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Nawar AE, Ali AYA, Massoud OM, Alagorie AR. Effectiveness of Suprachoroidal Injection of Triamcinolone Acetonide in Diabetic Macular Edema Following Pars Plana Vitrectomy Using a Modified Custom Microneedle. Clin Ophthalmol 2024; 18:2049-2060. [PMID: 39051023 PMCID: PMC11268719 DOI: 10.2147/opth.s472910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/28/2024] [Indexed: 07/27/2024] Open
Abstract
Purpose The present study evaluated the efficacy of suprachoroidal injection of Triamcinolone Acetonide (SCTA) in diabetic macular edema (DME) following pars plana vitrectomy (PPV) using a modified microneedle. Patients and methods A prospective interventional study was conducted on 60 eyes of 60 patients with centrally involved diabetic macular edema following pars plana vitrectomy (PPV). SCTA was performed at the baseline and repeated after 3 months in case of persistent subretinal or intraretinal fluid, central macular thickness (CMT) more than 300 µm or visual loss by more than one line of the Snellen chart. Results The present study detected significant reduction of the CMT from 498.3 ± 94.8 µm at the baseline to 212.3 ± 11.9 µm after 12 months of injection with p < 0.001 and a significant improvement of best corrected visual acuity (BCVA) from 1 (0.9-1.2) at the baseline to 0.5 (0.3-0.7) after 12 months of injection with p < 0.001. The intraocular pressure (IOP) increased significantly after 3 months of injection with p < 0.001 and then gradually declined to its normal level after 6 months. Inner segment/outer segment (IS/OS) disruption was the only significant predictor of the final CMT; however, the number of injections, IS/OS disruption, baseline BCVA and the HbA1C level were the significant predictors of the final BCVA after injection. Conclusion Suprachoroidal injection of TA using this microneedle resulted in significant anatomical and functional improvement in previously vitrectomized diabetic macular edema patients with no recorded ocular or systemic adverse events.
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Affiliation(s)
- Amin E Nawar
- Ophthalmology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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Ammari W, Chaabene H, Messaoud R. [Anatomical and functional outcomes of the "3+PRN" therapeutic protocol in the treatment of diabetic macular edema]. J Fr Ophtalmol 2024; 47:104234. [PMID: 38875945 DOI: 10.1016/j.jfo.2024.104234] [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: 09/17/2023] [Revised: 02/04/2024] [Accepted: 03/12/2024] [Indexed: 06/16/2024]
Abstract
PURPOSE To evaluate the anatomical and functional results of the "3+PRN" protocol in the treatment of diabetic macular edema (DME), determine the predictive factors for good final visual acuity, and compare it to other protocols. MATERIALS AND METHODS We conducted a retrospective, descriptive, comparative, cross-sectional study of patients with DME, which we dubbed HTSM. All patients were treated with three monthly initial intravitreal injections (IVT) of 1.25mg bevacizumab and followed according to the pro re nata (PRN) protocol for a period of 3years. The protocol was based on a monthly monitoring schedule for the first 3months, then increasingly spaced out over time. "On-demand" treatment was indicated with resumption of bevacizumab IVT in the event of worsening of DME. RESULTS A total of 52 patients were included. The mean age was 65years. Type 2 was the most frequently observed type of diabetes. The mean duration of the PRN protocol was 6months, and the mean number of injections was 6. The mean visual acuity (VA), initially 1/10, improved to 3/10 by the conclusion of the 3+PRN protocol, with an improvement of more than 5 letters in 77.6% of cases. The mean initial central macular thickness (CMT) was 451.5μm. The final mean EMC decreased to 298.5μm, which corresponds to a reduction of 153μm compared to the initial value. The mean subfoveal choroidal thickness, initially 304.2μm, decreased to a mean of 284.5μm at completion. Comparative analysis of the results before and after the PRN protocol confirmed the existence of a statistically significant correlation between VA and CMT (P<0.05). No correlation was observed between age and visual acuity or between initial and final VA. The analysis of the various tomographic parameters and VA revealed a significantly better visual improvement in the group in whom the external limiting membrane (MLE) and ellipsoid zone (ZE) were intact (P=0.04), as well as in the group in whom serous retinal detachment (SRD) was absent (P<0.001). Posterior vitreous detachment (PVD) was the most frequently observed vitreomacular anomaly. The final VA was similar in the groups with and without PVD (P=0.04). CONCLUSION The 3+PRN protocol is effective both functionally and tomographically in the treatment of DME. Various tomographic parameters might influence therapeutic efficacy. However, further in-depth studies are needed to better investigate these parameters.
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Affiliation(s)
- W Ammari
- Service d'ophtalmologie, hôpital universitaire Taher Sfar Mahdia, Jbel Dar Waja 5100, Tunisie; Faculté de médecine de Monastir, Monastir, Tunisie.
| | - H Chaabene
- Service d'ophtalmologie, hôpital universitaire Taher Sfar Mahdia, Jbel Dar Waja 5100, Tunisie; Faculté de médecine de Monastir, Monastir, Tunisie
| | - R Messaoud
- Service d'ophtalmologie, hôpital universitaire Taher Sfar Mahdia, Jbel Dar Waja 5100, Tunisie; Faculté de médecine de Monastir, Monastir, Tunisie
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Szeto SK, Lai TY, Vujosevic S, Sun JK, Sadda SR, Tan G, Sivaprasad S, Wong TY, Cheung CY. Optical coherence tomography in the management of diabetic macular oedema. Prog Retin Eye Res 2024; 98:101220. [PMID: 37944588 DOI: 10.1016/j.preteyeres.2023.101220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/24/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Abstract
Diabetic macular oedema (DMO) is the major cause of visual impairment in people with diabetes. Optical coherence tomography (OCT) is now the most widely used modality to assess presence and severity of DMO. DMO is currently broadly classified based on the involvement to the central 1 mm of the macula into non-centre or centre involved DMO (CI-DMO) and DMO can occur with or without visual acuity (VA) loss. This classification forms the basis of management strategies of DMO. Despite years of research on quantitative and qualitative DMO related features assessed by OCT, these do not fully inform physicians of the prognosis and severity of DMO relative to visual function. Having said that, recent research on novel OCT biomarkers development and re-defined classification of DMO show better correlation with visual function and treatment response. This review summarises the current evidence of the association of OCT biomarkers in DMO management and its potential clinical importance in predicting VA and anatomical treatment response. The review also discusses some future directions in this field, such as the use of artificial intelligence to quantify and monitor OCT biomarkers and retinal fluid and identify phenotypes of DMO, and the need for standardisation and classification of OCT biomarkers to use in future clinical trials and clinical practice settings as prognostic markers and secondary treatment outcome measures in the management of DMO.
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Affiliation(s)
- Simon Kh Szeto
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Timothy Yy Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Stela Vujosevic
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; Eye Clinic, IRCCS MultiMedica, Milan, Italy
| | - Jennifer K Sun
- Beetham Eye Institute, Harvard Medical School, Boston, USA
| | - SriniVas R Sadda
- Doheny Eye Institute, University of California Los Angeles, Los Angeles, USA
| | - Gavin Tan
- Singapore Eye Research Institute, SingHealth Duke-National University of Singapore, Singapore
| | - Sobha Sivaprasad
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Tien Y Wong
- Tsinghua Medicine, Tsinghua University, Beijing, China; Singapore Eye Research Institute, Singapore
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
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Hein M, Vukmirovic A, Constable IJ, Raja V, Athwal A, Freund KB, Balaratnasingam C. Angiographic biomarkers are significant predictors of treatment response to intravitreal aflibercept in diabetic macular edema. Sci Rep 2023; 13:8128. [PMID: 37208427 DOI: 10.1038/s41598-023-35286-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/16/2023] [Indexed: 05/21/2023] Open
Abstract
This prospective single-center study aims to identify biomarkers that predict improvement in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) at 6 months, in 76 eyes with diabetic macular edema (DME) treated monthly with intravitreal aflibercept. At baseline, all patients underwent standardized imaging with color photography, optical coherence tomography (OCT), fluorescein angiography (FA) and OCT angiography (OCTA). Glycosylated hemoglobin, renal function, dyslipidemia, hypertension, cardiovascular disease and smoking were recorded. Retinal images were graded in a masked fashion. Baseline imaging, systemic and demographic variables were investigated to detect associations to BCVA and CRT change post aflibercept. Predictors of BCVA improvement included greater macular vessel density quantified using OCTA (p = 0.001) and low-density lipoprotein (LDL) ≥ 2.6 mmol/L (p = 0.017). Lower macular vessel density eyes showed a significant reduction in CRT but no BCVA improvement. Predictors of CRT reduction included peripheral non-perfusion seen on ultrawide-field FA (p = 0.005) and LDL ≥ 2.6 mmol/L (p < 0.001). Retinal angiographic biomarkers derived from OCTA and ultrawide-field FA may help predict functional and anatomic response to anti-vascular endothelial growth factor (VEGF) therapy in patients with DME. Elevated LDL is associated with treatment response in DME. These results may be used to better-select patients who will benefit from intravitreal aflibercept for treatment of DME.
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Affiliation(s)
- Martin Hein
- Lions Eye Institute, Perth, Australia
- Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia
| | - Aleksandar Vukmirovic
- Lions Eye Institute, Perth, Australia
- Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia
| | - Ian J Constable
- Lions Eye Institute, Perth, Australia
- Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia
- Department of Ophthalmology, Sir Charles Gairdner Hospital, Perth, Australia
| | - Vignesh Raja
- Department of Ophthalmology, Sir Charles Gairdner Hospital, Perth, Australia
- Joondalup Eye Clinic, Perth, Australia
| | - Arman Athwal
- School of Engineering Science, Simon Fraser University, Burnaby, BC, Canada
- Department of Medical Physics and Biomedical Engineering, University College London, London, England
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, USA
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA
| | - Chandrakumar Balaratnasingam
- Lions Eye Institute, Perth, Australia.
- Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia.
- Department of Ophthalmology, Sir Charles Gairdner Hospital, Perth, Australia.
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Gurung RL, FitzGerald LM, Liu E, McComish BJ, Kaidonis G, Ridge B, Hewitt AW, Vote BJ, Verma N, Craig JE, Burdon KP. Predictive factors for treatment outcomes with intravitreal anti-vascular endothelial growth factor injections in diabetic macular edema in clinical practice. Int J Retina Vitreous 2023; 9:23. [PMID: 37016462 PMCID: PMC10074667 DOI: 10.1186/s40942-023-00453-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 03/13/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections are the standard of care for diabetic macular edema (DME), a common complication of diabetes. This study aimed to identify factors influencing DME intravitreal anti-VEGF treatment outcomes in real-world practice. METHODS This was a multi-center retrospective observational study using medical chart review of participants receiving anti-VEGF injections for DME (N = 248). Demographic and clinical variables were assessed for association with best corrected visual acuity (BCVA) and central macular thickness (CMT) outcomes using regression models. RESULTS There was a significant improvement in BCVA (p < 0.001) and CMT (p < 0.001) after 12 months of treatment, although 21% of participants had decreased BCVA, and 41% had a < 10% CMT reduction at 12 months. Higher baseline BCVA (p = 0.022, OR=-0.024, 95% CI=-0.046,-0.004) and longer duration of diabetic retinopathy (p = 0.048, OR=-0.064, 95% CI=-0.129,-0.001) were negative predictors for BCVA response, whereas Aflibercept treatment (p = 0.017, OR = 1.107, 95% CI = 0.220,2.051) compared with other drugs and a positive "early functional response" (p < 0.001, OR=-1.393, 95% CI=-1.946,-0.857) were positive predictors. A higher baseline CMT (p < 0.001, OR = 0.019, 95% CI = 0.012,0.0261) and an "early anatomical response", (p < 0.001, OR=-1.677, 95% CI=-2.456, -0.943) were predictors for greater reduction in CMT. Overall, the variables could predict only 23% of BCVA and 52% of CMT response. CONCLUSIONS The study shows a significant proportion of DME patients do not respond to anti-VEGF therapy and identifies several clinical predictors for treatment outcomes. TRIAL REGISTRATION The study was approved through the Human Research Ethics Committee, University of Tasmania (approval number H0012902), and the Southern Adelaide Clinical Human Research Ethics Committee (approval number 86 - 067).
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Affiliation(s)
- Rajya L Gurung
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street (Private Bag 23), Hobart, TAS, 7000, Australia.
| | - Liesel M FitzGerald
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street (Private Bag 23), Hobart, TAS, 7000, Australia
| | - Ebony Liu
- Department of Ophthalmology, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia
| | - Bennet J McComish
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street (Private Bag 23), Hobart, TAS, 7000, Australia
| | - Georgia Kaidonis
- Department of Ophthalmology, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia
| | - Bronwyn Ridge
- Department of Ophthalmology, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia
| | - Alex W Hewitt
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street (Private Bag 23), Hobart, TAS, 7000, Australia
- School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Brendan J Vote
- School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Nitin Verma
- School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Jamie E Craig
- Department of Ophthalmology, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia
| | - Kathryn P Burdon
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street (Private Bag 23), Hobart, TAS, 7000, Australia
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Morel JB, Fajnkuchen F, Amari F, Sritharan N, Bloch-Queyrat C, Giocanti-Aurégan A. Ultra-Wide-Field Fluorescein Angiography Assessment of Non-Perfusion in Patients with Diabetic Retinopathy Treated with Anti-Vascular Endothelial Growth Factor Therapy. J Clin Med 2023; 12:jcm12041365. [PMID: 36835902 PMCID: PMC9963628 DOI: 10.3390/jcm12041365] [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: 12/28/2022] [Revised: 01/25/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
Purpose: To follow the evolution of peripheral ischemia by fluorescein angiography (FA) on ultra-wide-field (UWF) images in diabetic patients treated with anti-vascular endothelial growth factor (anti-VEGF) for macular edema. Methods: Prospective, non-interventional cohort study analyzing UWF-FA images of 48 patients with diabetic retinopathy (48 eyes) treated for diabetic macular edema. UWF-FA was performed at baseline and after one year of anti-VEGF therapy (M12). The primary endpoint was the change in the non-perfusion index. Results: Of the 48 patients included in this study, 25 completed the one-year follow-up, and 20 had FA images of sufficient quality to be interpreted. The non-perfusion index did not significantly change from baseline after one year of anti-VEGF treatment (0.7% of the non-perfused area at baseline versus 0.5% at M12; p = 0.29). In contrast, the diabetic retinopathy severity score improved significantly between baseline and M12. Conclusions: Anti-VEGF treatment with aflibercept for diabetic macular edema had no impact on the retinal perfusion assessed by FA, but it allowed for artificially improving diabetic retinopathy severity scores.
