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Ushida H, Suzumura A, Yamada K, Shimizu H, Suzuki A, Ishikawa Y, Kikuchi R, Nishiguchi KM, Kaneko H. Decrease in electrolyte after vitrectomy surgery may affect the results of forensic investigations using vitreous humor. BMC Ophthalmol 2024; 24:219. [PMID: 38783230 PMCID: PMC11118106 DOI: 10.1186/s12886-024-03445-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 04/10/2024] [Indexed: 05/25/2024] Open
Abstract
PURPOSE Vitreous humor (VH) is used for postmortem biochemical studies because it is well protected in an uncontaminated state even after death. The goal of this research was to investigate electrolyte concentrations in the VH from human eyes with and without a history of vitrectomy surgery. METHODS We analyzed the sodium (Na), potassium (K), chloride (Cl) and magnesium (Mg) concentrations from 34 VH samples from 34 patients. Eleven samples were from eyes with a history of vitrectomy, and the remaining 23 eyes had no history of vitrectomy. The correlations of Na, K, Cl and Mg concentrations with patient age, interval between first and second vitrectomy, and lens status (history of cataract surgery) were also evaluated. RESULTS The Na, K, Cl and Mg concentrations in VH from vitrectomized eyes were 134.1 ± 7.9 mmol/L, 3.7 ± 0.2 mmol/L, 99.7 ± 6.7 mmol/L and 0.59 ± 0.09 mmol/L, respectively; all were significantly lower than the corresponding concentrations in VH from control eyes (lower by 5.0%, 11.0%, 11.7%, and 22.6%, respectively). Na, K, Cl and Mg concentrations in VH from vitrectomized eyes did not show significant correlations with patient ages or the interval between their first and second vitrectomies. There were no significant differences in Na, K, Cl and Mg concentrations in VH between phakic eyes and intraocular lens-implanted eyes. CONCLUSIONS With the increasing number of vitrectomies being performed, it is necessary to consider the history of vitrectomy when using a subject's VH in forensic examination.
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Affiliation(s)
- Hiroaki Ushida
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan
| | - Ayana Suzumura
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan
| | - Kazuhisa Yamada
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan
| | - Hideyuki Shimizu
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan
| | - Atsuo Suzuki
- Department of Clinical Laboratory, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan
| | - Yusuke Ishikawa
- Department of Clinical Laboratory, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan
| | - Ryosuke Kikuchi
- Division of Clinical Laboratory, Gifu University Hospital, 1-1 Yanagido, 501-1194, Gifu City, Japan
| | - Koji M Nishiguchi
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan
| | - Hiroki Kaneko
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan.
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Cheng Z, Liu X. Comparing the efficacy of glucocorticoids and anti-VEGF in treating diabetic macular edema: systematic review and comprehensive analysis. Front Endocrinol (Lausanne) 2024; 15:1342530. [PMID: 38586457 PMCID: PMC10995385 DOI: 10.3389/fendo.2024.1342530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/07/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction The aim of this study was to better understand the efficacy of various drugs, such as glucocorticoids and anti-vascular endothelial growth factors (VEGF), in the treatment of diabetic macular edema (DME), and to evaluate various clinical treatment regimens consisting of different therapeutic measures. Methods This study included randomized controlled trials up to February 2023 comparing the efficacy of corticosteroid-related therapy and anti-VEGF therapy. PubMed, the Cochrane Library, and Embase were searched, and the quality of the studies was carefully assessed. Finally, 39 studies were included. Results Results at 3-month followup showed that intravitreal injection of bevacizumab (IVB) + triamcinolone acetonide (TA) was the most beneficial in improving best-corrected visual acuity and reducing the thickness of macular edema in the center of the retina in patients with DME. Results at 6-month follow-up showed that intravitreal dexamethasone (DEX) was the most effective in improving patients' bestcorrected visual acuity and reducing the thickness of central macular edema. Discussion Overall, IVB+TA was beneficial in improving best-corrected visual acuity and reducing central macular edema thickness over a 3-month follow-up period, while DEX implants had a better therapeutic effect than anti-VEGF agents at 6 months, especially the patients with severe macular edema and visual acuity impaired. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=397100, identifier CRD42023397100.
