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Wang M, Shao Y, Gong Y, Liu B, Liu J, Luan R, Ma M, Li X. ASSOCIATION OF MACULAR STRUCTURE WITH MICROPERIMETRY SENSITIVITY FOLLOWING VITRECTOMY FOR PROLIFERATE DIABETIC RETINOPATHY. Retina 2024; 44:982-990. [PMID: 38767849 DOI: 10.1097/iae.0000000000004063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
PURPOSE To evaluate macular sensitivity using microperimetry in patients with proliferate diabetic retinopathy following vitrectomy and to investigate the relationship between the sensitivity and foveal microstructures with optical coherence tomography/angiography. METHODS Eighty-four eyes of 84 patients with proliferative diabetic retinopathy, who were indicated for vitrectomy, had no intraocular surgery history 3 months preoperatively, and were able to ensure fundus examination after the vitrectomy, were included. A logMAR best-corrected visual acuity, macular sensitivity of microperimetry, macular retinal thickness, and macular vessel perfusion using optical coherence tomography/angiography were examined at 1 week, 1 month, and 3 months postoperatively. RESULTS The logMAR best-corrected visual acuity and mean macular sensitivity of patients with proliferative diabetic retinopathy improved postoperatively (P < 0.05). There was a significant correlation between best-corrected visual acuity and mean sensitivity (P < 0.05). Postoperative mean macular sensitivity was significantly correlated with outer retinal thickness in the 0 to 6 mm macular area (P < 0.05) and also significantly correlated with deep capillary plexus perfusion (P < 0.05). Fixation stability and mean macular sensitivity did not show any correlation with glycated hemoglobin, triglyceride, serum total cholesterol, carbamide, and creatinine and duration of diabetes mellitus (P > 0.05). CONCLUSION Postoperative mean macular sensitivity was significantly correlated with outer retinal thickness and deep capillary plexus perfusion for patients with proliferative diabetic retinopathy. The authors found that the visual performance of patients can be evaluated by the outer retinal thickness and deep capillary plexus perfusion, so optical coherence tomography/angiography examination can be an important prognostic factor for visual performance in patients.Clinical Trial Registration: This trial is registered with the Chinese Clinical Trial Registry (http://www.chictr.org.cn; Registration No.: ChiCTR2100043399).
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Affiliation(s)
- Manqiao Wang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin, China
- Tianjin Branch of National Clinical Research Center for Ocular Disease, Tianjin, China
- Eye Institute and School of Optometry, Tianjin, China; and
- Tianjin Medical University Eye Hospital, Tianjin, China
| | - Yan Shao
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin, China
- Tianjin Branch of National Clinical Research Center for Ocular Disease, Tianjin, China
- Eye Institute and School of Optometry, Tianjin, China; and
- Tianjin Medical University Eye Hospital, Tianjin, China
| | - Yi Gong
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin, China
- Tianjin Branch of National Clinical Research Center for Ocular Disease, Tianjin, China
- Eye Institute and School of Optometry, Tianjin, China; and
- Tianjin Medical University Eye Hospital, Tianjin, China
| | - Boshi Liu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin, China
- Tianjin Branch of National Clinical Research Center for Ocular Disease, Tianjin, China
- Eye Institute and School of Optometry, Tianjin, China; and
- Tianjin Medical University Eye Hospital, Tianjin, China
| | - Juping Liu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin, China
- Tianjin Branch of National Clinical Research Center for Ocular Disease, Tianjin, China
- Eye Institute and School of Optometry, Tianjin, China; and
- Tianjin Medical University Eye Hospital, Tianjin, China
| | - Rong Luan
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin, China
- Tianjin Branch of National Clinical Research Center for Ocular Disease, Tianjin, China
- Eye Institute and School of Optometry, Tianjin, China; and
- Tianjin Medical University Eye Hospital, Tianjin, China
| | - Mingming Ma
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin, China
- Tianjin Branch of National Clinical Research Center for Ocular Disease, Tianjin, China
- Eye Institute and School of Optometry, Tianjin, China; and
- Tianjin Medical University Eye Hospital, Tianjin, China
| | - Xiaorong Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin, China
- Tianjin Branch of National Clinical Research Center for Ocular Disease, Tianjin, China
- Eye Institute and School of Optometry, Tianjin, China; and
- Tianjin Medical University Eye Hospital, Tianjin, China
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Bressler I, Aviv R, Margalit D, Rom Y, Ianchulev T, Dvey-Aharon Z. Autonomous screening for laser photocoagulation in fundus images using deep learning. Br J Ophthalmol 2024; 108:742-746. [PMID: 37217293 DOI: 10.1136/bjo-2023-323376] [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: 02/12/2023] [Accepted: 04/15/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Diabetic retinopathy (DR) is a leading cause of blindness in adults worldwide. Artificial intelligence (AI) with autonomous deep learning algorithms has been increasingly used in retinal image analysis, particularly for the screening of referrable DR. An established treatment for proliferative DR is panretinal or focal laser photocoagulation. Training autonomous models to discern laser patterns can be important in disease management and follow-up. METHODS A deep learning model was trained for laser treatment detection using the EyePACs dataset. Data was randomly assigned, by participant, into development (n=18 945) and validation (n=2105) sets. Analysis was conducted at the single image, eye, and patient levels. The model was then used to filter input for three independent AI models for retinal indications; changes in model efficacy were measured using area under the receiver operating characteristic curve (AUC) and mean absolute error (MAE). RESULTS On the task of laser photocoagulation detection: AUCs of 0.981, 0.95, and 0.979 were achieved at the patient, image, and eye levels, respectively. When analysing independent models, efficacy was shown to improve across the board after filtering. Diabetic macular oedema detection on images with artefacts was AUC 0.932 vs AUC 0.955 on those without. Participant sex detection on images with artefacts was AUC 0.872 vs AUC 0.922 on those without. Participant age detection on images with artefacts was MAE 5.33 vs MAE 3.81 on those without. CONCLUSION The proposed model for laser treatment detection achieved high performance on all analysis metrics and has been demonstrated to positively affect the efficacy of different AI models, suggesting that laser detection can generally improve AI-powered applications for fundus images.
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Affiliation(s)
| | | | | | - Yovel Rom
- AEYE Health, New York, New York, USA
| | - Tsontcho Ianchulev
- AEYE Health, New York, New York, USA
- Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
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Wang Y, Ding Y, Zhuang Q, Luan J. Comparison of the cytokines levels in aqueous humor in vitrectomized eyes versus non-vitrectomized eyes with diabetic macular edema. Int Ophthalmol 2024; 44:220. [PMID: 38713261 DOI: 10.1007/s10792-024-03136-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/11/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND This study was conducted to compare concentrations of VEGF family growth factors, inflammation-related factors, and adhesion molecules in the aqueous humor of eyes with diabetic macular edema (DME), with and without prior vitrectomy. METHODS A total of 31 eyes were included, 11 with DME that had undergone vitrectomy, 9 with DME but without vitrectomy, and 11 from age-related cataract patients as controls. The concentrations of cytokines including TNF-α, IL-6, IL-8, IP-10, MCP-1, IFN-γ, MIP-1 α, MIP-1 β, PECAM-1, MIF, VCAM-1, ICAM-1, PIGF were quantified using Luminex Human Discovery Assay. Central macular thickness (CMT) values of all eyes were measured using optical coherence tomography (OCT). RESULTS (1) Vitrectomized DME eyes exhibited significantly higher levels of IL-6 and IL-8 compared to non-vitrectomized eyes (P < 0.05). (2) In vitrectomized group, after Benjamini-Hochberg correction, there was a significant positive correlation between the levels of VEGF and PlGF (rs = 0.855, P < 0.05), as well as the levels of TNF-α and IFN-γ (rs = 0.858, P < 0.05). In non-vitrectomized group, significant positive correlations were found between VEGF and PlGF levels after correcting for multiple comparisons (rs = 0.9, P < 0.05). (3) In non-vitrectomized group, the concentrations of VEGF and PlGF in aqueous humor were significantly positively correlated with CMT values (rs = 0.95, P < 0.05; rs = 0.9, P < 0.05, respectively). CONCLUSIONS The concentrations of IL-6 and IL-8 in the aqueous humor were significantly higher in vitrectomized DME eyes compared to nonvitrectomized DME eyes and the levels of VEGF were similar in the two groups, suggesting that inflammation after vitrectomy may be a key factor in the occurrence and development of DME.
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Affiliation(s)
- Yiheng Wang
- Department of Ophthalmology, Zhongda Hospital, Southeast University, Nanjing, 210009, Jiangsu Province, China
- School of Medicine, Southeast University, Nanjing, 210009, Jiangsu Province, China
| | - Yuzhi Ding
- Department of Ophthalmology, Zhongda Hospital, Southeast University, Nanjing, 210009, Jiangsu Province, China
| | - Qiuyu Zhuang
- Department of Ophthalmology, Zhongda Hospital, Southeast University, Nanjing, 210009, Jiangsu Province, China
- School of Medicine, Southeast University, Nanjing, 210009, Jiangsu Province, China
| | - Jie Luan
- Department of Ophthalmology, Zhongda Hospital, Southeast University, Nanjing, 210009, Jiangsu Province, China.
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Sharma A, Wu L, Bloom S, Stanga P, Walinjkar J, Netralaya SR, Patel AQ, Netralaya R, Nicholson L, Lanzetta P, Veritti D, Sarao V, Boyer D, Cheung CMG, Gupta A, Agrawal V, Rezaei KA. RWC Update: Different Surgical Techniques for Macular Hole Associated With Retinal Detachment; Diabetic Macular Edema - How Do You Treat Patients With Good Visual Acuity?; Benign Familial Fleck Retina. Ophthalmic Surg Lasers Imaging Retina 2024; 55:249-252. [PMID: 38752801 DOI: 10.3928/23258160-20240425-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
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Durmaz Engin C, Saatci AO. Macular oedema exacerbation and bacillary layer detachment following the scatter laser photocoagulation in a patient with proliferative diabetic retinopathy. Clin Exp Optom 2024; 107:465-468. [PMID: 36919523 DOI: 10.1080/08164622.2023.2188175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 02/12/2023] [Indexed: 03/16/2023] Open
Affiliation(s)
- Ceren Durmaz Engin
- Department of Ophthalmology, Karadeniz Eregli State Hospital, Zonguldak, Turkey
| | - Ali Osman Saatci
- Department of Ophthalmology, Dokuz Eylul University School of Medicine, Izmir, Turkey
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Gurelik IG, Ozdemir HB, Acar B. The effect of adjuvant Mitomycin C during vitrectomy on functional and anatomical outcomes in patients with severe diabetic tractional retinal detachment. Int Ophthalmol 2024; 44:210. [PMID: 38691217 DOI: 10.1007/s10792-024-03152-3] [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: 03/28/2024] [Accepted: 04/12/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE To evaluate the effect of adjuvant Mitomycin C (MMC) use on the anatomical and functional success of vitreoretinal surgery (VRS) in severe diabetic tractional retinal detachment (dTRD) patients. METHODS A retrospective analysis of consecutive patients undergoing VRS due to severe dTRD was conducted. Patients were categorized into those who received 20 µg/0.1 mL MMC via MMC sandwich method (Group 1) and those who did not (Group 2). Demographics, surgical characteristics, visual outcomes, and complications that may related to MMC were analyzed. RESULTS A total of 25 eyes were included, 13 in Group 1 and 12 in Group 2. No statistical difference was observed in baseline characteristics between the groups. The mean best-corrected visual acuity was 1.90 ± 0.43 logMAR and 1.93 ± 0.41 logMAR preoperatively and 1.60 ± 0.78 logMAR and 1.56 ± 0.78 logMAR postoperatively in Groups 1 and 2, respectively (p = 0.154). The postoperative mean intraocular pressure was 16.23 ± 2.55 mmHg and 13.08 ± 4.94 mmHg in Groups 1 and 2, respectively (p = 0.225). The rate of re-surgery was significantly lower in Group 1 (0% vs. 41.7% in Group 2, p = 0.015). Retina was attached in all patients at the last visit. No MMC-related complication was recorded. CONCLUSION Intraoperative adjuvant MMC application for severe dTRD significantly reduces re-surgery rates with good anatomical and functional outcomes safely.
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Affiliation(s)
- Ihsan Gokhan Gurelik
- Ophthalmology Department, Gazi University School of Medicine, Gazi Universitesi Tip Fakültesi Goz Hastaliklari Anabilim Dali, Besevler, 06500, Ankara, Turkey
| | - Huseyin Baran Ozdemir
- Ophthalmology Department, Gazi University School of Medicine, Gazi Universitesi Tip Fakültesi Goz Hastaliklari Anabilim Dali, Besevler, 06500, Ankara, Turkey.
| | - Burak Acar
- Ophthalmology Department, Gazi University School of Medicine, Gazi Universitesi Tip Fakültesi Goz Hastaliklari Anabilim Dali, Besevler, 06500, Ankara, Turkey
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Fadakar K, Rahmani S, Tedeschi T, Lavine JA, Fawzi AA. Short Term Effect of Pre-Operative Anti-VEGF on Angiogenic and Fibrotic Profile of Fibrovascular Membranes of Proliferative Diabetic Retinopathy. Invest Ophthalmol Vis Sci 2024; 65:37. [PMID: 38652648 PMCID: PMC11044842 DOI: 10.1167/iovs.65.4.37] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/31/2024] [Indexed: 04/25/2024] Open
Abstract
Purpose Adjuvant, pre-operative intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections have been used to reduce peri-operative bleeding in eyes undergoing pars-plana vitrectomy for complications of proliferative diabetic retinopathy (PDR). To address the concern over their potential off-target effects of progressive fibrous contraction, we sought to dissect the transcriptional changes in the surgically extracted fibrovascular membranes (FVMs). Methods We analyzed surgically extracted FVMs from 10 eyes: 4 eyes pretreated with intravitreal bevacizumab (IVB) and 6 untreated eyes. FVMs were digested into single cells, mRNA was extracted from endothelial cell-enriched (microbead selection with CD31) and non-endothelial cell compartments, followed by RT-qPCR quantification. We then compared the relative expression of genes involved in angiogenesis, endothelial cell integrity, and myofibroblastic processes between treated and untreated FVMs. Results Endothelial cells from IVB pretreated FVMs showed significant reduction of VEGFA, VEGF receptors (FLT1 and KDR), and angiopoietin 2 expression as well as increased vascular endothelial cadherin and endothelin, suggesting reduced angiogenesis and enhanced vascular integrity. The non-endothelial cell fraction showed decreased expression of VEGFA and fibronectin, without significant difference in the expression of other profibrotic factors. Conclusions Our findings confirm that adjuvant pre-operative IVB decreased fibronectin and increase endothelin-1 expression without affecting other profibrotic gene expression, uncovering an important interaction between IVB and endothelin-1 that deserves further study.