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Affiliation(s)
- Jean-Baptiste Morel
- Ophthalmology Department, Paris Seine Saint Denis Hospital, Sorbonne Paris Nord University, 125 Rue de Stalingrad, 93000 Bobigny, France
| | - Franck Fajnkuchen
- Ophthalmology Department, Paris Seine Saint Denis Hospital, Sorbonne Paris Nord University, 125 Rue de Stalingrad, 93000 Bobigny, France
| | - Fatima Amari
- Ophthalmology Department, Paris Seine Saint Denis Hospital, Sorbonne Paris Nord University, 125 Rue de Stalingrad, 93000 Bobigny, France
| | - Nanthara Sritharan
- Department of Clinical Research, Paris Seine Saint Denis Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 93000 Bobigny, France
| | - Coralie Bloch-Queyrat
- Department of Clinical Research, Paris Seine Saint Denis Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 93000 Bobigny, France
| | - Audrey Giocanti-Aurégan
- Ophthalmology Department, Paris Seine Saint Denis Hospital, Sorbonne Paris Nord University, 125 Rue de Stalingrad, 93000 Bobigny, France
- Correspondence:
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Li Y, Liang H, Zhang C, Qiu Y, Wang D, Wang H, Chen A, Hong C, Wang L, Wang H, Hu B. Ophthalmic Solution of Smart Supramolecular Peptides to Capture Semaphorin 4D against Diabetic Retinopathy. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023; 10:e2203351. [PMID: 36437109 PMCID: PMC9875641 DOI: 10.1002/advs.202203351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/24/2022] [Indexed: 06/16/2023]
Abstract
Diabetic retinopathy (DR) is the leading cause of vision loss in working age population. Intravitreal injection of anti-VEGF antibody is widely used in clinical practice. However, about 27% of patients show poor response to anti-VEGF therapy and about 50% of these patients continue to have macular thickening. Frequent intravitreal injections of antibody may increase the chance of endophthalmitis and cause visual loss or even blindness once happened. Therefore, there is a greatly urgent need for novel noninvasive target to treat DR clinically. Here, the formulation of a smart supramolecular peptide (SSP) eye drop for DR treatment that is effective via specifically identifying and capturing soluble semaphorin 4D (sSema4D), a strongly pro-angiogenesis and exudates factor, is reported. The SSP nanostructures encapsulate sSema4D so that all biological effects mediated by three receptors of sSema4D are inhibited, thereby significantly alleviating pathological retinal angiogenesis and exudates in DR. Moreover, it is found that combination of SSPs eye drop and anti-VEGF injection shows better therapeutic effect over anti-VEGF treatment alone. Overall, SSP eye drop provide an alternative and effective method for noninvasive treatment for DR.
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Affiliation(s)
- Ya‐Nan Li
- Department of NeurologyUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430022China
| | - Hong‐Wen Liang
- CAS Center for Excellence in NanoscienceCAS Key Laboratory for Biomedical Effects of Nanomaterials and NanosafetyNational Center for Nanoscience and Technology (NCNST)Center of Materials Science and Optoelectronics EngineeringUniversity of Chinese Academy of SciencesBeijing100190China
| | - Chun‐Lin Zhang
- Department of NeurologyUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430022China
| | - Yan‐Mei Qiu
- Department of NeurologyUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430022China
| | - David Wang
- Neurovascular DivisionDepartment of NeurologyBarrow Neurological InstituteSaint Joseph's Hospital and Medical CenterPhoenixAZ85013USA
| | - Hai‐Ling Wang
- Department of NeurologyUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430022China
| | - An‐Qi Chen
- Department of NeurologyUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430022China
| | - Can‐Dong Hong
- Department of NeurologyUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430022China
| | - Lei Wang
- CAS Center for Excellence in NanoscienceCAS Key Laboratory for Biomedical Effects of Nanomaterials and NanosafetyNational Center for Nanoscience and Technology (NCNST)Center of Materials Science and Optoelectronics EngineeringUniversity of Chinese Academy of SciencesBeijing100190China
| | - Hao Wang
- CAS Center for Excellence in NanoscienceCAS Key Laboratory for Biomedical Effects of Nanomaterials and NanosafetyNational Center for Nanoscience and Technology (NCNST)Center of Materials Science and Optoelectronics EngineeringUniversity of Chinese Academy of SciencesBeijing100190China
| | - Bo Hu
- Department of NeurologyUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430022China
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Alshalan HA, Arevalo JF, Alomary SI, Ardah HI, Hazzazi MA. Effect of age on response to anti-VEGF agents in patients with center involving diabetic macular edema in a tertiary hospital. Int J Retina Vitreous 2022; 8:84. [PMID: 36514180 PMCID: PMC9746215 DOI: 10.1186/s40942-022-00434-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/04/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The aim of the current study is to evaluate the effect of age as an independent factor for the response to two anti-VEGF agents, intravitreal ranibizumab and intravitreal aflibercept, among patients presented with central-involving DME in one tertiary care center in Riyadh, Saudi Arabia. METHODS Retrospective cohort study. RESULTS A total of 210 eyes of 121 patients were included in the study. The mean age was 61.2 ± 11.40 years, 50.4% were males. On characterizing groups based on age, the group of patients 60 years or younger are 48 patients (mean age 51.5 ± 9.92) and 52.1% of them are females. On the other hand, the group of patients older than 60 years are 73 patients (mean age 67.6 ± 6.85) and 52.1% of them are males. The two anti-VEGF agents used were aflibercept (88.1%) and ranibizumab (11.9%). The mean BCVA using ETDRS letter score improved after treatment (5.55238095 ± 15.9538695) and the mean change in CST decreased after treatment (- 106.91 ± 117.385 μm). Regarding age, we found that there is no significant difference in mean improvement of BCVA in patients according to their age (p = 0.5429), patients younger than 60 years old gained 5.64 ETDRS letter score and those older than 60 years old gained 5.49 improvement. Similarly, mean improvement in CST was different between patients younger than 60 years old (- 125.1 μm) and those who were older than 60 years old (- 94 μm) with a trend favoring younger patients but this difference was not statistically significant (p = 0.08). CONCLUSION Age is a clinically significant factor affecting the outcome of anti-VEGF injections. Patients' CST had a difference of > 30 μm on average between the two age groups favoring younger patients. However, it was not statistically significant, maybe a bigger sample size is needed to prove statistical significance.
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Affiliation(s)
- Hanan A. Alshalan
- grid.415329.80000 0004 0604 7897Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - J. Fernando Arevalo
- grid.21107.350000 0001 2171 9311Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD USA
| | - Saleh I. Alomary
- grid.415254.30000 0004 1790 7311Department of Family Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia ,grid.452607.20000 0004 0580 0891King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - Husam I. Ardah
- grid.452607.20000 0004 0580 0891King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - Mohammd A. Hazzazi
- grid.452607.20000 0004 0580 0891King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia ,grid.415254.30000 0004 1790 7311Department of Ophthalmology, King Abdulaziz Medical City, Riyadh, Saudi Arabia ,grid.412149.b0000 0004 0608 0662King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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9
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Nawar AE. Effectiveness of Suprachoroidal Injection of Triamcinolone Acetonide in Resistant Diabetic Macular Edema Using a Modified Microneedle. Clin Ophthalmol 2022; 16:3821-3831. [PMID: 36438589 PMCID: PMC9698330 DOI: 10.2147/opth.s391319] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/09/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose The present study evaluated the effectiveness of suprachoroidal injection of triamcinolone acetonide (TA) in resistant diabetic macular edema (DME) using a modified microneedle. Patients and Methods This is a prospective nonrandomized interventional study that was conducted on 55 eyes of 39 patients with centrally involving DME resistant to previous antivascular endotheli qal growth factor (VEGF) agents. All patients received suprachoroidal injection of triamcinolone acetonide 4 mg/0.1 mL by a modified specialized microneedle. Results The mean central macular thickness (CMT) decreased sign ificantly from 478.7±170.2 µm before injection to 230.2±47.4 µm after 12 months with p-value <0.001. Significant improvement of the mean best corrected visual acuity (BCVA) from 1.193±0.2 by logMAR at the baseline to 0.76±0.3 by logMAR was achieved after 12 months with p-value <0.001. The IOP increased significantly at one month after injection and returned to the baseline value at the third month. Eyes with more baseline CMT and worse baseline BCVA achieved worse final BCVA 12 months after injection. Eyes with inner segment/outer segment (IS/OS) disruption and neurosensory detachment (NSD) showed worse final visual outcomes. IS/OS segment disruption, NSD and baseline BCVA were the main independent predictors of the final BCVA. Conclusion Suprachoroidal injection of TA using this new modified microneedle resulted in marked anatomical and functional results in cases of DME resistant to previous anti-VEGF drugs with no serious ocular or systemic side effects. The study was prospectively registered with clinical trial.gov ID (NCT04690608) in 27–12-2020.
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Affiliation(s)
- Amin E Nawar
- Ophthalmology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
- Correspondence: Amin E Nawar, Ophthalmology Department, Faculty of Medicine, Tanta University, Tanta, 31516, Egypt, Tel +20 1140095692, Email
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10
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Bromeo AJ, Grulla-Quilendrino P, Antolin RC, Salcedo EJJ, Arcinue CA, De Jesus RA, Veloso A. Optical coherence tomography angiography analysis of changes in the foveal avascular zone in eyes with diabetic macular edema treated with intravitreal anti-vascular endothelial growth factor. Int J Retina Vitreous 2022; 8:57. [PMID: 36028899 PMCID: PMC9419407 DOI: 10.1186/s40942-022-00406-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 08/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background To analyze the changes in foveal avascular zone (FAZ) area, perimeter, and circularity in the superficial (SCP) and deep (DCP) capillary plexuses in eyes with diabetic macular edema (DME) treated with intravitreal anti-VEGF using optical coherence tomography angiography (OCTA). Methods This prospective observational study included 56 eyes from 32 patients with DME that received intravitreal anti-VEGF. OCTA images were obtained at baseline and 1, 3, and 6 months of follow-up. The outcome measures were FAZ area, perimeter, and circularity in both the SCP and DCP, as well as central subfield thickness (CST) and best-corrected visual acuity (BCVA). Results The mean number of intravitreal anti-VEGF injections received during the observation period was 4.60 ± 0.82 (range: 3–6). The FAZ area, perimeter, and circularity were statistically unchanged at all observation points in both the SCP (p = 0.772, p = 0.405, p = 0.157, respectively) and the DCP (p = 0.620, p = 0.769, p = 0.481, respectively). Despite having no change in the FAZ parameters, there was still a statistically significant decrease in CST (p < 0.001) as well as a statistically significant increase in BCVA (p = 0.004) during the observation period. Conclusions The FAZ area, perimeter, and circularity in the SCP and DCP as measured by OCTA remained stable during the first 6 months of intravitreal anti-VEGF therapy in eyes with DME. While there were no significant changes in the FAZ, treatment with intravitreal anti-VEGF still resulted in decreased CST and improved BCVA.
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Affiliation(s)
| | | | | | | | - Cheryl A Arcinue
- Asian Eye Institute, Makati, Philippines.,Department of Ophthalmology and Visual Sciences, Philippine General Hospital, University of the Philippines, Manila, Philippines
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11
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Shah J, Nguyen V, Hunt A, Mehta H, Romero-Nuñez B, Zarranz-Ventura J, Viola F, Bougamha W, Barnes R, Barthelmes D, Gillies MC, Fraser-Bell S. Characterization of poor visual outcomes of diabetic macular edema: the Fight Retinal Blindness! Project. Ophthalmol Retina 2022; 6:540-547. [PMID: 35307607 DOI: 10.1016/j.oret.2022.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE To investigate the incidence, characteristics and baseline predictors of poor visual outcomes in eyes with diabetic macular edema (DME) receiving intravitreal therapy in routine clinical practice. DESIGN Observational study. PARTICIPANTS Treatment-naive eyes starting intravitreal therapy for DME between 2014 and 2018 tracked in the Fight Retinal Blindness! registry. We examined two groups with poor visual outcomes: 1) Those with sustained vision loss of >10 letters from baseline without recovery of visual acuity (VA) or 2) Those with VA<55 letters at 2 years. Respective controls were eyes that did not experience poor visual outcomes. METHODS Kaplan-Meier curves analyzed proportion of eyes that experienced poor outcomes. Cox proportional hazards models evaluated potential baseline predictors of poor outcomes. MAIN OUTCOME MEASURES The proportion of eyes that experienced poor visual outcomes within 2 years of treatment initiation and its baseline predictors. RESULTS The proportion of eyes with sustained VA>10 letter loss was 14% at 2 years while 16% of eyes had VA< 55 letters 2 years after starting intravitreal therapy. Initial treatment with intravitreal corticosteroid was independently associated with higher incidence of >10 letter loss was (Hazard ratio [HR], 3.21; 95% confidence interval [CI], 1.60-6.44; P< 0.01). No improvement in VA 3 months after starting treatment was associated with >10 letter loss (HR, 6.81; 95% CI, 4.11-11.27; P <0.01) and VA<55 letters at 2 years (HR, 4.28; 95% CI, 2.66- 6.89; P <0.01). The other factors related to higher risk of VA<55 letters were older age (HR, 1.02 per year; 95% CI, 1-1.04; P = 0.04) and poor baseline VA (HR, 0.68 per 5 letters; 95% CI, 0.65- 0.72, P <0.001). CONCLUSION Fourteen percent of eyes managed with intravitreal therapy in routine clinical care experienced >10 letter loss and 16% had VA<55 letters 2 years after starting treatment for DME. Identification of the incidence and predictors of poor outcomes provides more accurate assessment of the potential benefit from intravitreal therapy.