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Affiliation(s)
- Zhi’ang Cheng
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Xiaoyong Liu
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
- Department of Ophthalmology, The Affiliated Shunde Hospital of Jinan University, Foshan, Guangdong, China
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Wang J, Rodriguez SH, Xiao J, Luo W, Gonnah R, Shaw L, Dao D, Schechet SA, Mackin AG, Komati R, Skondra D. FULL-THICKNESS MACULAR HOLE CLOSURE WITH TOPICAL MEDICAL THERAPY. Retina 2024; 44:392-399. [PMID: 37948745 DOI: 10.1097/iae.0000000000003988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/21/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE To examine the efficacy and clinical characteristics of successful full-thickness macular hole closure with topical therapy. METHODS Retrospective case series of full-thickness macular holes managed by a single retinal physician (DS) diagnosed and treated from 2017 to 22. RESULTS Of 168 patients with full-thickness macular holes, 71 patients were started on steroid, carbonic anhydrase inhibitor, and nonsteroidal antiinflammatory (NSAID) drops. 49 patients (mean 67 years, 59% women) were included in the analysis, and 22 patients were excluded for poor follow-up. In total, 7/49 were secondary post-PPV holes and 42/49 were idiopathic. In addition, 18/49 eyes (36.7%) achieved closure on topical therapy, of which 13 were idiopathic. Hole size was directly correlated with odds of closure: for every 10 μm decrease in size and odds of closure increased by 1.2× ( P = 0.001, CI 1.1-1.4). Average time to closure was 107.2 days (range 20-512 days) and was not correlated with hole size ( P = 0.217, CI -0.478 to +1.938). The presence of VMT was found to be inversely related to successful closure (OR 6.1, P = 0.029, CI 1.2-31.3). There was no significant difference in final best-corrected visual acuity for eyes undergoing primary pars plana vitrectomy versus those trialing drops before undergoing pars plana vitrectomy ( P = 0.318, CI -0.094 to +0.112). CONCLUSION In the first study to date to report the overall efficacy and clinical characteristics of successful macular hole closure with topical therapy, drops achieved an overall closure rate of 36.7%, with higher efficacy in smaller holes and those without VMT. Rates of MH narrowing and reduction in central foveal thickness acted as predictors of effectiveness of drop therapy.
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Affiliation(s)
- Jessie Wang
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, Illinois
| | - Sarah H Rodriguez
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, Illinois
| | - Jason Xiao
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, Illinois
| | - Wendy Luo
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, Illinois
| | - Reem Gonnah
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, Illinois
| | - Lincoln Shaw
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, Illinois
| | - David Dao
- Elman Retina Group, Baltimore, Maryland
| | | | | | | | - Dimitra Skondra
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, Illinois
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Han YE, Jo J, Kim YJ, Lee J. Factors Affecting Intensive Aflibercept Treatment Response in Diabetic Macular Edema: A Real-World Study. J Diabetes Res 2023; 2023:1485059. [PMID: 37497120 PMCID: PMC10368507 DOI: 10.1155/2023/1485059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 05/15/2023] [Accepted: 06/29/2023] [Indexed: 07/28/2023] Open
Abstract
Objective To investigate the systemic and ocular factors that affect the response to intensive aflibercept treatment in diabetic macular edema (DME) in a real-world setting. Methods This retrospective cohort study evaluated 30 eyes of 23 patients with DME who underwent intensive intravitreal aflibercept injections (five monthly loading doses). Treatment response was assessed by central retinal thickness (CRT) and best-corrected visual acuity (BCVA) at each monthly visit. The patients were categorized as good (<300 μm) and suboptimal (≥300 μm) responders based on CRT after the loading phase. Baseline systemic and ocular factors associated with treatment response were investigated. Results The mean CRT and BCVA significantly improved after five loading injections (486.87 ± 95.46 to 334.90 ± 69.47 μm and 0.51 ± 0.30 to 0.35 ± 0.25 LogMAR, respectively, all p < 0.05). During 12 months of follow-up, 16 eyes (53.33%) maintained CRT without additional treatment. Eyes with diabetes mellitus (DM) for ≥15 years, estimated glomerular filtration rate (eGFR) < 80 mL/min/1.73 m2, serum creatinine ≥ 0.95 mg/dL and potassium ≥ 4.7 mmol/L, and presence of epiretinal membrane (ERM) were more likely to have a suboptimal response to the treatment. Conclusions Five monthly loading doses of intravitreal aflibercept injection provided significant anatomical and visual improvements in patients with DME. Patients with longer DM duration, lower eGFR, higher serum creatinine or potassium levels, or ERM were predisposed to a suboptimal treatment response. Individual response to intensive aflibercept treatment for DME can be predicted by these systemic and ocular risk factors.
