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Chen H, Shi X, Zhang W, Han Q. Aflibercept versus ranibizumab for diabetic macular edema: A meta-analysis. Eur J Ophthalmol 2024; 34:615-623. [PMID: 37226427 PMCID: PMC11067396 DOI: 10.1177/11206721231178658] [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: 10/05/2022] [Accepted: 05/10/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The purpose of this study was to compare the efficacy and safety of aflibercept (AFL) versus ranibizumab (RAN) for the treatment of diabetic macular edema (DME). METHODS The PubMed, Embase, Cochrane Library, and CNKI databases were searched up to September 2022 to identify prospective randomized controlled trials (RCTs) comparing AFL with RAN for the treatment of DME. Review Manager 5.3 software was used for data analysis. We used the GRADE system to evaluate the quality of the evidence for each outcome. RESULTS A total of 8 RCTs involving 1067 eyes (939 patients) were included; there were 526 eyes in the AFL group and 541 eyes in the RAN group. Meta-analysis revealed that there was no significant difference between RAN and AFL in the best-corrected visual acuity (BCVA) of DME patients at 6 months (WMD: -0.05, 95% CI = -0.12 to 0.01, moderate quality) and 12 months after injection (WMD: -0.02, 95% CI = -0.07 to 0.03, moderate quality). Additionally, there was no significant difference between RAN and AFL in the reduction of central macular thickness (CMT) at 6 months (WMD: -0.36, 95% CI = -24.99 to 24.26, very low quality) and 12 months after injection (WMD: -6.36, 95% CI = -16.30 to 3.59, low quality). Meta-analysis showed that the number of intravitreal injections (IVIs) for AFL was significantly lower than that for RAN (WMD: -0.47, 95% CI = -0.88 to -0.05, very low quality). There were fewer adverse reactions to AFL than to RAN, but the difference was not significant. CONCLUSION This study found that there was no difference in BCVA, CMT or adverse reactions between AFL and RAN at 6 and 12 months of follow-up, but AFL needed fewer IVIs than RAN.
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Affiliation(s)
- Haiyan Chen
- Department of Ophthalmology, the Sixth Hospital of Beijing, Beijing, China
| | - Xuehui Shi
- Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wang Zhang
- Department of Ophthalmology, the Sixth Hospital of Beijing, Beijing, China
| | - Qianqian Han
- Department of Ophthalmology, the Sixth Hospital of Beijing, Beijing, China
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Li S, Tao Y, Yang M, Zhao H, Si M, Cui W, Wang H. Aflibercept 5+PRN with retinal laser photocoagulation is more effective than retinal laser photocoagulation alone and aflibercept 3+PRN with retinal laser photocoagulation in patients with high-risk proliferative diabetic retinopathy and diabetic macular edema: a 12-month clinical trial. Front Endocrinol (Lausanne) 2024; 15:1286736. [PMID: 38455651 PMCID: PMC10919144 DOI: 10.3389/fendo.2024.1286736] [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: 08/31/2023] [Accepted: 01/25/2024] [Indexed: 03/09/2024] Open
Abstract
Objective This study aimed to investigate and compare the efficacy and safety of retinal laser photocoagulation (PRP) alone, PRP with aflibercept 3+PRN, and PRP with aflibercept 5+PRN in patients with both high-risk proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME). Methods Overall, 170 patients with high-risk PDR and DME (170 eyes from 170 patients) who visited our ophthalmology clinic from December 2018 to December 2020 were divided into the PRP (n=58), aflibercept 5+PRN with PRP (n=53), and aflibercept 3+PRN with PRP (n= 59) groups. General information, such as age, sex, and eye category, was obtained. Moreover, best-corrected visual acuity (BCVA), baseline central macular foveal thickness (CFT), microaneurysm (MA), area of neovascularization (NV), area of hard exudate (HE), and cytokine levels in atrial fluid before and after treatment, were assessed. The χ2 test was used for comparison between groups for statistical data. Analysis of variance was used for the statistical description of measurement data, independent samples were analyzed using Student's t-test, and Student-Newman-Keuls test was used for group comparisons. Differences were considered statistically significant at P < 0.05. Results After treatment, no significant improvement in the BCVA (logMAR) of patients in the PRP group was observed. The BCVA (log MAR) decreased from 0.72 ± 0.17 and 0.74 ± 0.17 to 0.50 ± 0.13 and 0.53 ± 0.17 in PRP with aflibercept 5+PRN and PRP with aflibercept 3+PRN groups, respectively, with a statistically significant difference compared to those in the PRP group (P<0.05 in all cases). However, no statistically significant difference was observed between the combined treatment groups (P>0.05). The CFT in the PRP-only group decreased slightly from 361.80 ± 36.70 μm to 353.86 ± 40.88 μm, with no statistically significant difference (P>0.05), whereas the CFT in the aflibercept 5+PRN with PRP and aflibercept 3+PRN with PRP groups decreased from 356.57 ± 37.57 μm and 358.17 ± 44.66 μm to 284.87 ± 31.52 μm and 303.19 ± 37.00 μm, respectively, with statistically significant differences before and after treatment (P<0.05 for both groups). Statistically significant differences were observed in CFT between the three groups after treatment (P<0.05 in all cases). The number of MA (pcs) in the PRP, aflibercept 5+PRN with PRP, and aflibercept 3+PRN with PRP groups decreased from 118.34 ± 27.96, 118.60 ± 33.34, and 116.59 ± 28.95 to 92.95 ± 29.04, 44.60 ± 20.73, and 54.26 ± 25.43, respectively. The two-way comparison of the three groups revealed statistically significant differences in MA (P<0.05 in all cases). In the three groups, NV decreased from 1.00 ± 0.21 mm², 1.01 ± 0.18 mm², and 0.98 ± 0.20 mm² before treatment to 0.49 ± 0.17 mm², 0.31 ± 0.16 mm², and 0.38 ± 0.14 mm², respectively, with statistically significant differences (P<0.05 in all cases). After 12 months of treatment, 13, 18, and 18 patients had reduced HE area in the PRP-only, aflibercept 5+PRN with PRP, and aflibercept 3+PRN with PRP groups, respectively, with statistically significant differences (P<0.05 in all cases). After 12 months of treatment, vascular endothelial growth factor, monocyte chemoattractant protein-1, and glial fibrilliary acidic protein levels (pg/mL) in the aqueous humor decreased in both combined treatment groups compared with that at baseline, with statistically significant differences; however, no significant difference was observed between the two combined treatment groups (P>0.05). Conclusion Aflibercept 5+PRN combined with PRP was safe and effective in treating patients with high-risk PDR and DME, and was more effective than PRP-only and aflibercept 3+PRN with PRP in improving CFT and MA.