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Affiliation(s)
- Janika Shah
- Save Sight Institute, The University of Sydney, NSW, Australia; Sydney Hospital and Sydney Eye Hospital, NSW, Australia.
| | - Vuong Nguyen
- Save Sight Institute, The University of Sydney, NSW, Australia
| | - Adrian Hunt
- Save Sight Institute, The University of Sydney, NSW, Australia
| | - Hemal Mehta
- Save Sight Institute, The University of Sydney, NSW, Australia; Department of Ophthalmology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Barbara Romero-Nuñez
- Hospital Clínic de Barcelona Institut Clinic de Oftalmología (ICOF), Barcelona, Spain
| | | | - Francesco Viola
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Walid Bougamha
- Department of Ophthalmology, University Hospital Nice, University of Nice, France
| | | | - Daniel Barthelmes
- Save Sight Institute, The University of Sydney, NSW, Australia; Department of Ophthalmology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Mark C Gillies
- Save Sight Institute, The University of Sydney, NSW, Australia; Sydney Hospital and Sydney Eye Hospital, NSW, Australia
| | - Samantha Fraser-Bell
- Save Sight Institute, The University of Sydney, NSW, Australia; Sydney Hospital and Sydney Eye Hospital, NSW, Australia
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12
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Borrelli E, Grosso D, Barresi C, Lari G, Sacconi R, Senni C, Querques L, Bandello F, Querques G. Long-Term Visual Outcomes and Morphologic Biomarkers of Vision Loss in Eyes With Diabetic Macular Edema Treated With Anti-VEGF Therapy. Am J Ophthalmol 2022; 235:80-89. [PMID: 34509431 DOI: 10.1016/j.ajo.2021.09.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 09/02/2021] [Accepted: 09/02/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE To analyze the morphological characteristics and long-term visual outcomes in eyes with diabetic retinopathy (DR) and diabetic macular edema (DME) treated with anti-vascular endothelial growth factor (anti-VEGF) therapy. DESIGN Retrospective clinical cohort study. METHODS Patients with a long-term follow-up and evidence of resolved DME in at least 1 visit (study visit) after 5 years of follow-up after the initiation of anti-VEGF therapy were included. At the study visit, structural optical coherence tomography (OCT) scans were reviewed for qualitative features reflecting a distress of the neuroretina or retinal pigment epithelium (RPE). A quantitative topographical assessment of the inner and outer retinal thicknesses was also provided. RESULTS A total of 61 eyes (50 patients) were included and were divided into 2 subgroups according to visual acuity (VA) at the study visit, yielding a group of 24 eyes with a VA <20/40 ("poor/intermediate vision" group), and 37 eyes with a VA ≥20/40 ("good vision" group). The external limiting membrane (ELM) and RPE bands were more frequently disrupted or absent in the poor/intermediate vision group (P = .003 and P = .019). Similarly, disorganization of retinal inner layers was more prevalent in the poor/intermediate vision group (P = .013). The foveal and parafoveal outer retinal thicknesses were reduced in eyes with poor/intermediate vision (P = .022 and P = .044). Multivariate stepwise linear regression analysis demonstrated that VA was associated with appearances of the RPE and ELM (P < .0001 and P = .048), foveal and parafoveal outer retinal thicknesses (P = .046 and P = .035). CONCLUSIONS Modifications in the outer retina and RPE represent OCT biomarkers of long-term visual outcomes in eyes with DME treated with anti-VEGF.
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13
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Angermann R, Hofer M, Huber AL, Rauchegger T, Nowosielski Y, Casazza M, Falanga V, Zehetner C. The impact of compliance among patients with diabetic macular oedema treated with intravitreal aflibercept: a 48-month follow-up study. Acta Ophthalmol 2022; 100:e546-e552. [PMID: 34145756 PMCID: PMC9291031 DOI: 10.1111/aos.14946] [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: 01/14/2021] [Accepted: 05/31/2021] [Indexed: 11/29/2022]
Abstract
Purpose This study aimed to compare anatomical and functional outcomes between patients with non‐proliferative diabetic retinopathy (NPDR) with diabetic macular oedema (DME) who adhered to intravitreal aflibercept therapy and patients lost to follow‐up (LTFU). Methods We enrolled 200 patients and recorded the interval between each procedure and the subsequent follow‐up visit. Moreover, visual acuity (VA) and anatomical outcomes were measured at each follow‐up examination. Results Among the patients, 103 (51%) patients adhered to intravitreal aflibercept therapy and follow‐up examination while 97 (49%) patients were LTFU. Forty‐six (47%) patients LTFU who returned for further treatment showed a significant decrease in VA from 0.51 (±0.46) to 0.89 (±0.38) logarithm of the minimum angle of resolution (logMAR) after 48 months (p = 0.004). Compared with the adherent group, the return group showed a worse VA at 48 months (p = 0.036). Further, 1 (1%) patient in the adherent group and 8 (17%) patients in the return group developed a proliferative DR. Patients who were LTFU had a 13.0 times greater chance to develop a proliferative DR (p = 0.022). Conclusions Patients who did not adhere to intravitreal aflibercept therapy for DME showed significantly worse visual outcomes compared to patients with good therapy adherence. Moreover, patients with LTFU had a 13 times higher risk of developing a proliferative DR. Considering the potential disease progress, better strategies should be applied to optimize the functional outcome of patients at risk of reduced adherence.
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Affiliation(s)
- Reinhard Angermann
- Department of Ophthalmology Medical University Innsbruck Innsbruck Austria
- Department of Ophthalmology Paracelsus Medical University Salzburg Salzburg Austria
| | - Markus Hofer
- Department of Ophthalmology Medical University Innsbruck Innsbruck Austria
| | - Anna Lena Huber
- Department of Ophthalmology Medical University Innsbruck Innsbruck Austria
| | - Teresa Rauchegger
- Department of Ophthalmology Medical University Innsbruck Innsbruck Austria
| | - Yvonne Nowosielski
- Department of Ophthalmology Medical University Innsbruck Innsbruck Austria
| | - Marina Casazza
- Department of Ophthalmology Medical University Innsbruck Innsbruck Austria
| | - Valeria Falanga
- Department of Ophthalmology Medical University Innsbruck Innsbruck Austria
| | - Claus Zehetner
- Department of Ophthalmology Medical University Innsbruck Innsbruck Austria
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14
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Gurung RL, FitzGerald LM, Liu E, McComish BJ, Kaidonis G, Ridge B, Hewitt AW, Vote BJ, Verma N, Craig JE, Burdon KP. The effect of insulin on response to intravitreal anti-VEGF injection in diabetic macular edema in type 2 diabetes mellitus. BMC Ophthalmol 2022; 22:94. [PMID: 35227220 PMCID: PMC8883612 DOI: 10.1186/s12886-022-02325-x] [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: 11/06/2021] [Accepted: 02/17/2022] [Indexed: 11/10/2022] Open
Abstract
Objectives To assess whether insulin therapy impacts the effectiveness of anti-vascular endothelial growth factor (anti-VEGF) injection for the treatment of diabetic macular edema (DME) in type 2 diabetes mellitus. Methods This was a retrospective multi-center analysis. The best-corrected visual acuity (BCVA) at 12 months, BCVA change, central macular thickness (CMT), CMT change, and cumulative injection number were compared between the insulin and the oral hypoglycemic agent (OHA) groups. Results The mean final BCVA and CMT improved in both the insulin (N = 137; p < 0.001; p < 0.001, respectively) and the OHA group (N = 61; p = 0.199; p < 0.001, respectively). The two treatment groups were comparable for final BCVA (p = 0.263), BCVA change (p = 0.184), final CMT (p = 0.741), CMT change (p = 0.458), and the cumulative injections received (p = 0.594). The results were comparable between the two groups when stratified by baseline vision (p > 0.05) and baseline HbA1c (p > 0.05). Conclusion Insulin therapy does not alter treatment outcomes for anti-VEGF therapy in DME. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-022-02325-x.
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Affiliation(s)
- Rajya L Gurung
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street (Private Bag 23), Hobart, Tas, 7000, Australia.
| | - Liesel M FitzGerald
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street (Private Bag 23), Hobart, Tas, 7000, Australia
| | - Ebony Liu
- Department of Ophthalmology, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South, Australia
| | - Bennet J McComish
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street (Private Bag 23), Hobart, Tas, 7000, Australia
| | - Georgia Kaidonis
- Department of Ophthalmology, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South, Australia
| | - Bronwyn Ridge
- Department of Ophthalmology, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South, Australia
| | - Alex W Hewitt
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street (Private Bag 23), Hobart, Tas, 7000, Australia.,School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Brendan Jt Vote
- School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Nitin Verma
- School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Jamie E Craig
- Department of Ophthalmology, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South, Australia
| | - Kathryn P Burdon
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street (Private Bag 23), Hobart, Tas, 7000, Australia
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15
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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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16
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Levinger N, Tiosano L, Assayag E, Lender R, Batash T, Levy J, Chowers I. Correlation of response to intravitreal bevacizumab treatment between the first and second treated eyes in diabetic macular edema. Eur J Ophthalmol 2021; 32:2712-2718. [PMID: 34779280 DOI: 10.1177/11206721211059680] [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: 11/15/2022]
Abstract
PURPOSE To evaluate whether outcome of bevacizumab treatment in the first treated eye can guide the selection of compound for the second treated eye in patients with bilateral diabetic macular edema. METHODS Demographic, clinical, and optical coherence tomography data were retrospectively collected from consecutive patients who underwent bevacizumab therapy for bilateral diabetic macular edema. Change in central subfield thickness and visual acuity were evaluated and compared between the first treated eye and second treated eye. RESULTS A total of 66 eyes of 33 patients were included in the study. The mean ± SD follow-up time was 13 ± 5 months. The mean ± SD central subfield thickness at baseline was 464 ± 30 μm in the first treated eye and 461 ± 29 μm in the second treated eye (p = 0.91). Final central subfield thickness was reduced to 392 ± 27 μm in the first treated eye (p = 0.01 compared with baseline) and 416 ± 25 μm in the second treated eye (p = 0.03 compared with baseline). Using ≥5% or ≥10% reduction of central subfield thickness as diagnostic criteria to predict similar magnitude of thickness reduction in the first treated eye yielded a positive and negative predictive value ranging from 46% to 81%, and sensitivity and specificity ranging from 54% to 84%. Regression models did not show correlation between central subfield thickness reduction in first treated eye and the second treated eye at the end of follow-up. CONCLUSIONS Bevacizumab therapy reduced macular thickness in both eyes in bilateral diabetic macular edema. Treatment outcome of the first treated eye could not predict the outcome of the second treated eye. Particularly, failure to reduce central subfield thickness in the first treated eye does not preclude a favorable response to bevacizumab therapy in the second eye.
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Affiliation(s)
- Nadav Levinger
- Faculty of Medicine, Department of Ophthalmology, Hadassah-Hebrew University Medical Center, 26742Hebrew University of Jerusalem, Israel
| | - Liran Tiosano
- Faculty of Medicine, Department of Ophthalmology, Hadassah-Hebrew University Medical Center, 26742Hebrew University of Jerusalem, Israel
| | - Elishai Assayag
- Faculty of Medicine, Department of Ophthalmology, Hadassah-Hebrew University Medical Center, 26742Hebrew University of Jerusalem, Israel
| | - Rivkah Lender
- Faculty of Medicine, Department of Ophthalmology, Hadassah-Hebrew University Medical Center, 26742Hebrew University of Jerusalem, Israel
| | - Tomer Batash
- Faculty of Medicine, Department of Ophthalmology, Hadassah-Hebrew University Medical Center, 26742Hebrew University of Jerusalem, Israel
| | - Jaime Levy
- Faculty of Medicine, Department of Ophthalmology, Hadassah-Hebrew University Medical Center, 26742Hebrew University of Jerusalem, Israel
| | - Itay Chowers
- Faculty of Medicine, Department of Ophthalmology, Hadassah-Hebrew University Medical Center, 26742Hebrew University of Jerusalem, Israel
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17
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Halim MS, Afridi R, Hasanreisoglu M, Hassan M, Ibrahim-Ahmed M, Do DV, Sepah YJ. Differences in the characteristics of subjects achieving complete, partial, or no resolution of macular edema in the READ-3 study. Graefes Arch Clin Exp Ophthalmol 2021; 259:2941-2948. [PMID: 33792788 PMCID: PMC10919548 DOI: 10.1007/s00417-021-05148-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 02/16/2021] [Accepted: 03/02/2021] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To identify baseline characteristics of subjects enrolled in the READ-3 study that would predict the response of macular edema to ranibizumab (RBZ) therapy at year 1. METHODS In this post hoc analysis of the READ-3 randomized, multicenter phase 2 clinical trial, subjects with diabetic macular edema (DME) were randomized to receive monthly intravitreal injections of RBZ (0.5 or 2.0 mg) for 6 consecutive injections followed by as-needed treatments based on pre-defined retreatment criteria. In this sub-study, subjects were divided into three groups (persistent, rebound, and resolved) based on edema status at month 12 (M12). Multi-logistic regression was utilized to assess the probability of edema outcomes M12, based on the baseline characteristics. RESULTS One hundred twenty-three out of 152 subjects were analyzed for this sub-study. A significant difference was observed in the baseline (BL) central subfield thickness (CST) among the study groups (p < 0.05). BL CST was a significant predictor for edema outcome at M12 with > 80% probability of the subject having persistent edema if BL CST was > 570 μm (p < 0.05). This association persisted when controlled for the dose of RBZ (relative risk (RR), 1.007; p < 0.05). BL CST was also a significant predictor for having persistent edema at M12 in subjects without vitreomacular adhesion (VMA) (> 80% probability of edema persistence at CST > 570 μm [RR, 1.006; p < 0.05]). However, in the presence of VMA, BL CST was no longer a significant predictor of having persistent edema at month 12 (RR, 1.005; p > 0.05). CONCLUSIONS Subjects with high CST (> 570 μm) at baseline may not benefit from repeated intravitreal injections of anti-VEGF for resolution of edema.