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Affiliation(s)
- Ye Eun Han
- Department of Ophthalmology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, Republic of Korea
| | - Jaehyuck Jo
- Department of Ophthalmology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, Republic of Korea
| | - Yoon Jeon Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, Republic of Korea
| | - Junyeop Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, Republic of Korea
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Hsieh TC, Deng GH, Chang YC, Chang FL, He MS. A real-world study for timely assessing the diabetic macular edema refractory to intravitreal anti-VEGF treatment. Front Endocrinol (Lausanne) 2023; 14:1108097. [PMID: 37265702 PMCID: PMC10230025 DOI: 10.3389/fendo.2023.1108097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 05/08/2023] [Indexed: 06/03/2023] Open
Abstract
Background Early Identifying and characterizing patients with diabetic macular edema (DME) is essential for individualized treatment and outcome optimization. This study aimed to timely investigate optical coherence tomography (OCT) biomarkers of DME refractory to intravitreal anti-vascular endothelial growth factor (VEGF) therapy. Methods We retrospective reviewed 72 eyes from 44 treatment-naïve patients who were treated with intravitreal anti-VEGF for DME. OCT scans prior to anti-VEGF were evaluated for serous retinal detachment (SRD), size of outer nuclear layer cystoid changes, diffuse retinal thickening, integrity of the inner segment-outer segment (IS-OS) junction, quantity and location of hyperreflective foci, vitreomacular interface abnormalities, and epiretinal membrane (ERM). The Baseline best-corrected visual acuity (BCVA) and central macular thickness was recorded at baseline and 4 months after treatment with anti-VEGF. The main outcome measure was the correlation between spectral-domain OCT measurements and BCVA response at baseline and after anti-VEGF treatment (mean change from baseline; ≥ 10 Early Treatment Diabetic Retinopathy Study letters in BCVA). Results Partially continuous IS-OS layers (partially vs. completely continuous: β, -0.138; Wald chi-square, 16.392; P<0.001) was predictor of better response to anti-VEGF treatment. In contrast, ERM (present vs. absent ERM: β, 0.215; Wald chi-square, 5.921; P=0.015) and vitreomacular traction (vitreomacular traction vs. posterior vitreous detachment: β=0.259; Wald chi-square=5.938; P=0.015) were the predictors of poor response. The improvement of BCVA trended toward the OCT predictive value of central macular thickness reduction; however, this was not significant. Conclusion Partially continuous IS-OS layers is predictive of better response to anti-VEGF therapy in DME. Meanwhile, ERM is a significant predictor of poor response.
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Affiliation(s)
| | - Guang-Hong Deng
- Tzu Chi University Research Center for Big Data Teaching, Research and Statistic Consultation, Hualien, Taiwan
| | - Yung-Ching Chang
- Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Fang-Ling Chang
- Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Ming-Shan He
- Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
- Department of Ophthalmology and Visual Science, Tzu Chi University, Hualien, Taiwan
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Gong Y, Wang M, Li Q, Shao Y, Li X. Evaluating the effect of vitreomacular interface abnormalities on anti-vascular endothelial growth factor treatment outcomes in diabetic macular edema by optical coherence tomography: a systematic review and meta-analysis. Photodiagnosis Photodyn Ther 2023; 42:103555. [PMID: 37088331 DOI: 10.1016/j.pdpdt.2023.103555] [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: 12/20/2022] [Revised: 04/02/2023] [Accepted: 04/03/2023] [Indexed: 04/25/2023]
Abstract
PURPOSE To evaluate the effect of vitreomacular interface (VMI) configuration on treatment outcomes after intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy for diabetic macular edema (DME) using optical coherence tomography (OCT). METHODS A systematic literature search was performed on PubMed, Embase, web of science and clinicaltrials.gov. The primary outcome parameters were central macular thickness (CMT), best-corrected visual acuity (BCVA) and mean injection numbers. We performed this meta-analysis by Review Manager (RevMan) 5.4.1. RESULTS The impact of epiretinal membrane (ERM), vitreomacular traction (VMT) and vitreomacular adhesion (VMA) on the treatment outcomes were analyzed separately. 9 clinical studies involving 699 eyes were eligible for the meta-analysis for evaluating the effect of ERM/VMT on efficacy. And 7 studies with 610 eyes were included to access whether VMA affected the response to anti-VEGF therapy in patients with DME. The ERM/VMT group had poorer CMT reductions than the control group at 1 month ([MD] 52.91mm, P<0.00001), while no significant difference at 3 months ([MD] 43.95 mm, P=0.22) and over 12 months ([MD] 30.51 mm, P=0.45). No statistically significant difference in the mean BCVA change at 1 month ([MD] -0.03 Log MAR, P=0.79), whereas ERM/VMT group had poor visual acuity gains at 3 months ([MD] 0.08 Log MAR, P=0.003), and a tendency of poor vision improvement over 12 months follow-up ([MD] 0.07 Log MAR, P=0.11). There was no significant difference in the visual and anatomical results over 3 months in DME patients with or without VMA ([MD] -21.92 mm, P = 0.09; [MD] 1.79 letters, P=0.22). Besides, VMI configuration was not found to affect mean injection numbers. CONCLUSION The limited evidence suggested that ERM/VMT was associated with worse CMT reduction at 1 month, poor BCVA gain at 3 months and a tendency of limited vision improvement over 12 months follow-up in DME patients treated with anti-VEGF agents. And VMA may not adversely affect the anatomic and functional outcomes. However, the results of this meta-analysis should be interpreted with caution because of the heterogeneity among study designs.
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Affiliation(s)
- Yi Gong
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Manqiao Wang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Qingbo Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Yan Shao
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China.
| | - Xiaorong Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China.