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Affiliation(s)
- Kaveh Fadakar
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Safa Rahmani
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Thomas Tedeschi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Jeremy A. Lavine
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Amani A. Fawzi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
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Aras C, Senturk F, Erdur SK, Kocabora MS, Dogramaci M, Burke C, Aras E. Preoperative co-application of bevacizumab and tissue plasminogen activator in vitrectomy for proliferative diabetic retinopathy. Arq Bras Oftalmol 2024; 87:e20230001. [PMID: 38451688 DOI: 10.5935/0004-2749.2023-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/15/2023] [Indexed: 03/08/2024] Open
Abstract
PURPOSE To investigate the clinical benefits of the co-application of bevacizumab and tissue plasminogen activator as adjuncts in the surgical treatment of proliferative diabetic retinopathy. METHODS Patients who underwent vitrectomy for proliferative dia-betic retinopathy complications were preoperatively given in-travitreal injection with either bevacizumab and tissue plasminogen activator (Group 1) or bevacizumab alone (Group 2). Primary outcomes were surgery time and number of intraoperative iatrogenic retinal breaks. Secondary outcomes included changes in the best-corrected visual acuity and postoperative complications at 3 months postoperatively. RESULTS The mean surgery time in Group 1 (52.95 ± 5.90 min) was significantly shorter than that in Group 2 (79.61 ± 12.63 min) (p<0.001). The mean number of iatrogenic retinal breaks was 0.50 ± 0.59 (0-2) in Group 1 and 2.00 ± 0.83 (0-3) in Group 2 (p<0.001). The best-corrected visual acuity significantly improved in both groups (p<0.001). One eye in each group developed retinal detachment. CONCLUSION Preoperative co-application of bevacizumab and tissue plasminogen activator as adjuncts in the surgical treatment of proliferative diabetic retinopathy shortens the surgery time and reduces the number of intraoperative iatrogenic retinal breaks.
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Affiliation(s)
- Cengiz Aras
- Department of Ophthalmology, Medicine Faculty, Istanbul Medipol University, Istanbul, Turkey
| | - Fevzi Senturk
- Department of Ophthalmology, Medicine Faculty, Istanbul Medipol University, Istanbul, Turkey
| | - Sevil Karaman Erdur
- Department of Ophthalmology, Medicine Faculty, Istanbul Medipol University, Istanbul, Turkey
| | - Mehmet Selim Kocabora
- Department of Ophthalmology, Medicine Faculty, Istanbul Medipol University, Istanbul, Turkey
| | - Mahmut Dogramaci
- Department of Ophthalmology, The Princess Alexandra Hospital NHS Trust, London, UK
| | - Cahit Burke
- Department of Ophthalmology, Medicine Faculty, Istanbul Medipol University, Istanbul, Turkey
| | - Efe Aras
- Medicine Faculty, Yeditepe University, Istanbul, Turkey
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Kim GH, Lee MY. Results of office-based fluid-air exchange for postvitrectomy hemorrhage in diabetic retinopathy. Arq Bras Oftalmol 2024; 87:e20220334. [PMID: 38451685 DOI: 10.5935/0004-2749.2022-0334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/23/2023] [Indexed: 03/08/2024] Open
Abstract
PURPOSE This study aimed to evaluate the efficacy and clinical outcomes of a one-way fluid-air exchange procedure for the treatment of postvitrectomy diabetic vitreous hemorrhage in patients with proliferative diabetic retinopathy. METHODS This retrospective study included 233 patients with proliferative diabetic retinopathy, who underwent vitrectomy. A one-way fluid-air exchange procedure was performed in 24 eyes of 24 (10.30%) patients with persistent vitreous cavity rebleeding after the operation. Preprocedural and postprocedural best-corrected visual acuity values were achieved. Complications occurring during and after the procedure were analyzed. RESULTS Significant visual improvement was observed 1 month after the one-way fluid-air exchange procedure (2.62 ± 0.60 LogMAR at baseline vs. 0.85 ± 0.94 LogMAR at postprocedure, p<0.0001). Moreover, 19 (79.17%) eyes needed the procedure once, and 5 (20.83%) eyed had the procedure more than twice. In 3 (12.50%) eyes, reoperation was eventually required because of persistent rebleeding despite several fluid-air exchanges. No complication was observed during the follow-up. CONCLUSIONS The one-way fluid-air exchange procedure can be an excellent alternative to re-vitrectomy for patients with proliferative diabetic retinopathy suffering from postvitrectomy diabetic vitreous hemorrhage by removing the hemorrhagic contents directly and achieving fast recovery of visual function without apparent complications.
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Affiliation(s)
- Gee-Hyun Kim
- Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mee Yon Lee
- Department of Ophthalmology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Gyeonggi-do, Republic of Korea
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Shiraki A, Tsuboi K, Wakabayashi T, Shiraki N, Nishida K. Reperfusion of retinal nonperfusion by neovascular-vascular anastomosis in proliferative diabetic retinopathy. Eur J Ophthalmol 2024; 34:NP28-NP32. [PMID: 37915118 DOI: 10.1177/11206721231210896] [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] [Indexed: 11/03/2023]
Abstract
BACKGROUND Retinal nonperfusion is a significant cause of vision loss in patients with proliferative diabetic retinopathy (PDR). Therefore, reperfusion of a nonperfusion has been a matter of strong interest, but few previous studies have demonstrated the potential benefits of reperfusion. CASE REPORTS Here, we report longitudinal optical coherence tomography angiographic analysis of two cases of PDR, in which the retinal neovascularization (RNV) that developed in response to retinal ischemia formed anastomoses with pre-existing physiological retinal vessels, resulting in both superficial and deep capillary reperfusion within the nonperfusion. We named this interesting finding "neovascular-vascular anastomosis." Retinal reperfusion due to neovascular-vascular anastomosis differed from recanalization, defined as reperfusion of once-occluded blood vessels, and has not been reported previously. CONCLUSION Our observation highlights the potential of RNV to rescue retinal ischemia by the formation of neovascular-vascular anastomoses.
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Affiliation(s)
- Akihiko Shiraki
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Yamadaoka, Suita, Japan
| | - Kotaro Tsuboi
- Casey Eye Institute, Oregon Health and Science University, Portland, USA
- Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Taku Wakabayashi
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Yamadaoka, Suita, Japan
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nobuhiko Shiraki
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Yamadaoka, Suita, Japan
| | - Kohji Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Yamadaoka, Suita, Japan
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Osaka, Suita, Japan
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Tai F, Nanji K, Garg A, Zeraatkar D, Phillips M, Steel DH, Garg SJ, Kaiser PK, Guymer RH, Wykoff CC, Sivaprasad S, Chaudhary V. Subthreshold Compared with Threshold Macular Photocoagulation for Diabetic Macular Edema: A Systematic Review and Meta-Analysis. Ophthalmol Retina 2024; 8:223-233. [PMID: 37805099 DOI: 10.1016/j.oret.2023.09.022] [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: 03/21/2023] [Revised: 08/01/2023] [Accepted: 09/21/2023] [Indexed: 10/09/2023]
Abstract
TOPIC To compare the efficacy and safety of subthreshold macular laser to conventional focal laser photocoagulation for the treatment of vision loss secondary to diabetic macular edema (DME). CLINICAL RELEVANCE Macular laser remains an important and cost effective treatment option for vision loss secondary to DME. Although anti-VEGF therapy is often first-line, macular laser is of utility in low-resource or remote settings, for patients at risk of loss to follow-up, and for DME not meeting country-specific reimbursement criteria for anti-VEGF therapy. Subthreshold laser is a modality that does not produce clinical or histologic evidence of thermal damage, thereby potentially limiting the common complications of conventional laser. METHODS Ovid MEDLINE, EMBASE, and CENTRAL databases were searched for randomized controlled trials (RCTs) from inception to September 28, 2022. Meta-analyses were performed using random-effects modeling. Data were collected at 12 and 24 months for best-corrected visual acuity (BCVA), central retinal thickness, diabetic retinopathy severity scale, rate of adverse events, rate of enrolled patients not completing treatment, rate of patients receiving retreatment, and quality-of-life measures. The risk of bias and certainty of evidence were assessed using Cochrane's Risk-of-Bias version 2 and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) frameworks, respectively. Subgroup analysis was performed between subthreshold laser modalities and evaluated with Instrument to assess the Credibility of Effect Modification Analyses tool. RESULTS Fourteen RCTs comprising 514 eyes receiving conventional laser and 574 eyes receiving subthreshold laser were included. Subthreshold laser likely results in no difference to BCVA (moderate GRADE certainty) compared with conventional laser. Conventional laser demonstrated a small, statistically significant improvement in central retinal thickness (low GRADE certainty); however, the magnitude of this improvement is unlikely to be clinically important. There may not be a difference in the rate of adverse events (low GRADE certainty) at 12 months when comparing subthreshold laser to conventional laser for DME. CONCLUSION Randomized controlled trial literature to date suggests subthreshold laser to be as effective as conventional laser in the treatment of DME. Increased follow-up duration is needed to observe any long-term safety benefit from reduced retinal damage. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Felicia Tai
- Division of Ophthalmology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Keean Nanji
- Division of Ophthalmology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Anubhav Garg
- Division of Ophthalmology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Dena Zeraatkar
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Mark Phillips
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - David H Steel
- Department of Eye and Visual Sciences, Sunderland Eye Infirmary, Sunderland, United Kingdom; Department of Eye and Visual Sciences, Bioscience Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Sunir J Garg
- Department of Ophthalmology, Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Peter K Kaiser
- Department of Ophthalmology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Robyn H Guymer
- Department of Ophthalmology, Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia; Department of Surgery (Ophthalmology), the University of Melbourne, Melbourne, Australia
| | - Charles C Wykoff
- Retina Consultants of Texas, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas
| | - Sobha Sivaprasad
- Department of Ophthalmology, NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, United Kingdom
| | - Varun Chaudhary
- Division of Ophthalmology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
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Mafrici M, Fragiotta S, Tarsitano MG, Lorenzi U, Toscani L. Topical anesthesia versus topical and subconjunctival anesthesia combined in diabetic retinopathy photocoagulation. Eur J Ophthalmol 2024; 34:529-533. [PMID: 37654069 DOI: 10.1177/11206721231199206] [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] [Indexed: 09/02/2023]
Abstract
PURPOSE comparison between two anesthetic techniques on the ability to reduce pain during panretinal photocoagulation (PRP) treatment. METHODS Observational retrospective single center study. Medical charts of patients who underwent PRP for proliferative diabetic retinopathy were revised. Patients were included if they had the first eye treated with oxybuprocaine hydrochloride drops, and in case of severe pain, the fellow eye received topical anesthesia in combination with 2% subconjunctival lidocaine. The groups were compared for pain perception using an analog visual scale (VAS), number of laser spots, number of interruptions, and laser session duration. RESULTS Forty-two eyes of 21 patients (mean age: 58.3 ± 7.6 years) were analyzed. The mean number of laser spots was significantly higher under combined anesthesia (+84.2 ± 155.9 spots, p = 0.01), with a reduced time for laser execution (-2.5 ± 3.12, p = 0.0008). The use of combined anesthesia significantly decreased the number of interruptions (-40.8%, p < 0.0001) into a single session. On the pain grading scale, the pain perception was significantly lower in the combined anesthesia group (p < 0.0001). In eyes receiving topical anesthesia the treatment was stopped for pain in 5 eyes (23.8%), while 5 eyes under combined anesthesia presented subconjunctival hemorrhage (23.8%). CONCLUSION Using combined anesthesia in patients subjected to PRP appeared to reduce pain perception limiting the treatment duration and the interruptions for pain without significant complications. Further studies on a larger scale would be desirable to replicate such findings and standardize the analgesic procedures in ophthalmology.
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Affiliation(s)
- M Mafrici
- Department of Ophthalmology, Ales-Cevennes Hospital, Ales, France
| | - S Fragiotta
- NESMOS Department, Ophthalmology Unit, St. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy
| | - M G Tarsitano
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - U Lorenzi
- Department of Ophthalmology, Charles-Nicolle Hospital, Rouen, France
| | - L Toscani
- Department of Anesthesiology and Intensive Care, Sandro Pertini Hospital, Rome, Italy
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Okonkwo ON, Hassan AO, Oyekunle I, Akanbi T, Agweye C. Visual outcome of treating proliferative sickle cell retinopathy in 108 eyes. Eur J Ophthalmol 2024; 34:558-565. [PMID: 37670511 DOI: 10.1177/11206721231199273] [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] [Indexed: 09/07/2023]
Abstract
AIM To report treatment methods and visual outcome of treating proliferative sickle cell retinopathy (PSCR). DESIGN Retrospective interventional. METHODS Review of PSCR eyes treated between 2017 to 2022. Patient demographics, fundus findings at presentation, genotype, PSCR stage, treatment used, and visual outcome were assessed. RESULTS 108 eyes of 88 consecutive patients were studied. Male: Female 48:40. Mean age: 38.91 (SD:12.52) years. Genotype: sickle cell haemoglobin C (SC) 83 eyes (76.9%), sickle cell haemoglobin S (SS) 19 eyes (17.6%), and sickle cell trait (AS) 6 eyes (5.5%). PSCR stages: 3: 15 eyes (11.0%), 4: 74 eyes (67.0%), and 5: 19 eyes (22.0%). Treatment methods: Intravitreal Injection (IVI) of anti-vascular endothelial growth factor (VEGF) only (27 eyes,25%), scatter retinal laser photocoagulation (SRLP) only (7 eyes, 6.5%), Vitrectomy + SRLP (29 eyes, 26.9%), IVI + SRLP (25 eyes, 23.1%), and Vitrectomy + IVI + SRLP (20 eyes, 18.5%). The treatment used correlated with PSCR stage (p = 0.000). IVI only was mostly used to treat stage 4 (81.4%), and SRLP only was used for stages 3 (42.9%) and 5 (57.1%). IVI + SRLP treated eyes had the best pre- and post-treatment vision. Vitrectomy + SRLP treated eyes had the most improved vision. SRLP only had least visual improvement. Fundus findings correlated with visual outcome (p = 0.003); but stage of PSCR, genotype and treatment used had no correlation (P > 0.05). CONCLUSION Several options effectively treat PSCR. Visual outcome improved or remained same in 90.7% of treated eyes. Randomized controlled trials will determine the optimum treatment for each distinct presentation of PSCR. Treatment guidelines and a disease classification system of prognostic value are unmet needs.
