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Remolí Sargues L, Castro Navarro V, Monferrer Adsuara C, Navarro Palop C, Montero Hernández J, Cervera Taulet E. Optical coherence tomography angiography analysis of choroidal microvasculature in various forms of diabetic macular edema. J Fr Ophtalmol 2024; 47:103950. [PMID: 37758547 DOI: 10.1016/j.jfo.2023.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/27/2023] [Accepted: 03/14/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION Optical coherence tomography angiography (OCTA) research in diabetic macular edema (DME) has focused on the retinal microvasculature with little attention to the choroid. The goal of this study was to analyze the association between quantitative choroidal OCTA parameters and various forms of DME observed on optical coherence tomography. METHODS We conducted a retrospective study of 61 eyes of 53 patients with DME. DME was classified as early or advanced, and as sponge-like diffuse retinal thickening (DRT), cystoid macular edema (CME) or serous retinal detachment (SRD). Quantitative OCTA parameters (vessel density [VD] in the superficial capillary plexus [SCP], middle capillary plexus [MCP], deep capillary plexus [DCP] and choriocapillaris [CC]) were recorded. RESULTS The VD in the CC and SCP was significantly higher in patients with early DME compared to patients with advanced DME (P value<0.01). CC VD was lower in subjects with SRD compared to DRT and CME (P value<0.001). Moreover, it was lower in CME compared to DRT (P value<0.05). No statistical differences were found between VD in the MCP and DCP (P value>0.05). Furthermore, CC VD was lower in patients with increased retinal thickness, disruption of the ellipsoid zone (EZ) or external limiting membrane (ELM), and disorganization of the inner retinal layers (DRIL) (P value<0.05). CONCLUSION CC ischemia plays an important role in the pathogenesis of DME. We demonstrated a decrease in CC VD in patients with severe DME, SRD, retinal thickening, EZ and/or ELM disruption and DRIL.
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Affiliation(s)
- L Remolí Sargues
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Av. Tres Cruces 2, 46014 Valencia, Spain.
| | - V Castro Navarro
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Av. Tres Cruces 2, 46014 Valencia, Spain
| | - C Monferrer Adsuara
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Av. Tres Cruces 2, 46014 Valencia, Spain
| | - C Navarro Palop
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Av. Tres Cruces 2, 46014 Valencia, Spain
| | - J Montero Hernández
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Av. Tres Cruces 2, 46014 Valencia, Spain
| | - E Cervera Taulet
- Department of Ophthalmology, Consorcio Hospital General Universitario of Valencia, Av. Tres Cruces 2, 46014 Valencia, Spain
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Nourinia R, Nouri H, Abtahi SH, Nakao S, Eslamipour J, Gerami E, Ahmadieh H. Intravitreal fasudil monotherapy for treatment of refractory diabetic macular edema: A prospective interventional case series. J Fr Ophtalmol 2023:S0181-5512(23)00367-4. [PMID: 37620196 DOI: 10.1016/j.jfo.2023.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 03/22/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Suboptimal response to conventional treatments in refractory diabetic macular edema (rDME) encourages efforts to identify new therapeutic options. PURPOSE To evaluate the effect of three monthly intravitreal injections of a Rho-associated protein kinase (ROCK) inhibitor (Fasudil, Asahi Kasei Pharma Corporation, Tokyo, Japan) in eyes with rDME. METHODS Ten eyes of 10 patients with DME unresponsive to at least six previous intravitreal bevacizumab (IVB) injections were recruited and underwent 3 consecutive monthly intravitreal injection of 0.025mg/0.05mL Fasudil. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were evaluated as functional and anatomical response indicators, respectively. RESULTS The mean age was 60.1±5.1 years (range, 53-68). Five cases responded to treatment, two with both anatomical and functional responses (reduction of CMT from 521 to 395 and from 390 to 301 microns and improvement of BCVA from 0.3 to 0.1 LogMAR and 0.6 to 0.4 LogMAR, respectively) and three with only functional improvement (0.7 to 0.4; 0.7 to 0.4; and 0.3 to 0.1 LogMAR). Of note, cases with no significant change in CMT showed morphologic improvement of the retinal microstructure to some extent. No adverse event was observed during the study period. CONCLUSION Monotherapy with intravitreal injection of ROCK inhibitors appears to have moderate visual benefits in eyes with DME refractory to IVB. Such effects may be functionally significant without obvious anatomical improvement.