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Uwimana A, Ma C, Chen S, Ma X. Metformin therapy as a strategy to compensate anti-VEGF resistance in patients with diabetic macular edema. Medicine (Baltimore) 2022; 101:e31266. [PMID: 36281139 PMCID: PMC9592524 DOI: 10.1097/md.0000000000031266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Diabetic macular edema (DME) is the complication of diabetic retinopathy, the leading cause of vision loss among diabetic patients. Metformin is the main antidiabetic treatment. It is preferable for its great anti-angiogenic and anti-inflammatory effects. Anti-vascular endothelial growth factor (VEGF) therapy is the preferable treatment for DME despite its lack of convincing results in some patients. To assess whether the combination of metformin and anti-VEGF drugs may decrease the risk of anti-VEGF resistance among DME patients. We included DME patients with a central retinal thickness (CRT) ≥ 250 μm who consecutively underwent at least 3 anti-VEGF therapies from January 1, 2020, to December 30, 2021. Anti-VEGF resistance was defined as persistent macular edema with decreased CRT ≤ 25% after 3 anti-VEGF injections. 109 patients were considered for this research, of whom 65 (59.6%) were resistant to anti-VEGF therapy. The mean CRT of the non-metformin group decreased from 344.88 ± 129.48 to 318.29 ± 123.23 (20.85%) and from 415.64 ± 144.26 to 277.11 ± 99.25 (31.51%) (P = .031) in the metformin group. Moreover, the metformin group had fewer resistant patients than the non-metformin, 24 (45.3%) versus 41 (73.2%). Furthermore, a considerable gain in visual acuity was observed in both groups, with a BCVA gain of 40.41% in the metformin group and 39.9% in the non-metformin group. Metformin may be combined with an anti-VEGF drug to minimize the risk of anti-VEGF resistance among DME patients. Moreover, it can serve to design effective therapeutic deliveries.
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Affiliation(s)
- Alexandre Uwimana
- Department of Ophthalmology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Cong Ma
- Department of Ophthalmology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shengyao Chen
- Department of Ophthalmology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiang Ma
- Department of Ophthalmology, First Affiliated Hospital of Dalian Medical University, Dalian, China
- *Correspondence: Xiang Ma, Department of Ophthalmology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Xigang District, Dalian 116044, China (e-mail: )
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Yuen YS, Tan GSW, Gan NY, Too IHK, Mothe RK, Basa P, Shaikh J. Real-World Evidence in the Management of Diabetic Macular Edema with Intravitreal Anti-VEGFs in Asia: A Systematic Literature Review. Clin Ophthalmol 2022; 16:3503-3526. [PMID: 36274678 PMCID: PMC9579008 DOI: 10.2147/opth.s378392] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022] Open
Abstract
Purpose To evaluate the visual outcomes and safety profile of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy in the treatment of diabetic macular edema (DME) in real-world studies in Asian countries. Methods A systematic review of electronic literature databases (Embase, Medline, and the Cochrane Library from January 1, 2010, to March 16, 2021) was conducted to identify observational studies that reported clinical and safety outcomes of anti-VEGF treatments for DME in Asia. We analyzed baseline patient characteristics, treatment patterns, mean number of injections, best-corrected visual acuity (BCVA), retinal thickness, and safety outcomes. Results Seventy-one studies were included in this review. Most studies reported treatment of DME with ranibizumab (n = 33), followed by aflibercept (n = 13), bevacizumab (n = 28), and conbercept (n = 9). At 12 months, the cumulative mean number of injections for ranibizumab, aflibercept, and conbercept was 5.2, 4.6, and 6, respectively. At the 12-month follow-up, the cumulative mean BCVA gain was 6.8 letters (ranibizumab), 4.6 letters (aflibercept), 4.9 letters (bevacizumab), and 8.3 letters (conbercept). The cumulative mean reduction in retinal thickness at 12 months was 116.9 μm (ranibizumab), 105.9 μm (aflibercept), 81.7 μm (bevacizumab), and 135.2 μm (conbercept). A strong positive correlation (r = 0.78) was observed between mean number of injections and change in BCVA at 12 months. A moderate positive correlation (r = 0.54) was observed between mean number of injections and mean reduction in retinal thickness at 12 months. A weak positive correlation was observed between baseline retinal thickness and visual acuity at 12 months. Baseline BCVA and mean number of injections were predictors of BCVA at 12 months. Conclusion All anti-VEGFs were effective in the treatment of DME in Asia. The data suggest that a greater number of anti-VEGF injections was associated with better improvement in BCVA and moderate reduction in retinal thickness at the 1-year follow-up.
