine, Seoul, South Korea
| | - Eun Hee Hong
- Department of Ophthalmology, Hanyang University College of Medicine, Seoul, South Korea
| | - Han Woong Lim
- Department of Ophthalmology, Hanyang University College of Medicine, Seoul, South Korea
| | - Min Ho Kang
- Department of Ophthalmology, Hanyang University College of Medicine, Seoul, South Korea
| | - Mincheol Seong
- Department of Ophthalmology, Hanyang University College of Medicine, Seoul, South Korea
| | - Heeyoon Cho
- Department of Ophthalmology, Hanyang University College of Medicine, Seoul, South Korea.
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Marupally AG, Vupparaboina KK, Peguda HK, Richhariya A, Jana S, Chhablani J. Semi-automated quantification of hard exudates in colour fundus photographs diagnosed with diabetic retinopathy. BMC Ophthalmol 2017; 17:172. [PMID: 28931389 PMCID: PMC5607622 DOI: 10.1186/s12886-017-0563-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 09/05/2017] [Indexed: 01/18/2023] Open
Abstract
Background Hard exudates (HEs) are the classical sign of diabetic retinopathy (DR) which is one of the leading causes of blindness, especially in developing countries. Accordingly, disease screening involves examining HEs qualitatively using fundus camera. However, for monitoring the treatment response, quantification of HEs becomes crucial and hence clinicians now seek to measure the area of HEs in the digital colour fundus (CF) photographs. Against this backdrop, we proposed an algorithm to quantify HEs using CF images and compare with previously reported technique using ImageJ. Methods CF photographs of 30 eyes (20 patients) with diabetic macular edema were obtained. A robust semi-automated algorithm was developed to quantify area covered by HEs. In particular, the proposed algorithm, a two pronged methodology, involved performing top-hat filtering, second order statistical filtering, and thresholding of the colour fundus images. Subsequently, two masked observers performed HEs measurements using previously reported ImageJ-based protocol and compared with those obtained through proposed method. Intra and inter-observer grading was performed for determining percentage area of HEs identified by the individual algorithm. Results Of the 30 subjects, 21 were males and 9 were females with a mean age of the 50.25 ± 7.80 years (range 33–66 years). The correlation between the two measurements of semi-automated and ImageJ were 0.99 and 0.99 respectively. Previously reported method detected only 0–30% of the HEs area in 9 images, 30–60% in 12 images and 60–90% in remaining images, and more than 90% in none. In contrast, proposed method, detected 60–90% of the HEs area in 13 images and 90–100% in remaining 17 images. Conclusion Proposed method semi-automated algorithm achieved acceptable accuracy, qualitatively and quantitatively, on a heterogeneous dataset. Further, quantitative analysis performed based on intra- and inter-observer grading showed that proposed methodology detects HEs more accurately than previously reported ImageJ-based technique. In particular, we proposed algorithm detect faint HEs also as opposed to the earlier method.
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Affiliation(s)
- Abhilash Goud Marupally
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V.Prasad Eye Institute, Hyderabad, 500034, India
| | - Kiran Kumar Vupparaboina
- Engineering Group, Srujana Center for Innovation, L.V.Prasad Eye Institute, Hyderabad, 500034, India.,Deptartment of Electrical Engineering, Indian Institute of Technology Hyderabad, Hyderabad, 502285, India
| | - Hari Kumar Peguda
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V.Prasad Eye Institute, Hyderabad, 500034, India
| | - Ashutosh Richhariya
- Engineering Group, Srujana Center for Innovation, L.V.Prasad Eye Institute, Hyderabad, 500034, India
| | - Soumya Jana
- Deptartment of Electrical Engineering, Indian Institute of Technology Hyderabad, Hyderabad, 502285, India
| | - Jay Chhablani
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V.Prasad Eye Institute, Hyderabad, 500034, India.
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Abstract
This overview introduces contributions to a special issue on causes of vision loss from diabetes mellitus, focusing on the retina and also the cornea. Diabetic retinopathy is the most common and leading cause of vision loss among people with diabetes. Research to detect early symptoms, understand mechanisms leading to diabetic eye disease, and the development of treatments is a highly active research area, with currently about 2000 scientific publication per year. We provide a series of 27 comprehensive reviews and research articles from leading experts in the field.