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Affiliation(s)
- Muhammad Sohail Halim
- Byers Eye Institute, Stanford University, 2370 Watson Court - Suite 200, Palo Alto, CA, 94303, USA
- Ocular Imaging Research and Reading Center, Menlo Park, CA, USA
| | - Rubbia Afridi
- Byers Eye Institute, Stanford University, 2370 Watson Court - Suite 200, Palo Alto, CA, 94303, USA
| | - Murat Hasanreisoglu
- Byers Eye Institute, Stanford University, 2370 Watson Court - Suite 200, Palo Alto, CA, 94303, USA
- Department of Ophthalmology, Koç University, School of Medicine, Istanbul, Turkey
- Koç University Research Center for Translational Medicine, Istanbul, Turkey
| | - Muhammad Hassan
- Byers Eye Institute, Stanford University, 2370 Watson Court - Suite 200, Palo Alto, CA, 94303, USA
| | | | - Diana V Do
- Byers Eye Institute, Stanford University, 2370 Watson Court - Suite 200, Palo Alto, CA, 94303, USA
| | - Yasir Jamal Sepah
- Byers Eye Institute, Stanford University, 2370 Watson Court - Suite 200, Palo Alto, CA, 94303, USA.
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18
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Zhang CL, Wang HL, Li PC, Hong CD, Chen AQ, Qiu YM, Zeng AP, Zhou YF, Hu B, Li YN. Mfsd2a overexpression alleviates vascular dysfunction in diabetic retinopathy. Pharmacol Res 2021; 171:105755. [PMID: 34229049 DOI: 10.1016/j.phrs.2021.105755] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 06/30/2021] [Accepted: 06/30/2021] [Indexed: 11/30/2022]
Abstract
Diabetic retinopathy (DR) is one of the common complications in diabetic patients. Nowadays, VEGF pathway is subject to extensive research. However, about 27% of the patients have a poor visual outcome, with 50% still having edema after two years' treatment of diabetic macular edema (DME) with ranibizumab. Docosahexaenoic acid (DHA), the primary ω-3 long-chain polyunsaturated fatty acid (LC-PUFA), reduces abnormal neovascularization and alleviates neovascular eye diseases. A study reported that fish oil reduced the incidence of retinopathy of prematurity (ROP) by about 27.5% in preterm infants. Although ω-3 LC-PUFAs protects against pathological retinal neovascularization, the treatment effectiveness is low. It is interesting to investigate why DHA therapy fails in some patients. In human vitreous humor samples, we found that the ratio of DHA and DHA-derived metabolites to total fatty acids was higher in vitreous humor from DR patients than that from macular hole patients; however, the ratio of DHA metabolites to DHA and DHA-derived metabolites was lower in the diabetic vitreous humor. The expression of Mfsd2a, the LPC-DHA transporter, was reduced in the oxygen-induced retinopathy (OIR) model and streptozotocin (STZ) model. In vitro, Mfsd2a overexpression inhibited endothelial cell proliferation, migration and vesicular transcytosis. Moreover, Mfsd2a overexpression in combination with the DHA diet obviously reduced abnormal retinal neovascularization and vascular leakage, which is more effective than Mfsd2a overexpression alone. These results suggest that DHA therapy failure in some DR patients is linked to low expression of Mfsd2a, and the combination of Mfsd2a overexpression and DHA therapy may be an effective treatment.
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Affiliation(s)
- Chun-Lin Zhang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Hai-Ling Wang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Peng-Cheng Li
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Can-Dong Hong
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - An-Qi Chen
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yan-Mei Qiu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Ai-Ping Zeng
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yi-Fan Zhou
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Bo Hu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Ya-Nan Li
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
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19
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Sharma S, Sharma T, Prasad S, Gopalakrishnan M, Chaturvedi A. Treatment Landscape of Macular Disorders in Indian Patients with the Advent of Razumab™ (World's First Biosimilar Ranibizumab): A Comprehensive Review. Ophthalmol Ther 2021; 10:431-443. [PMID: 34155608 PMCID: PMC8216589 DOI: 10.1007/s40123-021-00362-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/08/2021] [Indexed: 11/27/2022] Open
Abstract
Ranibizumab is approved for the treatment of several macular disorders, including wet age-related macular degeneration (wet AMD), diabetic macular edema (DME), retinal vein occlusion (RVO) and myopic choroidal neovascularization (mCNV), among others. The unaffordability of the innovator ranibizumab among patients from developing countries such as India led to the development of the world’s first biosimilar ranibizumab, which is a cost-effective alternative that does not compromise efficacy and safety. Razumab™, developed and produced by Intas Pharmaceuticals Ltd., India, is the world’s first biosimilar of ranibizumab, and is approved in India for the treatment of various macular disorders, including wet AMD, DME, RVO and mCNV. The efficacy and safety of Razumab for the treatment of these macular disorders have been evaluated in both prospective and real-world retrospective studies. Razumab has shown an efficacy similar to that of the innovator ranibizumab, achieving improved visual acuity, as measured by the best corrected visual acuity, and reduction in the central macular thickness, leading to improved patient outcomes. The safety profile of Razumab is comparable to that of the innovator ranibizumab and is well tolerated without any new safety concerns. Here, we review the clinical and real-world data of Razumab in the treatment of macular disorders.
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Affiliation(s)
- Shashikant Sharma
- Medical Affairs, Intas Pharmaceuticals Limited, Ahmedabad, Gujarat, India.
| | | | - Somdutt Prasad
- AMRI & Fortis Medical Centre, Kolkata, West Bengal, India
| | | | - Alok Chaturvedi
- Medical Affairs, Intas Pharmaceuticals Limited, Ahmedabad, Gujarat, India
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20
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Sim SY, Ghulakhszian A, Minocha A, Ramcharan D, Nokhostin S, Cheong-Leen R, George S, Posner E, Dinah C. Factors Influencing Response to Aflibercept in Diabetic Macular Oedema Patients in a Diverse North West London Population: A Real-World Study. Clin Ophthalmol 2021; 15:2089-2097. [PMID: 34045845 PMCID: PMC8144175 DOI: 10.2147/opth.s314614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/07/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Diabetic macular oedema (DMO) is the leading cause of sight impairment in working age populations in developed countries. Current first line treatment for centre-involving DMO involves intravitreal anti-VEGF but treatment response can be variable. In this retrospective, real world, multi-centre cohort study, we aim to identify ocular and systemic characteristics that correlate with anatomical and functional outcomes for treatment-naive DMO patients treated with intravitreal aflibercept. METHODS Retrospective multicentre cohort study of treatment-naive DMO patients initiated on aflibercept at three North West London hospitals between 2016 and 2018. Baseline systemic and ocular factors, best corrected visual acuity (BCVA) and central macular thickness (CMT) at 12 months were determined and statistically analysed. RESULTS A total of 270 eyes of 221 DMO patients met inclusion criteria. Mean age was 62.8 ± 12.1, mean baseline HbA1c was 67 ± 20 mmol/mol, and mean eGFR was 72 mL/min/1.7m2. Mean number of aflibercept injections at 12 months was 6.2. Better baseline BCVA, lower baseline CMT, and absence of epiretinal membrane (ERM) were associated with better BCVA at 12 months whilst lower baseline CMT and proliferative retinopathy status were associated with lower CMT at 12 months. CONCLUSION Our study is the largest real-world dataset examining factors influencing functional and anatomical response to aflibercept in DMO in the UK. Older age, lower baseline BCVA, higher baseline CMT and more severe diabetic retinopathy were associated with poorer visual acuity at 12 months and prioritisation of these patients within a pressured healthcare setting is recommended.
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Affiliation(s)
- Sing Yue Sim
- Department of Ophthalmology, The Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - Arevik Ghulakhszian
- Department of Ophthalmology, London North West University Healthcare NHS Trust, London, UK
| | - Amal Minocha
- Department of Ophthalmology, The Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - Dhannie Ramcharan
- Department of Ophthalmology, London North West University Healthcare NHS Trust, London, UK
| | - Soroush Nokhostin
- Department of Ophthalmology, Imperial College Healthcare NHS Trust, London, UK
| | - Richard Cheong-Leen
- Department of Ophthalmology, The Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - Sheena George
- Department of Ophthalmology, The Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - Esther Posner
- Department of Ophthalmology, Imperial College Healthcare NHS Trust, London, UK
| | - Christiana Dinah
- Department of Ophthalmology, London North West University Healthcare NHS Trust, London, UK
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21
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PRAGMATISM OF RANDOMIZED CLINICAL TRIALS ON RANIBIZUMAB FOR THE TREATMENT OF DIABETIC MACULAR EDEMA: Impact on Clinical Outcomes. Retina 2021; 40:919-927. [PMID: 30789463 PMCID: PMC7176348 DOI: 10.1097/iae.0000000000002476] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the pragmatism and generalizability of randomized clinical trials (RCTs) on ranibizumab for diabetic macular edema and determine whether clinical outcomes would differ based on whether or not patients fulfill the eligibility criteria of these RCTs. METHODS Pragmatism and generalizability of three RCTs on ranibizumab for diabetic macular edema (DRCRnet Protocols I and T, and RESTORE) were rated using the PRECIS-2 tool. A cohort of consecutive patients with diabetic macular edema was assessed to determine whether clinical outcomes differed based on whether or not patients met the RCT eligibility criteria. Univariable and multivariable regression analyses, adjusted for baseline best-corrected visual acuity, central retinal thickness and number of injections received, were used. RESULTS All RCTs were rated as being more pragmatic than explanatory, with DRCRnet trials being the most pragmatic. Of the 216 eyes (176 patients) included in the cohort, 63% would have met eligibility criteria for Protocol T, 61% for Protocol I, and 56% for RESTORE. When adjusted for best-corrected visual acuity, central retinal thickness, and number of ranibizumab injections received, there were no statistically significant differences in best-corrected visual acuity or central retinal thickness found between "eligible" and "ineligible" patients. CONCLUSION Randomized clinical trials evaluating ranibizumab for diabetic macular edema were more pragmatic than explanatory. "Ineligible" patients still benefited from ranibizumab therapy.
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22
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Ehlers JP, Uchida A, Sevgi DD, Hu M, Reed K, Berliner A, Vitti R, Chu K, Srivastava SK. Retinal Fluid Volatility Associated With Interval Tolerance and Visual Outcomes in Diabetic Macular Edema in the VISTA Phase III Trial. Am J Ophthalmol 2021; 224:217-227. [PMID: 33253664 DOI: 10.1016/j.ajo.2020.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 11/07/2020] [Accepted: 11/13/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE To describe longitudinal retinal fluid dynamics on spectral domain OCT and to identify imaging biomarkers that predict the worsening of DME with interval extension during anti-vascular endothelial growth factor (VEGF) therapy. DESIGN A post hoc sub-analysis of phase III, VISTA-DME study. METHODS Eyes received either intravitreal aflibercept injection 2 mg every 4 weeks (2q4) or every 8 weeks after 5 initial monthly injections (2q8), and eyes imaged with the Cirrus HD-OCT system were included. The macular cube was analyzed for 10 time-points from baseline through week 100. Retinal OCT images were evaluated using a novel software platform to extract retinal fluid features for calculation of volumetric fluid parameters, including the retinal fluid index (RFI): the percentage of retinal volume that was occupied by intraretinal fluid. RESULTS Fifty-five eyes were included in the 2q4 group, and 58 eyes were included in the 2q8 group. Early RFI volatility with a central macular RFI increase by ≥5 points from week 4 to 8 (P = .004, odds ratio [OR] 31.3, 95% confidence interval [CI] 3.0 to 329) and cumulative RFI volatility with an aggregate increase in macular RFI by ≥10 points from those timepoints with increased RFI between baseline to week 20, P = .005, OR 10.2, 95% CI 2.1 to 51.3) were both significant predictors for the worsening of DME and visual acuity when the treatment interval was extended to 8 weeks in the 2q8 group. CONCLUSIONS Early fluid dynamics as measured by (1) early RFI volatility and (2) cumulative RFI instability with aggregate increased RFI were associated with intolerance of interval extension.
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23
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Choovuthayakorn J, Tantraworasin A, Phinyo P, Patumanond J, Kunavisarut P, Srisomboon T, Winaikosol P, Patikulsila D, Chaikitmongkol V, Watanachai N, Pathanapitoon K. Factors associated with 1-year visual response following intravitreal bevacizumab treatment for diabetic macular edema: a retrospective single center study. Int J Retina Vitreous 2021; 7:17. [PMID: 33663604 PMCID: PMC7931592 DOI: 10.1186/s40942-021-00286-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/15/2021] [Indexed: 01/05/2023] Open
Abstract
Background To explore the association of clinical characteristics and retinal microstructural features on optical coherence tomography in predicting 1-year visual response following intravitreal bevacizumab injections in eyes with visual impairment from center-involved diabetic macular edema (CI-DME). Methods Medical records of patients with visual impairment from CI-DME, who initiated intravitreal bevacizumab injections between Jan 2012 and Dec 2016 and were followed for a minimum of 12 months were retrospectively reviewed. Results The study included 226 eyes with a mean (SD) baseline visual acuity (VA) of 51.8 (19.1) letters. At week 12, following the three initial treatments, a mean (SD) VA improved to 61.7 (17.8) letters. Visual gain ≥ 10 letters was observed in 109 eyes (48.2%), while a limited early visual gain < 5 letters was noted in 80 eyes (35.4%). At one year, 110 eyes (48.7%) achieved a good VA gain ≥ 10 letters. In addition, eyes with poor baseline VA had a higher proportion of eyes that obtained limited early VA gained at week 12 (< 5 letters) and maintained in this visual response category at moth 12 compared to eyes with better baseline VA (74.1% versus 59.1%). In the multivariable logistic regression, the following factors reduced the probability of 1-year visual gain ≥ 10 letters: elderly (p = 0.040), better baseline vision (p = 0.001), and limited early visual gain < 5 letters at week 12 (p < 0.001). In multivariable linear regression, male (p = 0.010) and eyes with the presence of hyperreflective foci on baseline OCT (p = 0.010) were likely to have higher VA improvement. However, eyes with better baseline VA (p = 0.002), limited early VA gain at week 12 (p < 0.001), and a presence of EZ disruption at week 12 (p = 0.002) were likely to have less VA improvement. Conclusions Although bevacizumab is considered as effective management for CI-DME, variability in treatment responses is expected. This study revealed that baseline characteristics and visual responses at week 12 might help predict the long-term treatment response. Eyes with characteristics at risk of limited long-term visual outcome may require attention in optimizing their individual treatment strategies.