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Affiliation(s)
- Yew Sen Yuen
- Department of Ophthalmology, National University Hospital, Singapore
| | - Gavin Siew Wei Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Nicola Yi’An Gan
- Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute, Singapore, Singapore
| | - Issac Horng Khit Too
- Novartis Singapore Pte. Ltd., Mapletree Business City, Singapore,Correspondence: Issac Horng Khit Too, Novartis Singapore Pte Ltd, Mapletree Business City, 20 Pasir Panjang Road #10-25/28, 117439, Singapore, Tel +6567226189, Email
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Retinal Delivery of the Protein Kinase C-β Inhibitor Ruboxistaurin Using Non-Invasive Nanoparticles of Polyamidoamine Dendrimers. Pharmaceutics 2022; 14:pharmaceutics14071444. [PMID: 35890338 PMCID: PMC9322846 DOI: 10.3390/pharmaceutics14071444] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/22/2022] [Accepted: 07/06/2022] [Indexed: 01/25/2023] Open
Abstract
Ruboxistaurin (RBX) is an anti-vascular endothelial growth factor (anti-VEGF) agent that is used in the treatment of diabetic retinopathy and is mainly given intravitreally. To provide a safe and effective method for RBX administration, this study was designed to develop RBX nanoparticles using polyamidoamine (PAMAM) dendrimer generation 5 for the treatment of diabetic retinopathy. Drug loading efficiency, and in vitro release of proposed complexes of RBX: PAMAM dendrimers were determined and the complexation ratio that showed the highest possible loading efficiency was selected. The drug loading efficiency (%) of 1:1, 2.5:1, and 5:1 complexes was 89.2%, 96.4%, and 97.6%, respectively. Loading capacities of 1:1, 2.5:1, and 5:1 complexes were 1.6%, 4.0%, and 7.2% respectively. In comparison, the 5:1 complex showed the best results in the aforementioned measurements. The in vitro release studies showed that in 8 h, the RBX release from 1:1, 2.5:1, and 5:1 complexes was 37.5%, 35.9%, and 77.0%, respectively. In particular, 5:1 complex showed the highest drug release. In addition, particle size measurements showed that the diameter of empty PAMAM dendrimers was 214.9 ± 8.5 nm, whereas the diameters of loaded PAMAM dendrimers in 1:1, 2.5:1, 5:1 complexes were found to be 461.0 ± 6.4, 482.4 ± 12.5, and 420.0 ± 7.1 nm, respectively. Polydispersity index (PDI) showed that there were no significant changes in the PDI between the free and loaded PAMAM dendrimers. The zeta potential measurements showed that the free and loaded nanoparticles possessed neutral charges due to the presence of anionic and cationic terminal structures. Furthermore, the safety of this formulation was apparent on the viability of the MIO-M1 cell lines. This nanoformulation will improve the therapeutic outcomes of anti-VEGF therapy and the bioavailability of RBX to prevent vision loss in patients with diabetic retinopathy.
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Li Z, Deng X, Lu T, Zhou L, Xiao J, Lan Y, Jin C. Hyperreflective Material Serves as a Potential Biomarker of Dyslipidemia in Diabetic Macular Edema. Photodiagnosis Photodyn Ther 2022; 39:102903. [DOI: 10.1016/j.pdpdt.2022.102903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
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Ivastinovic D, Haas A, Weger M, Seidel G, Mayer-Xanthaki C, Lindner E, Guttmann A, Wedrich A. Vitrectomy for diabetic macular edema and the relevance of external limiting membrane. BMC Ophthalmol 2021; 21:334. [PMID: 34525998 PMCID: PMC8444500 DOI: 10.1186/s12886-021-02095-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/01/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To evaluate the relevance of external limiting membrane (ELM) on the visual and morphological results in eyes with diabetic macular edema (DME) that underwent pars plana vitrectomy (PPV) with epiretinal membrane (ERM) and internal limiting membrane (ILM) peeling. METHODS Medical records of patients with DME who underwent PPV at our unit between January 2017 and December 2019 were reviewed. We assessed preoperative and postoperative best-corrected visual acuity (BCVA), central macular thickness (CMT) using spectral domain OCT (optical coherence tomography). Exclusion criteria were previous PPV; incomplete data; concomitant diseases including retinal vein occlusion, age-related macular degeneration, uveitis; and a follow-up of less than 12 months. The surgeries were performed using 23- or 27-gauge vitrectomy. The ELM was graded depending on its configuration (grade 0 = intact, grade 1 to 3: disruption of varying extent). RESULTS Ninety-nine eyes were enrolled. The postoperative follow up averaged 23.7 months. The preoperative and final BCVA averaged 0.71 ± 0.28 and 0.52 ± 0.3 logMAR, respectively (p = 0.002). The CMT averaged 515.2 ± 209.1 μm preoperatively and 327 ± 66.1 μm postoperatively (p = 0.001). Eyes with intact ELM (n = 8) had a significantly better BCVA compared to those with ELM disruption (0.28 ± 0.14 vs. 0.7 ± 0.25 logMAR, p = 0.01). The final CMT was similar among the groups (intact ELM: 317 ± 54.6 μm; ELM disruption: 334 ± 75.2, p = 0.31). CONCLUSIONS PPV with ERM and ILM peeling is an effective treatment of DME. Eyes with intact ELM preoperatively had a significantly better final visual outcome. To maximize the benefit for patients with DME we recommend early PPV as long as ELM is intact.