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Affiliation(s)
- Shuting Li
- Department of Ophthalmology, Qilu Hospital of Shandong Province, Jinan, China
| | - Yuan Tao
- Department of Ophthalmology, The Second People’s Hospital of Jinan, Jinan, China
| | - Mengyao Yang
- Department of Ophthalmology, Qilu Hospital of Shandong Province, Jinan, China
| | - Hui Zhao
- Department of Ophthalmology, Qilu Hospital of Shandong Province, Jinan, China
| | - Mingwei Si
- Department of Ophthalmology, Qilu Hospital of Shandong Province, Jinan, China
| | - Wenxuan Cui
- Department of Ophthalmology, Qilu Hospital of Shandong Province, Jinan, China
| | - Hong Wang
- Department of Ophthalmology, Qilu Hospital of Shandong Province, Jinan, China
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Khattab AM, Hagras SM, Lotfy NM. Pre-operative versus post-operative intravitreal aflibercept injection for management of DME in patients undergoing cataract surgery. Graefes Arch Clin Exp Ophthalmol 2023; 261:3223-3229. [PMID: 37329361 DOI: 10.1007/s00417-023-06138-6] [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: 03/26/2023] [Revised: 05/19/2023] [Accepted: 06/01/2023] [Indexed: 06/19/2023] Open
Abstract
AIM The aim of this paper is to investigate the need of deferring cataract surgery until treating the co-existing diabetic macular edema (DME) using intravitreal (IVI) anti-vascular endothelial growth factor (anti-VEGF). METHODS A prospective randomized interventional study included diabetic patients with visually significant cataract and DME. Patients were divided into 2 groups. Group A received three preoperative intravitreal (IVI) aflibercept injections with a monthly interval; the third injection was given intra-operatively. Group B received a single intra-operative injection, and two post-operative injections with a monthly interval. The primary outcome measure was the change in central macular thickness (CMT) at 1st and 6th month post-operative. The secondary outcome measures were best corrected visual acuity (BCVA) at same points and any documented adverse effects. RESULTS Forty patients were enrolled in the study, 20 patients in each group. Means of CMT at 1 month post-operatively were significantly higher in group B than group A but no statistical difference at 6 months. There was no statistical difference between the 2 groups regarding BCVA at 1 or 6 months post-operatively. Compared with the baseline values, BCVA and CMT improved significantly after 1 and 6 months within both groups. CONCLUSION IVI of aflibercept given before cataract surgeries does not seem to have superior effect over postoperative injections in either macular thickness or visual outcomes. Hence, preoperative controlling of DME might not be mandatory in patients undergoing cataract surgery. CLINICAL TRIAL REGISTRATION The study is registered in clinical trial. Gov (NCT05731089).
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Affiliation(s)
- Abeer M Khattab
- Department of Ophthalmology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
- Department of Ophthalmology, Al-Hadi Clinic, Jabriya, Kuwait
| | - Sherein M Hagras
- Department of Ophthalmology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | - Nancy M Lotfy
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Chung YR, Lee KH, Lee K. Clinical Application of Intravitreal Aflibercept Injection for Diabetic Macular Edema Comparing Two Loading Regimens. Medicina (B Aires) 2023; 59:medicina59030558. [PMID: 36984559 PMCID: PMC10054468 DOI: 10.3390/medicina59030558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 03/14/2023] Open
Abstract
Background and Objectives: We investigated and compared the efficacy of three and five monthly loading regimens of an intravitreal aflibercept injection (IVA) in patients with diabetic macular edema (DME). Materials and Methods: This was a retrospective study that included patients diagnosed with DME and treated with an either three or five monthly aflibercept loading regimen from July 2018 to March 2022. Information on clinical characteristics and changes in the central retinal thickness (CRT) were obtained from medical records. Results: In total, 44 eyes of 44 patients with DME treated with IVA were included in this study, with 30 eyes treated with 3-monthly loadings (three-loading group) and 14 eyes with 5-monthly loadings (five-loading group). The mean CRT significantly decreased from the baseline one month after loading in both the three-loading and five-loading groups (p < 0.001). Four cases were refractory to treatment in the three-loading group, while there were no cases of refractory DME in the five-loading group. The stability rate was significantly higher in the five-loading group at three months after loading (p = 0.033). Conclusions: Five-monthly loading regimens of IVA might be favorable for DME considering the rate of refractory cases, stable duration, and the importance of early responsiveness to IVA in DME.
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Affiliation(s)
- Yoo-Ri Chung
- Department of Ophthalmology, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Kyung Ho Lee
- Love Eye Clinic, Hwaseong 18309, Republic of Korea
| | - Kihwang Lee
- Department of Ophthalmology, Ajou University School of Medicine, Suwon 16499, Republic of Korea
- Correspondence: ; Tel.: +82-31-219-7814
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Enomoto H, Sugimoto M, Asami S, Kondo M. Progress of Diabetic Macular Edema after Loading Injection of Anti-Vascular Endothelial Growth Factor Agents in Real-World Cases. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58101318. [PMID: 36295479 PMCID: PMC9610068 DOI: 10.3390/medicina58101318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: To evaluate the recurrence of diabetic macular edema (DME) after loading an injection of anti-VEGF agents by a pro re nata (PRN) protocol using central retinal thickness (CRT) as a re-injection criterion. Materials and Methods: This is a retrospective, observational single-center study. DME patients with a central retinal thickness (CRT) over 350 μm received a PRN injection of anti-VEGF agents following one to three consecutive monthly loading injections (bevacizumab, ranibizumab, and aflibercept) for 6 months from January 2012 to June 2019. Results: We enrolled a total of 72 eyes for loading injections and the mean CRT improved from 434.04 ± 139.4 μm (before treatment) to 362.9 ± 125.0 μm after the loading injection. One week after injection, 36 eyes (50%) obtained a CRT of ≤350 μm. Fourteen eyes (19.4%) remained with a CRT of ≤350 μm for 6 months without additional injections. A total of 22 eyes (30.6%) had a CRT of >350 μm at 6 months. Fifteen eyes did not receive additional injections because of visual improvement. Conclusions: About 20% of DME patients can be maintained at a CRT of ≤350 μm for 6 months with only a loading injection. However, there is a tendency to delay additional injections for patients with recurrences using PRN protocol.