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Affiliation(s)
- Janejit Choovuthayakorn
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Apichat Tantraworasin
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Clinical Epidemiology and Clinical Statistics Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Phichayut Phinyo
- Clinical Epidemiology and Clinical Statistics Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. .,Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. .,Musculoskeletal Science and Translational Research (MSTR), Chiang Mai University, Chiang Mai, Thailand.
| | - Jayanton Patumanond
- Clinical Epidemiology and Clinical Statistics Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Paradee Kunavisarut
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Titipol Srisomboon
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pawara Winaikosol
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Direk Patikulsila
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Voraporn Chaikitmongkol
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nawat Watanachai
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kessara Pathanapitoon
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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24
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Valera-Cornejo DA, Romero-Morales V, García-Roa M, Ramírez-Neria P, Villalpando-Gómez Y, García-Franco R. Association Between First- and Third-Month Responses to Intravitreal Ranibizumab for Diabetic Macular Edema. JOURNAL OF VITREORETINAL DISEASES 2021; 5:99-107. [PMID: 37009080 PMCID: PMC9979050 DOI: 10.1177/2474126420936461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: This work examines the relationship between first- and third-month anatomical and visual response with antivascular endothelial growth factor for diabetic macular edema. Methods: We prospectively evaluated 58 eyes with center-involved diabetic macular edema. Response was categorized upon the anatomical status after 3 monthly doses based on the reduction of central macular thickness (CMT) from baseline (≥20% or not). Correlation analysis between the anatomical response status, gained letters, optical coherence tomography morphological features, and other baseline characteristics were obtained. Results: Twenty-five eyes (43.1%) achieved an anatomical reduction of ≥20% at the third month. Those with a reduction of ≥20% of CMT had subretinal fluid ( P < .01), lower hemoglobin A1c values ( P < .01), lower proportion of intraretinal cysts ( P < .01), a greater anatomical reduction, and visual improvement at the first month of treatment. Multiple logistic regression analysis, showed that the change of CMT after the first injection was an independent predictor for the anatomical reduction of ≥20% after the loading phase ( P < .05). Best corrected visual acuity gain after the first dose showed a significant association with an improvement of ≥10 letters after the loading phase ( P < .05), but not for macular thickness reduction. Conclusions: First month anatomical reduction was associated with the anatomical response at 3 months ( P = .042) after monthly ranibizumab therapy. Visual improvement at the first month was predictive only for the visual outcome after the 3 monthly doses ( P = .032).
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Affiliation(s)
- Diego Alejandro Valera-Cornejo
- Retina Service, Mexican Institute of Ophthalmology, Querétaro, México
- National Autonomous University of Mexico, Mexico City, Mexico
| | - Verónica Romero-Morales
- Retina Service, Mexican Institute of Ophthalmology, Querétaro, México
- National Autonomous University of Mexico, Mexico City, Mexico
| | - Marlon García-Roa
- Retina Service, Mexican Institute of Ophthalmology, Querétaro, México
- National Autonomous University of Mexico, Mexico City, Mexico
| | - Paulina Ramírez-Neria
- Retina Service, Mexican Institute of Ophthalmology, Querétaro, México
- National Autonomous University of Mexico, Mexico City, Mexico
| | - Yolanda Villalpando-Gómez
- Retina Service, Mexican Institute of Ophthalmology, Querétaro, México
- National Autonomous University of Mexico, Mexico City, Mexico
| | - Renata García-Franco
- Retina Service, Mexican Institute of Ophthalmology, Querétaro, México
- National Autonomous University of Mexico, Mexico City, Mexico
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25
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Usui-Ouchi A, Tamaki A, Sakanishi Y, Tamaki K, Mashimo K, Sakuma T, Ebihara N. Factors Affecting a Short-Term Response to Anti-VEGF Therapy in Diabetic Macular Edema. Life (Basel) 2021; 11:life11020083. [PMID: 33503815 PMCID: PMC7912394 DOI: 10.3390/life11020083] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/15/2021] [Accepted: 01/23/2021] [Indexed: 11/16/2022] Open
Abstract
Diabetic macular edema (DME) is a common cause of visual impairment in patients with diabetes. Although intravitreal anti-vascular endothelial growth factor (VEGF) injections were efficacious in clinical trials, several patients exhibited a poor response. This study aimed to compare clinical features between patients who were susceptible to intravitreal anti-VEGF injections for DME and those who were not. A single-center, retrospective study of 102 such patients was conducted (123 eyes; mean ± standard deviation age, 63.4 ± 10.8 years; 57.8% males). Systemic and ocular data, assessed at baseline and after a month, were compared between good (>20% decrease in central macular thickness (CMT)) and poor (≤20% decrease in CMT) responders using the Mann-Whitney U test/Fisher's exact test. Eighty-one eyes (65.9%) were good responders. The glycosylated hemoglobin level was higher (p = 0.011) in poor (7.5% ± 0.94%) than in good (7.04% ± 1.19%) responders. The foveal avascular zone was larger (p = 0.0003) in poor (0.67 ± 0.33 μm2) than in good (0.47 ± 0.23 μm2) responders. The number of microaneurysms in the pericapillary network was higher (p = 0.0007) in poor (2.7 ± 2.2) than in good (1.4 ± 2.0) responders. Baseline glycemic control and macular ischemia may be associated with the short-term response to intravitreal anti-VEGF injections.
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26
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Gabrielle P, Massin P, Arnould L, Couturier A, Bouché‐Pillon J, Maupin E, Aho‐Glele S, Bron AM, Kodjikian L, Creuzot‐Garcher C. Development of a 1-year risk-prediction nomogram for good functional response with anti-VEGF agents in naive diabetic macular oedema. Acta Ophthalmol 2020; 98:e975-e982. [PMID: 32268017 DOI: 10.1111/aos.14428] [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: 10/02/2019] [Accepted: 03/12/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To develop a risk-prediction nomogram based on baseline variables for good functional response during the 1st year of treatment with anti-VEGF agents in naive diabetic macular oedema (DME). METHODS This retrospective study included patients presenting naive-DME treated with anti-VEGF therapy at Dijon University Hospital (France) between 1 February 2012 and 31 March 2015 (derivation cohort). We studied baseline variables that had significant associations with a good functional response to anti-VEGF agents during the 1st year of treatment. We used a program to generate a nomogram based on a binary logistic regression predictive model. Then, this nomogram was tested on data from a separate cohort of naive-DME patients from a multicenter study involving 20 French ophthalmologic centres between January 2014 and June 2015 (validation cohort). RESULTS Age, baseline BCVA and ellipsoid zone integrity on spectral-domain optical coherence tomography (SD-OCT) are functional prognostic factors and were used to build a nomogram. The nomogram showed excellent discrimination for good functional responders (area under the curve (AUC) = 0.906, 95% confidence interval (95% CI) = [0.849-0.964], p = 0.004). The discriminative power of this nomogram was tested on the validation cohort data, demonstrating good discrimination of good functional responders (AUC = 0.942, 95% CI = [0.898-0.986], p < 0.001). CONCLUSION This nomogram provides a useful estimation of a good functional response in naive-DME patients treated with anti-VEGF agents.
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Affiliation(s)
- Pierre‐Henry Gabrielle
- Ophthalmology Department University Hospital Dijon France
- Eye and Nutrition Research Group Centre des Sciences du Goût et de l’Alimentation UMR1324 INRA 6265 CNRS University of Bourgogne Franche‐Comté Dijon France
| | - Pascale Massin
- Ophthalmology Department Lariboisière Hospital Assistance Publique des Hôpitaux de Paris Université Paris Diderot Paris France
| | - Louis Arnould
- Ophthalmology Department University Hospital Dijon France
| | - Aude Couturier
- Ophthalmology Department Lariboisière Hospital Assistance Publique des Hôpitaux de Paris Université Paris Diderot Paris France
| | | | - Edouard Maupin
- Ophthalmology Department University Hospital Dijon France
| | | | - Alain M. Bron
- Ophthalmology Department University Hospital Dijon France
- Eye and Nutrition Research Group Centre des Sciences du Goût et de l’Alimentation UMR1324 INRA 6265 CNRS University of Bourgogne Franche‐Comté Dijon France
| | - Laurent Kodjikian
- Ophthalmology Department Lyon la Croix‐Rousse Hospices civils de Lyon Lyon France
| | - Catherine Creuzot‐Garcher
- Ophthalmology Department University Hospital Dijon France
- Eye and Nutrition Research Group Centre des Sciences du Goût et de l’Alimentation UMR1324 INRA 6265 CNRS University of Bourgogne Franche‐Comté Dijon France
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27
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Campochiaro PA, Iftikhar M, Hafiz G, Akhlaq A, Tsai G, Wehling D, Lu L, Wall GM, Singh MS, Kong X. Oral N-acetylcysteine improves cone function in retinitis pigmentosa patients in phase I trial. J Clin Invest 2020; 130:1527-1541. [PMID: 31805012 DOI: 10.1172/jci132990] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 12/03/2019] [Indexed: 01/31/2023] Open
Abstract
BACKGROUNDIn retinitis pigmentosa (RP), rod photoreceptors degenerate from 1 of many mutations, after which cones are compromised by oxidative stress. N-acetylcysteine (NAC) reduces oxidative damage and increases cone function/survival in RP models. We tested the safety, tolerability, and visual function effects of oral NAC in RP patients.METHODSSubjects (n = 10 per cohort) received 600 mg (cohort 1), 1200 mg (cohort 2), or 1800 mg (cohort 3) NAC bid for 12 weeks and then tid for 12 weeks. Best-corrected visual acuity (BCVA), macular sensitivity, ellipsoid zone (EZ) width, and aqueous NAC were measured. Linear mixed-effects models were used to estimate the rates of changes during the treatment period.RESULTSThere were 9 drug-related gastrointestinal adverse events that resolved spontaneously or with dose reduction (maximum tolerated dose 1800 mg bid). During the 24-week treatment period, mean BCVA significantly improved at 0.4 (95% CI: 0.2-0.6, P < 0.001), 0.5 (95% CI: 0.3-0.7, P < 0.001), and 0.2 (95% CI: 0.02-0.4, P = 0.03) letters/month in cohorts 1, 2, and 3, respectively. There was no significant improvement in mean sensitivity over time in cohorts 1 and 2, but there was in cohort 3 (0.15 dB/month, 95% CI: 0.04-0.26). There was no significant change in mean EZ width in any cohort.CONCLUSIONOral NAC is safe and well tolerated in patients with moderately advanced RP and may improve suboptimally functioning macular cones. A randomized, placebo-controlled trial is needed to determine if oral NAC can provide long-term stabilization and/or improvement in visual function in patients with RP.TRIAL REGISTRATIONNCT03063021.FUNDINGMr. and Mrs. Robert Wallace, Mr. and Mrs. Jonathan Wallace, Rami and Eitan Armon, Marc Sumerlin, Cassandra Hanley, and Nacuity Pharmaceuticals, Inc.
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Affiliation(s)
- Peter A Campochiaro
- Wilmer Eye Institute and.,Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | | | | | | | | | | | | | | | - Xiangrong Kong
- Wilmer Eye Institute and.,Department of Biostatistics.,Department of Epidemiology, and.,Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Busch C, Okada M, Zur D, Fraser‐Bell S, Rodríguez‐Valdés PJ, Cebeci Z, Lupidi M, Fung AT, Gabrielle P, Giancipoli E, Chaikitmongkol V, Laíns I, Santos AR, Kunavisarut P, Sala‐Puigdollers A, Chhablani J, Ozimek M, Hilely A, Degenhardt V, Loewenstein A, Iglicki M, Rehak M. Baseline predictors for visual acuity loss during observation in diabetic macular oedema with good baseline visual acuity. Acta Ophthalmol 2020; 98:e801-e806. [PMID: 32115886 DOI: 10.1111/aos.14390] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 02/04/2020] [Accepted: 02/09/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE To investigate clinical baseline characteristics and optical coherence tomography biomarkers predicting visual loss during observation in eyes with diabetic macular oedema (DMO) and good baseline visual acuity (VA). METHODS A sub-analysis of a 12-month, retrospective study, including patients with baseline VA ≤0.1 logMAR (≥20/25 Snellen) and centre-involving DMO. The primary outcome measure was the correlation between baseline characteristics and VA loss ≥10 letters during follow-up. RESULTS A total of 249 eyes were included in the initial study, of which 147 eyes were observed and 80 eyes received anti-vascular endothelial growth factor (VEGF) treatment at baseline. Visual acuity (VA) loss ≥10 letters occurred in 21.8% (observed cohort) and in 24.3% (treated cohort), respectively. Within observed eyes, presence of hyperreflective foci [HRF; odds ratio (OR): 3.18, p = 0.046], and disorganization of inner retina layers (DRIL; OR: 2.71, p = 0.026) were associated with a higher risk of VA loss ≥10 letters. In observed eyes with a combined presence of HRF, DRIL and ellipsoid zone (EZ) disruption, the risk of VA loss was further increased (OR: 3.86, p = 0.034). In eyes with combined presence of DRIL, HRF and EZ disruption, risk of VA loss was 46.7% (7/15 eyes) in the observed cohort, and 26.3% (5/19 eyes) in the treated cohort (p = 0.26). CONCLUSION Patients with DMO and good baseline VA, managed by observation, are of increased risk for VA loss if DRIL, HRF and EZ disruption are present at baseline. Earlier treatment with anti-VEGF in these patients may potentially decrease the risk of VA loss at 12 months.