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Affiliation(s)
- R Nourinia
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - H Nouri
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - S-H Abtahi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S Nakao
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - J Eslamipour
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - E Gerami
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - H Ahmadieh
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Khodriss C, El Harch I, Bennis A, Chraibi F, El Fakir S, Abdellaoui M, Tachfouti N, Benatiya Andaloussi I. [Impact of the SARS-CoV-2 pandemic on diabetic macular edema and prognostic factors]. J Fr Ophtalmol 2021; 44:1313-1318. [PMID: 34538511 PMCID: PMC8421111 DOI: 10.1016/j.jfo.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/05/2021] [Accepted: 07/13/2021] [Indexed: 11/28/2022]
Abstract
But Décrire le retentissement sur l’acuité visuelle et l’épaisseur centromaculaire après arrêt des injections intravitréennes d’anti-VEGF chez les patients diabétiques marocains au cours de la pandémie du Coronavirus. Et étudier les facteurs pouvant être associés à l’aggravation. Matériel et méthodes Cette étude transversale monocentrique a inclus les patients programmés pour injections intravitréennes de Bevacizumab au cours de la période du confinement (20 mars 2020–20 mai 2020) et qui n’en ont pas bénéficié. Ont été recueillis : l’âge, le sexe, l’ancienneté du diabète, le nombre d’injections reçues avant le confinement, l’acuité visuelle en pré-confinement et post-confinement ainsi que l’épaisseur centromaculaire pré-confinement et post-confinement. Résultats Cent cinquante quatre yeux de 104 patients ont été analysés. 57,8 % étaient des hommes avec une moyenne d’âge de 59,4 ± 9,04 ans. La durée moyenne d’arrêt des injections intravitréennes est de 57,3 ± 6,7 jours. Le nombre moyen d’injections intravitréennes de Bevacizumab reçues avant le confinement a été estimé à 2,29 ± 2,1. L’aggravation de l’acuité visuelle a été notée chez 44,8 % de nos patients. Les facteurs associés à l’aggravation fonctionnelle sont le faible nombre d’injections intravitréennes de Bevacizumab reçues avant le confinement (p = 0,001) ainsi que le déséquilibre diabétique (p = 0,04). L’aggravation structurelle a été constatée chez 26,6 % des patients et elle était associée au faible nombre d’injections réalisées avant le confinement (p = 0,038). Conclusion Le report des injections intravitréennes au cours du confinement a eu des effets négatifs sur l’acuité visuelle et l’épaisseur centromaculaire des yeux avec OMD. Un report prolongé des injections intravitréennes d’anti-VEGF chez les patients diabétiques doit être évité.
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Affiliation(s)
- C Khodriss
- Service d'ophtalmologie, hôpital Omar Drissi, CHU Hassan II Fès, faculté de médecine et de pharmacie de Fès, université Sidi Mohamed Ben Abdellah, 24, RCE sanabil II, Appt2, avenue Mly Hicham, 30050 Fès, Maroc.
| | - I El Harch
- Laboratoire d'épidémiologie, recherche clinique et de santé communautaire, faculté de médecine et de pharmacie de Fès, université Sidi Mohamed Ben Abdella, Fès, Maroc.
| | - A Bennis
- Service d'ophtalmologie, hôpital Omar Drissi, CHU Hassan II Fès, faculté de médecine et de pharmacie de Fès, université Sidi Mohamed Ben Abdellah, 24, RCE sanabil II, Appt2, avenue Mly Hicham, 30050 Fès, Maroc.