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Affiliation(s)
- M Elizabeth Hartnett
- Department of Ophthalmology, John A. Moran Eye Center, University of Utah Health Sciences, Salt Lake City, UT 84132, United States.
| | - Wolfgang Baehr
- Department of Ophthalmology, John A. Moran Eye Center, University of Utah Health Sciences, Salt Lake City, UT 84132, United States
| | - Yun Z Le
- Section of Endocrinology and Diabetes, Departments of Medicine, Cell Biology and Ophthalmology and Harold Hamm Diabetes Center, University of Oklahoma, Oklahoma City, OK 73104-5020, United States
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Dervenis N, Mikropoulou AM, Tranos P, Dervenis P. Ranibizumab in the Treatment of Diabetic Macular Edema: A Review of the Current Status, Unmet Needs, and Emerging Challenges. Adv Ther 2017; 34:1270-1282. [PMID: 28484955 PMCID: PMC5487872 DOI: 10.1007/s12325-017-0548-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Indexed: 01/08/2023]
Abstract
Diabetic retinopathy (more specifically diabetic macular edema, DME) is the most common cause of loss of vision in the working population in developed countries. Anti-vascular endothelial growth factor (anti-VEGF) agents considerably changed the treatment algorithms and improved prognosis of center-involving DME. Ranibizumab was the first approved anti-VEGF agent that revolutionized DME treatment. The vast increase in the number of patients undergoing intravitreal treatment and the role of anti-VEGF pharmacotherapy as the mainstay of DME treatment have triggered several challenges. Among them, of considerable interest is the quest for an optimal dosing scheme and the search for combination therapies. Although a significant body of research is directed towards other molecules that could potentially be new therapeutic targets, VEGF inhibition is expected to play an important long-term role in the treatment of DME considering the pathogenesis of the disease. Finally, recent studies revealed that ranibizumab may constitute a significant treatment modality in the management of other diabetic vision-threatening complications including proliferative diabetic retinopathy.
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Lai IA, Hsu WC, Yang CM, Hsieh YT. Prognostic factors of short-term outcomes of intravitreal ranibizumab in diabetic macular edema. Int J Ophthalmol 2017; 10:765-771. [PMID: 28546935 DOI: 10.18240/ijo.2017.05.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 09/29/2016] [Indexed: 01/09/2023] Open
Abstract
AIM To evaluate the prognostic factors for short-term visual and anatomical improvement of intravitreal ranibizumab (IVR) for diabetic macular edema (DME). METHODS Fifty-one eyes from 35 patients that received three consecutive monthly IVR for DME with moderate visual loss were retrospectively recruited; all cases had their baseline best-corrected visual acuity (BCVA) between 20/400 and 20/40. BCVA and central subfield thickness (CST) at baseline and month 3 were collected. Linear mixed models were used to evaluate the prognostic factors for visual and anatomical improvement at month 3. RESULTS Younger age, poorer baseline BCVA and proliferative diabetic retinopathy (PDR) were correlated with better visual improvement at month 3 (P=0.002, 0.0001 and 0.007, respectively). Thicker CST and the presence of subretinal fluid at baseline were correlated with a greater reduction in CST (P<0.0001 and P=0.018, respectively). The presence of epiretinal membrane or previous posterior subtenon injection of triamcinolone acetonide (PSTA) were associated with a smaller reduction in CST (P=0.029 and 0.018, respectively), but had no significant effects in visual improvement at month 3 (P>0.05 for both). CONCLUSION For eyes with DME and moderate visual loss, those with younger age, poorer baseline BCVA or PDR tend to have better visual improvement after three consecutive monthly IVR. Epiretinal membrane or previous PSTA result in less resolution of CST, but do not significantly affect visual improvement.