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Affiliation(s)
- Ogugua Ndubuisi Okonkwo
- Department of Ophthalmology, Eye Foundation Retina Institute, Lagos, Nigeria
- Department of Ophthalmology, Eye Foundation Hospital, Lagos, Nigeria
- Department of Ophthalmology, Eye Foundation Hospital, Abuja, Nigeria
| | - Adekunle Olubola Hassan
- Department of Ophthalmology, Eye Foundation Retina Institute, Lagos, Nigeria
- Department of Ophthalmology, Eye Foundation Hospital, Lagos, Nigeria
- Department of Ophthalmology, Eye Foundation Hospital, Abuja, Nigeria
| | - Idris Oyekunle
- Department of Ophthalmology, Eye Foundation Hospital, Lagos, Nigeria
| | - Toyin Akanbi
- Department of Ophthalmology, Eye Foundation Hospital, Abuja, Nigeria
| | - Chineze Agweye
- Ophthalmology Department, University of Calabar Teaching Hospital, Cross River, Nigeria
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Mei JH, Lin Z. Subthreshold micropulse diode laser treatment in diabetic macular edema: biological impact, therapeutic effects, and safety. Int Ophthalmol 2024; 44:3. [PMID: 38315299 DOI: 10.1007/s10792-024-02973-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 12/04/2023] [Indexed: 02/07/2024]
Abstract
PURPOSE To introduce the treatment of diabetic macular edema (DME) with subthreshold micropulse diode laser (SMPL), to summarize the biological impact, therapeutic effects, and safety of this treatment, and to discuss the response to DME when SMPL is combined with anti-vascular endothelial growth factor (anti-VEGF) or steroid. METHODS The literature search was performed on the PubMed database, with a selection of English-language articles published from 2000 to 2023 with the following combinations of search terms: diabetes macular (o) edema, micropulse laser or subthreshold micropulse laser, anti-vascular endothelial growth factor, and steroid. RESULTS SMPL is a popular, invisible retinal laser phototherapy that is inexpensive, safe, and effective in the treatment of DME. It can selectively target the retinal pigment epithelium, reduce the expression of pro-inflammatory factors, promote the absorption of macular edema, and exert a similar and lasting clinical effect to traditional lasers. No significant difference was found in the therapeutic effects of SMPL between different wavelengths. However, HbA1c level and pretreatment central macular thickness (CMT) may affect the therapeutic outcomes of SMPL. CONCLUSION SMPL has a slow onset and produces lasting clinical effects similar to conventional photocoagulation. It has been reported that SMPL combined with the intravitreal anti-VEGF injection can significantly reduce the number of injections without influencing the therapeutic effect, which is essential for clinical applications and research. Although 577 nm SMPL is widely used clinically, there are no standardized protocols for SMPL. Additionally, some important problems regarding the treatment of SMPL require further discussion and exploration.
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Affiliation(s)
- Jing Hao Mei
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, No. 207, Xueyuan West Road, Wenzhou, 325027, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, No. 207, Xueyuan West Road, Wenzhou, 325027, Zhejiang, China
| | - Zhong Lin
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, No. 207, Xueyuan West Road, Wenzhou, 325027, Zhejiang, China.
- National Clinical Research Center for Ocular Diseases, No. 207, Xueyuan West Road, Wenzhou, 325027, Zhejiang, China.
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Xu D, Zhu T, Huang L, Wang X, Chen M. Clinical efficacy of subthreshold micropulse laser combined with anti-VEGF drugs in the treatment of diabetic macular edema: A meta-analysis. Medicine (Baltimore) 2024; 103:e34583. [PMID: 38306515 PMCID: PMC10843376 DOI: 10.1097/md.0000000000034583] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/13/2023] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND To systematically evaluate the efficacy and safety of subthreshold micropulse laser (SML) combined with anti-vascular endothelial growth factor (VEGF) drugs for the treatment of diabetic macular edema (DME). METHODS The randomized controlled trials on SML combined with anti-VEGF drugs for DME were retrieved from China National Knowledge Infrastructure, Wan Fang Data, VIP Data, Sino Med (China Biomedical Literature Database), PubMed, Web of Science, The Cochrane Library, and Embase by computer from inception to April 19, 2022. The observation group was treated with SML combined with anti-VEGF drugs, while the control group was treated with anti-VEGF agents alone or SML. And the references of the included literature were manually searched. The Meta-analysis was performed using Revman 5.4 and STATA SE 15. RESULTS This study finally included 15 randomized controlled trials involving 891 eyes for Meta-analysis. The results showed that there was no statistically significant difference between the 2 groups in best-corrected visual acuity at 1, 3, 6, 9, and 12 months after treatment. There was no statistical difference between the 2 groups in central macular thickness (CMT) at 1, 3, and 6 months after treatment (P > .05). CMT in the observation group was lower than that in the control group at 9 and 12 months (P < .05). There was no statistical difference between the 2 groups in total macular volume at 3, 6, 9, and 12 months in CMT (P > .05). The number of anti-VEGF drugs injections in the observation was lower than that in the control group (P < .05). The occurrence of complications between the 2 groups was not statistically significant difference (P > .05). CONCLUSION SML in combination with anti-VEGF drugs in patients with DME are comparable in reducing the number of anti-VEGF drugs injections and CMT, thereby reducing the financial burden on patients. It does not differ in best-corrected visual acuity and total macular volume.
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Affiliation(s)
- Dahua Xu
- Aier School of Ophthalmology, Central South University, Changsha, Hunan Province, China
| | - Ting Zhu
- Aier School of Ophthalmology, Central South University, Changsha, Hunan Province, China
| | - Lin Huang
- Aier School of Ophthalmology, Central South University, Changsha, Hunan Province, China
| | - Xiaolin Wang
- Aier School of Ophthalmology, Central South University, Changsha, Hunan Province, China
| | - Mei Chen
- Chongqing Aier Eye Hospital, Chongqing, China
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17
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García-Luna S, Pita-Ortíz IY, Quevedo-Martínez JU, Somilleda-Ventura SA, Pérez-Cano HJ. Vitreous rebleeding rate after vitrectomy or phacovitrectomy in patients with proliferative diabetic retinopathy: A retrospective study. Arch Soc Esp Oftalmol (Engl Ed) 2024; 99:62-66. [PMID: 38013130 DOI: 10.1016/j.oftale.2023.11.014] [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] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/04/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND The most common complication after vitrectomy is the rebleeding in vitreous cavity. It is important to detect the different factors that can increase the vitreous rebleeding rate in these patients. OBJECTIVE To carry out a retrospective review of the rate of vitreous rebleeding after vitrectomy or phacovitrectomy. METHOD Retrospective, descriptive and comparative study of patients with a diagnosis of proliferative diabetic retinopathy with phacovitrectomy or vitrectomy procedure. Personal background data, type of surgical intervention and grade of the surgeon who carried out the procedure were obtained. RESULTS 1227 files of diabetic patients with vitrectomy or phacovitrectomy were reviewed. 65% presented systemic arterial hypertension. The average glomerular filtration rate was 63.50 (±32.36) ml/min/1.73 m2 and glycosylated hemoglobin (HBA1C) of 8% (4.6 to 15%). In the comparison of variables, a significant difference in the rate of vitreous rebleeding was obtained comparing phacovitrectomy with vitrectomy. (p = 0.003), in the relationship between vitrectomy with vitreous rebleeding, an odds ratio of 1.44 was obtained. CONCLUSION The results obtained show a lower rate of rebleeding in patients undergoing phacovitrectomy in patients with proliferative diabetic retinopathy.
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Affiliation(s)
- S García-Luna
- Servicio de Retina, Fundación Hospital Nuestra Señora de la Luz I.A.P., Mexico City, Mexico
| | - I Y Pita-Ortíz
- Servicio de Retina, Fundación Hospital Nuestra Señora de la Luz I.A.P., Mexico City, Mexico
| | - J U Quevedo-Martínez
- Servicio de Córnea, Fundación Hospital Nuestra Señora de la Luz I.A.P., Mexico City, Mexico
| | - S A Somilleda-Ventura
- Centro Interdisciplinario de Ciencias de la Salud, Unidad Santo Tomás, Instituto Politécnico Nacional, Mexico City, Mexico; Centro de Investigación Biomédica, Fundación Hospital Nuestra Señora de la Luz I.A.P., Mexico City, Mexico
| | - H J Pérez-Cano
- Centro de Investigación Biomédica, Fundación Hospital Nuestra Señora de la Luz I.A.P., Mexico City, Mexico; Facultad de Química, Universidad Nacional Autónoma de México, Mexico City, Mexico.
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Karasu B, Akbas YB, Aykut A, Çelebi ARC. Subthreshold Photocoagulation, Laser Endpoint Management Based on Optical Coherence Tomography Angiography in Cases of Diabetic Macular Edema Refractory to Anti-VEGF. Klin Monbl Augenheilkd 2024; 241:197-208. [PMID: 35453154 DOI: 10.1055/a-1792-3009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE This study aimed to determine the changes that occur in the vasculature, as based on optical coherence tomography angiography (OCTA) after non-damaging endpoint management (EpM), using a continuous wave yellow laser. The study was on eyes with diabetic macular edema (DME) that were resistant to anti-vascular endothelial growth factors (anti-VEGFs). MATERIALS AND METHODS This was a retrospective analysis of OCTA images of 44 eyes in 44 patients with DME refractory to anti-VEGF. The eyes were treated with a PASCAL Streamline yellow laser (577 nm wavelength, 200 mm spot size). Treatment was administered to the DME area and utilized 10% continuous wave laser energy and 0.50 µm beam diameter spot spacing. Best-corrected visual acuity (BCVA) and enhanced in-depth imaging with optical coherence tomography (EDI-OCT) and fundus autofluorescence (FAF) images were recorded at baseline, and 3 and 6 months posttreatment. Total choroidal area (TCA), luminal area (LA), stromal area (SA), and the choroidal vascularity index (CVI) were calculated using Image J software. The macula was divided into five quadrants in accordance with the mapping system in the Early Treatment Diabetic Retinopathy Study (ETDRS). RESULTS All patients (mean age: 58.90 ± 9.55 years) were diagnosed with diabetes mellitus type 2. Mean BCVA at baseline was 0.30 ± 0.11 logarithm of the minimum angle of resolution (logMAR) versus 0.23 ± 0.10 logMAR at 3 months (p = 0.032) and 0.17 ± 0.10 logMAR at 6 months (p = 0.013). The foveal avascular zone area (FAZ) decreased in the deep capillary plexus (DCP) from baseline to 6 months (p = 0.028). Vessel densities (VDs) of the superficial capillary plexus (SCP), DCP, and choriocapillaris decreased significantly in the fovea at 3 and 6 months compared to baseline (p < 0.05 for both follow-up time points). There were significant decreases in SCP and DCP in the superior quadrant at the end of month 6 (p = 0.001 and p = 0.038, respectively). There was a significant decrease in the nasal quadrant of the DCP and choriocapillaris at the end of month 6 (p = 0.024 and p = 0.049, respectively). Although there was a significant decrease in central macular thickness (CMT) (p < 0.001), subfoveal choroidal thickness (SFCT) (p < 0.001), and LA (p = 0.034) at months 3 and 6, there was no significant change in the CVI (p = 0.19). According to the DME recovery rate, 36 eyes (81%) were irradiated once, whereas 8 eyes (19%) were irradiated twice. CONCLUSIONS Non-damaging EpM therapy using a continuous wave yellow laser in eyes with DME that are resistant to anti-VEGFs induces significant changes in the SCP, choriocapillaris, and, most commonly, the DCP, which caused a significant decrease in VDs during 6 months of follow-up.
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Affiliation(s)
- Bugra Karasu
- Ophthalmology, Beyoglu Eye Training and Research Hospital, Içmeler Mahallesi, Piri Reis Caddesi, Tuzla State Hospital, Tuzla, Turkey
| | - Yusuf Berk Akbas
- Ophthalmology, Beyoglu Eye Training and Research Hospital, Bereketzade, Beyoglu, Turkey
| | - Aslan Aykut
- Ophthalmology, Marmara University School of Medicine, Istanbul, Turkey
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Núñez-Amaro CD, López M, Adán-Castro E, Robles-Osorio ML, García-Franco R, García-Roa M, Villalpando-Gómez Y, Ramírez-Neria P, Pineiro N, Rubio-Mijangos JF, Sánchez J, Ramírez-Hernández G, Siqueiros-Márquez L, Díaz-Lezama N, López-Star E, Bertsch T, Marínez de la Escalera G, Triebel J, Clapp C. Levosulpiride for the treatment of diabetic macular oedema: a phase 2 randomized clinical trial. Eye (Lond) 2024; 38:520-528. [PMID: 37673971 PMCID: PMC10858020 DOI: 10.1038/s41433-023-02715-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 08/08/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND/OBJECTIVE The prokinetic levosulpiride elevates vasoinhibin levels in the vitreous of patients with proliferative diabetic retinopathy (PDR) suggesting clinical benefits due to the anti-vasopermeability and anti-angiogenic properties of vasoinhibin. We investigated the biological activity of levosulpiride in centre-involving diabetic macular oedema (DME). PATIENTS/METHODS Prospective, randomized, double-blinded, dual-centre, phase 2 trial in patients with centre-involving DME orally treated with placebo (n = 17) or levosulpiride (n = 17) for 8 weeks or in patients with PDR undergoing elective pars plana vitrectomy and receiving placebo (n = 18) or levosulpiride (n = 18) orally for the 1 week before vitrectomy. RESULTS Levosulpiride improved changes from baseline in best-corrected visual acuity (p ≤ 0.037), central foveal thickness (CFT, p ≤ 0.013), and mean macular volume (MMV, p ≤ 0.002) at weeks 4, 6, and 8 compared to placebo. At 8 weeks, the proportion of eyes gaining ≥5 ETDRS letters at 4 m (41% vs. 28%), losing ≥21 μm in CFT (55% vs. 28%), and dropping ≥0.06 mm3 in MMV (65% vs. 29%) was higher after levosulpiride than placebo. The overall grading of visual and structural parameters improved with levosulpiride (p = 0.029). Levosulpiride reduced VEGF (p = 0.025) and PlGF (p = 0.008) levels in the vitreous of PDR patients. No significant adverse side-effects were detected. CONCLUSIONS Oral levosulpiride for 8 weeks improved visual and structural outcomes in patients with centre-involving DME by mechanisms that may include intraocular upregulation of vasoinhibin and downregulation of VEGF and PlGF. Larger clinical trials evaluating long-term efficacy and safety are warranted.