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Affiliation(s)
- Catharina Busch
- Department of Ophthalmology University Hospital Leipzig Leipzig Germany
| | - Mali Okada
- Royal Victorian Eye and Ear Hospital Melbourne Victoria Australia
| | - Dinah Zur
- Division of Ophthalmology Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Samantha Fraser‐Bell
- Discipline of Clinical Ophthalmology and Eye Health University of Sydney Sydney New South Wales Australia
| | | | - Zafer Cebeci
- Department of Ophthalmology Istanbul Faculty of Medicine Istanbul University Istanbul Turkey
| | - Marco Lupidi
- Department of Biomedical and Surgical Sciences Section of Ophthalmology University of Perugia Perugia Italy
| | - Adrian T. Fung
- Discipline of Clinical Ophthalmology and Eye Health University of Sydney Sydney New South Wales Australia
- Department of Ophthalmology Westmead Hospital Sydney New South Wales Australia
- Faculty of Medicine and Health Sciences Macquarie University Hospital Sydney New South Wales Australia
| | - Pierre‐Henry Gabrielle
- Ophthalmology Department Dijon University Hospital Dijon France
- Center for Taste and Feeding Behaviour INRA UMR1324 Dijon France
| | - Ermete Giancipoli
- Department of Surgical Microsurgical and Medical Sciences Eye Clinic University of Sassari Sassari Italy
- Department of Biomedical Sciences University of Sassari Sassari Italy
| | - Voraporn Chaikitmongkol
- Retina Division Department of Ophthalmology Faculty of Medicine Chiang Mai University Chiang Mai Thailand
| | - Inês Laíns
- Faculty of Medicine University of Coimbra Coimbra Portugal
- Association for Innovation and Biomedical Research on Light and Image Coimbra Portugal
- Massachusetts Eye and Ear Harvard Medical School Boston Massachusetts USA
| | - Ana Rita Santos
- Association for Innovation and Biomedical Research on Light and Image Coimbra Portugal
- Department of Orthoptics Superior School of Health Polytechnic of Porto Porto Portugal
| | - Paradee Kunavisarut
- Retina Division Department of Ophthalmology Faculty of Medicine Chiang Mai University Chiang Mai Thailand
| | | | - Jay Chhablani
- UPMC Eye Center University of Pittsburgh Pittsburgh Pennsylvania USA
- L.V. Prasad Eye Institute Banjara Hills Hyderabad India
| | - Malgorzata Ozimek
- Department of General Ophthalmology and Pediatric Ophthalmology Service Medical University of Lublin Lublin Poland
| | - Assaf Hilely
- Division of Ophthalmology Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Valentin Degenhardt
- Department of Ophthalmology University Hospital Leipzig Leipzig Germany
- Department of Ophthalmology University Hospital Heidelberg Heidelberg Germany
| | - Anat Loewenstein
- Division of Ophthalmology Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
- Incumbent Sydney A. Fox chair in Ophthalmology Tel Aviv University Tel Aviv Israel
| | - Matias Iglicki
- Private Retina Service University of Buenos Aires Buenos Aires Argentina
| | - Matus Rehak
- Department of Ophthalmology University Hospital Leipzig Leipzig Germany
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Zafar S, Smith K, Boland MV, Weng CY, Solomon S, Channa R. Real-world Outcomes among Eyes with Center-Involving Diabetic Macular Edema and Good Visual Acuity. Curr Eye Res 2020; 45:879-887. [PMID: 31829753 PMCID: PMC10407997 DOI: 10.1080/02713683.2019.1703007] [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] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 11/09/2019] [Accepted: 12/02/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE We aimed to determine long-term visual and anatomical outcomes among patients with center involving-diabetic macular edema and good vision and evaluate factors associated with visual and anatomic outcomes. MATERIALS AND METHODS In this retrospective study, all patients with type 2 diabetes aged ≥18 years had seen at the Wilmer Eye Institute between March 2015-June 2018 and with diabetic macular edema confirmed on spectral-domain optical coherence tomography imaging were included, provided they had visual acuity of 20/30 or better in ≥1 eye and a follow-up duration of ≥3 clinic visits. Change in logMAR visual acuity and central 1 mm foveal thickness from baseline, lines of visual acuity gained/lost for overall cohort stratified by treatment were analyzed. RESULTS Among 197 (243 eyes) participants, mean (± standard deviation) age was 63.4 ± 11.2 years, and half were males. Average duration of follow-up was 1.7 ± 0.7 years. One hundred and forty-six eyes (60%) received anti-vascular endothelial growth factor injections, at an average of 3.7 ± 2.9 injections/eye/year. Mean logMAR visual acuity at baseline was 0.1 ± 0.1 [Snellen 20/25] in both treatment and observation (no anti-vascular endothelial growth factor treatment received during and 3 months prior to the study inclusion period) groups. Final logMAR visual acuity was 0.2 ± 0.2 in the treatment group [Snellen 20/32] versus 0.1 ± 0.3 in observation group [Snellen 20/25]; (p = .23). Mean central foveal thickness changed from 333 ± 66 to 308 ± 45 microns in treatment group and 319 ± 41 to 308 ± 65 microns in observation group. CONCLUSIONS After an average of 1.7 years of follow-up, there were no significant differences in final vision or central foveal thickness irrespective of whether patients received or did not receive treatment with anti-vascular endothelial growth factor injections.
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Affiliation(s)
- Sidra Zafar
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kerry Smith
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael V. Boland
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christina Y. Weng
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Sharon Solomon
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Roomasa Channa
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
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The role of semaphorins in small vessels of the eye and brain. Pharmacol Res 2020; 160:105044. [PMID: 32590102 DOI: 10.1016/j.phrs.2020.105044] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/19/2020] [Accepted: 06/19/2020] [Indexed: 12/20/2022]
Abstract
Small vessel diseases, such as ischemic retinopathy and cerebral small vessel disease (CSVD), are increasingly recognized in patients with diabetes, dementia and cerebrovascular disease. The mechanisms of small vessel diseases are poorly understood, but the latest studies suggest a role for semaphorins. Initially identified as axon guidance cues, semaphorins are mainly studied in neuronal morphogenesis, neural circuit assembly, and synapse assembly and refinement. In recent years, semaphorins have been found to play important roles in regulating vascular growth and development and in many pathophysiological processes, including atherosclerosis, angiogenesis after stroke and retinopathy. Growing evidence indicates that semaphorins affect the occurrence, perfusion and regression of both the macrovasculature and microvasculature by regulating the proliferation, apoptosis, migration, barrier function and inflammatory response of endothelial cells, vascular smooth muscle cells (VSMCs) and pericytes. In this review, we concentrate on the regulatory effects of semaphorins on the cell components of the vessel wall and their potential roles in microvascular diseases, especially in the retina and cerebral small vessel. Finally, we discuss potential molecular approaches in targeting semaphorins as therapies for microvascular disorders in the eye and brain.
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Lai K, Huang C, Li L, Gong Y, Xu F, Zhong X, Lu L, Jin C. Anatomical and functional responses in eyes with diabetic macular edema treated with "1 + PRN" ranibizumab: one-year outcomes in population of mainland China. BMC Ophthalmol 2020; 20:229. [PMID: 32539744 PMCID: PMC7296700 DOI: 10.1186/s12886-020-01510-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 06/09/2020] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND To evaluate the anatomical and functional responses in eyes with diabetic macular edema (DME) treated with ranibizumab under "1 + pro re nata (PRN)" regimen. METHODS This prospective interventional case series included 69 eyes of 69 patients with DME treated with intravitreal injections of 0.5 mg ranibizumab followed by repeated injections as needed. Best-corrected visual acuity (BCVA), central foveal thickness (CFT), subfoveal choroidal thickness (SFCT), and predictive factors for final visual outcomes were assessed. RESULTS Logarithm of minimal angle of resolution (logMAR) BCVA improved from 0.64 ± 0.23 at baseline to 0.56 ± 0.27, 0.53 ± 0.26, 0.47 ± 0.25, 0.44 ± 0.32, 0.47 ± 0.26 and 0.46 ± 0.26 at time-point of months 1, 2, 3, 6, 9, and 12, respectively (P < 0.05 for any follow-up time-point except month 1). CFT decreased from 478.23 ± 172.31 μm at baseline to 349.74 ± 82.21 μm, 313.52 ± 69.62 μm, 292.59 ± 61.07 μm, 284.67 ± 69.85 μm, 268.33 ± 43.03 μm, and 270.39 ± 49.27 μm at above time-points, respectively (P < 0.05). The number of injections was 6.83 times over 12 months' follow-up under "1 + PRN" regimen. Multivariate analysis showed that the factors including age, BCVA at baseline, disruption of ellipsoid zone, posterior vitreous detachment (PVD), and vitreomacular traction (VMT) were correlated with the final BCVA. CONCLUSIONS Intravitreal injections of ranibizumab under "1 + PRN" regimen is a not only effective but also safe way to improve visual acuity of DME patients. And older age, lower baseline BCVA, VMT, and disruption of ellipsoid zone are predictors for final poor BCVA while PVD is a positive predictive factor for good final BCVA. TRIAL REGISTRATION The trial was registered retrospectively in ClinicalTrials.gov on 2 June 2019 (NCT03973138).
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Affiliation(s)
- Kunbei Lai
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, 510060, China
| | - Chuangxin Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, 510060, China
| | - Longhui Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, 510060, China
| | - Yajun Gong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, 510060, China
| | - Fabao Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, 510060, China
| | - Xiaojing Zhong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, 510060, China
| | - Lin Lu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, 510060, China
| | - Chenjin Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, 510060, China.
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Anti-VEGF Treatment of Diabetic Macular Edema: Two-Year Visual Outcomes in Routine Clinical Practice. J Ophthalmol 2020; 2020:6979758. [PMID: 32280530 PMCID: PMC7125496 DOI: 10.1155/2020/6979758] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/05/2020] [Accepted: 02/17/2020] [Indexed: 01/18/2023] Open
Abstract
Purpose The purpose of this study was to evaluate 2-year visual outcomes in patients with diabetic macular edema (DME) treated with anti-VEGF agents in a routine clinical setting. Methods The medical records of patients treated with ranibizumab or aflibercept due to DME at the Eye Hospital, University Medical Centre Ljubljana, Slovenia, between January 2016 and March 2019 were retrospectively reviewed. After applying inclusion and exclusion criteria, 123 patients (123 eyes) were included in the study. Results Baseline visual acuity (VA) was 60.9 ± 15.2 letters (median 63; range 7-85). Baseline central retinal subfield thickness (CRT) was 440.7 ± 132.5 μm (median 430; range 114-1000). No significant change in VA over 2 years was found (mean change +2.1 ± 16.8 letters (median 2; range -53-52)). However, there was a significant change in VA in the subgroup with baseline VA <70 letters (mean change +5.7 ± 17.9 letters (median 5; range -52-52)). VA gains of ≥15 letters were achieved in 25 eyes (20.3%). Changes in CRT were significant over 2 years. Patients received 4.5 ± 2.1 (median 5, range 1-9) and 2.6 ± 2.3 (median 2, range 0-8) injections in the first and second years, respectively. Conclusions The two-year visual outcomes in this retrospective analysis appear to be comparable to previously reported outcomes in routine clinical practice. Our analysis provides some information about the effectiveness of anti-VEGF treatment in routine clinical practice in Slovenia. More intensive treatment should be implemented in the management of patients in order to achieve better visual outcomes.
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ASSOCIATION BETWEEN EARLY ANATOMIC RESPONSE TO ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY AND LONG-TERM OUTCOME IN DIABETIC MACULAR EDEMA: An Independent Analysis of Protocol i Study Data. Retina 2020; 39:88-97. [PMID: 29474302 PMCID: PMC6325771 DOI: 10.1097/iae.0000000000002110] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
This retrospective analysis of Protocol I study data demonstrates a significant positive association between early (Week 12) retinal anatomical response and long-term (1- and 3-year) anatomical response with ranibizumab in center-involved diabetic macular edema. By contrast, early anatomical response was not significantly associated with long-term visual acuity response. Purpose: This post hoc analysis explores the relationship between early retinal anatomical response and long-term anatomical and visual outcomes with ranibizumab in center-involved diabetic macular edema. Methods: Eyes randomized to the ranibizumab plus prompt laser and ranibizumab plus deferred laser treatment arms in the Protocol I study were categorized according to their proportional reduction (<20 vs. ≥20%) in central retinal thickness (CRT) after 12 weeks. Adjusted and unadjusted analyses assessed the association between early (Week 12) anatomical response and long-term (Weeks 52 and 156) anatomical and best-corrected visual acuity outcomes. Results: Of 335 study eyes, 118 showed limited (<20%) and 217 showed strong (≥20%) CRT reduction at Week 12. In unadjusted and adjusted analyses, limited early CRT response was negatively and significantly associated with strong CRT response at Weeks 52 and 156. Sensitivity analyses indicated that this association was robust and unrelated to any “floor effect.” In unadjusted analyses, a strong early CRT response was associated with greater long-term improvement in best-corrected visual acuity; after controlling for confounders, the association lost statistical significance. Conclusion: Early CRT response to ranibizumab is a significant prognostic indicator of medium- to long-term anatomical outcome in center-involved diabetic macular edema.
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Wu JH, Li YN, Chen AQ, Hong CD, Zhang CL, Wang HL, Zhou YF, Li PC, Wang Y, Mao L, Xia YP, He QW, Jin HJ, Yue ZY, Hu B. Inhibition of Sema4D/PlexinB1 signaling alleviates vascular dysfunction in diabetic retinopathy. EMBO Mol Med 2020; 12:e10154. [PMID: 31943789 PMCID: PMC7005627 DOI: 10.15252/emmm.201810154] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 12/02/2019] [Accepted: 12/06/2019] [Indexed: 12/17/2022] Open
Abstract
Diabetic retinopathy (DR) is a common complication of diabetes and leads to blindness. Anti‐VEGF is a primary treatment for DR. Its therapeutic effect is limited in non‐ or poor responders despite frequent injections. By performing a comprehensive analysis of the semaphorins family, we identified the increased expression of Sema4D during oxygen‐induced retinopathy (OIR) and streptozotocin (STZ)‐induced retinopathy. The levels of soluble Sema4D (sSema4D) were significantly increased in the aqueous fluid of DR patients and correlated negatively with the success of anti‐VEGF therapy during clinical follow‐up. We found that Sema4D/PlexinB1 induced endothelial cell dysfunction via mDIA1, which was mediated through Src‐dependent VE‐cadherin dysfunction. Furthermore, genetic disruption of Sema4D/PlexinB1 or intravitreal injection of anti‐Sema4D antibody reduced pericyte loss and vascular leakage in STZ model as well as alleviated neovascularization in OIR model. Moreover, anti‐Sema4D had a therapeutic advantage over anti‐VEGF on pericyte dysfunction. Anti‐Sema4D and anti‐VEGF also conferred a synergistic therapeutic effect in two DR models. Thus, this study indicates an alternative therapeutic strategy with anti‐Sema4D to complement or improve the current treatment of DR.