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Affiliation(s)
- I-An Lai
- Department of Ophthalmology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan, China
| | - Wei-Cherng Hsu
- Department of Ophthalmology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan, China.,School of Medicine, Tzu Chi University, Hualien 970, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 10002, Taiwan, China
| | - Yi-Ting Hsieh
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 10002, Taiwan, China
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Itoh Y, Petkovsek D, Kaiser PK, Singh RP, Ehlers JP. Optical Coherence Tomography Features in Diabetic Macular Edema and the Impact on Anti-VEGF Response. Ophthalmic Surg Lasers Imaging Retina 2017; 47:908-913. [PMID: 27759856 DOI: 10.3928/23258160-20161004-03] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 08/17/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND OBJECTIVE To assess the relationship between spectral-domain optical coherence tomography (SD-OCT) features and functional outcomes for diabetic macular edema (DME) undergoing treatment with intravitreal bevacizumab (Avastin; Genentech, South San Francisco, CA). PATIENTS AND METHODS Institutional review board-approved, retrospective, consecutive case series of eyes receiving intravitreal bevacizumab (1.25 mg) for DME. SD-OCT features were evaluated and correlated with functional response to anti-vascular endothelial growth factor (VEGF) therapy. RESULTS One hundred fifty-nine eyes of 159 subjects were included in this study. Mean visual acuity improved from 20/76 to 20/58. The proportion of eyes with 20/40 or greater visual acuity increased with treatment (35% at initial visit, 51% at final visit). SD-OCT factors that were associated with functional outcomes to anti-VEGF therapy include ellipsoid zone integrity and severity of intraretinal fluid. CONCLUSION SD-OCT features appear to provide important markers for functional response to anti-VEGF therapy in DME. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:908-913.].
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Ashraf M, Kayal HE, Souka AAR. Safety and Efficacy of Ziv-Aflibercept in the Treatment of Refractory Diabetic Macular Edema. Ophthalmic Surg Lasers Imaging Retina 2017; 48:399-405. [DOI: 10.3928/23258160-20170428-06] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 02/22/2017] [Indexed: 01/28/2023]
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Mori Y, Murakami T, Suzuma K, Ishihara K, Yoshitake S, Fujimoto M, Dodo Y, Yoshitake T, Miwa Y, Tsujikawa A. Relation between macular morphology and treatment frequency during twelve months with ranibizumab for diabetic macular edema. PLoS One 2017; 12:e0175809. [PMID: 28407012 PMCID: PMC5391111 DOI: 10.1371/journal.pone.0175809] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 03/31/2017] [Indexed: 12/17/2022] Open
Abstract
Purpose To investigate whether baseline optical coherence tomography (OCT) parameters can predict the treatment frequency of intravitreal ranibizumab (IVR) injections during the first year in patients with diabetic macular edema (DME) treated with pro re nata (PRN) IVR injections. Methods We retrospectively reviewed 68 eyes of 63 patients with center-involved DME who received IVR injections for 12 months or longer according to three monthly IVR injections followed by the PRN dosing. We measured the mean retinal thicknesses in the individual subfields of the Early Treatment Diabetic Retinopathy Study grid and evaluated the qualitative and quantitative parameters on OCT sectional images. We investigated the relationship between these OCT parameters at baseline and the number of IVR injections during the 12-month follow-up. Results Three loading doses were administered to 10 eyes; four to seven annualized IVR injections were administered to 34 eyes. The number of eyes that received IVR injections decreased gradually until month 6 and was almost constant from months 7 to 11. No relationships were seen between the treatment frequency and baseline systemic factors and the ophthalmic examination findings. Univariate analyses showed that the number of IVR injections during the first year was associated with the mean retinal thickness in the individual subfields and the transverse length of the disrupted external limiting membrane (ELM) and ellipsoid zone of the photoreceptors. Multivariate analysis showed a significant association with the thickness in the inferior subfield alone. The treatment frequency during the 12-month follow-up was not correlated with improved visual acuity but was associated with the decrease in the central subfield thickness and disrupted ELM. Conclusion The retinal thickness in the inferior subfield predicts the treatment frequency during the first year in eyes with DME treated with PRN IVR injections.