| | - F Chraibi
- Service d'ophtalmologie, hôpital Omar Drissi, CHU Hassan II Fès, faculté de médecine et de pharmacie de Fès, université Sidi Mohamed Ben Abdellah, 24, RCE sanabil II, Appt2, avenue Mly Hicham, 30050 Fès, Maroc.
| | - S El Fakir
- Laboratoire d'épidémiologie, recherche clinique et de santé communautaire, faculté de médecine et de pharmacie de Fès, université Sidi Mohamed Ben Abdella, Fès, Maroc.
| | - M Abdellaoui
- Service d'ophtalmologie, hôpital Omar Drissi, CHU Hassan II Fès, faculté de médecine et de pharmacie de Fès, université Sidi Mohamed Ben Abdellah, 24, RCE sanabil II, Appt2, avenue Mly Hicham, 30050 Fès, Maroc.
| | - N Tachfouti
- Laboratoire d'épidémiologie, recherche clinique et de santé communautaire, faculté de médecine et de pharmacie de Fès, université Sidi Mohamed Ben Abdella, Fès, Maroc.
| | - I Benatiya Andaloussi
- Service d'ophtalmologie, hôpital Omar Drissi, CHU Hassan II Fès, faculté de médecine et de pharmacie de Fès, université Sidi Mohamed Ben Abdellah, 24, RCE sanabil II, Appt2, avenue Mly Hicham, 30050 Fès, Maroc.
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Routier M, Ducloyer JB, Masse H, Lebreton O, Fossum P, Clement M, Weber M. [Real life retrospective study of 98 eyes treated with intravitreal dexamethasone or anti-VEGF injections for macular edema due to diabetes or retinal vein occlusion]. J Fr Ophtalmol 2021:S0181-5512(21)00326-0. [PMID: 34353656 DOI: 10.1016/j.jfo.2020.11.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 10/27/2020] [Accepted: 11/05/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate long term outcomes of patients presenting with diabetic macular edema (DME) or edema secondary to a retinal vein occlusion (RVO). METHODS This is a real world, retrospective, single-center study of 65 eyes of 47 patients treated for DME and 33 eyes of 33 patients with macular edema secondary to RVO between July 2012 and October 2018. The patients treated were treatment-naive and were followed for at least one year. We collected data such as visual acuity, central macular thickness, intravitreal injections (number/year, injection schedule, number of switches), number of visits and cases of vision loss. RESULTS DME: the mean age at inclusion was 65.9years with 60.4% women, and the mean follow-up was 28.5months. The mean gain in visual acuity after 1year of follow-up was 6.4 ETDRS letters for patients treated with anti-VEGF and 2.6 letters for patients treated with dexamethasone. The average number of intravitreal injections of anti-VEGF was 5.6/year, compared to 2.9/year for dexamethasone. Fourteen patients initially treated with anti-VEGF were switched to dexamethasone. RVO: the mean age at inclusion was 68.8years with 54.5% women and a mean follow-up of 31.1months. The mean gain in visual acuity after 1year of follow-up was 26.7 ETDRS letters for patients treated with anti-VEGF and 7.0 letters for patients treated with dexamethasone. The average number of intravitreal injections of anti-VEGF was 5.8/year, compared to 2.4/year for dexamethasone. Five patients initially treated with anti-VEGF were switched to dexamethasone in the first year of follow-up. CONCLUSION In this real-life retrospective study, we found good anatomical and functional results similar to those reported in other studies, remaining stable over time, for patients with DME or macular edema secondary to RVO.