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Fernández-Vigo JI, Contreras I, Crespo MJ, Beckford C, Flores-Moreno I, Cobo-Soriano R, Pareja J, Martín MD, Moreno L, Arrevola-Velasco L. Expert Panel Consensus for Addressing Anti-VEGF Treatment Challenges of Diabetic Macular Edema in Spain. Clin Ophthalmol 2022; 16:3097-3106. [PMID: 36164581 PMCID: PMC9507974 DOI: 10.2147/opth.s374763] [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: 05/15/2022] [Accepted: 08/03/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The treatment of diabetic macular edema (DME) has evolved rapidly in the past decade, highlighting the need to address the challenges of routine clinical practice decision-making through expert consensus agreements. Methods After a literature review and discussion of real-world experience on DME management, a group of ten retina specialists agreed on a consensus of recommendations for the most appropriate management of DME patients using vascular endothelial growth factor inhibitors (anti-VEGF) in Spain. Results The panel recommended early treatment initiation in DME patients with worse baseline visual acuity (VA) to maintain or improve outcome. For patients with good VA, an observation strategy was recommended, considering the presence of diabetic retinopathy, optical coherence tomography biomarkers, and impact on patient's quality of life. Based on the available evidence and clinical experience, the panel recommended the use of anti-VEGF intensive loading doses with the objective of achieving anatomic and visual responses as soon as possible, followed by a Treat & Extend (T&E) strategy to maintain VA improvement. Aflibercept was recommended for patients with a baseline decimal VA <0.5, followed by a T&E strategy, including the possibility to extend frequency of injections up to 16 weeks. Conclusion An expert panel proposes a consensus for the management of DME in Spain. Early treatment initiation with anti-VEGF in DME patients is recommended to maintain or improve VA; aflibercept is recommended for patients with a poor baseline VA.
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Affiliation(s)
- José Ignacio Fernández-Vigo
- Deparment of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - Inés Contreras
- Deparment of Ophthalmology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS) and Clínica Rementería, Madrid, Spain
| | - María José Crespo
- Department of Ophthalmology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Carlos Beckford
- Department of Ophthalmology, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | | | - Rosario Cobo-Soriano
- Department of Ophthalmology, Hospital Universitario Henares, Universidad Francisco de Vitoria, Madrid, Spain
| | - Jesús Pareja
- Department of Ophthalmology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Luis Moreno
- Department of Ophthalmology, Hospital 12 de Octubre, Madrid, Spain
| | - Luis Arrevola-Velasco
- Department of Ophthalmology, Clinica Baviera Instituto Oftalmológico Europeo, Madrid, Spain
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Gascon P, Borget I, Comet A, Carton L, Matonti F, Dupont-Benjamin L. Costs comparison of treating diabetic macular edema with aflibercept, ranibizumab or dexamethasone at 1 year in France (INVICOST study). Eur J Ophthalmol 2022; 32:1702-1709. [PMID: 34284605 PMCID: PMC9109236 DOI: 10.1177/11206721211033480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 06/29/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE INVICOST, a medico-economic analysis, compared costs of managing treatment-naive patients with diabetic macular edema (DME) receiving intravitreal injections (IVIs) of aflibercept (AFL), dexamethasone implant (DXI) or ranibizumab (RAN) over 1 year. METHODS Healthcare resource use and associated costs were estimated using individual patient data from INVICTUS, a prospective, open-label, monocentric study. Healthcare costs comprised direct medical costs such as drug acquisition and administration, consultations and ophthalmological procedures. Costs were assessed from the French National Health Insurance perspective using published national tariffs expressed in 2019 euros. RESULTS Of the 60 treated eyes, 48 had no treatment switch; 14 received AFL, 19 received DXI and 15 received RAN. AFL-treated eyes received an average of 6.5 IVIs, DXI-treated patients received 2 IVIs and RAN-treated received 6.8 IVIs. All treated eyes received an initial prescription for adjunctive ocular medications and 349 follow-up procedures were performed including an average of 3.9 optical coherence tomography and 3.2 retinography procedures per eye. Average total direct cost of per-eye treatment was €4516 (€1128-€8257). Average cost was €5782 for eyes treated with AFL, €2779 with DXI and €5536 with RAN. Drug therapy was the cost driver: €4394 (76%) for AFL, €1915 for DXI (69%) and €4268 (77%) for RAN. CONCLUSION The difference in total treatment cost is largely explained by the significantly lower frequency of IVI and annual cost of therapy with DXI, compared with AFL and RAN. INVICOST is the first study comparing treatment costs with AFL, DXI and RAN in France in current clinical practice.