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Affiliation(s)
- Yuki Mori
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tomoaki Murakami
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
- * E-mail:
| | - Kiyoshi Suzuma
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kenji Ishihara
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shin Yoshitake
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masahiro Fujimoto
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoko Dodo
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tatsuya Yoshitake
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuko Miwa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Qin YW, Yu J, Zhang Q. Characteristics of retinal vein occlusion with final vision better than 78 letters after sequential therapy with ranibizumab and triamcinolone acetate. Int J Ophthalmol 2017; 10:271-276. [PMID: 28251088 DOI: 10.18240/ijo.2017.02.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 07/23/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To analyze the reasons that may lead to the different vision result by combining the ranibizumab and triamcinolone acetate (TA) in sequence to treat macular edema in retinal vein occlusion (RVO). METHODS Ranibizumab and TA were combined in sequence to treat 43 patients with macular edema secondary to RVO. Six months after the treatment, patients with central fovea thickness (CFT) less than 300 µm in optical coherence tomography (OCT) were collected into Groups I and II, based on vision acuity (VA) better than 78 letters or less than 60 letters. The age, baseline VA, duration from onset to treatment, CFT at the baseline, sub-retinal fluid (SRF), sub-foveal exudates and injection times of TA and ranibizumab were taken into comparison. RESULTS The mean age of the subjects was 46.4y in Group I but 57.5y in Group II. The difference of age was significant between groups (P<0.01). The mean baseline VA was 51.4 letters in Group I and 43.9 letters in Group II (P<0.05). The baseline CFT were 670.9 µm in Group I with SRF in 54.3% patients and 678.1 µm in Group II with SRF in 52.9% (P>0.05). The mean number of injections of TA was 0.9 and the mean number of injections of ranibizumab was 2.3 in Group I but 1.7 and 2.9 respectively in Group II. The treatment times of ranibizumab had no difference between the 2 groups (P>0.05) but the difference of TA injection times was significant, P<0.05. Subfoveal exudates at final stage happened in no subjects in Group I but in 45.83% subjects in Group II. CONCLUSION This combined treatment is safer than TA injection and cheaper than ranibizumab injection alone. Younger patients and earlier treatment will help to get better vision outcome. Subfoveal exudates at the final stage have significant relationship with vision outcome. No relationship existed between the baseline CFT, SRF and the vision outcome.
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Affiliation(s)
- Yao-Wu Qin
- Ophthalmology Department of EENT Hospital, Affiliated to Fudan University, Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200031, China
| | - Jia Yu
- Ophthalmology Department of EENT Hospital, Affiliated to Fudan University, Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200031, China
| | - Quan Zhang
- Ophthalmology Department of EENT Hospital, Affiliated to Fudan University, Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200031, China
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Daniel E, Grunwald JE, Kim BJ, Maguire MG, Jaffe GJ, Toth CA, Ferris FL, Martin DF, Shaffer J, Ying GS. Visual and Morphologic Outcomes in Eyes with Hard Exudate in the Comparison of Age-Related Macular Degeneration Treatments Trials. Ophthalmol Retina 2017; 1:25-33. [PMID: 28620652 DOI: 10.1016/j.oret.2016.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE To compare baseline characteristics, visual acuity (VA) and morphological outcomes between eyes with baseline hard exudates (HE) and all other eyes among patients with neovascular age-related macular degeneration (NVAMD) treated with anti-vascular endothelial growth factors (anti-VEGF). DESIGN Prospective cohort study within the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT). PARTICIPANTS Patients with NVAMD. METHODS Readers evaluated baseline and follow-up morphology on digital color images, fluorescein angiography (FA), and optical coherence tomography (OCT) in eyes with NVAMD that were randomly assigned to treatment with either ranibizumab or bevacizumab. Ophthalmologists identified HE on color images in the study eye. MAIN OUTCOME MEASURES VA; scar; geographic atrophy; retinal thickness, fluid; and number of anti-VEGF injections. RESULTS HE was present in 128 of 1185 (11%) study eyes at baseline, 77% within 1 disc diameter of the foveal center. Patients with study eye HE were more likely female (81% vs 60%; p<0.001) and non-smokers (53% vs 42%; p=0.004). Both groups had similar proportions of hypercholesterolemia and hypertriglyceridemia. At baseline, eyes with HE had worse VA (mean 57 vs 61 letters; p=0.003), larger total lesion size (3.3 vs 2.4 DA; p <0.001), greater total foveal thickness (522µm vs 452µm; p<0.001), more retinal angiomatous proliferation (18% vs 10%; p=0.009) and sub-RPE fluid (65% vs 47%; p<0.001). At 1 year, VA was similar in both groups; more eyes with baseline HE had no fluid (45% vs 29%; p<0.001) and greater reduction in total foveal thickness (-266µm vs -158u; p<0.001). VA at year 2 was similar but retinas of eyes with baseline HE were thinner (267µm vs 299µm; p=0.03) and fewer eyes had sub-retinal fluid (23% vs 36%; p=0.008). HE was present in 19% of eyes at 1 year and 5% of eyes at 2 years. LIPC promoter SNP rs10468017 was not associated with NVAMD HE. CONCLUSION Eyes with HE have larger CNV lesions and more RAP. Their initially thicker retina rapidly becomes thinner on anti-VEGF treatment. HE is not significantly associated with hyperlipidemia. HE at baseline does not significantly influence VA, scar and GA outcomes in eyes with NVAMD treated with anti-VEGF. Few eyes have HE at year 2.