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Affiliation(s)
- Domagoj Ivastinovic
- Department of Ophthalmology, Medical University Graz, Auenbruggerplatz 4, 8036, Graz, Austria.
| | - Anton Haas
- Department of Ophthalmology, Medical University Graz, Auenbruggerplatz 4, 8036, Graz, Austria
| | - Martin Weger
- Department of Ophthalmology, Medical University Graz, Auenbruggerplatz 4, 8036, Graz, Austria
| | - Gerald Seidel
- Department of Ophthalmology, Medical University Graz, Auenbruggerplatz 4, 8036, Graz, Austria
| | | | - Ewald Lindner
- Department of Ophthalmology, Medical University Graz, Auenbruggerplatz 4, 8036, Graz, Austria
| | - Andreas Guttmann
- Department of Ophthalmology, Medical University Graz, Auenbruggerplatz 4, 8036, Graz, Austria
| | - Andreas Wedrich
- Department of Ophthalmology, Medical University Graz, Auenbruggerplatz 4, 8036, Graz, Austria
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12
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Wan W, Long Y, Jin X, Li Q, Wan W, Liu H, Zhu Y. Protective Role of microRNA-200a in Diabetic Retinopathy Through Downregulation of PDLIM1. J Inflamm Res 2021; 14:2411-2424. [PMID: 34113148 PMCID: PMC8187036 DOI: 10.2147/jir.s303540] [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: 01/25/2021] [Accepted: 05/04/2021] [Indexed: 12/26/2022] Open
Abstract
Background Diabetic retinopathy (DR) is a most common microvascular complication and regarded as the leading cause of blindness in the working age population. The involvement of miR-200a in various disorders has become recognized, and the objective of this study was to identify the protective effect of miR-200a in the development of DR. Methods The contents of miR-200a and its potential target gene, PDZ and LIM domain protein 1 (PDLIM1), were detected in both in-vivo and in-vitro DR models. Retinal leakage and inflammatory factor concentrations were detected after vitreous injections of miR-200a/PDLIM1 vectors in mice. The cellular viability, apoptosis and cellular migration were investigated using trypan blue staining, flow cytometry and transwell assay with human retinal microvascular endothelial cells (HRMECs). Besides, the prediction and confirmation of miR-200a targeting PDLIM1 were conducted with bioinformation analyses and dual-luciferase reporter assay. Results Lower miR-200a and higher PDLIM1 levels were detected in both in-vivo and in-vitro DR models. Besides, it was found that miR-200a treatment would significantly inhibit retinal permeability and inflammatory factors. Through targeting PDLIM1, it was found that miR-200a could improve cellular viability, remit apoptotic status and reduce cellular migration significantly in high glucose-treated HRMECs. Conclusion Our results demonstrated that miR-200a could be used as a potential therapy target through down-regulating PDLIM1 in DR.
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Affiliation(s)
- Wencui Wan
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yang Long
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Xuemin Jin
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Qiuming Li
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Weiwei Wan
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Hongzhuo Liu
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yu Zhu
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
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13
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Chen D, Shen Z, Cheng X, Wang Q, Zhou J, Ren F, Sun Y, Wang H, Huang R. Homeobox A5 activates p53 pathway to inhibit proliferation and promote apoptosis of adrenocortical carcinoma cells by inducing Aldo-Keto reductase family 1 member B10 expression. Bioengineered 2021; 12:1964-1975. [PMID: 34027794 PMCID: PMC8806264 DOI: 10.1080/21655979.2021.1924545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Aldo-Keto Reductase Family 1 Member B10 (AKR1B10) and Homeobox A5 (HOXA5) are both down-regulated in adrenocortical carcinoma (ACC), and HOXA5 is predicted to bind to the promoter of AKR1B10. We aimed to investigate whether HOXA5 could bind to AKR1B10 to regulate ACC cells proliferation and apoptosis. The expression of AKR1B10 and HOXA5 in ACC patients and the relationship of their expression between ACC prognosis were evaluated by searching database. Then, NCI-H295R cells were overexpressed to detect the alteration of cell proliferation, apoptosis and the expression of p53 and p21 proteins. The interaction between AKR1B10 and HOXA5 was validated by luciferase report and chromatin immunoprecipitation. Finally, NCI-H295R cells were silenced with HOXA5 in the presence of AKR1B10 overexpression, and then cell proliferation and apoptosis were also assessed. Results revealed that AKR1B10 and HOXA5 are down-regulated in ACC patients and the low expression of it is correlated with low percent of overall survival (OS) and disease free survival (DFS). Compared with Y1 cells, SW-13 and NCI-H295R cells exerted lower expression of AKR1B10 and HOXA5. AKR1B10 significantly inhibited cell viability, colony formation and expression of Ki67 and PCNA, but promoted apoptosis and expression of p53 and p21 in NCI-H295R cells. HOXA5 could interact with AKR1B10 and enhance AKR1B10 expression. Furthermore, HOXA5 knockdown obviously blocked the effect of AKR1B10 overexpression on NCI-H295R cells proliferation and apoptosis. In conclusion, HOXA5 could bind to AKR1B10 promotor to increase its expression, activate p53 signaling, thereby inhibiting proliferation and promoting apoptosis of ACC cells.