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Affiliation(s)
- Carlos D Núñez-Amaro
- Facultad de Ciencias Naturales, Universidad Autónoma de Querétaro (UAQ), Querétaro, México
| | - Mariana López
- Instituto Mexicano de Oftalmología (IMO), Querétaro, México
| | - Elva Adán-Castro
- Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus UNAM-Juriquilla, Querétaro, México
| | | | | | | | | | | | - Nayeli Pineiro
- Instituto Mexicano de Oftalmología (IMO), Querétaro, México
| | | | - Jorge Sánchez
- Instituto de la Retina del Bajío (INDEREB), Querétaro, México
| | - Gabriela Ramírez-Hernández
- Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus UNAM-Juriquilla, Querétaro, México
| | - Lourdes Siqueiros-Márquez
- Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus UNAM-Juriquilla, Querétaro, México
| | - Nundehui Díaz-Lezama
- Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus UNAM-Juriquilla, Querétaro, México
| | | | - Thomas Bertsch
- Institute for Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Nuremberg General Hospital and Paracelsus Medical University, Nuremberg, Germany
| | | | - Jakob Triebel
- Institute for Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Nuremberg General Hospital and Paracelsus Medical University, Nuremberg, Germany
| | - Carmen Clapp
- Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus UNAM-Juriquilla, Querétaro, México.
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Ben Addou Idrissi S, Bengebara O, Filali Sadouk M, Himmich M, Lahlou L, El Ouazzani Taybi H, Moutei H, Bennis A, Chraibi F, Abdellaoui M, Benatiya Andaloussi I. Comparison of pars plana vitrectomy and combined pars plana vitrectomy with phacoemulsification for proliferative diabetic retinopathy: A retrospective study about 120 eyes. Indian J Ophthalmol 2024; 72:S287-S292. [PMID: 38271425 DOI: 10.4103/ijo.ijo_1976_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/04/2023] [Indexed: 01/27/2024] Open
Abstract
PURPOSE To compare the outcomes of pars plana vitrectomy (PPV) and combined PPV with phacoemulsification (PPVCE) surgeries for proliferative diabetic retinopathy (PDR) and cataract treatment. METHODS Retrospective analysis of 120 diabetic patients who underwent PPV or PPVCE. RESULTS The key outcome indicators were best-corrected visual acuity (BCVA) and post-operative complications. The PPVCE group had an average age of 53 years, with 50% females and 50% males. The initial visual acuity (VA) was 1.84 log MAR. In this group, BCVA remained stable or increased in 61 eyes (74%). Regarding the PPV group, the average age was 43 years; 65% were men while 34% were women. The initial VA was 1.83 log MAR; in this group, the VA increased or remained stable in 28 eyes (73%). The evolution of the VA was rather symmetric in the two groups without a significant difference (P = 0.9). Similarly, the occurrence of postoperative complications was comparable for the main complications studied, namely the inflammatory reaction (P = 0.809), ocular hypertension (P = 0.344), corneal edema (P = 0.07), and neovascular glaucoma (P = 0.413). However, there was a decrease in BCVA (three lines) in the PPV group after 6 months of follow-up (P = 0.05) in patients with a clear lens preoperatively and who developed a clinically evident cataract. CONCLUSION According to this study, for diabetic patients with severe cataracts and vitreoretinal disease requiring vitrectomy, combining vitrectomy with phacoemulsification as a single surgical intervention may be a suitable therapeutic choice. This approach does not significantly increase the risk of visual impairment or retinopathy development.
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Affiliation(s)
- Sara Ben Addou Idrissi
- Department of Ophthalmology, Omar Drissi Hospital, Faculty of Medicine, Pharmacy and Dental Medicine, FEZ, Morocco
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21
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Anam A, Malik IQ, Hameed Z. Comparison of effect of machine muteness to reduce noise anxiety vs regular settings on patient compliance during pan-retinal photocoagulation. J PAK MED ASSOC 2024; 74:384-386. [PMID: 38419242 DOI: 10.47391/jpma.9181] [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] [Indexed: 03/02/2024]
Abstract
This Quasi Experimental study was conducted at Major Eye Clinic, Gujranwala, from January to December 2022, to study the effect of muting the sound of Argon Laser machine on patient compliance and the pain felt during pan-retinal photocoagulation (PRP). Eighty patients were included in the study with proliferative diabetic retinopathy (PDR), retinal breaks, lattice and myopic fundus degenerations for which PRP was performed. A total of 80 patients were enrolled, who were divided in two groups with 40 patients in each group. Group A patients received muted machine settings, while group B underwent regular PRP. The mean age was 54.6±3.4 years. Sixty-eight (85%) cases were of PDR, 4 (5%) of retinal breaks, 3 (3.75%) of lattice degenerations associated with breaks, and 5 (6.25%) of laser barrage. In group A, 28 (70%) patients had grade 1 and grade 2 pain score, while in group B, 26 (65%) had grade 3 and grade 4 pain score. It was concluded that by eliminating machine sound, noise anxiety can be greatly reduced ensuring better patient cooperation.
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Affiliation(s)
- Amna Anam
- Department of Ophthalmology, Gujranwala Medical College, DHQ Teaching Hospital, Gujranwala, Pakistan
| | - Irfan Qayyum Malik
- Department of Ophthalmology, Gujranwala Medical College, DHQ Teaching Hospital, Gujranwala, Pakistan
| | - Zeeshan Hameed
- Department of Ophthalmology, Gujranwala Medical College, DHQ Teaching Hospital, Gujranwala, Pakistan
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22
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Yilmaz U, Akçaoğlu T, Avunduk MA, Kaya H, Parça O. Investigation of the recurrent vitreous hemorrhage risk factors after early 25G vitrectomy in diabetic vitreous hemorrhage. Medicine (Baltimore) 2024; 103:e36963. [PMID: 38241585 PMCID: PMC10798761 DOI: 10.1097/md.0000000000036963] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/21/2023] [Indexed: 01/21/2024] Open
Abstract
Vitreous hemorrhage (VH) is one of the main causes of vision loss in diabetic retinopathy (DRP). Early surgery increases the visibility of the retina, allowing early recognition of DRP complications and additional treatments. One of the most important reasons affecting success after surgery is recurrent vitreous hemorrhage (RVH). We aimed to investigate the risk factors for RVH after early 25G vitrectomy in diabetic VH. Eighty eyes of eighty patients who underwent early 25G PPV surgery with a diagnosis of VH due to proliferative diabetic retinopathy (PDR) were included in this retrospective study. Vision acuity changes and intraocular pressure (IOP) changes were compared. The effect of arterial hypertension (HT), coronary artery disease (CAD), preoperative antiglaucomatous usage, and anticoagulant usage on RVH was investigated. A value of P < .05 was accepted as statistically significant. Postoperative RVH was observed in 18 (22.5%) patients. There was no correlation between the age of the patients and the development of postoperative RVH (r = -0.197, P = .08). The rate of HT and the mean HbA1C levels were found to be higher in the patients who developed RVH than in those who did not (P = .04 and < 0.001, respectively). The presence of CAD, preoperative glaucoma disease, and the use of anticoagulants did not have any effect on RVH (P = .229, 0.843, 0.932, respectively). HT and increased HbA1c were found to be risk factors for RVH in VH patients who underwent 25G vitrectomy in the early period in our study.
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Affiliation(s)
- Uğur Yilmaz
- Pamukkale University, Ophthalmology Department, Denizli, Turkey
| | - Tahsin Akçaoğlu
- Pamukkale University, Ophthalmology Department, Denizli, Turkey
| | | | - Hüseyin Kaya
- Pamukkale University, Ophthalmology Department, Denizli, Turkey
| | - Osman Parça
- Pamukkale University, Ophthalmology Department, Denizli, Turkey
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23
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Petrachkov DV, Alkharki L, Filippov VM, Balkar SS. [Outcomes of bimanual vitreoretinal surgery in the treatment of diabetic retinopathy complications]. Vestn Oftalmol 2024; 140:21-27. [PMID: 38739127 DOI: 10.17116/oftalma202414002221] [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] [Indexed: 05/14/2024]
Abstract
The incidence of diabetic retinopathy (DR) requiring vitreorentinal surgery is increasing. The search for new effective and safe methods of treatment, the choice of the optimal time for surgery, and the assessment of long-term treatment outcomes are relevant problems. PURPOSE This study evaluates the long-term results of vitreorentinal surgery using the bimanual technique in DR with different stages of fibrovascular proliferation. MATERIAL AND METHODS The study included 135 patients (135 eyes) who were divided into groups depending on the predominant type of proliferation - vascular or fibrous. Patients underwent vitrectomy with membranectomy using the bimanual technique, with peripheral panretinal endolaser coagulation of the retina and tamponade of the vitreous cavity with balanced salt solution. The postoperative observation period lasted up to 12 months. RESULTS Both groups showed statistically significant improvement in visual function and anatomical changes in central retinal thickness. A statistically significant improvement in best corrected visual acuity (BCVA) was found in patients with initially predominantly vascular proliferation. Correlation analysis showed that initially higher BCVA tends to persist in the postoperative period. A negative correlation was found between the final BCVA and the presence of type 2 diabetes mellitus, fibrous stage of proliferation, high central retinal thickness, and the presence of diabetic macular edema (DME) - both initially and after treatment. The frequency of complications in the groups was comparable, except for postoperative DME, which was more often detected in patients with fibrous proliferation. CONCLUSION The bimanual technique of vitreorentinal surgery for complications of DR allows achieving high anatomical and functional results. Higher BCVA is noted in patients with the vascular stage of proliferation and initially high BCVA. The obtained data allow us to form a hypothesis about the possibility of earlier surgery in patients with high BCVA, but require further investigation.
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Affiliation(s)
- D V Petrachkov
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
| | - L Alkharki
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
| | - V M Filippov
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
| | - S Sh Balkar
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
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24
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Brar AS, Behera UC, Karande S, Kanakagiri A, Sugumar S, Rani PK, Vignesh TP, Manayath G, Salian R, Giridhar A, Indurkhya S, Bhattacharjee H, Raman R, Sivaprasad S. Late postoperative vitreous cavity hemorrhage after vitrectomy for proliferative diabetic retinopathy-observation versus intervention. Indian J Ophthalmol 2024; 72:S22-S26. [PMID: 38131537 PMCID: PMC10833151 DOI: 10.4103/ijo.ijo_311_23] [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: 02/02/2023] [Revised: 06/28/2023] [Accepted: 07/17/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE To analyze the outcome of intervention versus observation for vitreous cavity hemorrhage occurring after a 2-month period of blood-free cavity (late postoperative vitreous cavity hemorrhage-POVCH) in eyes operated by vitrectomy for complications of proliferative diabetic retinopathy (PDR). METHODS This study was a 10-year retrospective, observational, multi-center study involving eight major vitreoretinal surgical centers across India from January 2010 to December 2019. The primary objective of the study was to assess the visual and clinical outcomes of various management approaches for late POVCH. The key secondary objective was to determine the best management option that prevented recurrence. Patients with follow-up of less than 6 months of POVCH management were excluded. RESULTS The occurrence of late POVCH was studied in 261 eyes. The median time to occurrence was 7 months (range: 2-87) postvitrectomy/silicone oil removal. The majority (58%) experienced a single, nonrecurring POVCH event. Visual acuity outcome was independent of all management approaches (P = 0.179; mean follow-up 20.7 ± 14.1 months). With watchful observation, spontaneous resolution was noted in 83% (60/72 eyes) of eyes in 81.5 days (interquartile range, 169.75). Silicone oil injection was most effective in preventing recurrence (P < 0.001). CONCLUSION The current treatment practice of late POVCH management in PDR suggests that watchful observation for at least 3 months could be as efficacious as any surgical intervention.
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Affiliation(s)
- Anand S Brar
- Retina and Vitreous Services, Anant Bajaj Retina Institute, L V Prasad Eye Institute (Mithu Tulsi Chanrai Campus), Bhubaneswar, Odisha, India
| | - Umesh C Behera
- Retina and Vitreous Services, Anant Bajaj Retina Institute, L V Prasad Eye Institute (Mithu Tulsi Chanrai Campus), Bhubaneswar, Odisha, India
| | - Sayali Karande
- Retina and Vitreous Services, Anant Bajaj Retina Institute, L V Prasad Eye Institute (Mithu Tulsi Chanrai Campus), Bhubaneswar, Odisha, India
| | - Akhila Kanakagiri
- Retina and Vitreous Services, Anant Bajaj Retina Institute, L V Prasad Eye Institute (Mithu Tulsi Chanrai Campus), Bhubaneswar, Odisha, India
| | - Shalini Sugumar
- Retina and Vitreous Services, Anant Bajaj Retina Institute, L V Prasad Eye Institute (Mithu Tulsi Chanrai Campus), Bhubaneswar, Odisha, India
| | - Padmaja K Rani
- Srimati Kanuri Santhamma Center for Vitreo-retinal Diseases, Anant Bajaj Retina Institute, LV Prasad Eye Institute (Kallam Anji Reddy Campus), Hyderabad, Telangana, India
| | - T P Vignesh
- Vitreo-retina Department, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - George Manayath
- Vitreo-retina Department, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Romit Salian
- Vitreo-retina Department, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | | | - Swati Indurkhya
- Vitreo-retina Department, Giridhar Eye Institute, Cochin, Kerala, India
| | - Harsha Bhattacharjee
- Department of Anterior and Posterior Segment, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
| | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
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25
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Hatano M, Wakuta M, Yamamoto K, Arai E, Enoki M, Fujimoto K, Yamauchi K, Ishikawa K, Sonoda KH, Kimura K. Use of Ranibizumab for evaluating focal laser combination therapy for refractory diabetic macular edema patients: an exploratory study on the RELAND trials. Sci Rep 2023; 13:22965. [PMID: 38151499 PMCID: PMC10752877 DOI: 10.1038/s41598-023-48665-6] [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: 06/03/2023] [Accepted: 11/29/2023] [Indexed: 12/29/2023] Open
Abstract
Anti-vascular endothelial growth factor (VEGF) therapy is the first-line treatment for diabetic macular edema (DME), but is less effective in some patients. We conducted a prospective study to determine whether laser combination therapy with anti-VEGF was more effective than Ranibizumab monotherapy in anti-VEGF-resistant DME patients. There was no significant difference in the improvement of the best-corrected visual acuity (BCVA) between the laser combination therapy and Ranibizumab monotherapy groups (3.2 letters and -7.5 letters, p = 0.165). BCVA did not significantly change between visits 1 and 7 (the laser combination group, 64.3 letters 70.3 letters, respectively, p = 0.537; the Ranibizumab monotherapy group, 72.3 letters and 64.8 letters, respectively, p = 0.554), with no significant improvements in central foveal retinal thickness (the laser combination therapy group, 9.3%: the Ranibizumab monotherapy groups, - 7.3%; p = 0.926). There was no significant difference in the number of Ranibizumab intravitreal therapy (IVT) sessions between the groups (laser combination therapy, 5.2; ranibizumab monotherapy, 6.0; p = 0.237). This study did not show that laser combination therapy was significantly more effective for anti-VEGF-resistant DME than anti-VEGF monotherapy alone. Therefore, for anti-VEGF-resistant DME, alternative therapeutic approaches beyond combined laser therapy may be considered.