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Affiliation(s)
- Pierre Gascon
- Ophthalmology Department, Aix-Marseille University, Hôpital Nord, Marseille, France
| | - Isabelle Borget
- Department of Biostatistics and Epidemiology, Oncostat U1018, Inserm, labeled Ligue Contre le Cancer Gustave Roussy, University Paris-Saclay, Villejuif, France
- EA GRADES, University Paris-Saclay, Châtenay-Malabry, France
| | - Alban Comet
- Ophthalmology Department, Aix-Marseille University, Hôpital Nord, Marseille, France
| | | | - Frédéric Matonti
- Centre Monticelli Paradis, Marseille, France
- Aix Marseille University, CNRS, INT, Timone Neurosciences Institute, Marseille, France
- Groupe Almaviva Santé, Clinique Juge, Marseille, France
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Tran THC, Verdun S, Le Rouic JF, Uzzan J, Milazzo S, Kodjikian L, Erginay A. Two-Year Outcome of Aflibercept Intravitreal Injection in Vitrectomized Eyes with Diabetic Macular Edema. Clin Ophthalmol 2022; 16:603-609. [PMID: 35310546 PMCID: PMC8923833 DOI: 10.2147/opth.s352152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/03/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Thi Ha Chau Tran
- Ophthalmology Department, Lille Catholic Hospitals, Lille Catholic University, INSERM, U1172, Lille, France
- Correspondence: Thi Ha Chau Tran, Ophthalmology Department, Lille Catholic Hospitals, Lille Catholic University, INSERM, Boulevard de Belfort – BP387. 59020 Lille Cedex, U1171, France, Tel +33 3 20 87 74 42, Fax +33 20 87 75 58, Email
| | - Stephane Verdun
- Biostatistics Department-Delegations for Clinical Research and Innovation, Lille Catholic Hospitals, Lille, France
| | | | | | - Solange Milazzo
- Ophthalmology Department, Picardie Jules Verne University, Amiens, France
| | - Laurent Kodjikian
- Ophthalmology Department, Hospice Civils de Lyon, Lyon 1 University, UMR-CNRS 5510, Lyon, France
| | - Ali Erginay
- Ophthalmology Department, Lariboisière Hospital, Paris University, Paris, France
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Kodjikian L, Baillif S, Couturier A, Creuzot-Garcher C, Delyfer MN, Matonti F, Weber M. Recommendations for the management of diabetic macular oedema with intravitreal dexamethasone implant: A national Delphi consensus study. Eur J Ophthalmol 2021; 32:2845-2856. [PMID: 34779302 DOI: 10.1177/11206721211052852] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE The intravitreal dexamethasone implant (DEX-I) is an alternative to anti-VEGF for the first-line treatment of diabetic macular oedema (DME). However, several questions remain regarding its routine use and its place in certain situations not always specified in current recommendations. A national consensus approach was, therefore, initiated by French retinal experts. METHODS An iterative Delphi consensus approach was used. A steering committee (SC) of seven experts analysed data from the literature to formulate statements divided into five key areas of treatment. These statements were submitted to the independent and anonymous electronic vote of 87 French retina experts among whom 39 expressed their opinion and therefore constituted the voting panel. RESULTS After two rounds of voting, 22 and 7 of 38 statements received a strong consensus and a good consensus, respectively. The consensus level was higher for statements regarding first-line indications and safety of DEX-I compared to those regarding efficacy assessment, reprocessing time or pathophysiological biomarkers. The panellists recommended the preferential use of DEX-I for patients with limited availability for multiple injections, those who needed to undergo cataract surgery or who had a recent cardiovascular history, and as a therapeutic alternative to anti-VEGF in patients with a history of vitrectomy, retinal serous detachment, hyper-reflective points or dry exudates in optical coherence tomography (OCT). However, some statements proposed by SC experts were not validated. CONCLUSION This study provides some key recommendations to clinicians treating diabetic macular oedema, which may be useful when using intravitreal dexamethasone implants in daily practice.
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Affiliation(s)
- Laurent Kodjikian
- 386696Hospital La Croix-Rousse Ophthalmology, Lyon, Rhône-Alpes, France
| | - Stephanie Baillif
- Department of Ophthalmology, 37045Centre Hospitalier Universitaire de Nice, Nice, France
| | - Aude Couturier
- Department of Ophthalmology, 378772Hospital Lariboisière, Paris, Île-de-France, France
| | | | | | - Frédéric Matonti
- Centre Monticelli Paradis, Marseille, France.,Aix Marseille University, Marseille, France
| | - Michel Weber
- 26922University Hospital Centre Nantes, Nantes, Pays de la Loire, France
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Lindboe JB, Schmidt Laugesen C, Sørensen TL, Brynskov T. Similar real-world two-year visual acuity gains in treatment-naive patients with diabetic macular oedema treated with a loading dose of three initial monthly injections versus less intensive regimens of intravitreal anti-vascular endothelial growth factor. Acta Ophthalmol 2021; 99:e1248-e1249. [PMID: 33956397 DOI: 10.1111/aos.14724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 11/15/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Johanne Bjerre Lindboe
- Clinical Eye Research Division Department of Ophthalmology Zealand University Hospital Roskilde Denmark
| | - Caroline Schmidt Laugesen
- Clinical Eye Research Division Department of Ophthalmology Zealand University Hospital Roskilde Denmark
| | - Torben Lykke Sørensen
- Clinical Eye Research Division Department of Ophthalmology Zealand University Hospital Roskilde Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Troels Brynskov
- Clinical Eye Research Division Department of Ophthalmology Zealand University Hospital Roskilde Denmark
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Mieno H, Yoneda K, Terao N, Yoshii K, Kojima K, Nagata K, Sotozono C. Prospective Clinical Trial of Intravitreal Aflibercept Treat-and-extend Regimen for Diabetic Macular Edema: 1-Year Outcomes. KOREAN JOURNAL OF OPHTHALMOLOGY 2021; 34:290-296. [PMID: 32783421 PMCID: PMC7419240 DOI: 10.3341/kjo.2020.0003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/26/2020] [Accepted: 04/10/2020] [Indexed: 01/21/2023] Open
Abstract
Purpose To investigate the efficacy of aflibercept for the treatment of diabetic macular edema via a treat-and-extend regimen. Methods This prospective, single-center, open-label, interventional study involved 30 patients with a best-corrected visual acuity (BCVA) ≤0.6 and a central retinal thickness (CRT) ≥300 µm. The enrolled eyes each received a monthly intravitreal aflibercept injection until the CRT decreased below 300 µm, upon which the administration interval was extended for 1 month until the CRT once again increased to ≥300 µm. Main outcome measures were median BCVA and CRT at 6 and 12 months after initiation of treatment via last observation carried forward analysis, the median number of injections over the 12 months, and the effects on the diabetic retinopathy severity scale (DRSS) score of the patients who completed the 12-month follow-up period. Results Of the 30 enrolled patients, 29 and 25 respectively completed the 6- and 12-month follow-up examinations. From baseline to 6 and 12 months after treatment initiation, the median BCVA (logarithm of the minimum angle of resolution) significantly improved from 0.52 to 0.30 and 0.35, respectively, and the median CRT significantly decreased from 439.5 to 268.5 and 249.0 µm, respectively. The median number of injections over the 12-month follow-up period was 6.0. Compared to baseline, the DRSS score at 12 months was improved by 2 steps in 16% of patients; in no cases did the DRSS score worsen or improve by three steps or more. Conclusions When administered in a treat-and-extend regimen, aflibercept is an effective treatment option for diabetic macular edema.