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Affiliation(s)
- Ebenezer Daniel
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, United States. Department of Ophthalmology, Duke University, Durham, NC, United States. Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States. National Eye Institute, Bethesda, MD, United States
| | - Juan E Grunwald
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, United States. Department of Ophthalmology, Duke University, Durham, NC, United States. Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States. National Eye Institute, Bethesda, MD, United States
| | - Benjamin J Kim
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, United States. Department of Ophthalmology, Duke University, Durham, NC, United States. Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States. National Eye Institute, Bethesda, MD, United States
| | - Maureen G Maguire
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, United States. Department of Ophthalmology, Duke University, Durham, NC, United States. Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States. National Eye Institute, Bethesda, MD, United States
| | - Glenn J Jaffe
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, United States. Department of Ophthalmology, Duke University, Durham, NC, United States. Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States. National Eye Institute, Bethesda, MD, United States
| | - Cynthia A Toth
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, United States. Department of Ophthalmology, Duke University, Durham, NC, United States. Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States. National Eye Institute, Bethesda, MD, United States
| | - Frederick L Ferris
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, United States. Department of Ophthalmology, Duke University, Durham, NC, United States. Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States. National Eye Institute, Bethesda, MD, United States
| | - Daniel F Martin
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, United States. Department of Ophthalmology, Duke University, Durham, NC, United States. Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States. National Eye Institute, Bethesda, MD, United States
| | - James Shaffer
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, United States. Department of Ophthalmology, Duke University, Durham, NC, United States. Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States. National Eye Institute, Bethesda, MD, United States
| | - Gui-Shuang Ying
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, United States. Department of Ophthalmology, Duke University, Durham, NC, United States. Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States. National Eye Institute, Bethesda, MD, United States
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Mori Y, Suzuma K, Uji A, Ishihara K, Yoshitake S, Fujimoto M, Dodo Y, Yoshitake T, Miwa Y, Murakami T. Restoration of foveal photoreceptors after intravitreal ranibizumab injections for diabetic macular edema. Sci Rep 2016; 6:39161. [PMID: 27966644 PMCID: PMC5155247 DOI: 10.1038/srep39161] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 11/17/2016] [Indexed: 12/22/2022] Open
Abstract
Anti-vascular endothelial growth factor drugs are the first-line treatment for diabetic macular edema (DME), although the mechanism of the visual acuity (VA) improvement remains largely unknown. The association between photoreceptor damage and visual impairment encouraged us to retrospectively investigate the changes in the foveal photoreceptors in the external limiting membrane (ELM) and ellipsoid zone (EZ) on spectral-domain optical coherence tomography (SD-OCT) images in 62 eyes with DME treated with intravitreal ranibizumab (IVR) injections. The transverse lengths of the disrupted EZ and ELM were shortened significantly (P < 0.001 and P = 0.044, respectively) at 12 months. The qualitative investigation also showed restoration of the EZ and ELM lines on SD-OCT images. The EZ at 12 months lengthened in 34 of 38 eyes with discontinuous EZ and was preserved in 16 of 21 eyes with complete EZ at baseline. VA improvement was positively correlated with shortening of the disrupted EZ at 12 months (ρ = 0.463, P < 0.001), whereas the decrease in central subfield thickness was associated with neither VA improvement nor changes in EZ status (ρ = 0.215, P = 0.093 and (ρ = 0.209, P = 0.103, respectively). These data suggested that photoreceptor restoration contributes to VA improvement after pro re nata treatment with IVR injections for DME independent of resolved retinal thickening.