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Affiliation(s)
- Makoto Hatano
- Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8585, Japan
| | - Makiko Wakuta
- Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8585, Japan
| | | | - Eika Arai
- Department of Ophthalmology, Nagato General Hospital, Nagato, Japan
| | - Miho Enoki
- Department of Ophthalmology, Ogori Daiichi General Hospital, Yamaguchi, Japan
| | | | - Kazuhiko Yamauchi
- Department of Ophthalmology, Yamaguchi Red Cross Hospital, Yamaguchi, Japan
| | - Keijiro Ishikawa
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koh-Hei Sonoda
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuhiro Kimura
- Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8585, Japan.
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Liu J, Liu B, Liu J, Wen D, Wang M, Shao Y, Li X. Comparison of 27-gauge beveled-tip and 25-gauge flat-tip microincision vitrectomy surgery in the treatment of proliferative diabetic retinopathy: a randomized controlled trial. BMC Ophthalmol 2023; 23:504. [PMID: 38087284 PMCID: PMC10718007 DOI: 10.1186/s12886-023-03251-2] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
PURPOSE To compare the effectiveness and safety of a 27-gauge (27G) beveled-tip microincision vitrectomy surgery (MIVS) with a 25-gauge (25G) flat-tip MIVS for the treatment of proliferative diabetic retinopathy (PDR). METHODS A prospective, single-masked, randomized, controlled clinical trial included 52 eyes (52 patients) with PDR requiring proliferative membrane removal. They were randomly assigned in a 1:1 ratio to undergo the 27G beveled-tip and or 25G flat-tip MIVS (the 27G group and the 25G group, respectively). During surgery, the productivity of cutting the membrane, the number of vitrectomy probe (VP) exchanges to microforceps, total operation time, vitrectomy time and intraoperative complications were measured. Best-corrected visual acuity (BCVA), intraocular pressure (IOP) and postoperative complications were also assessed to month 6. RESULTS Forty-seven eyes (47 patients) completed the follow-up, including 25 in the 27G group and 22 in the 25G group. During surgery in the 27G group, cutting the membrane was more efficient (P = 0.001), and the number of VP exchanges to microforceps was lower (P = 0.026). The occurrences of intraoperative hemorrhages and electrocoagulation also decreased significantly (P = 0.004 and P = 0.022). There were no statistical differences in the total operation time or vitrectomy time between the two groups (P = 0.275 and P = 0.372), but the former was slightly lower in the 27G group. Additionally, the 27G group required fewer wound sutures (P = 0.044). All the follow-up results revealed no significant difference between the two groups. CONCLUSIONS Compared with the 25G flat-tip MIVS, the 27G beveled-tip MIVS could be more efficient in removing the proliferative membrane while reducing the occurrence of intraoperative hemorrhages and electrocoagulation using appropriate surgical techniques and instrument parameters. Its vitreous removal performance was not inferior to that of the 25G MIVS and might offer potential advantages in total operation time. In terms of patient outcomes, advanced MIVS demonstrates equal effectiveness and safety to 25G flat-tip MIVS. TRIAL REGISTRATION The clinical trial has been registered at Clinicaltrials.gov (NCT0544694) on 07/07/2022. And all patients in the article were enrolled after registration.
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Affiliation(s)
- Jingjie Liu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of the National Clinical Research Center for Ocular Disease, Eye Institute, School of Optometry, Tianjin Medical University Eye Hospital, 251 Fukang Road, Tianjin, China
| | - Boshi Liu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of the National Clinical Research Center for Ocular Disease, Eye Institute, School of Optometry, Tianjin Medical University Eye Hospital, 251 Fukang Road, Tianjin, China
| | - Juping Liu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of the National Clinical Research Center for Ocular Disease, Eye Institute, School of Optometry, Tianjin Medical University Eye Hospital, 251 Fukang Road, Tianjin, China
| | - Dejia Wen
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of the National Clinical Research Center for Ocular Disease, Eye Institute, School of Optometry, Tianjin Medical University Eye Hospital, 251 Fukang Road, Tianjin, China
| | - Manqiao Wang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of the National Clinical Research Center for Ocular Disease, Eye Institute, School of Optometry, Tianjin Medical University Eye Hospital, 251 Fukang Road, Tianjin, China
| | - Yan Shao
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of the National Clinical Research Center for Ocular Disease, Eye Institute, School of Optometry, Tianjin Medical University Eye Hospital, 251 Fukang Road, Tianjin, China.
- Tianjin Medical University Eye Hospital, 251 Fukang Road, 300384, Tianjin, China.
| | - Xiaorong Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of the National Clinical Research Center for Ocular Disease, Eye Institute, School of Optometry, Tianjin Medical University Eye Hospital, 251 Fukang Road, Tianjin, China.
- Tianjin Medical University Eye Hospital, 251 Fukang Road, 300384, Tianjin, China.
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27
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Lee HJ, Cho S, Park J, Jin Y, Kim HM, Jee D. Cost-effectiveness of the anti-vascular endothelial growth factor intravitreal injection and panretinal photocoagulation for patients with proliferative diabetic retinopathy in South Korea. BMC Health Serv Res 2023; 23:1388. [PMID: 38082399 PMCID: PMC10714639 DOI: 10.1186/s12913-023-10280-6] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 11/06/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND We determined the cost-effectiveness of the anti-vascular endothelial growth factor (VEGF) intravitreal injection versus panretinal photocoagulation (PRP) for patients with proliferative diabetic retinopathy (PDR) in South Korea. METHODS We simulated four treatment strategies using PRP and the anti-VEGF injection by constructing a Markov model for a hypothetical cohort of 50-year-old PDR patients: (1) PRP only; (2) anti-VEGF injection only; (3) PRP first; and (4) anti-VEGF injection first. RESULTS In this cost-effectiveness analysis, compared with only-PRP, the incremental cost-effectiveness ratio was $95,456 per quality-adjusted life-year (QALY) for PRP first, $34,375 per QALY for anti-VEGF injection first, and $33,405 per QALY for anti-VEGF injection only from a healthcare perspective. From the societal and payer perspective, strategy (2) was more cost-saving and effective than (1). In the probabilistic sensitivity analysis, only-PRP was cost-effective up to the willingness-to-pay (WTP) of about $42,000, while anti-VEGF injection only was cost-effective from a healthcare perspective. From the societal and payer perspectives, regardless of the value of WTP, anti-VEGF injection only was the most cost-effective strategy. CONCLUSION In our study, the anti-VEGF injection for PDR was cost-effective from the payer and societal perspectives.
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Grants
- NA20-011, NAM21-004 National Evidence-based Healthcare Collaborating Agency
- NA20-011, NAM21-004 National Evidence-based Healthcare Collaborating Agency
- NA20-011, NAM21-004 National Evidence-based Healthcare Collaborating Agency
- NA20-011, NAM21-004 National Evidence-based Healthcare Collaborating Agency
- NA20-011, NAM21-004 National Evidence-based Healthcare Collaborating Agency
- NA20-011, NAM21-004 National Evidence-based Healthcare Collaborating Agency
- HC23C0130 Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea
- HC23C0130 Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea
- HC23C0130 Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea
- HC23C0130 Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea
- HC23C0130 Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea
- HC23C0130 Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea
- Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea
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Affiliation(s)
- Hyeon-Jeong Lee
- Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, South Korea
| | - Songhee Cho
- Patient-Centered Clinical Research Coordinating Center, National Evidence-based Healthcare Collaborating Agency, Seoul, South Korea
| | - Jungeun Park
- Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, South Korea
| | - Yan Jin
- Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, South Korea
- Department of Rehabilitation, College of Acupuncture and Moxibustion and Massage Health Preservation and Rehabilitation, Nanjing University of Chinese Medicine, Jiangsu, China
| | - Hyung Min Kim
- Artificial intelligence, Kai Health, Seoul, South Korea
| | - Donghyun Jee
- Department of Ophthalmology and Visual Science, St. Vincent's Hospital, Suwon, South Korea.
- The College of Medicine, Catholic University of Korea, Seoul, South Korea.
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28
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Chen SN, Chen SJ, Wu TT, Wu WC, Yang CH, Yang CM. Refining vitrectomy for proliferative diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol 2023; 261:3659-3670. [PMID: 37314522 PMCID: PMC10667443 DOI: 10.1007/s00417-023-06134-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 06/15/2023] Open
Abstract
Pars plana vitrectomy (PPV) is the main treatment modality for patients with severe diabetic retinopathy. With the development of systems for microincision, wide-angle viewing, digitally assisted visualization, and intraoperative optical coherence tomography, contemporary PPV for diabetic retinopathy has been performed on a wider range of indications than previously considered. In this article, we reviewed, in conjunction with our collective experiences with Asian patients, the applications of new technologies for PPV in eyes with diabetic retinopathy and highlighted several important procedures and entities not generally reiterated in the literature, in order for vitreoretinal surgeons to optimize their approaches when facing the challenges imposed by the complications in diabetic eyes.
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Affiliation(s)
- San-Ni Chen
- Department of Ophthalmology, China Medical University Hospital, Taichung, Taiwan
- Department of Medicine, School of Medicine, China Medical University, Taichung, Taiwan
| | - Shih-Jen Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tsung-Tien Wu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chang-Hao Yang
- Department of Ophthalmology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 10002, Taiwan
- School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 10002, Taiwan.
- School of Medicine, National Taiwan University, Taipei, Taiwan.
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29
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Jiang JH, Wu RH, Ren MX, Lin K, Lin W, Hu XT, Chen F, Zhao ZQ, Ge LN, Lin Z. Surgical strategy and outcome in patients with bilateral proliferative diabetic retinopathy. Int Ophthalmol 2023; 43:4921-4931. [PMID: 37837486 DOI: 10.1007/s10792-023-02895-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/27/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVES To investigate the current surgery strategies for bilateral proliferative diabetic retinopathy (PDR), as well as the surgical outcomes of patients with bilateral PDR who underwent pars plana vitrectomy (PPV). MATERIALS Patients undergoing bilateral vitrectomy for PDR from January 2019 to December 2020 at The Eye Hospital of Wenzhou Medical University were enrolled. Clinical data were collected from the electronic medical records. Factors associated with the time interval between the surgeries on two eyes and postoperative visual outcomes were analyzed. RESULTS In total, 152 patients with bilateral PDR who underwent bilateral PPV were included in this analysis. Mean age was 53.7 ± 11.4 years. Compared with second-surgery eyes, 60.5% of first-surgery eyes had worse preoperative best-corrected visual acuity (BCVA). The overall PPV time (median, quartile range) between first and second surgeries eye was 1.40 (0.70, 3.15) months. Multivariate analysis showed that the preoperative BCVA of the second-surgery eye had a significant effect on the inter-surgery time interval (P = 0.048). First-surgery eyes had greater vision improvement than second-surgery eyes (Difference of the logarithm of the minimum angle of resolution [LogMAR] BCVA: - 1.00 [- 1.48, - 0.12] versus 0.00 [- 1.30, 0.00], respectively, P < 0.001), especially when eyes with poorer BCVA underwent PPV first (- 1.15 [- 1.87, - 0.54] versus 0.00 [- 0.70, 0.00], respectively, P < 0.001). CONCLUSIONS Visual acuity is a significant factor that influences surgical strategies, including both surgery order and interval, for patients with bilateral PDR. The eyes operated upon first show more vision improvement due to prompt surgery.
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Affiliation(s)
- Jun Hong Jiang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, No. 270 West College Road, Wenzhou, 325027, Zhejiang, China
| | - Rong Han Wu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, No. 270 West College Road, Wenzhou, 325027, Zhejiang, China
| | - Ming Xue Ren
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, No. 270 West College Road, Wenzhou, 325027, Zhejiang, China
| | - Ke Lin
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, No. 270 West College Road, Wenzhou, 325027, Zhejiang, China
| | - Wei Lin
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, No. 270 West College Road, Wenzhou, 325027, Zhejiang, China
| | - Xu Ting Hu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, No. 270 West College Road, Wenzhou, 325027, Zhejiang, China
| | - Feng Chen
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, No. 270 West College Road, Wenzhou, 325027, Zhejiang, China
| | - Zhen Quan Zhao
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, No. 270 West College Road, Wenzhou, 325027, Zhejiang, China
| | - Li Na Ge
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, No. 270 West College Road, Wenzhou, 325027, Zhejiang, China
| | - Zhong Lin
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, No. 270 West College Road, Wenzhou, 325027, Zhejiang, China.
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Li Z, Zhou L, Huang C, Lu T, Liang J, Cong Q, Lan Y, Jin C. Long-Term Real-World Outcomes of Corneal Changes in Proliferative Diabetic Retinopathy: Panretinal Photocoagulation vs. Intravitreal Conbercept. Photodiagnosis Photodyn Ther 2023; 44:103765. [PMID: 37625766 DOI: 10.1016/j.pdpdt.2023.103765] [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: 07/26/2023] [Revised: 08/06/2023] [Accepted: 08/22/2023] [Indexed: 08/27/2023]
Abstract
PURPOSE To compare long-term real-world outcomes of corneal thickness (CT) alterations in proliferative diabetic retinopathy (PDR) patients treated with panretinal photocoagulation (PRP) and intravitreal conbercept (IVC). METHODS This retrospective study included 69 eyes of 69 patients with PDR (42 PRP and 27 IVC). Full corneal thickness (FCT), corneal epithelial thickness (CET) and corneal stromal thickness (CST) measured by anterior segment optical coherence tomography at baseline were compared between groups. These CT changes at last follow-up from baseline were also compared between groups and within each group. RESULTS During a mean follow-up of more than two years, the IVC group demonstrated a significantly increased corneal thickness from baseline compared to the PRP group in some areas (PRP vs. IVC: FCT 0-2 mm: -0.59 ± 9.31 vs. 5.59 ± 9.23 μm, p = 0.009; CST 0-2 mm: -2.05 ± 8.79 vs. 3.48 ± 7.52 μm, p = 0.015; CST 2-5 mm: -1.78 ± 13.27 vs. 5.68 ± 14.53 μm, p = 0.046). In within-group comparisons, a significantly increased FCT from baseline was found in the 0-2 mm area in the IVC group (p = 0.004), but no significant change was observed in the PRP group (p = 0.691). For CET changes, a significantly increased CT was observed in the 0-2 mm, 2-5 mm and 5-7 mm areas in both groups respectively (all p < 0.05). Regarding CST, an increased CT was found in the 0-2 mm area in the IVC group (p = 0.037), while a decreased trend was observed in 0-2 mm and 2-5 mm areas in the PRP group (all p > 0.05). CONCLUSION When using PRP or IVC in the long-term management of PDR, CT changes should be considered. This may provide evidence for corneal protection during PDR treatment.