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Affiliation(s)
- Danyan Chen
- Departments of Endocrinology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, China
| | - Zhaonan Shen
- Departments of Nephrology, The Fifth People's Hospital of Chongqing, Chongqing China
| | - Xi Cheng
- Departments of Science & Education, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, China
| | - Qi Wang
- Departments of Laboratory, Chengdu Sixth People's Hospital, Chengdu, Sichuan Province China
| | - Junlin Zhou
- Departments of Endocrinology, The First Affiliated Hospital of University of South China, Hengyang, Hunan Province China
| | - Fang Ren
- Departments of Emergency, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing China
| | - Yue Sun
- Departments of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing China
| | - Hongman Wang
- Departments of Endocrinology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, China
| | - Rongxi Huang
- Departments of Endocrinology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, China
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14
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Schnichels S, Paquet-Durand F, Löscher M, Tsai T, Hurst J, Joachim SC, Klettner A. Retina in a dish: Cell cultures, retinal explants and animal models for common diseases of the retina. Prog Retin Eye Res 2020; 81:100880. [PMID: 32721458 DOI: 10.1016/j.preteyeres.2020.100880] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 06/23/2020] [Accepted: 06/26/2020] [Indexed: 12/11/2022]
Abstract
For many retinal diseases, including age-related macular degeneration (AMD), glaucoma, and diabetic retinopathy (DR), the exact pathogenesis is still unclear. Moreover, the currently available therapeutic options are often unsatisfactory. Research designed to remedy this situation heavily relies on experimental animals. However, animal models often do not faithfully reproduce human disease and, currently, there is strong pressure from society to reduce animal research. Overall, this creates a need for improved disease models to understand pathologies and develop treatment options that, at the same time, require fewer or no experimental animals. Here, we review recent advances in the field of in vitro and ex vivo models for AMD, glaucoma, and DR. We highlight the difficulties associated with studies on complex diseases, in which both the initial trigger and the ensuing pathomechanisms are unclear, and then delineate which model systems are optimal for disease modelling. To this end, we present a variety of model systems, ranging from primary cell cultures, over organotypic cultures and whole eye cultures, to animal models. Specific advantages and disadvantages of such models are discussed, with a special focus on their relevance to putative in vivo disease mechanisms. In many cases, a replacement of in vivo research will mean that several different in vitro models are used in conjunction, for instance to analyze and validate causative molecular pathways. Finally, we argue that the analytical decomposition into appropriate cell and tissue model systems will allow making significant progress in our understanding of complex retinal diseases and may furthermore advance the treatment testing.
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Affiliation(s)
- Sven Schnichels
- University Eye Hospital, Centre for Ophthalmology, University of Tübingen, Germany.
| | - François Paquet-Durand
- Institute for Ophthalmic Research, Centre for Ophthalmology, University of Tübingen, Germany
| | - Marina Löscher
- University Eye Hospital, Centre for Ophthalmology, University of Tübingen, Germany
| | - Teresa Tsai
- Experimental Eye Research Institute, University Eye Hospital, Ruhr-University Bochum, Germany
| | - José Hurst
- University Eye Hospital, Centre for Ophthalmology, University of Tübingen, Germany
| | - Stephanie C Joachim
- Experimental Eye Research Institute, University Eye Hospital, Ruhr-University Bochum, Germany
| | - Alexa Klettner
- Department of Ophthalmology, University Medical Center, University of Kiel, Kiel, Germany
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15
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Liu Y, Cheng J, Gao Y, Qin L, Min X, Zhang M. Efficacy of switching therapy to aflibercept for patients with persistent diabetic macular edema: a systematic review and meta-analysis. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:382. [PMID: 32355826 PMCID: PMC7186737 DOI: 10.21037/atm.2020.02.04] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background To evaluate functional and anatomical consequences of switching anti-vascular endothelial growth factor (anti-VEGF) therapy from bevacizumab and/or ranibizumab to aflibercept intravitreal injection for the treatment of persistent diabetic macular edema (DME). Methods Analysis of switching treatment in patients with persistent DME was performed using a literature search across multiple databases (PubMed, Medline, EMBASE, Cochrane Library and Web of Science) prior to May 2019. Therapeutic effect parameters, including mean change of best-corrected visual acuity (BCVA) and central macular thickness (CMT), were extracted from baseline to different follow-up times post initial injections. The quality of studies was assessed with the Downs and Black checklist. Data pertaining to ocular and systemic safety adverse events (SAEs) were collected as well as subgroup analysis stratified by pre-switch anti-VEGF reagents. All results were analyzed and pooled using random-effects models with 95% confidence intervals (CI). Results Fourteen studies involving 489 eyes met the inclusion criteria. The mean differences in BCVA were significantly improved at 1, 2 and 3 months with −0.11 logMAR (P=0.016), −0.22 logMAR (P<0.001) and −0.24 logMAR (P<0.01), respectively. Vision gain was also assessed following the aflibercept injection with a mean change of −0.10 logMAR (P<0.001) at 6 months and −0.08 logMAR (P=0.01) at 12 months. CMT reduction was significant from baseline with a mean decrease of 80.52 µm (P<0.001) at 1 month, 89.6 µm (P<0.013) at 2 months, 113.88 µm (P<0.001) at 3 months and 125.12 µm (P<0.001) at 6 months. Mean CMT continued to decline by 75.70 µm (P<0.001) at 12 months as well. Conclusions This meta-analysis indicated the comparable efficacy and safety of a conversion treatment to aflibercept in cases of unsatisfactory responses to other anti-VEGF drugs. Switching treatment produces significant advantage for vision acuity recovery and macular edema improvement among persistent DME patients.