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Couturier A, Giocanti-Auregan A, Massin P. [Treatment switch in diabetic macular edema: Literature review and management algorithm]. J Fr Ophtalmol 2020; 43:710-717. [PMID: 32653096 DOI: 10.1016/j.jfo.2019.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/21/2019] [Accepted: 12/27/2019] [Indexed: 12/01/2022]
Abstract
Initial management of diabetic macular edema (DME) is well-defined, but there is a lack of national or international consensus for patients who do not respond or respond only partially to these treatments. Several studies, mostly retrospective, have assessed medication switches, but currently, the literature contains no randomized studies. The goal of this article is to present an algorithm for switching medications, which can be proposed to DME patients treated with anti-VEGF agents, as defined by a group of French retina experts, supported by the existing literature on the subject. After initiation of an anti-VEGF treatment for DME, the response is usually assessed after 5 monthly injections. A partial anatomical response (reduction of central retinal thickness between 10 and 20%), seen in 30 to 40% of patients, is associated with a favorable visual prognosis according to randomized studies. Continuation of the anti-VEGF injections after the induction phase is thus possible. If the response remains incomplete after 3 additional anti-VEGF injections, a complete ophthalmologic examination should be performed, and a switch to another therapeutic class (corticosteroids) may be proposed in the absence of contraindications. If a complete non-response is seen initially (reduction of central retinal thickness<10%), the switch is proposed immediately after the induction phase.
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Affiliation(s)
- A Couturier
- Service d'ophtalmologie, hôpital Lariboisière, université de Paris, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France.
| | - A Giocanti-Auregan
- Service d'ophtalmologie, hôpital Avicenne, DHU vision et handicaps, université Paris, 13, AP-HP, Bobigny, France
| | - P Massin
- Centre d'ophtalmologie Breteuil, centre Broca, hôpital Lariboisière, Paris, France
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Cakir A, Erden B, Bolukbasi S, Aydin A, Yurttaser Ocak S, Maden G, Elcioglu MN. Comparison of the effect of ranibizumab and dexamethasone implant in diabetic macular edema with concurrent epiretinal membrane. J Fr Ophtalmol 2019; 42:683-689. [PMID: 31088741 DOI: 10.1016/j.jfo.2019.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/30/2019] [Accepted: 02/11/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare the efficacy and safety of intravitreal ranibizumab (RZB) injections and intravitreal dexamethasone (DEX) implant in diabetic macular edema (DME) with concurrent epiretinal membrane (ERM). METHODS This was a retrospective, observational, comparative study. Medical records of DME patients with concurrent ERM were retrospectively reviewed. Seventeen eyes of 16 patients treated with 3 consecutive monthly RZB injections (RZB group) and 22 eyes of 18 patients treated with a DEX implant (DEX group) were included. The groups were compared at baseline, 1st, 2nd, 3rd and 4th months in terms of best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP). RESULTS Eighteen of the 39 eyes (46.1%) were phakic at baseline, 9 (52.9%) of which were treated with RZB, whereas 9 (40.9%) were treated with DEX implant (P=0.528). Although CMT improved significantly in both the RZB and DEX groups (P<0.001); the trend was different (P=0.003). The mean change in CMT at 1month in the DEX group was greater (DEX: 188.2±142.7μm; RZB: 95.7±110.7μm; P=0.034); it was in favor of RZB group at the 3rd and 4th months (DEX: -52.7±86.9μm; RZB: 1.4±31.4μm; P=0.012. DEX: -63±67.3μm; RZB: -5.8±43.9μm; P=0.004, respectively). BCVA improved significantly in both groups (P<0.001). There was no statistical difference between the groups with regard to gain in BCVA or IOP change throughout the study period (P=0.572, P=0.064, respectively). CONCLUSION Both RZB and DEX are effective in improving anatomical and visual outcomes in DME with concurrent ERM. The DEX group was associated with a prompt anatomic response, but with a gradual decrease from 3rd month.