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Affiliation(s)
- Zijing Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou 510060, China; Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou 510020, China
| | - Lijun Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou 510060, China
| | - Chuangxin Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou 510060, China
| | - Tu Lu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou 510060, China
| | - Jiandong Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou 510060, China
| | - Qifeng Cong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou 510060, China
| | - Yuqing Lan
- Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou 510020, China
| | - Chenjin Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou 510060, China.
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Takkar B, Tyagi M. Fibrin Glue-Assisted Hemostasis during Proliferative Diabetic Retinopathy Surgery. Ophthalmol Retina 2023; 7:1126. [PMID: 37831038 DOI: 10.1016/j.oret.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 10/14/2023]
Affiliation(s)
- Brijesh Takkar
- Anant Baja Retina Institute, L V Prasad Eye Institute, Hyderabad, India; Indian Health Outcomes, Public Health and Economics Research Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Mudit Tyagi
- Anant Baja Retina Institute, L V Prasad Eye Institute, Hyderabad, India
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Mansour HA, Mahmoudzadeh R, Hsu J. Intraocular Fibrin Glue to Lower the Risk of Postoperative Vitreous Hemorrhage After Diabetic Pars Plana Vitrectomy. Retina 2023; 43:2148-2152. [PMID: 36731110 DOI: 10.1097/iae.0000000000003597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To investigate the use of intraocular fibrin glue to lower the risk of vitreous hemorrhage (VH) after pars plana vitrectomy (PPV) in eyes with diabetic VH or traction retinal detachment. METHODS A matched, case-control, single-surgeon, pilot study of patients undergoing PPV for diabetic VH or traction retinal detachment with versus without fibrin glue was performed. RESULTS Thirty-nine patients (13 glue and 26 control patients) were included. In the glue group, mean (SD) logarithm of the minimum angle of resolution visual acuity (Snellen) significantly improved from 1.53 (0.6) (20/678) to 0.99 (0.9) (20/195) at postoperative month 6 ( P = 0.03). In the control group, mean logarithm of the minimum angle of resolution visual acuity also improved from 1.45 (0.8) (20/564) to 1.17 (0.9) (20/296) at postoperative Month 6 ( P = 0.3). Persistent post-PPV VH was similar between the 2 groups (15.4% in both groups, P > 0.99). However, early recurrent VH (<3 months post-PPV) was seen in 34.6% in the control group and none in the glue group ( P = 0.02). No intraocular inflammatory events were seen in the glue group. CONCLUSION Intraocular fibrin glue may be a safe adjuvant in diabetic vitrectomy and may reduce the rate of early recurrent postoperative VH.
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Affiliation(s)
- Hana A Mansour
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
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Micevych PS, Taha AM, Poddar A, Stewart JM. Individual and Systems-Based Risk Factors for Diabetic Vitrectomy in an Urban Safety-Net Hospital. Ophthalmol Retina 2023; 7:1027-1034. [PMID: 37236319 DOI: 10.1016/j.oret.2023.05.014] [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: 03/05/2023] [Revised: 05/14/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To identify individual and systems-focused risk factors for pars plana vitrectomy among patients with proliferative diabetic retinopathy (PDR) in a diverse, urban, safety-net hospital setting. DESIGN Single-center, retrospective, observational, case-control study at Zuckerberg San Francisco General Hospital and Trauma Center between 2017 and 2022. SUBJECTS Two hundred twenty-two patients with PDR over a 5-year span (2017-2022), consisting of 111 cases who underwent vitrectomy for vision-threatening complications (tractional retinal detachment, nonclearing vitreous hemorrhage, and neovascular glaucoma) and 111 controls with PDR with no history of vitrectomy or vision-threatening complications. Controls were matched 1:1 through incidence density sampling. METHODS Medical records were reviewed from time of entry into hospital system to vitrectomy date (or date-matched clinic visit for controls). Individual-focused exposures included age, gender, ethnicity, language, homelessness, incarceration, smoking status, area deprivation index, insurance status, baseline retinopathy stage, baseline visual acuity, baseline hemoglobin A1c, panretinal photocoagulation status, and cumulative anti-VEGF treatments. System-focused exposures included external department involvement, referral route, time within hospital and ophthalmology systems, interval between screening and ophthalmology appointment, interval between conversion to proliferative disease and panretinal photocoagulation or first treatment, and loss-to-follow-up in intervals of active proliferative disease. MAIN OUTCOME MEASURES Odds ratios (ORs) for each exposure on vision-threatening diabetic complications requiring vitrectomy. RESULTS The absence of panretinal photocoagulation was the primary significant individual-focused risk factor for vitrectomy in the multivariable analysis (OR, 4.78; P = 0.011). Systems-focused risk factors included longer interval between PDR diagnosis and initial treatment (weeks; OR, 1.06; P = 0.024) and greater cumulative duration of loss-to-follow-up during intervals of active PDR (months; OR, 1.10; P = 0.002). Greater duration in the ophthalmology system was the primary systems-focused protective factor against vitrectomy (years; OR, 0.75; P = 0.035). CONCLUSIONS Largely modifiable variables modulate risk of complications requiring diabetic vitrectomy. Each additional month of loss-to-follow-up for patients with active proliferative disease increased odds of vitrectomy by 10%. Optimizing modifiable factors to promote earlier treatment and maintain critical follow-up in proliferative disease may reduce vision-threatening complications requiring vitrectomy in a safety-net hospital setting. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Paul S Micevych
- Department of Ophthalmology, University of California San Francisco, San Francisco, California; Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Abu M Taha
- Department of Ophthalmology, University of California San Francisco, San Francisco, California; Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Aunoy Poddar
- Department of Ophthalmology, University of California San Francisco, San Francisco, California; Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Jay M Stewart
- Department of Ophthalmology, University of California San Francisco, San Francisco, California; Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California.
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Berrocal MH, Acaba-Berrocal L. Minimal, Relaxing Membranectomies for the Management of Opacified Hyaloid With Diabetic Tractional Retinal Detachments in Monocular Patients: A Novel Surgical Technique. Retina 2023; 43:2144-2147. [PMID: 35594575 DOI: 10.1097/iae.0000000000003524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE Vitrectomy for severe tractional retinal detachments is a high-risk procedure given the surgical complexity and potential for postoperative complications. The risk is compounded when operating on monocular patients. We developed a novel technique using hyaloidal removal and minimal relaxing membranectomies for tractional retinal detachments with an opacified hyaloid over the fovea in monocular, diabetic patients and evaluated complications and outcomes. METHODS The technique was performed in nine monocular, diabetic patients with decreased visual acuity from opaque hyaloid with centripetal tractional retinal detachments. Outcomes included postoperative best-corrected visual acuity, retinal reattachment rate, redetachments, and complications. RESULTS Average age was 58 years (range 43-74) and the average follow-up time was 43.6 months (range 36-64). Preoperative best-corrected visual acuity ranged from 1.0 to 2.3 logMAR (20/200 - Hand Motion) with a mean of 1.39 logMAR (20/500). Postoperative best-corrected visual acuity at last follow-up ranged from 0.2 to 1.0 logMAR (20/30-20/200) with a mean of 0.49 logMAR (20/60) ( P < 0.001). All eyes had attached posterior poles at last follow-up. Complications were observed in two eyes and included nonclearing hemorrhage and capsular opacity. CONCLUSION Vitrectomy with minimal, relaxing membranectomies is an option for monocular patients in whom intervention is needed, but are at high risk for complications.
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Affiliation(s)
| | - Luis Acaba-Berrocal
- Illinois Eye and Ear Infirmary, University of Illinois Chicago, Chicago, Illinois
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Koca S, Kılıç D. Long-term longitudinal retinal changes after conventional and pattern scan laser panretinal photocoagulation in diabetic retinopathy. Photodiagnosis Photodyn Ther 2023; 44:103845. [PMID: 37838233 DOI: 10.1016/j.pdpdt.2023.103845] [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: 05/22/2023] [Revised: 09/25/2023] [Accepted: 10/11/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE Comparison the effect of conventional and pattern scan laser (PASCAL) panretinal photocoagulation (PRP) on macula and optic disk in diabetic retinopathy (DR). METHODS This retrospective study included 57 patients. In the conventional laser group, PRP was completed using the LightMed LightLas 532 laser device in accordance with the ETDRS protocol. In the pattern laser group, it was completed in a single session using PASCAL device with 20 ms pulse duration and multispot pattern. Central macular thickness (CMT) and retinal nerve fiber layer (RNFL) thickness were evaluated before laser treatment and at 1, 6 and 12 months after treatment. RESULTS There were 30 eyes in the conventional laser group and 27 eyes in the PASCAL group. There was no significant difference between the groups in terms of age (p = 0.560), sex (p = 0.866), duration (p = 0.498) and stage (p = 0.503) of diabetes, visual acuity (p = 0.104) and intraocular pressure (p = 0.963).In both groups, CMT increased significantly (p ˂0.001), while RNFL thickness decreased significantly (p ˂0.001) at 12 months. While CMT and mean RNFL thickness increased in the first month in both groups, it decreased progressively until the 12th month. CONCLUSION Conventional and pattern laser systems used in the treatment of DR................ cause an increase in CMT and thinning of RNFL thickness in the long term. This change is more in the conventional laser group compared to the pattern laser.
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Affiliation(s)
- Semra Koca
- Department of Ophthalmology, Kayseri City Education and Research Hospital, Kayseri, Turkey.
| | - Deniz Kılıç
- Department of Ophthalmology, Kayseri City Education and Research Hospital, Kayseri, Turkey
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Yoon CY, Shin MC, Kim P, Shin YK, Kim WJ. Photocoagulation Up to Ora Serrata in Diabetic Vitrectomy to Prevent Recurrent Vitreous Hemorrhage. Korean J Ophthalmol 2023; 37:477-484. [PMID: 37899285 PMCID: PMC10721404 DOI: 10.3341/kjo.2023.0066] [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: 07/05/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/31/2023] Open
Abstract
PURPOSE To evaluate the role of performing photocoagulation up to ora serrata during vitrectomy in preventing recurrent vitreous hemorrhage (VH) in patients undergoing pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR). METHODS This retrospective, nonrandomized study included 60 eyes from 60 patients who had undergone PPV for VH due to PDR. These patients were divided into two groups: group 1, those who underwent photocoagulation up to ora serrata using the scleral indentation technique during surgery; and group 2, those who did not undergo scleral indentation when photocoagulation and underwent photocoagulation up to vortex veins. Their hospital records were analyzed to investigate the recurrence rate of VH, the time until recurrence of VH after surgery, logarithm of the minimal angle of resolution (logMAR) best-corrected visual acuity (BCVA) measured before surgery and at 1, 2, and 3 years after surgery, and the occurrence of complications such as neovascular glaucoma (NVG) during follow-up. RESULTS Group 1 exhibited lower recurrence rate of VH (2 of 30 [6.7%] vs. 10 of 30 [33.3%], p = 0.01) and lower occurrence of postoperative NVG (2 of 30 [6.7%] vs. 8 of 30 [26.7%], p = 0.038) compared with group 2. There were no statistically significant differences in logMAR BCVA measured at 1, 2, and 3 years between the two groups (at 1 year: 0.54 ± 0.43 vs. 0.54 ± 0.44, p = 0.954; at 2 years: 0.48 ± 0.47 vs. 0.55 ± 0.64, p = 0.235; at 3 years: 0.51 ± 0.50 vs. 0.61 ± 0.77, p = 0.200). Logistic regression analysis showed that among several factors that could affect recurrence rate of VH, only range of photocoagulation performed was a statistically significant factor (odds ratio, 0.119; 95% confidence interval, 0.022-0.659; p = 0.015). CONCLUSIONS Photocoagulation treatment over a wider range with scleral indentation could be a beneficial adjunct procedure for preventing postoperative recurrent VH following diabetic vitrectomy.