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Affiliation(s)
- Hiroki Mieno
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuhito Yoneda
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Nobuhiro Terao
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kengo Yoshii
- Department of Mathematics and Statistics in Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kentaro Kojima
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kenji Nagata
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Chie Sotozono
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Tran THC, Erginay A, Verdun S, Fourmaux E, Le Rouic JF, Uzzan J, Milazzo S, Baillif S, Kodjikian L. One-Year Outcome of Aflibercept Intravitreal Injection in Vitrectomized Eyes with Diabetic Macular Edema. Clin Ophthalmol 2021; 15:1971-1978. [PMID: 34007150 PMCID: PMC8123959 DOI: 10.2147/opth.s304030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/10/2021] [Indexed: 11/23/2022] Open
Abstract
Aim To evaluate the efficacy of intravitreal Aflibercept injection (IAI) for vitrectomized eyes with diabetic macular edema (DME) at one year. Methods This is a prospective, non-comparative, multicenter observational study including diabetic patients whose HbA1c is < 9%, with visual acuity between 20/400 to 20/40 due to DME, who have undergone vitrectomy since at least 3 months before the first aflibercept injection. Treatment protocol included 5 monthly aflibercept injection followed by a ProReNata regimen during the first year. Visual acuity, OCT findings and number of IAI were assessed at 6 months and one year. Results Forty-six eyes were included. Indications for vitrectomy were epiretinal membrane (58.7%), intravitreal hemorrhage (26.1%), and vitreomacular traction (8.7%), retinal detachment (4.3%), and other cause (4.3%). Median duration of macular edema was 3 years. Median interval between vitrectomy and first visit was 9 months. Thirty eyes were non-naïve and received previously thermal laser (44.3%), intravitreal injection of triamcinolone (26.7%), of ranibizumab (70%), of dexamethasone implant (36.7%), or bevacizumab (6.7%). Data was available for 35 eyes at 1 year. Visual gain was significant, +6 letters (p <0.001) and central subfield thickness (CST) decreased significantly (−108μm, p < 0.001) at 1 year. Mean number of injections was 9.3 and mean interval injection was 5.8 weeks. Conclusion These results suggest that IAI may be beneficial in vitrectomized eyes with refractory DME which require frequent injections to obtain visual and anatomical improvement. Clinical Trial Registration http://www.clinicaltrials.gov, registration Number NCT02874859.
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Affiliation(s)
- Thi Ha Chau Tran
- Service d'Ophtalmologie, Université Catholique de Lille, Faculté de Médecine et Maieutique, INSERM U1171, Lille, France
| | - Ali Erginay
- Service d'Ophtalmologie, Hôpital Lariboisière APHP, Universite de Paris, Paris, France
| | - Stephane Verdun
- Département de Recherche Médicale, Groupement des Hôpitaux Catholiques de Lille, Lille, France
| | | | | | | | - Solange Milazzo
- Service d'Ophtalmologie, Centre Hospitalier Universitaire d'Amiens Picardie, Université de Picardie Jules Verne, Amiens, France
| | - Stephanie Baillif
- Service d'Ophtalmologie, Centre Hospitalier Université Côte d'Azur, Université Côte d'Azur, Nice, France
| | - Laurent Kodjikian
- Service d'Ophtalmologie, Croix Rousse Hospital, Hospice Cilvils de Lyon 1, Université de Lyon 1, Lyon, France
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13
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Kim YC, Shin JP, Pak KY, Kim HW, Sagong M, Lee SJ, Chung IY, Park SW, Lee JE. Two-year outcomes of the treat-and-extend regimen using aflibercept for treating diabetic macular oedema. Sci Rep 2020; 10:22030. [PMID: 33328488 PMCID: PMC7745011 DOI: 10.1038/s41598-020-78954-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 11/18/2020] [Indexed: 11/21/2022] Open
Abstract
This study was performed to investigate the efficacy of the treat-and-extend regimen using aflibercept for treating diabetic macular oedema (DME). This prospective, multicentre, interventional, single-arm, 104-week clinical trial included 48 patients with DME visual impairment. The patients’ eyes received five consecutive intravitreal injections (2 mg aflibercept) every four weeks with two-week adjustments based on central subfield macular thickness (CSMT) changes. Injections were deferred when CSMT was stable. The number of injections, best-corrected visual acuity (BCVA), CSMT, and diabetic retinopathy severity scale scores were analysed. Compared to baseline, BCVA improved by + 9.1 letters at 52 weeks and was maintained with + 9.4-letter gain at 104 weeks (P < 0.001). Between baseline and 104 weeks, CSMT decreased from 489 to 298 μm (P < 0.001) and eyes with vision ≥ 20/40 increased from 17.4 to 43.5% (P = 0.007). The mean number of injections decreased from 8.5 in year one to 3.9 in year two. The injection interval was extended to ≥ 12 weeks in 56.5% of patients. The treat-and-extend regimen of aflibercept in DME showed 2-year efficacy comparable to that of fixed dosing regimens. The flexible dosing of this regimen reduced the number of injections in year two while maintaining efficacy.
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Affiliation(s)
- Yu Cheol Kim
- Department of Ophthalmology, Keimyung University School of Medicine, Daegu, Korea
| | - Jae Pil Shin
- Department of Ophthalmology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Kang Yeun Pak
- Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hyun Woong Kim
- Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Min Sagong
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Sang Joon Lee
- Department of Ophthalmology, Kosin University College of Medicine, Busan, Korea
| | - In Young Chung
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Sung Who Park
- Department of Ophthalmology, Pusan National University, School of Medicine, 49, Busandaehak-ro, Mulgeum-eup, Yangsan, Gyeongsangnam-do, 50612, Korea.,Biomedical Institute, Pusan National University Hospital, Busan, Korea
| | - Ji Eun Lee
- Department of Ophthalmology, Pusan National University, School of Medicine, 49, Busandaehak-ro, Mulgeum-eup, Yangsan, Gyeongsangnam-do, 50612, Korea. .,Biomedical Institute, Pusan National University Hospital, Busan, Korea.