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Affiliation(s)
- Yuki Mori
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kiyoshi Suzuma
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akihito Uji
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kenji Ishihara
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shin Yoshitake
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masahiro Fujimoto
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoko Dodo
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tatsuya Yoshitake
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuko Miwa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tomoaki Murakami
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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50
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Egan C, Zhu H, Lee A, Sim D, Mitry D, Bailey C, Johnston R, Chakravarthy U, Denniston A, Tufail A, Khan R, Mahmood S, Menon G, Akerele T, Downey L, McKibbin M, Varma A, Lobo A, Wilkinson E, Fitt A, Brand C, Tsaloumas M, Mandal K, Kumar V, Natha S, Crabb D. The United Kingdom Diabetic Retinopathy Electronic Medical Record Users Group, Report 1: baseline characteristics and visual acuity outcomes in eyes treated with intravitreal injections of ranibizumab for diabetic macular oedema. Br J Ophthalmol 2016; 101:75-80. [PMID: 27965262 DOI: 10.1136/bjophthalmol-2016-309313] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 10/12/2016] [Accepted: 11/15/2016] [Indexed: 11/04/2022]
Abstract
AIMS To describe baseline characteristics and visual outcome for eyes treated with ranibizumab for diabetic macular oedema (DMO) from a multicentre database. METHODS Structured clinical data were anonymised and extracted from an electronic medical record from 19 participating UK centres: age at first injection, ETDRS visual acuity (VA), number of injections, ETDRS diabetic retinopathy (DR) and maculopathy grade at baseline and visits. The main outcomes were change in mean VA from baseline, number of injections and clinic visits and characteristics affecting VA change and DR grade. RESULTS Data from 12 989 clinic visits was collated from baseline and follow-up for 3103 eyes. Mean age at first treatment was 66 years. Mean VA (letters) for eyes followed at least 2 years was 51.1 (SD=19.3) at baseline, 54.2 (SD: 18.6) and 52.5 (SD: 19.4) at 1 and 2 years, respectively. Mean visual gain was five letters. The proportion of eyes with VA of 72 letters or better was 25% (baseline) and 33% (1 year) for treatment naïve eyes. Eyes followed for at least 6 months received a mean of 3.3 injections over a mean of 6.9 outpatient visits in 1 year. CONCLUSIONS In a large cohort of eyes with DMO treated with ranibizumab injections in the UK, 33% of patients achieved better than or equal to 6/12 in the treated eye at 12 months compared with 25% at baseline. The mean visual gain was five letters. Eyes with excellent VA at baseline maintain good vision at 18 months.
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Affiliation(s)
- Catherine Egan
- Department of Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Institute of Ophthlamology, London, UK
| | | | - Aaron Lee
- Department of Ophthalmology, University of Washington, Seattle, USA
| | - Dawn Sim
- Department of Medical Retina, Moorfields Eye Hospital, London, UK.,Department of Cell Biology, UCL Institute of Ophthalmology, London, UK
| | - Danny Mitry
- Department of Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Robert Johnston
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | | | | | - Adnan Tufail
- Department of Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Institute of Ophthlamology, London, UK
| | - Rehna Khan
- Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | | | - Geeta Menon
- Eye Department, Frimley Park Hospital, Frimley, UK
| | - Toks Akerele
- Hinchingbrooke Health Care NHS Trust, Huntingdon, Cambridgeshire, UK
| | - Louise Downey
- Department of Ophthalmology, Hull Royal Infirmary, Hull, UK
| | | | - Atul Varma
- Mid Yorkshire Hospitals NHS Trust, Yorkshire, UK
| | - Aires Lobo
- Moorfields Eye Hospital NHS Foundation Trust, London, London, UK
| | | | - Alan Fitt
- Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, Peterborough, UK
| | | | - Marie Tsaloumas
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Kaveri Mandal
- Department of Ophthalmology, Warrington and Halton Hospitals NHS Foundation Trust, Warrington, UK
| | - Vineeth Kumar
- Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - Salim Natha
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - David Crabb
- Division of Optometry & Visual Science, City University, London, UK
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