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Affiliation(s)
- Chan Young Yoon
- Department of Ophthalmology, Hallym University Chuncheon Sacred Heart Hospital, Hallym University Medical Center, Chuncheon,
Korea
| | - Min Chul Shin
- Department of Ophthalmology, Hallym University Chuncheon Sacred Heart Hospital, Hallym University Medical Center, Chuncheon,
Korea
| | - Patrick Kim
- Department of Ophthalmology, Hallym University Chuncheon Sacred Heart Hospital, Hallym University Medical Center, Chuncheon,
Korea
| | | | - Won Jun Kim
- Department of Ophthalmology, Hallym University Chuncheon Sacred Heart Hospital, Hallym University Medical Center, Chuncheon,
Korea
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Cundy O, Lange CA, Bunce C, Bainbridge JW, Solebo AL. Face-down positioning or posturing after macular hole surgery. Cochrane Database Syst Rev 2023; 11:CD008228. [PMID: 37987517 PMCID: PMC10661040 DOI: 10.1002/14651858.cd008228.pub3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
BACKGROUND Macular holes cause severe impairment of sight. With the aim of improving the outcome of surgery for macular holes, particularly larger macular holes (those measuring over 400 μm), a variable period of face-down positioning may be advised. This review is an update of a Cochrane Review published in 2011. OBJECTIVES To evaluate the effect of postoperative face-down positioning on the outcome of surgery for macular hole. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2022, Issue 5), which contains the Cochrane Eyes and Vision Trials Register, Ovid MEDLINE, Ovid Embase, the ISRCTN registry, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform. There were no date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 25 May 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) in which postoperative face-down positioning was compared to no face-down positioning following surgery for macular holes. The primary outcome of interest was closure of the macular hole. Other outcomes of interest included visual outcomes, quality of life outcomes, and the occurrence of adverse events. Pairs of review authors independently selected studies for inclusion, extracted data, assessed risk of bias, and evaluated the certainty of evidence using GRADE. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We analysed dichotomous data as risk ratios (RRs), and continuous data as mean differences (MDs), with 95% confidence intervals (CI). The unit of analysis was eyes. MAIN RESULTS We included eight studies allocating a total of 709 eyes (699 participants). There was heterogeneity in study design, including the control group treatment (from no positioning to strict maintenance of other 'face-forward' postures) and surgical procedures (with or without inner limiting membrane peeling, with or without cataract surgery). There were also different durations of positioning, with two studies using 3 days, two studies using 5 days, and three studies using 10 days of face-down positioning. Whilst the overall risk of bias was low, all included studies were judged to be at high or unclear risk of bias due to absence of assessment of adherence to the 'prescribed' intervention of face-down positioning or posturing. The primary outcome of successful anatomical hole closure at one to six months following surgery was reported in 95 of every 100 eyes of participants advised to position face-down for at least three days after surgery, and in 85 of every 100 eyes of participants not advised to position face-down (RR 1.05, 95% CI 0.99 to 1.12, 709 eyes, 8 studies, I² = 44%). Amongst the 327 eyes of participants with macular holes of at least 400 μm, hole closure was noted in 94 of every 100 eyes of participants advised to position face-down, and in 84 of every 100 eyes of participants not advised to position face-down (RR 1.08, 95% CI 0.93 to 1.26, 5 studies, I² = 62%). Amongst the 129 eyes of participants with macular holes of less than 400 μm, hole closure was noted in 100 of every 100 eyes of participants advised to position face-down, and in 96 of every 100 eyes of participants not advised to position face-down (RR 1.03, CI 0.97 to 1.11, 4 studies, I² = 0%). The certainty of the evidence was low, downgraded for imprecision (CIs including no effect) and study design limitations (with different durations of face-down posturing used in the absence of a dose-response gradient, and limitations in measuring the exposure). Meta-analysis of visual acuity data was challenging given the use of different definitions of postoperative visual outcome across studies. Three studies reported findings by gain in Early Treatment Diabetic Retinopathy Study (ETDRS) letters (MD 2.04, 95% CI -0.01 to 4.09, very low-certainty evidence). Meta-analyses of quality of life data were not possible because of inconsistency in outcome metrics across studies. One study reported no difference between groups in quality of life, as reported on a validated quality of life metric scale (the National Eye Institute Visual Function Questionnaire - 25 (NEI VFQ-25), between face-down positioning for five days and non-face-down positioning (median NEI VFQ-25 score was 89 (interquartile range (IQR) 76 to 94) in the face-down group versus 87 (IQR 73 to 93) in the non-face-down group (adjusted mean difference on a logistic scale 0.02, 95% CI -0.03 to 0.07, P = 0.41)). Two studies reported increased ease of positioning and less pain in non-face-down positioning groups on non-validated 0-to-10-point visual analogue scores. On an ease-of-positioning score running from 0 (very difficult) to 10 (very easy), there were consistent reports of the discomfort associated with face-down positioning: the median participant-reported ease-of-positioning score was 6 (IQR 4 to 8) in those undergoing 5 days of face-down positioning versus 9 (IQR 7 to 10) in the comparator group (P = 0.01). On a pain score with 0 being pain-free and 10 being in severe pain, mean pain score was 6.52 ± 2.48 in the face-down positioning group versus 2.53 ± 2.6 in the non-face-down positioning group. The adverse event of postoperative nerve compression occurred in less than 1 in every 100 (3 per 1000) participants advised to position face-down, and 0 in every 100 participants not advised to position face-down (699 participants, 8 studies, moderate-certainty evidence). AUTHORS' CONCLUSIONS We identified eight RCTs evaluating face-down positioning following surgery for macular hole. The included studies were not all directly comparable due to differences in the surgical techniques used and the durations of postoperative positioning advised. Low-certainty evidence suggests that face-down positioning may have little or no effect on macular hole closure after surgery. Face-down positioning is a low-risk intervention, with serious adverse events affecting fewer than 1 in 300 people. We suggest that any future trials focus on patients with larger macular holes, with interventions and outcome measures used in previous trials (i.e. with inner limiting membrane peeling, positioning durations of three to five days, and validated quality of life metrics) to allow future meta-analyses to determine any effect with greater precision and confidence.
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Affiliation(s)
- Olivia Cundy
- Ophthalmology , Imperial College Hospital, London, UK
| | - Clemens Ak Lange
- Eye Center, Medical Center, Medical Faculty, University of Freiburg, Freiburg, Germany
- Augenzentrum am St. Franziskus-Hospital, Münster, Germany
| | - Catey Bunce
- NIHR Biomedical Reseach Centre, The Royal Marsden NHS Foundation Trust, London, UK
- UCL Institute of Ophthalmology, London, UK
| | - James W Bainbridge
- UCL Institute of Ophthalmology, London, UK
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London , UK
| | - Ameenat Lola Solebo
- Vision and Eyes Group , Population, Policy and Practice Research and Teaching Department, UCL GOS Institute of Child Health, London, UK
- Ophthalmology and Rheumatology , Great Ormond Street Hospital , London , UK
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L S, Banerjee M, Venkatesh P, Azad SV, Joshi HK, Chawla R, Kumar V, Vohra R, Kumar A. ASSESSMENT OF QUALITY AND ADEQUACY OF PANRETINAL PHOTOCOAGULATION IN PROLIFERATIVE DIABETIC RETINOPATHY USING ULTRA-WIDEFIELD IMAGING. Retina 2023; 43:1922-1927. [PMID: 37490757 DOI: 10.1097/iae.0000000000003902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
PURPOSE To assess the characteristics of completed panretinal photocoagulation (PRP), using ultra-widefield imaging in proliferative diabetic retinopathy. METHODS Quantitative assessment of ultra-widefield imaging images of 133 patients with proliferative diabetic retinopathy with completed PRP was made using ImageJ software. The parameters assessed included distance of laser spots from the optic disk, foveal center, superior and inferior arcades, and extent of the maximum width of laser. Areas assessed were total area of the image, area of the inner limit within which laser spots are restricted, minimum areas of unlasered patches, total area lasered, and ideal area to be covered by PRP. RESULTS Two hundred one images were assessed for the final analysis. The mean distance of laser spots was 4.2 ± 2.4 mm from the optic disk (nasal) and 6.6 ± 2.5 mm from the foveal center (temporal). The mean distance of laser spots from the superior arcade vessel was 3.2 ± 1.9 mm and 6.2 ± 4.4 mm from the inferior arcade. The mean area of the retina that should have been ideally lasered was found to be 900 ± 267 mm 2 , and the actual area lasered was found to be 681 ± 254.4 mm 2 . CONCLUSION Approximately one-quarter area of the retina continues to remain ischemic because of the lack of inadequate coverage of PRP. Further longitudinal studies are recommended, using ultra-widefield imaging to objectively assess the adequacy of PRP and its role in modulating the course of progression of the retinopathy.
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Affiliation(s)
- Sowmya L
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi
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Cao H, Wang K, Pan Q, Li C. Analysis of the Macular Region Following Panretinal Photocoagulation for the Treatment of Diabetic Retinopathy Using Optical Coherence Tomography. Altern Ther Health Med 2023; 29:324-328. [PMID: 37632956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/28/2023]
Abstract
Background Diabetic retinopathy (DR) is the most prevalent microvascular complication of diabetes. Panretinal photocoagulation (PRP) is the established treatment for mitigating severe visual impairment resulting from proliferative DR. Objective This study aims to investigate the impact of PRP on the macular region in patients with DR, utilizing optical coherence tomography (OCT) for assessment. Design An experimental study was meticulously designed, implementing PRP as the primary intervention. Setting The investigation was conducted within the Department of Ophthalmology at the Affiliated Huaian No.1 People's Hospital, Huai'an, Jiangsu, China. Participants A total of 120 participants diagnosed with DR and undergoing treatment at our hospital were enrolled in the study. Interventions The participants were randomly assigned to either the control group (CG, n = 60) or the study group (SG, n = 60). The CG received conventional drug treatment involving oral iodized lecithin, while the SG received PRP. OCT was employed to monitor changes in macular fovea volume and macular retinal thickness. Primary Outcome Measures Evaluation criteria encompassed clinical efficacy, macular fovea volume, macular retinal thickness, IL-6 and VEGF levels, incidence of adverse reactions, and quality of life in both groups. Results The study resulted in a higher total effective rate in the SG (96.67%) compared to the CG (80.00%) (χ2 = 8.09, P < .05). Post-treatment, reductions were observed in macular fovea volume and macular retinal thickness, with significantly lower SG values than CG values (P < .05). Both serum IL-6 and VEGF levels exhibited reductions in both groups after treatment, with the SG displaying a more significant decrease compared to the CG (P < .05). The occurrence of adverse reactions significantly decreased in the SG relative to the CG (P < .05). Quality of life scores for the SG was notably elevated compared to the CG (P < .05). Conclusions PRP emerges as a highly valuable approach in the management of DR. It contributes to retinal thickness improvement within the macular region and inflammation reduction, and also enhances therapeutic outcomes, minimizes adverse reactions, and optimizes patients' quality of life. These findings warrant further clinical adoption and widespread promotion.
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Campochiaro PA. Peripheral photocoagulation not the answer for DMO. Eye (Lond) 2023; 37:3302-3303. [PMID: 37277613 PMCID: PMC10630400 DOI: 10.1038/s41433-023-02596-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/09/2023] [Accepted: 05/17/2023] [Indexed: 06/07/2023] Open
Affiliation(s)
- Peter A Campochiaro
- The Wilmer Eye Institute, Departments of Ophthalmology and Neuroscience, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Liu S, Wang Y. Effect of Laser Panretinal Photocoagulation Combined with Lucentis on Long-Term Visual Acuity of Patients with Retinal Arterial Macroaneurysm. Altern Ther Health Med 2023; 29:412-417. [PMID: 37632971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/28/2023]
Abstract
Objective To analyze the efficacy of laser panretinal photocoagulation in combination with Lucentis treatment on patients with retinal arterial macroaneurysm and investigate more effective novel therapy options to treat retinal arterial macroaneurysm. Method This study was conducted in the Pediatric department of Chongqing Aier Hospital between October 2016 and October 2020, and a total of 62 inpatients were enrolled for the study. Patients were randomly organized into two groups, an 'observation group' with patients receiving combinational treatment of laser panretinal photocoagulation and Lucentis, and a 'control group' with patients treated by only laser panretinal photocoagulation, were allotted. Though a comparative statistical analysis, the clinical outcomes and adverse effects on both groups, including their best corrected visual acuity, central macular thickness, intraocular pressure, and required number of laser treatments before and after treatments, were investigated. Also prognosis associated factors for patient's visual function, were analyzed. Results The clinical efficacy of the combinational treatment of laser panretinal photocoagulation and Lucentis was better than single laser panretinal photocoagulation treatment, accompanied by decreased incidence of adverse reactions (P < .05). For a combinational treatment, the observation group showed improved best corrected visual acuity and reduced central macular thickness and intraocular pressure, including fewer laser treatments (P < .05). Also, a better prognostic quality of life score; (measured as physical function, mental state, visual function, and social activity ability of patients), was observed for a combinational treatment than that of laser panretinal photocoagulation treatment (P < .05). Conclusion Laser panretinal photocoagulation combined with lucentis can deliver with reduced incidence of adverse effects compared to laser panretinal photocoagulation treatment and hence can more effectively contribute to retinal rehabilitation of patients with retinal arterial macroaneurysm.
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Mistry H, Maredza M, Campbell C, Lois N. Subthreshold micropulse laser versus standard laser for the treatment of central-involving diabetic macular oedema with central retinal thickness of <400µ: a cost-effectiveness analysis from the DIAMONDS trial. BMJ Open 2023; 13:e067684. [PMID: 37852765 PMCID: PMC10603454 DOI: 10.1136/bmjopen-2022-067684] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/29/2023] [Indexed: 10/20/2023] Open
Abstract
OBJECTIVES To estimate the economic costs, health-related quality-of-life outcomes and cost-effectiveness of subthreshold micropulse laser (SML) versus standard laser (SL) for the treatment of diabetic macular oedema (DMO) with central retinal thickness (CRT) of <400µ. DESIGN An economic evaluation was conducted within a pragmatic, multicentre, randomised clinical trial, DIAbetic Macular Oedema aNd Diode Subthreshold. SETTING 18 UK Hospital Eye Services. PARTICIPANTS Adults with diabetes and centre involving DMO with CRT<400µ. INTERVENTIONS Participants (n=266) were randomised 1:1 to receive SML or SL. METHODS The base-case used an intention-to-treat approach conducted from a UK National Health Service (NHS) and personal social services (PSS) perspective. Costs (2019-2020 prices) were collected prospectively over the 2-year follow-up period. A bivariate regression of costs and quality-adjusted life-years (QALYs), with multiple imputation of missing data, was conducted to estimate the incremental cost per QALY gained and the incremental net monetary benefit of SML in comparison to SL. Sensitivity analyses explored uncertainty and heterogeneity in cost-effectiveness estimates. RESULTS One participant in the SL arm withdrew consent for data to be used; data from the remaining 265 participants were included in analyses. Mean (SE) NHS and PSS costs over 24 months were £735.09 (£111.85) in the SML arm vs £1099.70 (£195.40) in the SL arm (p=0.107). Mean (SE) QALY estimates were 1.493 (0.024) vs 1.485 (0.020), respectively (p=0.780), giving an insignificant difference of 0.008 QALYs. The probability SML is cost-effective at a threshold of £20 000 per QALY was 76%. CONCLUSIONS There were no statistically significant differences in EQ-5D-5L scores or costs between SML and SL. Given these findings and the fact that SML does not burn the retina, unlike SL and has equivalent efficacy to SL, it may be preferred for the treatment of people with DMO with CRT<400µ. TRIAL REGISTRATION NUMBERS ISRCTN17742985; NCT03690050.
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Affiliation(s)
- Hema Mistry
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Mandy Maredza
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Noemi Lois
- Department of Ophthalmology, Wellcome-Wolfson Institute for Experimental Medicine, Queens University Belfast, Belfast, UK
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Wang X, Yao J, Li S, Zhang W, Wang L, Zhou A. Panretinal photocoagulation plus intravitreal conbercept for diabetic retinopathy in real world: a retrospective study. BMC Ophthalmol 2023; 23:400. [PMID: 37794367 PMCID: PMC10552403 DOI: 10.1186/s12886-023-03157-z] [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: 02/01/2023] [Accepted: 09/28/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND To evaluate outcomes of panretinal photocoagulation (PRP) plus intravitreal conbercept (IVC) for diabetic retinopathy (DR) in real world and explore risk factors for patients with poor reactivity and presence of vision-threatening complications after combination treatment. METHODS Retrospective review of DR patients received PRP plus IVC over 6 months. The main outcome was improvement ≥ 2 steps in ETDRS diabetic retinopathy severity scale (DRSS) levels. Different strategies for eyes receiving IVC within or over 1 month after PRP were analyzed. For patients with DRSS improvement < 2 steps and presence of vision-threatening adverse events, a binary logistic regression method was used to select risk factors. RESULTS Sixty one eyes were involved in this study. After treated with combination therapy with a median number of 3 injections, 44% of eyes improved ≥ 2 steps in DRSS levels. A total of 14 eyes (23%) occurred vision-threatening adverse events. No significant difference was found in eyes receiving conbercept within or over 1 month after PRP. Duration of diabetes (OR 0.849, 95%CI 0.734-0.982, P = 0.027), GFR (OR 0.961, 95%CI 0.933-0.990, P = 0.010) and baseline DRSS levels (OR 3.290, 95%CI 1.483-7.295, P = 0.003) were independent risk factors for DRSS improvement < 2 steps after treatment. Occurrence of vision-threatening complications was only related to high DRSS levels (OR 3.668, 95%CI 1.710-7.868, P = 0.001). CONCLUSIONS The combination therapy was effective for most patients with DR in real world. Eyes received PRP combined with earlier or later conbercept was demonstrated no significant difference for outcomes. For patients with poor renal function, high DRSS levels or occurred DR at the early stage of diabetes, follow-up should be strengthened.