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14
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Bonfiglio V, Platania CBM, Lazzara F, Conti F, Pizzo C, Reibaldi M, Russo A, Fallico M, Ortisi E, Pignatelli F, Longo A, Avitabile T, Drago F, Bucolo C. TGF-β Serum Levels in Diabetic Retinopathy Patients and the Role of Anti-VEGF Therapy. Int J Mol Sci 2020; 21:ijms21249558. [PMID: 33334029 PMCID: PMC7765505 DOI: 10.3390/ijms21249558] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/04/2020] [Accepted: 12/12/2020] [Indexed: 12/16/2022] Open
Abstract
Transforming growth factor β1 (TGFβ1) is a proinflammatory cytokine that has been implicated in the pathogenesis of diabetic retinopathy (DR), particularly in the late phase of disease. The aim of the present study was to validate serum TGFβ1 as a diagnostic and prognostic biomarker of DR stages. Thirty-eight subjects were enrolled and, after diagnosis and evaluation of inclusion and exclusion criteria, were assigned to six groups: (1) healthy age-matched control, (2) diabetic without DR, (3) non-proliferative diabetic retinopathy (NPDR) naïve to treatment, (4) NPDR treated with intravitreal (IVT) aflibercept, (5) proliferative diabetic retinopathy (PDR) naïve to treatment and (6) PDR treated with IVT aflibercept. Serum levels of vascular endothelial growth factor A (VEGF-A), placental growth factor (PlGF) and TGFβ1 were measured by means of enzyme-linked immunosorbent assay (ELISA). Foveal macular thickness (FMT) in enrolled subjects was evaluated by means of structural-optical coherence tomography (S-OCT). VEGF-A serum levels decreased in NPDR and PDR patients treated with aflibercept, compared to naïve DR patients. PlGF serum levels were modulated only in aflibercept-treated NPDR patients. Particularly, TGFβ1 serum levels were predictive of disease progression from NPDR to PDR. A Multivariate ANOVA analysis (M-ANOVA) was also carried out to assess the effects of fixed factors on glycated hemoglobin (HbA1c) levels, TGFβ1, and diabetes duration. In conclusion, our data have strengthened the hypothesis that TGFβ1 would be a biomarker and pharmacological target of diabetic retinopathy.
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Affiliation(s)
- Vincenza Bonfiglio
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section, University of Palermo, 90133 Palermo, Italy;
| | - Chiara Bianca Maria Platania
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, 95123 Catania, Italy; (C.B.M.P.); (F.L.); (F.C.); (F.D.)
| | - Francesca Lazzara
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, 95123 Catania, Italy; (C.B.M.P.); (F.L.); (F.C.); (F.D.)
| | - Federica Conti
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, 95123 Catania, Italy; (C.B.M.P.); (F.L.); (F.C.); (F.D.)
| | - Corrado Pizzo
- Department of Ophthalmology, University of Catania, 95123 Catania, Italy; (C.P.); (A.R.); (M.F.); (E.O.); (A.L.); (T.A.)
| | - Michele Reibaldi
- Department of Surgical Science, Eye Clinic, University of Torino, 10124 Torino, Italy;
| | - Andrea Russo
- Department of Ophthalmology, University of Catania, 95123 Catania, Italy; (C.P.); (A.R.); (M.F.); (E.O.); (A.L.); (T.A.)
| | - Matteo Fallico
- Department of Ophthalmology, University of Catania, 95123 Catania, Italy; (C.P.); (A.R.); (M.F.); (E.O.); (A.L.); (T.A.)
| | - Elina Ortisi
- Department of Ophthalmology, University of Catania, 95123 Catania, Italy; (C.P.); (A.R.); (M.F.); (E.O.); (A.L.); (T.A.)
| | | | - Antonio Longo
- Department of Ophthalmology, University of Catania, 95123 Catania, Italy; (C.P.); (A.R.); (M.F.); (E.O.); (A.L.); (T.A.)
| | - Teresio Avitabile
- Department of Ophthalmology, University of Catania, 95123 Catania, Italy; (C.P.); (A.R.); (M.F.); (E.O.); (A.L.); (T.A.)
| | - Filippo Drago
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, 95123 Catania, Italy; (C.B.M.P.); (F.L.); (F.C.); (F.D.)
- Center for Research in Ocular Pharmacology-CERFO, University of Catania, 95123 Catania, Italy
| | - Claudio Bucolo
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, 95123 Catania, Italy; (C.B.M.P.); (F.L.); (F.C.); (F.D.)
- Center for Research in Ocular Pharmacology-CERFO, University of Catania, 95123 Catania, Italy
- Correspondence:
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15
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Haider S, Sadiq SN, Lufumpa E, Sihre H, Tallouzi M, Moore DJ, Nirantharakumar K, Price MJ. Predictors for diabetic retinopathy progression-findings from nominal group technique and Evidence review. BMJ Open Ophthalmol 2020; 5:e000579. [PMID: 33083555 PMCID: PMC7549478 DOI: 10.1136/bmjophth-2020-000579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/15/2020] [Accepted: 08/17/2020] [Indexed: 12/15/2022] Open
Abstract
Objectives Risk stratification is needed for patients referred to hospital eye
services by Diabetic Eye Screening Programme UK. This requires a set of candidate predictors. The literature contains a large number of predictors. The objective of this research was to arrive at a small set of clinically important predictors for the outcome of the progression of diabetic retinopathy (DR). They need to be evidence based and readily available during the clinical consultation. Methods and analysis Initial list of predictors was obtained from a systematic review of prediction models. We sought the clinical expert opinion using a formal qualitative study design. A series of nominal group technique meetings to shorten the list and to rank the predictors for importance by voting were held with National Health Service hospital-based clinicians involved in caring for patients with DR in the UK. We then evaluated the evidence base for the selected predictors by critically appraising the evidence. Results The source list was presented at nominal group meetings (n=4), attended by 44 clinicians. Twenty-five predictors from the original list were ranked as important predictors and eight new predictors were proposed. Two additional predictors were retained after evidence check. Of these 35, 21 had robust supporting evidence in the literature condensed into a set of 19 predictors by categorising DR. Conclusion We identified a set of 19 clinically meaningful predictors of DR progression that can help stratify higher-risk patients referred to hospital eye services and should be considered in the development of an individual risk stratification model. Study design A qualitative study and evidence review. Setting Secondary eye care centres in North East, Midlands and South of England.