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Affiliation(s)
- A Cakir
- Department of Ophthalmology, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey.
| | - B Erden
- Department of Ophthalmology, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - S Bolukbasi
- Department of Ophthalmology, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - A Aydin
- Clinique Universitaire d'Ophtalmologie, Faculté de Médecine, Université d'Istanbul Medipol, Fatih Caddesi, Yenibosna, Istanbul, Turkey
| | - S Yurttaser Ocak
- Department of Ophthalmology, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - G Maden
- Department of Ophthalmology, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - M N Elcioglu
- Department of Ophthalmology, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey
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Liang J, Lei W, Cheng J. Correlations of blood lipids with early changes in macular thickness in patients with diabetes. J Fr Ophtalmol 2019; 42:276-280. [PMID: 30736987 DOI: 10.1016/j.jfo.2018.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 07/26/2018] [Accepted: 07/26/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE This study aimed to investigate the correlations of blood lipids with changes in macular volume and thickness in patients with diabetes. METHODS Central subfield macular thickness (CSMT) and central subfield macular volume (CSMV) were measured in 85 patients with type 2 diabetes (DM2) using spectral-domain optical coherence tomography (SD-OCT). In addition, serum creatinine (Cr), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDLC), low-density lipoprotein cholesterol (LDLC), glycated hemoglobin (HbA1c), and proteinuria were measured in all patients. RESULTS The mean CSMT of the 85 patients was 272.8±16.9μm, and CSMV was 215.1±14.6×10-3mm3. TC, LDLC, HbA1c, and proteinuria were closely correlated to CSMT, and HDLC, HbA1c, and proteinuria were correlated to CSMV. After adjustment for sex, age, DM2 course, proteinuria, and HbA1c, LDLC was significantly correlated to CSMT (95% confidence interval (CI), 1.93-11.05, P=0.008) and CSMV (95% CI, 0.92-8.41, P=0.021); however, HDLC, TC, and TG showed no significant correlation with CSMT or CSMV. CONCLUSIONS Increased LDLC was closely correlated to changes in CSMT and CSMV in early diabetic patients, and increased CSMT was also accompanied by increased LDLC; therefore, this type of patient would be more likely to develop macular edema.
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Affiliation(s)
- J Liang
- Department of Ophthalmology, Central Hospital of Linyi, Linyi 276400, Shandong, China
| | - W Lei
- Department of Ophthalmology, Central Hospital of Linyi, Linyi 276400, Shandong, China
| | - J Cheng
- Department of Ophthalmology, Central Hospital of Linyi, Linyi 276400, Shandong, China.
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Denier C, Fajnkuchen F, Giocanti-Aurégan A. Central retinal thickness assessment in a real life setting after cataract surgery in diabetic patients. J Fr Ophtalmol 2018; 41:904-9. [PMID: 30470488 DOI: 10.1016/j.jfo.2018.03.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/16/2018] [Accepted: 03/23/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE To assess in a real life setting the progression of central retinal thickness (CRT) during the first month after surgery in diabetic patients without previous diabetic macular edema (DME) and to identify potential risk factors for DME leading to increased postoperative follow-up. METHODS We conducted a prospective study of diabetic patients without history of DME who underwent uncomplicated cataract surgery. Best-corrected visual acuity (BCVA) and SD-OCT were performed 7 days and 1 month after surgery. We assumed absence of preoperative DME when there was no edema of SD-OCT at D7. Our primary endpoint was the central retinal thickness (CRT) variation between 7 days and 1 month after cataract surgery in patients without previous history of DME. RESULTS We included 55 eyes of 42 patients. BCVA was 0.57±0.72 logMar (20/80) prior to surgery and increased significantly to 0.11±0.17 (20/25) at one month (P=0.001) post-surgery. The mean baseline CRT was 209±35μm and 229±69μm (P=0.06) one month after surgery. Four eyes (7.4%) developed macular edema at one month. We found no linear correlation between HbA1C and CRT. DISCUSSION/CONCLUSION We found no link between a high level of HbA1C and postoperative increase in CRT. We found that cataract surgery in diabetic patients without previous DME has no negative impact on CRT, and visual outcomes are good. We suggest that in diabetic patients without complete visual recovery at 1-month post-cataract surgery, OCT examination should be performed in order to detect an early stage of DME.