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Affiliation(s)
- Xin Wang
- Department of Ophthalmology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Jing Yao
- Department of Ophthalmology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Shengen Li
- Department of Ophthalmology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Wenyi Zhang
- Department of Ophthalmology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Lijun Wang
- Department of Ophthalmology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Aiyi Zhou
- Department of Ophthalmology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China.
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Tsui MC, Yang CM, Wang LC. Characteristics and outcomes of full-thickness macular holes created during vitrectomy for proliferative diabetic retinopathy. Int Ophthalmol 2023; 43:3479-3490. [PMID: 37277662 DOI: 10.1007/s10792-023-02753-8] [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: 05/06/2022] [Accepted: 05/21/2023] [Indexed: 06/07/2023]
Abstract
PURPOSE To investigate the clinical features, management, and prognosis of full-thickness macular holes (FTMHs) inadvertently created during vitrectomy for eyes with proliferative diabetic retinopathy (PDR) and fibrovascular proliferation (FVP). METHODS Eyes with PDR and FVP that had intraoperatively created FTMHs were retrospectively collected as the study group, and age- and sex-matched subjects with PDR and FVP who did not have intraoperative FTMHs were selected as the control group. Fundus abnormalities, optical coherence tomography (OCT) features, and anatomical and functional outcomes were compared between the two groups. RESULTS Eleven eyes of 11 patients (5 male and 6 female) were identified as the study group. Follow-up duration was 36.8 ± 47.2 months. FTMHs were managed by ILM peeling or the inverted ILM flap technique. Anatomical success and MH closure were achieved in 100% of eyes in the study group. In comparison to the control group, the study group had a higher proportion of condensed prefoveal tissue (63.6% vs. 22.7%, p = 0.028), and a higher ratio of silicone oil tamponade (63.6% vs. 18.2%, p = 0.014), whereas there were no differences in preoperative and final BCVA, and the severity, activity, and locations of FVP between the two groups. CONCLUSION Condensed prefoveal tissue was a risk factor of FTMHs created during operation for eyes with PDR and FVP. The ILM peeling or the inverted ILM flap technique may be beneficial for the treatment with favorable anatomical and functional outcomes.
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Affiliation(s)
- Mei-Chi Tsui
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Ophthalmology, An Nan Hospital, China Medical University, Tainan, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Lu-Chun Wang
- Department of Ophthalmology, National Taiwan University Hospital Yunlin Branch, No.579, Sec. 2, Yunlin Rd., Douliou, Yunlin, Taiwan.
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45
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Varshney T, Babu KN, Elamurugan V, Krishnan M. Haemostasis during diabetic vitrectomy. Indian J Ophthalmol 2023; 71:3416-3417. [PMID: 37787247 PMCID: PMC10683686 DOI: 10.4103/ijo.ijo_1226_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Affiliation(s)
- Toshit Varshney
- Vitreous-Retina Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - K Naresh Babu
- Vitreous-Retina Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Vignesh Elamurugan
- Vitreous-Retina Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Muthu Krishnan
- Vitreous-Retina Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
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Reddy NG, Venkatesh R, Jayadev C, Agrawal S, Yadav NK, Chhablani J. DIRECT LASER PHOTOCOAGULATION TO THE DILATED RIGHT-ANGLED VESSEL IN THE MANAGEMENT OF PROLIFERATIVE TYPE 2 MACULAR TELANGIECTASIA. Retin Cases Brief Rep 2023; 17:620-624. [PMID: 35380183 DOI: 10.1097/icb.0000000000001253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE To report a case of proliferative Type 2 macular telangiectasia treated successfully with direct laser photocoagulation to the right-angled vessel. METHODS Descriptive case report. CASE DESCRIPTION A 61-year-old man, with no past medical history, was diagnosed and treated previously elsewhere for bilateral proliferative Type 2 macular telangiectasia. He complained of recent onset decrease in vision in his right eye for last 2 months. Right eye visual acuity was counting fingers at 3 m and left eye was 6/18. Fundus examination showed proliferative Type 2 macular telangiectasia in both eyes with active neovascular complex in the right eye. Direct thermal laser photocoagulation to the tips of the right-angled vessels with single-spot PASCAL Synthesis (Topcon Medical Laser System) at 532 nm wavelength was done. After laser, reduction in the hyporeflective space height was noted on optical coherence tomography. No additional intravitreal anti-vascular endothelial growth factor injections were required. At the last 6-months follow-up visit, visual acuity improved to 6/36, N18 in the right eye. CONCLUSION Direct laser photocoagulation to the right-angled vessel can be considered as possible treatment option for proliferative Type 2 macular telangiectasia, especially in patients nonresponsive to anti-vascular endothelial growth factor therapy. However, long-term follow-ups are required to see whether it is possible to maintain the efficacy.
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Affiliation(s)
- Nikitha G Reddy
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, India; and
| | - Ramesh Venkatesh
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, India; and
| | - Chaitra Jayadev
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, India; and
| | - Sameeksha Agrawal
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, India; and
| | - Naresh K Yadav
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, India; and
| | - Jay Chhablani
- University of Pittsburgh School of Medicine, Medical Retina and Vitreoretinal Surgery, Pittsburg, Pennsylvania
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Guo H, Wang Z, Nie Z, Zhang X, Wang K, Duan N, Bai S, Li W, Li X, Hu B. Establishment and validation of a prognostic nomogram for long-term low vision after diabetic vitrectomy. Front Endocrinol (Lausanne) 2023; 14:1196335. [PMID: 37693349 PMCID: PMC10485701 DOI: 10.3389/fendo.2023.1196335] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
Purpose We aimed to evaluate the risk factors and develop a prognostic nomogram of long-term low vision after diabetic vitrectomy. Methods This retrospective study included 186 patients (250 eyes) that underwent primary vitrectomy for proliferative diabetic retinopathy with a minimum follow-up period of one year. Patients were assigned to the training cohort (200 eyes) or validation cohort (50 eyes) at a 4:1 ratio randomly. Based on a cutoff value of 0.3 in best-corrected visual acuity (BCVA) measurement, the training cohort was separated into groups with or without low vision. Univariate and multivariate logistic regression analyses were performed on preoperative systemic and ocular characteristics to develop a risk prediction model and nomogram. The calibration curve and the area under the receiver operating characteristic curves (AUC) were used to evaluate the calibration and discrimination of the model. The nomogram was internally validated using the bootstrapping method, and it was further verified in an external cohort. Results Four independent risk factors were selected by stepwise forward regression, including tractional retinal detachment (β=1.443, OR=4.235, P<0.001), symptom duration ≥6 months (β=0.954, OR=2.595, P=0.004), preoperative BCVA measurement (β=0.540, OR=1.716, P=0.033), and hypertension (β=0.645, OR=1.905, P=0.044). AUC values of 0.764 (95% CI: 0.699-0.829) in the training cohort and 0.755 (95% CI: 0.619-0.891) in the validation cohort indicated the good predictive ability of the model. Conclusion The prognostic nomogram established in this study is useful for predicting long-term low vision after diabetic vitrectomy.
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Affiliation(s)
- Haoxin Guo
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Zhaoxiong Wang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
- Department of Ophthalmology, Tianjin Baodi Hospital, Tianjin, China
- Baodi Clinical College, Tianjin Medical University, Tianjin, China
| | - Zetong Nie
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Xiang Zhang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Kuan Wang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
- Department of Retinal Disease, Cangzhou Eye Hospital, Cangzhou, China
| | - Naxin Duan
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Siqiong Bai
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Wenbo Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Xiaorong Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Bojie Hu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
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Ahearn BE, Nguyen H, Sohn JH. Proliferative Diabetic Retinopathy Requiring Vitrectomy Over Clinic Management During COVID-19: Impact of Delayed Care. Korean J Ophthalmol 2023; 37:292-298. [PMID: 37336513 PMCID: PMC10427906 DOI: 10.3341/kjo.2022.0147] [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: 11/15/2022] [Revised: 03/04/2023] [Accepted: 06/17/2023] [Indexed: 06/21/2023] Open
Abstract
PURPOSE This study aimed to investigate the impact of delayed retinal clinical care during the COVID-19 pandemic on the severity of proliferative diabetic retinopathy (PDR) and drivers of follow-up delay. We compared disease severity and follow-up rates of PDR patients requiring vitrectomy to those managed nonsurgically, and identified factors associated with need for vitrectomy. METHODS The study included 739 patients diagnosed with PDR between January 1, 2018, and March 4, 2021, categorized into two groups based on outcome: vitrectomy nonvitrectomy. Statistical methods such as t-tests and chi-square tests were used to analyze differences in disease severity and follow-up rates before and after COVID-19 shutdown. A multivariate regression evaluated factors leading to vitrectomy by comparing initial ETDRS (Early Treatment of Diabetic Retinopathy Study) DR staging, disease stability, DR progression, proliferative complications, appointment intervals, follow-up variance, rescheduling rate, and no-show rate. RESULTS Of the 739 patients, 202 required vitrectomy, 537 were managed nonsurgically. The vitrectomy group had more severe or unstable disease before shutdown. The interval between patient visits preshutdown was 29.76 ± 45.11 days in the vitrectomy group and 40.23 ± 56.73 days in the nonvitrectomy group (p < 0.001). Both groups experienced a significant increase in appointment intervals after shutdown, with the vitrectomy group having a greater increase. Both groups had significantly increased rescheduling rate and minimally increased no-show rate. Patient-directed rescheduling was the main driver of appointment delays. Disease factors, such as tractional retinal detachment and higher ETDRS DR staging, increased the odds of vitrectomy, while appointment burden and follow-up variability had a minimal impact. CONCLUSIONS Patients with more severe PDR and greater delay in appointments due to the pandemic were more likely to require vitrectomy for proliferative complications. Patient-directed rescheduling was identified as the main driver of care delays, as opposed to clinic-directed rescheduling. This study highlights the importance of maintaining regular follow-up appointments for PDR patients during pandemics.
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Affiliation(s)
- Bennett E Ahearn
- Department of Ophthalmology, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Huy Nguyen
- Department of Ophthalmology, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Jeong-Hyeon Sohn
- Department of Ophthalmology, University of Texas Health San Antonio, San Antonio, TX, USA
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Rush RB, Gomez PL, Rush SW, Gomez Bastar P. INTERNAL LIMITING MEMBRANE PEELING IN PATIENTS UNDERGOING VITRECTOMY FOR TRACTIONAL RETINAL DETACHMENT SECONDARY TO DIABETIC RETIONPATHY. Retina 2023; 43:1282-1290. [PMID: 37071830 DOI: 10.1097/iae.0000000000003812] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
PURPOSE To assess the merits of internal limiting membrane (ILM) peeling during pars plana vitrectomy in subjects with a tractional retinal detachment secondary to proliferative diabetic retinopathy. METHODS One hundred and ninety-one proliferative diabetic retinopathy subjects undergoing pars plana vitrectomy for the principal indication of tractional retinal detachment were enrolled into this randomized controlled trial. Study subjects were intraoperatively randomized into one of the following treatment groups: Cohort A patients underwent ILM peeling, whereas Cohort B patients did not undergo ILM peeling. The main outcome was postsurgical epiretinal membrane development at 6 months. The secondary outcome was attainment of ≥ 20/50 visual acuity (Snellen) at 6 months. RESULTS One hundred and thirty-nine subjects underwent randomization and completed the study's 6-month trial period. Cohort A had 3.1% (2 of 64) of subjects developing an epiretinal membrane postoperatively, whereas Group B had 26.7% (20 of 75) of subjects developing an epiretinal membrane postoperatively at 6 months ( P < 0.001). Attainment of ≥ 20/50 visual acuity (Snellen) at 6 months was found in 21.9% (14 of 64) of subjects in Cohort A and 9.3% (7 of 75) of subjects in Cohort B ( P = 0.039). CONCLUSION Proliferative diabetic retinopathy patients undergoing pars plana vitrectomy for tractional retinal detachment have a lower frequency of postsurgical epiretinal membrane formation and a greater likelihood of attaining ≥20/50 Snellen visual acuity at 6 months when ILM peeling is conducted. Specialists may consider peeling of the ILM during pars plana vitrectomy an important surgical maneuver in this patient population.
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Affiliation(s)
- Ryan B Rush
- Instituto de la Visión-Hospital La Carlota, Montemorelos, Nuevo León, México
- Panhandle Eye Group, Amarillo, Texas
- Texas Tech University Health Science Center, Amarillo, Texas; and
- Southwest Retina Specialists, Amarillo, Texas
| | - Pedro Luis Gomez
- Instituto de la Visión-Hospital La Carlota, Montemorelos, Nuevo León, México
| | - Sloan W Rush
- Panhandle Eye Group, Amarillo, Texas
- Texas Tech University Health Science Center, Amarillo, Texas; and
| | - Pedro Gomez Bastar
- Instituto de la Visión-Hospital La Carlota, Montemorelos, Nuevo León, México
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Li H, Min F, Ni L, Wang Z, Li J. Comment on: Changes in aqueous and vitreous inflammatory cytokine levels in proliferative diabetic retinopathy: a systematic review and meta-analysis. Eye (Lond) 2023; 37:2161-2162. [PMID: 36310184 PMCID: PMC10333211 DOI: 10.1038/s41433-022-02294-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/08/2022] [Accepted: 10/13/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Hui Li
- Department of Ophthalmology, Jingmen No.1 People's Hospital, Jingmen, 448000, Hubei, China
| | - Feng Min
- Department of Medical Aesthetics, Jingmen No.1 People's Hospital, Jingmen, 448000, Hubei, China
| | - Lisha Ni
- Department of Ophthalmology, Lishui People's Hospital, Lishui, 323000, Zhejiang, China
| | - Zong Wang
- Department of Ophthalmology, Lishui People's Hospital, Lishui, 323000, Zhejiang, China
| | - Jun Li
- Department of Ophthalmology, Lishui People's Hospital, Lishui, 323000, Zhejiang, China.
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