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Affiliation(s)
| | | | | | | | | | - David J Moore
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Malcolm James Price
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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16
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Bolz M, Podkowinski D, Pretzl J, Mursch‐Edlmayr A, Luft N, Ring M. Patterns of morphologic alteration correlate with vision in diabetic macular oedema: a cross-sectional evaluation of patients using the SAVE II protocol. Acta Ophthalmol 2020; 98:e400-e406. [PMID: 31736255 DOI: 10.1111/aos.14288] [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: 04/17/2019] [Accepted: 10/03/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE We sought to describe and evaluate patients with clinically significant diabetic macular oedema (CSME) according to the improved SAVE II protocol and correlate findings with visual acuity and systemic parameters in the outpatient clinic for DR (diabetic retinopathy) management. METHODS This was a cross-sectional case series study of patients with CSME, regardless of prior treatment. Visual acuity testing was performed according to the Early Treatment of Diabetic Retinopathy Study (ETDRS) protocol. Optical coherence tomography (OCT) and fluorescence angiography (FA) were performed. All imaging data were evaluated according to an improved version of the SAVE grading protocol for CSME (SAVE II). The main outcome measures were SAVE II oedema types and best-corrected visual acuity. Additional parameters of a blood sample (fasting glucose, haemoglobin A1c, serum creatinine, triglycerides, cholesterol, low-density lipoproteins, and high-density lipoproteins) were taken. RESULTS In total, 66 eyes of 66 patients were included. The mean age of the patients was 64.9 ± 8.2 years. Two eyes were classified as SAVE oedema type 1, 19 eyes as SAVE oedema type 2, 28 eyes as SAVE oedema type 3, and 28 eyes as SAVE oedema type 4, respectively. Central retinal thickness and laboratory parameters were not significantly different between the groups. There was a statistically significant difference in ETDRS visual acuity between the SAVE groups 2 and 4 (p < 0.001) with lower vision in group 4. There was no statistically significant difference between oedema types 2 and 3 (p = 0.065) and oedema types 3 and 4 (p = 0.13). CONCLUSION There was a significant correlation between the four defined oedema types and visual acuity. Morphologic findings did not correlate with any of the evaluated blood parameters.
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Affiliation(s)
- Matthias Bolz
- Department of Ophthalmology Kepler University Clinic Johannes Kepler University Linz Austria
- Johannes Kepler University Linz Austria
| | - Dominika Podkowinski
- Department of Ophthalmology Kepler University Clinic Johannes Kepler University Linz Austria
- Johannes Kepler University Linz Austria
| | - Josef Pretzl
- Department of Ophthalmology Kepler University Clinic Johannes Kepler University Linz Austria
| | - Anna‐Sophie Mursch‐Edlmayr
- Department of Ophthalmology Kepler University Clinic Johannes Kepler University Linz Austria
- Johannes Kepler University Linz Austria
| | - Nikolaus Luft
- University Eye Hospital Ludwig‐Maximilians‐University Munich Germany
| | - Michael Ring
- Department of Ophthalmology Kepler University Clinic Johannes Kepler University Linz Austria
- Center for Medical Research Johannes Kepler University Linz Austria
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17
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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: 9] [Impact Index Per Article: 2.3] [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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18
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Augustin AJ, Feltgen N, Haritoglou C, Hoerauf H, Maier MM, Mardin CY, Schargus M. [Clinical Decision Making for Treatment of Diabetic Macular Oedema with DEX Implant: a Consensus Paper]. Klin Monbl Augenheilkd 2019; 238:73-84. [PMID: 31770786 DOI: 10.1055/a-1024-4089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Currently two intravitreally applied corticosteroids (dexamethasone and fluocinolone) are licensed in Germany for treatment of diabetic macular oedema (DME). The use of DEX implant for DME in daily clinical practice has not been defined in detail. Following a Delphi panel survey, a group of retina experts set out to come up with a consensus for use of the DEX implant in DME. MATERIAL AND METHODS International and national treatment recommendations were identified from the literature. A steering group generated a catalogue of 72 statements on the aetiology and pathogenesis of DME, therapy with DEX implant, use of DEX implant in patients previously treated with VEGF-inhibitors, use of DEX implant in combination therapy, safety of DME therapies as well as patients' burden of treatment. Twenty-two ophthalmologists from private practice and 6 hospital ophthalmologists participated in the Delphi panel via Survey Monkey. Consensus was reached if at least 75% of participants agreed or disagreed with a statement. Statements for which consensus was not reached were discussed once more during the expert consensus meeting and a vote was taken. Based on these results a treatment algorithm for foveal DME was proposed. RESULTS If a patient does not show sufficient response after 3 - 6 months of anti-VEGF treatment (visual acuity gain of < 5 ETDRS letters or reduction of central retinal thickness ≤ 20%), a switch to DEX implant should take place. DEX implant is also suitable in eyes with longer presentation of DME, showing e.g. massive lipid exudates. DEX implant is suitable as first-line therapy especially in pseudophakic patients, patients unwilling or able to comply with tight anti-VEGF injection intervals or patients with known vascular diseases. With fixed control visits every 4 - 8 weeks, use of DEX implant is flexible and individual. Decision parameters for repeated use should be visual acuity, retinal thickness and intraocular pressure. Treatment of both eyes on the same day should not take place. CONCLUSION The algorithm presented reflects survey as well as expert discussion results and may differ from recommendations issued by the German professional society. The consensus recommendations for the treatment of DME generated during the survey and meeting of retina experts are intended to guide use of DEX implant in daily practice.