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Demircan A, Ozkaya A, Alkin Z, Kemer B, Yesilkaya C, Demir G. Comparison of the effect of ranibizumab and dexamethasone implant on serous retinal detachment in diabetic macular edema. J Fr Ophtalmol 2018; 41:733-738. [PMID: 30213609 DOI: 10.1016/j.jfo.2018.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/08/2018] [Accepted: 03/15/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE To compare the efficacy of intravitreal ranibizumab (IVR) and intravitreal dexamethasone implant (IDI) on neurosensory retinal detachment (SRD) associated with diabetic macular edema (DME) in the early treatment period. METHODS This was a retrospective, interventional, case-control study. After three monthly loading doses of IVR or an initial IDI injection, the changes in best-corrected visual acuity (BCVA), central macular thickness (CMT) on OCT, and presence and height of SRD were evaluated. RESULTS The IVR and IDI groups consisted of 101 and 35 eyes, respectively. The mean changes in CMT in the IVR and IDI groups were 204.4±176.6 and 311.4±163, respectively (P<0.001). The mean changes in SRD height in the IVR and IDI groups were 133.6±92.1 and 168.6±103.9μm, respectively. The decrease in SRD height was significantly greater in the IDI group than in the IVR group (P=0.002). The SRD resolved completely in 72.2% and 71.4% of the patients in the IVR and IDI groups, respectively (P=0.9). CONCLUSION The mean reduction in CMT and SRD height was greater in the IDI group than in the IVR group. There was a negative correlation between baseline best-corrected visual acuity (BCVA) and SRD height and also between BCVA and CMT.
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Affiliation(s)
- A Demircan
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Bereketzade Cami Sok. No. 2 Beyoglu, Istanbul, Turkey.
| | - A Ozkaya
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Bereketzade Cami Sok. No. 2 Beyoglu, Istanbul, Turkey
| | - Z Alkin
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Bereketzade Cami Sok. No. 2 Beyoglu, Istanbul, Turkey
| | - B Kemer
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Bereketzade Cami Sok. No. 2 Beyoglu, Istanbul, Turkey
| | - C Yesilkaya
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Bereketzade Cami Sok. No. 2 Beyoglu, Istanbul, Turkey
| | - G Demir
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Bereketzade Cami Sok. No. 2 Beyoglu, Istanbul, Turkey
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Penaud B, Fajnkuchen F, Levy O, Chaine G, Giocanti-Auregan A. Relationship between visual outcomes and retinal fluid resorption in patients with diabetic macular edema treated with ranibizumab. J Fr Ophtalmol 2017; 40:839-843. [PMID: 29132693 DOI: 10.1016/j.jfo.2017.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 05/24/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE We assessed the relationship between visual acuity (VA) recovery and a qualitative criterion - complete retinal fluid resorption (CRFR) - among patients treated with ranibizumab for diabetic macular edema (DME) METHODS: All consecutive diabetic patients with central DME received a loading dose of 3 monthly injections of ranibizumab 0.5mg, followed by retreatments on an as-needed basis as determined by monthly follow-up. Patients were divided into 3 groups: CRFR (defined as a CRT <300μm and restoration of the foveolar pit) with BCVA≤70 letters (group 1: G1), CRFR with BCVA>70 letters (20/40) (G2), and persistent retinal fluid throughout the follow-up (G3). RESULTS Forty eyes were included. Mean baseline VA was 48.7 letters and no patient had VA>70 letters. Twenty-four (60%) eyes achieved CRFR: 12 (30%) in G1 and 12 (30%) in G2. In 16 patients (40%), the efficacy of the treatment was partial without CRFR (G3). At the time of the initial CRFR, VA was 57.4 letters in G1 (min-max: 30-65) and 77.5 letters in G2 (71-85). In G3, maximal VA during follow-up was 55 letters (25-70) and no patient achieved a VA >70 letters. CONCLUSIONS In this study, CRFR was required but not sufficient to achieve a VA>70 letters.