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Affiliation(s)
- Jie-Hong Wu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ya-Nan Li
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - An-Qi Chen
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Can-Dong Hong
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chun-Lin Zhang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hai-Ling Wang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi-Fan Zhou
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Peng-Cheng Li
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yong Wang
- Aier School of Ophthalmology, Wuhan Aier Eye Hospital, Central South University, Wuhan, China
| | - Ling Mao
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuan-Peng Xia
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Quan-Wei He
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hui-Juan Jin
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhen-Yu Yue
- Department of Neurology and Department of Neuroscience, The Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bo Hu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Rodrigues MW, Cardillo JA, Messias A, Siqueira RC, Scott IU, Jorge R. Bevacizumab versus triamcinolone for persistent diabetic macular edema: a randomized clinical trial. Graefes Arch Clin Exp Ophthalmol 2019; 258:479-490. [PMID: 31873786 DOI: 10.1007/s00417-019-04564-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/25/2019] [Accepted: 12/10/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To evaluate 24-week visual acuity and anatomic outcomes of two "pro re nata" (prn) treatment strategies (intravitreal bevacizumab [IVB] prn versus intravitreal triamcinolone acetonide [IVT] prn) in patients with persistent diabetic macular edema (pDME) after 24 weeks of prn-IVB. METHODS One hundred eyes with center-involving DME were enrolled and treated with prn-IVB for 24 weeks; at week 24, eyes with pDME (central subfield thickness [CST] on spectral domain optical coherence tomography > 300 μm) were randomized to IVB monthly prn (group I; prn-IVB) or IVT every 3 months prn (group II; prn-IVT) and eyes in which the CST was ≤ 300 μm were assigned to continue prn-IVB (group III). RESULTS Seventy-four eyes completed a 48-week study period. At week 24, 65 (79.3%) eyes still had DME with CST > 300 μm and, therefore, were randomized to prn-IVB (group I, n = 33) or prn-IVT (group II, n = 32); the remaining 17 (20.7%) eyes had CST ≤ 300 μm and were assigned to continued treatment with prn-IVB (group III). At baseline, mean CST (μm) ± standard error of the mean (SEM) was 447.2 ± 24.4, 478.0 ± 19.7, and 386.0 ± 21.0 in groups I, II, and III, respectively (p > 0.05). At week 48, there was no significant difference in mean CST between groups I and II (369.9 ± 23.3 and 426.0 ± 26.1, respectively; p = 0.9995). A significant reduction in mean CST, compared with baseline, was noted at weeks 28 (p = 0.0002) and 44 (p = 0.0002) in group II. Group I did not show a significant reduction in mean CST compared with baseline at any study visit. There were no significant differences in mean CST between groups I and II at any study visit. At baseline, mean ± SEM best-corrected visual acuity (BCVA) (logMAR) was 0.50 ± 0.00, 0.60 ± 0.10, and 0.50 ± 0.10 in groups I, II, and III, respectively (p > 0.05). At week 48, there was no statistically significant difference in mean BCVA between groups I and II (0.50 ± 0.10 and 0.80 ± 0.10, respectively; p = 0.4473). There was no significant improvement in mean BCVA, as compared with baseline, at any study follow-up visit in any of the groups. Group II demonstrated significantly lower BCVA after 24 weeks of IVT (at week 48) compared with baseline (p = 0.0435). There was no significant difference in mean BCVA between groups I and II at any time-point. CONCLUSION In eyes with pDME after 24 weeks of treatment with prn-IVB, there was no difference between continued treatment with prn-IVB versus a treatment switch to prn-IVT with respect to mean BCVA or mean CST at week 48. However, BCVA was stable in the prn-IVB group, while prn-IVT was associated with BCVA reduction from baseline and a higher risk of IOP elevation.
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Affiliation(s)
- Murilo W Rodrigues
- Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Brazil, 3900, Bandeirantes av., Campus, 12fl., Ribeirão Preto, São Paulo, 14048-900, Brazil.
| | - José A Cardillo
- Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Brazil, 3900, Bandeirantes av., Campus, 12fl., Ribeirão Preto, São Paulo, 14048-900, Brazil
| | - André Messias
- Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Brazil, 3900, Bandeirantes av., Campus, 12fl., Ribeirão Preto, São Paulo, 14048-900, Brazil
| | - Rubens C Siqueira
- Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Brazil, 3900, Bandeirantes av., Campus, 12fl., Ribeirão Preto, São Paulo, 14048-900, Brazil
| | - Ingrid U Scott
- Departments of Ophthalmology and Public Health Sciences, Penn State College of Medicine, 700 HMC Crescent Road, Hershey, PA, 17033, USA
| | - Rodrigo Jorge
- Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Brazil, 3900, Bandeirantes av., Campus, 12fl., Ribeirão Preto, São Paulo, 14048-900, Brazil
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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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Felfeli T, Juncal VR, Hillier RJ, Mak MY, Wong DT, Berger AR, Kohly RP, Kertes PJ, Eng KT, Boyd SR, Altomare F, Giavedoni LR, Muni RH. Aqueous Humor Cytokines and Long-Term Response to Anti-Vascular Endothelial Growth Factor Therapy in Diabetic Macular Edema. Am J Ophthalmol 2019; 206:176-183. [PMID: 30959004 DOI: 10.1016/j.ajo.2019.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 03/31/2019] [Accepted: 04/01/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE To determine the association of aqueous humor cytokine concentrations with long-term treatment response to anti-vascular endothelial growth factor (VEGF) agents in diabetic macular edema (DME). DESIGN Retrospective case series. METHODS Pooled data of aqueous humor cytokine concentrations collected at baseline and 2-month follow-up (2 injections) for treatment-naïve eyes with center-involving DME previously enrolled in a prospective study were reviewed. Subjects receiving intravitreal anti-VEGF injections outside of study protocol as per standard of care were classified into Responders versus Nonresponders based on qualitative assessment of optical coherence tomography for persistence of DME at longitudinal follow-up visits. RESULTS Of the 41 eyes, 85% were classified as Responders with a significant decline in baseline central subfield thickness and macular volume (P values < .001), and 15% were identified as Nonresponders to anti-VEGF therapy over 51.4 ± 18.7 months of follow-up. No significant difference in baseline aqueous humor VEGF concentration was noted, while at the 2-month follow-up the Nonresponder group had a significantly higher VEGF concentration compared with the Responder group (451.5 ± 690.9 pg/mL vs 113.7 ± 211.4 pg/mL; P = .02). The Responder group also demonstrated a significant decline from baseline to 2-month follow-up in concentration of intercellular adhesion molecule-1 (P < .001), interleukin-10 (P = .041), monocyte chemotactic protein-1 (P = .046), placental growth factor (P = .027), and transforming growth factor-β2 (P = .017). CONCLUSIONS Aqueous humor cytokine concentrations serve as an early biomarker for long-term response to anti-VEGF therapy and may enable more effective treatment regimens that improve anatomical outcomes in eyes with DME.
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Sophie R, Wang PW, Channa R, Quezada-Ruiz C, Clark A, Campochiaro PA. Different Factors Associated with 2-Year Outcomes in Patients with Branch versus Central Retinal Vein Occlusion Treated with Ranibizumab. Ophthalmology 2019; 126:1695-1702. [PMID: 31543350 DOI: 10.1016/j.ophtha.2019.07.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 06/21/2019] [Accepted: 07/17/2019] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To investigate characteristics associated with visual and anatomic outcomes in branch and central retinal vein occlusion (BRVO and CRVO) patients treated with ranibizumab. DESIGN Post hoc analysis of patients with BRVO and CRVO from 2 multicenter clinical trials who completed month 12 of the HORIZON extension trial. PARTICIPANTS 205 patients with BRVO and 181 patients with CRVO who completed month 12 of the extension trial. METHODS With the use of logistic regression, covariates with a P value < 0.20 from univariate analysis were included in multivariate models to identify independent factors associated with a given outcome (at P < 0.05), with preset variables of disease duration and original treatment assignment. MAIN OUTCOME MEASURES Best-corrected visual acuity (BCVA) ≥20/40 (≥70 letters), gain ≥15 letters, and central subfield thickness (CST) ≤250 μm at HORIZON month 12. RESULTS In patients with BRVO, good baseline BCVA (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.30-1.79), male sex (OR, 2.48; 95% CI, 1.20-5.13), and normal hematocrit (low vs. normal, OR, 0.26; 95% CI, 0.12-0.59) predicted BCVA ≥20/40; high central foveal thickness (OR, 1.03; 95% CI, 1.01-1.04) and normal hematocrit (low vs. normal, OR, 0.31; 95% CI, 0.15-0.66) predicted BCVA improvement ≥15 letters; and extensive baseline subretinal fluid modestly predicted CST ≤250 μm (OR, 1.08; 95% CI, 1.00-1.16). In patients with CRVO, good baseline BCVA (OR, 1.59; 95% CI, 1.35-1.89), never smoking (OR, 2.80; 95% CI, 1.27-6.17), and young age (OR, 0.58; 95% CI, 0.41-0.82) predicted BCVA ≥20/40; never smoking (OR, 2.13; 95% CI, 1.03-4.39), young age (OR, 0.41; 95% CI, 0.28-0.59), poor baseline BCVA (OR, 0.82; 95% CI, 0.73-0.93), hypertension (OR, 4.47; 95% CI, 1.70-11.75), and low diastolic ocular perfusion pressure (OPP) throughout the study (OR, 0.39; 95% CI, 0.21-0.72) predicted BCVA improvement ≥15 letters; and young age (OR, 0.65; 95% CI, 0.47-0.90), lower mean hematocrit (low vs. normal, OR, 2.81; 95% CI, 1.06-7.49), high systolic OPP throughout the study (OR, 1.61; 95% CI, 1.14-2.27), large areas of central hemorrhage (OR, 1.44; 95% CI, 1.04-2.00), and no subretinal fluid (OR, 2.15; 95% CI, 1.06-4.40) predicted CST ≤250 μm. CONCLUSIONS There are substantial differences in good outcome factors in CRVO versus BRVO, suggesting differences in pathophysiology. Young age, never smoking, hemodilution, and hypertension/high systolic perfusion pressure are more beneficial in CRVO, suggesting that avoidance of sluggish blood flow and maintenance of perfusion may be particularly important in CRVO.
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Affiliation(s)
- Raafay Sophie
- Medical College of Wisconsin, Department of Ophthalmology and Visual Sciences, Milwaukee, Wisconsin
| | - Pin-Wen Wang
- Genentech, Inc., South San Francisco, California
| | - Roomasa Channa
- Baylor College of Medicine, Department of Ophthalmology, Houston, Texas
| | | | - Ann Clark
- Genentech, Inc., South San Francisco, California
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Factors influencing clinical outcomes in patients with diabetic macular edema treated with intravitreal ranibizumab: comparison between responder and non-responder cases. Sci Rep 2019; 9:10952. [PMID: 31358777 PMCID: PMC6662817 DOI: 10.1038/s41598-019-47241-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 06/20/2019] [Indexed: 12/31/2022] Open
Abstract
Diabetic macular edema (DME) is the leading cause of visual impairment in patients with diabetes mellitus. A retrospective study was conducted to investigate the factors influencing the clinical outcomes in 73 patients (94 eyes) with DME treated with intravitreal ranibizumab therapy. Baseline demographic, systemic, and ocular data were assessed for the association with visual and anatomic outcomes after treatment. The mean best corrected visual acuity (BCVA) improved from 0.92 ± 0.45 to 0.61 ± 0.43 logarithm of the minimum angle of resolution (LogMAR) (p < 0.001) after treatment. The mean central subfield macular thickness (CST) decreased from 425.2 ± 127.4 to 328.6 ± 99.4 μm (p < 0.001). The treatment response was significantly influenced by Age (p = 0.003) and baseline BCVA (p = 0.001). In addition, glycosylated hemoglobin (HbA1c) (p = 0.013) and proliferative diabetic retinopathy (PDR) (p = 0.019) were the prognostic factors for the visual outcome in the responders and non-responders, respectively. Moreover, baseline CST was the strongest predictor of anatomic outcome in all subjects (p < 0.001). Intravitreal ranibizumab for DME resulted in significant improvement in clinical outcomes. Younger age and better baseline BCVA were associated with better visual outcome after the treatment. In addition, glycemic control in the treatment of patients with DME is crucial to achieve better visual outcomes, especially in the responders to ranibizumab treatment.
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Relationship between duration and extent of oedema and visual acuity outcome with ranibizumab in diabetic macular oedema: A post hoc analysis of Protocol I data. Eye (Lond) 2019; 34:480-490. [PMID: 31320738 PMCID: PMC7042302 DOI: 10.1038/s41433-019-0522-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/10/2019] [Accepted: 05/25/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND/OBJECTIVES This post hoc analysis explores the relationship between residual oedema exposure after ranibizumab treatment initiation and long-term visual acuity outcome in eyes with centre-involved diabetic macular oedema (DMO). SUBJECTS/METHODS Eyes randomised to the ranibizumab + prompt or deferred laser treatment arms in the Protocol I trial and with observed central retinal thickness (CRT) readings at baseline and ≥1 follow-up visits (n = 367) were stratified by 1) oedema duration (number of study visits with CRT ≥ 250 µm during the first 52 weeks of ranibizumab treatment); and 2) oedema extent (amount of excess CRT [≥ 250 µm] at each study visit, averaged over the first 52 weeks). Associations between measures of residual oedema and best-corrected visual acuity (BCVA) were assessed in multiple regression analyses. RESULTS Oedema duration and oedema extent during the first 52 weeks of ranibizumab treatment showed significant negative associations with BCVA improvement at weeks 52, 104 and 156. Eyes with the most persistent oedema gained (mean) 4.4 (95% CI 0.1─8.7) fewer Early Treatment Diabetic Retinopathy Study (ETDRS) letters at week 156 than eyes with the least persistent oedema (P = 0.044). Eyes with the greatest amount of oedema gained (mean) 9.3 (95% CI 4.0─14.5) fewer ETDRS letters at week 156 than eyes with the least amount of oedema (P < 0.001). CONCLUSIONS Macular oedema exposure over the first 52 weeks of ranibizumab treatment is a negative prognostic factor for long-term visual acuity improvement in centre-involved DMO.