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Affiliation(s)
| | | | | | | | | | | | - Marc Schargus
- Augenklinik, Asklepios Kliniken GmbH, Hamburg.,Universitäts-Augenklinik, Heinrich-Heine-Universität, Düsseldorf
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Karagiannis D, Kontomichos L, Georgalas I, Peponis V, Antoniou E, Parikakis E. Glioma-associated radiation retinopathy treated successfully with aflibercept. Ther Clin Risk Manag 2019; 15:937-941. [PMID: 31440056 PMCID: PMC6669310 DOI: 10.2147/tcrm.s204841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 07/08/2019] [Indexed: 11/24/2022] Open
Abstract
Radiation retinopathy is a chronic, progressive retinal microangiopathy which can occur with variable latency after retina exposure to ionizing radiation used for cancer treatment. It can occur secondary to treatment of nasopharyngeal tumors, as well as intraocular tumors, such as uveal melanoma and retinoblastoma. Several treatment modalities have been reported including intravitreal corticosteroids, intravitreal anti-VEGFs and argon laser photocoagulation. Our purpose is to present a case report of bilateral radiation retinopathy with macular edema in one eye that was revealed 6 years after glioma therapy and treated successfully by using monotherapy of aflibercept. A 59-year-old male patient presented with gradually deteriorating visual acuity in his left eye for the past 12 months. Best corrected visual acuity in his right eye was 20/25 and in his left eye 20/100. Fundoscopy and fluorescein angiography revealed severe non-proliferative retinopathy in his right eye and proliferative retinopathy in his left eye with macular edema. Following complete work-up and due to his past medical history, he was diagnosed with radiation retinopathy. The patient received 6 intravitreal injections of aflibercept in a period of 9 months in order to treat macular edema and radiation retinopathy. According to the literature, there is minimal experience using aflibercept monotherapy to successfully treat macular edema due to radiation retinopathy. In addition, radiotherapy for glioma is a rather rare cause of radiation retinopathy compared to other more common causes, such as nasopharyngeal tumors, meningiomas, and uveal melanomas.
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Affiliation(s)
- D Karagiannis
- Second Department of Ophthalmology, Opthalmiatreion Eye Hospital of Athens, Athens, Greece
| | - L Kontomichos
- Second Department of Ophthalmology, Opthalmiatreion Eye Hospital of Athens, Athens, Greece
| | - I Georgalas
- First Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | - V Peponis
- Second Department of Ophthalmology, Opthalmiatreion Eye Hospital of Athens, Athens, Greece
| | | | - E Parikakis
- Second Department of Ophthalmology, Opthalmiatreion Eye Hospital of Athens, Athens, Greece
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20
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Park NH, Kwak HD, Yoon CK, Lee JE, Sagong M, Lee SJ, Lee JE, Kim KH, Kim HW. One-year Outcome of Intravitreal Dexamethasone Implant for Diabetic Macular Edema Patients. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.2.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- No Hae Park
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hyun Duck Kwak
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Chang Ki Yoon
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ji Eun Lee
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea
| | - Min Sagong
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Sang Joon Lee
- Department of Ophthalmology, Kosin University College of Medicine, Busan, Korea
| | | | - Kun Hyung Kim
- Institute of Environmental and Occupational Medicine, Department of Occupational and Environmental Medicine, Inje University College of Medicine, Busan, Korea
| | - Hyun Woong Kim
- Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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21
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Ziemssen F, Wachtlin J, Kuehlewein L, Gamulescu MA, Bertelmann T, Feucht N, Voegeler J, Koch M, Liakopoulos S, Schmitz-Valckenberg S, Spital G. Intravitreal Ranibizumab Therapy for Diabetic Macular Edema in Routine Practice: Two-Year Real-Life Data from a Non-interventional, Multicenter Study in Germany. Diabetes Ther 2018; 9:2271-2289. [PMID: 30288700 PMCID: PMC6250630 DOI: 10.1007/s13300-018-0513-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The prospective, non-interventional OCEAN study examined the use of intravitreal ranibizumab injections for the treatment of diabetic macular oedema (DME) in a real-world setting in Germany. METHODS Adults with DME receiving ≥ 1 ranibizumab (0.5 mg) injections were recruited by 250 ophthalmologists. Best-corrected visual acuity (VA) testing, imaging and treatments were performed according to the investigators' routine practice and documented over 24 months. RESULTS The full analysis set included 1226 participants. Mean baseline VA was 60.6 [95% CI: 59.7; 61.5] Early Treatment Diabetic Retinopathy Study letters. VA improved by ≥ 15 letters in 21.5% and 23.5% of the participants at 12 months and 24 months, respectively. They received a mean number of 4.42 [95% CI: 4.30; 4.54] injections in the first year and 5.52 [95% CI: 5.32; 5.73] injections over 24 months, which was markedly lower than in clinical trials. Only 33.4% of the participants received an upload with four initial monthly injections as recommended by the German ophthalmologic societies. Time-to-event analyses that account for missing data inherent to a non-interventional study design demonstrated that participants receiving ≥ 7 injections in the first year had a faster response, but the duration of the response was shorter compared to the subgroups receiving 1-3 and 4-6 injections. Serious adverse events were reported for 143/1250 (11.4%) participants in the safety population. CONCLUSION Under-treatment is a major problem of DME anti- vascular endothelial growth factor therapy under real life conditions. Despite fewer injections given compared to randomised controlled trials with a consequently reduced overall mean visual gain, a profound functional improvement (≥ 15 letters) was achieved over 2 years in 23.5% of eyes with DME. TRIAL REGISTRATION NUMBER NCT02194803, ClinicalTrials.gov. FUNDING Novartis Pharma GmbH, Nuremberg, Germany.
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Affiliation(s)
- Focke Ziemssen
- Centre for Ophthalmology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany.
| | - Joachim Wachtlin
- St. Gertrauden Krankenhaus, Berlin, Germany
- Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Germany
| | - Laura Kuehlewein
- Centre for Ophthalmology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
| | | | - Thomas Bertelmann
- Artemis Eye Clinic, Dillenburg, Dillenburg, Germany
- Department of Ophthalmology, University Medical Center Goettingen, Goettingen, Germany
| | - Nikolaus Feucht
- Klinikum Rechts der Isar, Technical University, Munich, Germany
| | | | - Mirja Koch
- Novartis Pharma GmbH, Nuremberg, Germany
| | - Sandra Liakopoulos
- Centre for Ophthalmology, University Hospital of Cologne, Cologne, Germany
| | | | - Georg Spital
- Augenzentrum am St. Franziskus Hospital, Muenster, Germany
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