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Affiliation(s)
- B Penaud
- Ophthalmology department, Avicenne hospital, DHU vision and handicaps, 125, rue de Stalingrad, 93000 Bobigny, France
| | - F Fajnkuchen
- Ophthalmology department, Avicenne hospital, DHU vision and handicaps, 125, rue de Stalingrad, 93000 Bobigny, France; Centre d'imagerie et de laser, 11, rue Antoine-Bourdelle, 75015 Paris
| | - O Levy
- Ophthalmology department, Avicenne hospital, DHU vision and handicaps, 125, rue de Stalingrad, 93000 Bobigny, France
| | - G Chaine
- Ophthalmology department, Avicenne hospital, DHU vision and handicaps, 125, rue de Stalingrad, 93000 Bobigny, France
| | - A Giocanti-Auregan
- Ophthalmology department, Avicenne hospital, DHU vision and handicaps, 125, rue de Stalingrad, 93000 Bobigny, France; Inserm, U_968, CNRS, UMR_7210, institut de la vision, Sorbonne Universities, UPMC Université Paris 06, 75012 Paris, France.
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Qu-Knafo L, Fajnkuchen F, Sarda V, Nghiem-Buffet S, Chaine G, Giocanti-Auregan A. [French practice patterns in the management of diabetic macular edema]. J Fr Ophtalmol 2016; 39:521-6. [PMID: 27318630 DOI: 10.1016/j.jfo.2016.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 02/16/2016] [Accepted: 02/19/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess French practice patterns in the treatment of diabetic macular edema (DME). METHODS A 31-item survey investigating practice patterns in the diagnosis and management of DME was e-mailed in March 2015 to retina specialist members of the French-speaking Retina Specialist Society. During this time frame, only ranibizumab was reimbursed for this indication. For each question concerning the choice of treatments, respondents were asked to assume that all treatments having market approval were also reimbursed. Answers were analyzed anonymously by Evalandgo software. RESULTS Ninety-five specialists answered the survey. Two thirds of them initiated an intravitreal treatment for DME for a loss of vision greater than 0.5 (Monoyer scale). The three determining factors for treatment choice were potential VA improvement, expected retinal anatomic improvement, and patient availability for monthly follow-up. For central DME in phakic or pseudophakic eyes, the first choice of intravitreal (IVT) treatment was ranibizumab, even assuming that all drugs approved by French authorities (HAS) were reimbursed by the health care system. Eighty-five percent of retinal specialists propose bilateral intravitreal injections the same day for the same patient. CONCLUSION Most of the specialists initiate DME treatment for a VA>0.5 in France. Eighty-five percent of them perform bilateral intravitreal injections on the same day in the case of bilateral DME.
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Affiliation(s)
- L Qu-Knafo
- Service d'ophtalmologie, DHU vision and handicaps, hôpital CHU Avicenne, 125, rue de Stalingrad, 93000 Bobigny, France
| | - F Fajnkuchen
- Service d'ophtalmologie, DHU vision and handicaps, hôpital CHU Avicenne, 125, rue de Stalingrad, 93000 Bobigny, France; Centre ophtalmologique d'imagerie et de laser, 11, rue Antoine-Bourdelle, 75015 Paris, France
| | - V Sarda
- Service d'ophtalmologie, DHU vision and handicaps, hôpital CHU Avicenne, 125, rue de Stalingrad, 93000 Bobigny, France
| | - S Nghiem-Buffet
- Service d'ophtalmologie, DHU vision and handicaps, hôpital CHU Avicenne, 125, rue de Stalingrad, 93000 Bobigny, France; Centre ophtalmologique d'imagerie et de laser, 11, rue Antoine-Bourdelle, 75015 Paris, France
| | - G Chaine
- Service d'ophtalmologie, DHU vision and handicaps, hôpital CHU Avicenne, 125, rue de Stalingrad, 93000 Bobigny, France
| | - A Giocanti-Auregan
- Service d'ophtalmologie, DHU vision and handicaps, hôpital CHU Avicenne, 125, rue de Stalingrad, 93000 Bobigny, France.
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