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Ansari WH, Han MM, Haq S, Conti FF, Silva FQ, Singh RP. Baseline Ocular Characteristics of Patients Undergoing Initiation of Anti-Vascular Endothelial Growth Factor Therapy for Diabetic Macular Edema. Ophthalmic Surg Lasers Imaging Retina 2019; 50:69-75. [PMID: 30768213 DOI: 10.3928/23258160-20190129-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 11/02/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Patients with diabetic macular edema (DME) have variable anatomic and visual responses to anti-vascular endothelial growth (VEGF) treatments based on their presenting visual acuity (VA). The aim of study is to report the baseline ocular and imaging characteristics of patients presenting with DME who were treatment-naïve and who initiated anti-VEGF in routine clinical practice. PATIENTS AND METHODS Single-center, cross-sectional study of 638 patients. Subjects were divided into two VA groups: Early Treatment Diabetic Retinopathy Study (ETDRS) less than 70 and ETDRS greater than 70 and ocular variables were compared between groups. RESULTS Average central subfield thickness (CST) was 363.5 μm, cube volume was 11.7 mm3, and cube average thickness (CAT) was 326.1 μm. Additionally, 21.5% had subretinal fluid (SRF), and 50.5% had hard exudates on presentation. Eyes with ETDRS less than 70 had greater CAT (338.5 μm3 vs. 313.2 μm3; P < .001), greater cube volume (12.2 mm3 vs. 11.3 mm3; P < .001), greater CST (383.5 μm vs. 350.0 μm; P < .001), and SRF (25.5% vs. 17.3%; P = .012). Furthermore, 7.64% had glaucoma, 1.3% had dry age-related macular degeneration, 4.5% of patients were vitrectomized, and 28.7% were pseudophakic. Regarding diabetic stage, 37% had proliferative diabetic retinopathy (PDR) and 63% presented with nonproliferative diabetic retinopathy. Patients presenting with ETDRS less than 70 were more likely to have a history of vitrectomy (7.1% vs. 1.9%, P = .002) and presence of PDR (42.3% vs. 31.4%, P = .004). CONCLUSION The results describe a population of patients from a routine clinical practice not entirely represented in clinical trials, with key differences in ocular characteristics seen between VA groups. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:69-75.].
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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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Muftuoglu IK, Mendoza N, Gaber R, Alam M, You Q, Freeman WR. INTEGRITY OF OUTER RETINAL LAYERS AFTER RESOLUTION OF CENTRAL INVOLVED DIABETIC MACULAR EDEMA. Retina 2018; 37:2015-2024. [PMID: 28092342 DOI: 10.1097/iae.0000000000001459] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE To evaluate the integrity of outer retina layers after resolution of central involved diabetic macular edema (DME) and to demonstrate the effect of various baseline factors for the final vision and final external limiting membrane (ELM) integrity. METHODS Fifty-nine eyes of 48 patients with resolved DME were included. Several optical coherence tomography parameters including central subfield thickness, maximum foveal thickness, foveal center point thickness, and the extent of the ellipsoidal (ISe) layer and ELM damage were assessed at the time of DME and after resolution of DME. Eyes having laser scars near the fovea were excluded. Final visual acuity was classified as good (Snellen≥20/40, logarithm of the minimum angle of resolution ≤0.3) or impaired (Snellen <20/40, logarithm of the minimum angle of resolution >0.3) for the logistic regression analysis. Zero Inflated Poison Regression model was used to find the best predictors for post-treatment ELM damage. RESULTS External limiting membrane and inner segment ellipsoidal band layers were disrupted in 16 eyes (27.2%) and 21 eyes (35.5%) at the final visit, respectively. Baseline ELM damage (p=0.001), baseline impaired vision (p= 0.013), and the most recent glycosylated hemoglobin level (p=0.018) were the best set of parameters for having impaired final visual acuity. Baseline vision, severity of diabetic retinopathy, absence of intravitreal injection, central subfield thickness, and history of extrafoveal macular laser (not within 1 mm of fovea) (p<0.001, for all parameters) were independent predictors for the final ELM damage. CONCLUSION Outer retinal layers may be damaged even after complete resolution of DME, where inner segment ellipsoidal band layer damage appeared to be more common than ELM damage. Poorly controlled diabetic patients with damaged ELM and worse vision at the time of DME were more likely to have ELM damage and subsequent impaired vision after complete resolution of DME.
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Affiliation(s)
- Ilkay Kilic Muftuoglu
- *Department of Ophthalmology, Jacobs Retina Center, Shiley Eye Institute, University of California San Diego, La Jolla, California; †Department of Ophthalmology, Istanbul Training and Research Hospital, Istanbul, Turkey; ‡Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, California; and §Tanta University, Tanta, Egypt
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Silva RLE, Kanan Y, Mirando AC, Kim J, Shmueli RB, Lorenc VE, Fortmann SD, Sciamanna J, Pandey NB, Green JJ, Popel AS, Campochiaro PA. Tyrosine kinase blocking collagen IV-derived peptide suppresses ocular neovascularization and vascular leakage. Sci Transl Med 2018; 9. [PMID: 28100839 DOI: 10.1126/scitranslmed.aai8030] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 11/30/2016] [Indexed: 01/20/2023]
Abstract
Vascular endothelial growth factor (VEGF)-neutralizing proteins provide benefit in several retinal and choroidal vascular diseases, but some patients still experience suboptimal outcomes, and the need for frequent intraocular injections is a barrier to good outcomes. A mimetic peptide derived from collagen IV, AXT107, suppressed subretinal neovascularization (NV) in two mouse models predictive of effects in neovascular age-related macular degeneration (NVAMD) and inhibited retinal NV in a model predictive of effects in ischemic retinopathies. A combination of AXT107 and the current treatment aflibercept suppressed subretinal NV better than either agent alone. Furthermore, AXT107 caused regression of choroidal NV. AXT107 reduced the VEGF-induced vascular leakage that underlies macular edema in ischemic retinopathies and NVAMD. In rabbit eyes, which are closer to the size of human eyes, intraocular injection of AXT107 significantly reduced VEGF-induced vascular leakage by 86% at 1 month and 70% at 2 months; aflibercept significantly reduced leakage by 69% at 1 month and did not reduce leakage at 2 months, demonstrating the longer effectiveness of AXT107. AXT107 reduced ligand-induced phosphorylation of multiple receptors: VEGFR2, c-Met, and PDGFRβ. Optimal signaling through these receptors requires complex formation with β3 integrin, which was reduced by AXT107 binding to αvβ3 AXT107 also reduced total VEGFR2 levels by increasing internalization, ubiquitination, and degradation. This biomimetic peptide is a sustained, multitargeted therapy that may provide advantages over intraocular injections of specific VEGF-neutralizing proteins.
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Affiliation(s)
- Raquel Lima E Silva
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.,Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Yogita Kanan
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.,Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Adam C Mirando
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Jayoung Kim
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.,Translational Tissue Engineering Center, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Ron B Shmueli
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.,Translational Tissue Engineering Center, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Valeria E Lorenc
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.,Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Seth D Fortmann
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.,Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Jason Sciamanna
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.,Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Niranjan B Pandey
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.,AsclepiX Therapeutics, LLC, Baltimore, MD 21211, USA
| | - Jordan J Green
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.,Translational Tissue Engineering Center, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.,Institute for Nanobiotechnology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Aleksander S Popel
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Peter A Campochiaro
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.,Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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Maryam AK, Tafgeh M, Mahmoud M, Pasha A, Ahad S, Khalil GF. Short term effect of intravitreal bevacizumab for diabetic macular edema associated with epiretinal membrane. Rom J Ophthalmol 2018; 62:212-216. [PMID: 30505990 PMCID: PMC6256081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose: To evaluate the effect of intravitreal bevacizumab (IVB) injection on central macular thickness (CMT) in patients with diabetic macular edema (DME) associated with epiretinal membrane (ERM) and compare the results to those with DME without ERM. Methods: 54 eyes of 54 patients with DME were included in this prospective comparative case series. Twenty-eight patients had ERM. All patients received 2.5 mg/ 0.1 ml IVB. The primary outcome measure was the change in central macular thickness (CMT) and the secondary outcome measure was the change in best corrected visual acuity (BCVA), one month after the IVB injection. Results: All the patients completed 1-month follow-up. One month after the IVB injection, there was no statistically significant reduction in terms of CMT for the ERM group (22.64 ± 70.1 μm; P = 0.099), unlike eyes with DME alone (60.34 ± 88.5 µm; P = 0.002). Patients with ERM had a -0.09 ± 0.14 log MAR improvement in their BCVA (P =0.001) vs. 0.03 ± Log MAR change in the patients who did not have ERM (P = 0.37). Conclusion: In this study, intravitreal bevacizumab resulted in improvement in BCVA in patients who had DME associated with ERM. However, in patients who only had DME, despite a reduction in CMT, no improvement in BCVA occurred. Future randomized clinical trials are warranted to precisely assess the effect of bevacizumab on the ERM.
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Affiliation(s)
- Ashraf Khorasani Maryam
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences,
Tehran, Iran
| | - Mohammadi Tafgeh
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences,
Tehran, Iran
| | - Motallebi Mahmoud
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences,
Tehran, Iran
| | - Anvari Pasha
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences,
Tehran, Iran
| | - Sedaghat Ahad
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences,
Tehran, Iran
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Gerendas BS, Prager S, Deak G, Simader C, Lammer J, Waldstein SM, Guerin T, Kundi M, Schmidt-Erfurth UM. Predictive imaging biomarkers relevant for functional and anatomical outcomes during ranibizumab therapy of diabetic macular oedema. Br J Ophthalmol 2017; 102:195-203. [PMID: 28724636 DOI: 10.1136/bjophthalmol-2017-310483] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 04/27/2017] [Accepted: 05/06/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND/AIMS The objective is to identify imaging biomarkers in optical coherence tomography predicting functional/anatomical outcomes in diabetic macular oedema (DMO). METHODS The presented study is a post hoc analysis of the RESTORE/RESTORE-extension studies. Best-corrected visual acuity (BCVA) was analysed using general estimating equation models using treatment group/morphological features as predictor variables. In addition, linear multiple regression models analysed BCVA gain up to 12 and 36 months with BCVA/morphological baseline characteristics as independent predictor variables. The correlations between central retinal thickness (CRT)/BCVA were calculated as Spearman's/Pearson's correlation coefficients. RESULTS A weak negative linear correlation between CRT/BCVA was observed in all study arms at baseline (r=-0.34, p<0.001) and at month 36 (r=-0.26, p<0.001). Patients with baseline height of intraretinal cystoid fluid (IRC) ≤380 µm had better baseline BCVA compared with patients with IRC height >380 µm (64.84±10.63 vs 61.66±9.92 letters; p=0.0071, respectively), which was maintained until the end of month 12 (70.5±12.33 vs 67.0±14.09 letters; p=0.0252, respectively). With laser, there was a trend for patients with subretinal fluid (SRF) at baseline to lose BCVA letters at month 12 (-5.38±16.54 vs 2.49±9.72 letters; p=0.1038), whereas ranibizumab patients trended towards higher BCVA gains (10.28±7.14 vs 6.76±7.67; p=0.0563), compared with those without SRF. With combined therapy, all patients had similar BCVA gains regardless of SRF (p=0.3768). CONCLUSION With ranibizumab treatment, the height of IRC spaces at baseline was a better predictor of functional/anatomical improvement than CRT alone. There was also a trend for SRF to show a positive impact on ranibizumab therapy response and a negative impact on laser therapy response.
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Affiliation(s)
- Bianca S Gerendas
- Vienna Reading Center, Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.,Christian Doppler Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Sonja Prager
- Vienna Reading Center, Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Gabor Deak
- Vienna Reading Center, Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Christian Simader
- Vienna Reading Center, Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Jan Lammer
- Vienna Reading Center, Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Sebastian M Waldstein
- Vienna Reading Center, Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.,Christian Doppler Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | | | - Michael Kundi
- Institute of Environmental Health, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Ursula Margarethe Schmidt-Erfurth
- Vienna Reading Center, Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.,Christian Doppler Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
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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] [MESH Headings] [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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49
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Regillo CD, Callanan DG, Do DV, Fine HF, Holekamp NM, Kuppermann BD, Singer MA, Singh RP. Use of Corticosteroids in the Treatment of Patients With Diabetic Macular Edema Who Have a Suboptimal Response to Anti-VEGF: Recommendations of an Expert Panel. Ophthalmic Surg Lasers Imaging Retina 2017; 48:291-301. [PMID: 28419394 DOI: 10.3928/23258160-20170329-03] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/20/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVE Guidance on the use of corticosteroids in the treatment of diabetic macular edema (DME) is lacking. This study aimed to develop a clinically recommended treatment paradigm for DME with emphasis on the role of corticosteroids. PATIENTS AND METHODS An expert panel of nine retinal specialists in the United States developed consensus recommendations for DME treatment through a modified Delphi process. RESULTS The panelists typically use intravitreal injections of vascular endothelial growth factor (VEGF) antagonists as first-line treatment of DME and switch patients with an inadequate response to anti-VEGF therapy (failure of best-corrected visual acuity to improve to 20/40 or better because of edema after three to six monthly injections, or a less-than-50% reduction in excess macular thickness after three to four monthly injections) to intravitreal corticosteroid treatment. CONCLUSION Intravitreal corticosteroids have a potentially useful role in the treatment of patients with DME who have an inadequate response to intravitreal anti-VEGF therapy. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:291-301.].
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50
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Campochiaro PA, Khanani A, Singer M, Patel S, Boyer D, Dugel P, Kherani S, Withers B, Gambino L, Peters K, Brigell M. Enhanced Benefit in Diabetic Macular Edema from AKB-9778 Tie2 Activation Combined with Vascular Endothelial Growth Factor Suppression. Ophthalmology 2016; 123:1722-1730. [DOI: 10.1016/j.ophtha.2016.04.025] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 04/15/2016] [Accepted: 04/15/2016] [Indexed: 12/21/2022] Open
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