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Affiliation(s)
- Yilin Liu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jiahan Cheng
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yunxia Gao
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Ling Qin
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xiaoxue Min
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Ming Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu 610041, China
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Erden B, Çakır A, Bölükbaşı S, Özturan ŞG, Elçioğlu MN. The Effects of Epiretinal Membranes on the Treatment Outcomes of Dexamethasone Implants in Diabetic Macular Edema: A Real-Life Study. J Ocul Pharmacol Ther 2020; 36:298-303. [PMID: 32096674 DOI: 10.1089/jop.2019.0133] [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] [Indexed: 11/12/2022] Open
Abstract
Purpose: To evaluate the effects of a coexisting epiretinal membrane (ERM) on the treatment outcomes of a dexamethasone implant (DI) in diabetic macular edema (DME) patients. Methods: One hundred five eyes of 78 DME patients (44 F, 34 M; mean age: 65.7) treated with minimum 2 DIs were enrolled into this retrospective study. The study population was divided into the ERM (+) study group and the ERM (-) control group. The best corrected visual acuity (BCVA), intraocular pressure, and central macular thicknesses (CMTs) were evaluated at baseline and months 1, 2, and 3 after each DI treatment. Results: Both groups were comparable in baseline BCVA, CMT, HbA1c levels, and age. In the study group (n: 49), BCVA changed following the first DI from 0.83 to 0.76 and from 0.97 to 0.80 following the second DI. CMT decreased after the first DI from 465 to 377 μ (P < 0.001) and from 477 to 356 μ (P < 0.001) after the second DI. In the control group (n: 56), BCVA changed following the first DI from 0.81 to 0.77 and from 0.86 to 0.83 following the second DI. After the first DI, CMT decreased from 483 to 280 μ (P < 0.001) and from 468 to 301 μ (P < 0.001) after the second DI. The inter-group comparison revealed no significant difference in visual or anatomical gain (P = 0.46, P = 0.05, respectively). Conclusion: The presence of an epiretinal membrane did not change the treatment response to DI therapy.
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Affiliation(s)
- Burak Erden
- Department of Ophthalmology, University of Health Sciences, Okmeydanı Education and Research Hospital, Istanbul, Turkey
| | - Akın Çakır
- Department of Ophthalmology, University of Health Sciences, Okmeydanı Education and Research Hospital, Istanbul, Turkey
| | - Selim Bölükbaşı
- Department of Ophthalmology, University of Health Sciences, Okmeydanı Education and Research Hospital, Istanbul, Turkey
| | - Şeyma Gülcenur Özturan
- Department of Ophthalmology, University of Health Sciences, Okmeydanı Education and Research Hospital, Istanbul, Turkey
| | - Mustafa Nuri Elçioğlu
- Department of Ophthalmology, University of Health Sciences, Okmeydanı Education and Research Hospital, Istanbul, Turkey
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Cicinelli MV, Cavalleri M, Lattanzio R, Bandello F. The current role of steroids in diabetic macular edema. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2020.1729743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Maria Vittoria Cicinelli
- Department of Ophthalmology, Scientific Institute San Raffaele, Vita-Salute University, Milan, Italy
| | - Michele Cavalleri
- Department of Ophthalmology, Scientific Institute San Raffaele, Vita-Salute University, Milan, Italy
| | - Rosangela Lattanzio
- Department of Ophthalmology, Scientific Institute San Raffaele, Vita-Salute University, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, Scientific Institute San Raffaele, Vita-Salute University, Milan, Italy
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