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Sadegh Mousavi S, Jamali Dogahe S, Lyons LJ, Khanna CL. Head Turn During Visual Field Testing to Minimize the Influence of Prominent Facial Anatomy. J Neuroophthalmol 2024; 44:253-258. [PMID: 38088884 DOI: 10.1097/wno.0000000000002019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2024]
Abstract
BACKGROUND Facial contour naturally decreases the visual field. Peripheral visual field defects caused by facial anatomy and ocular pathology can be missed in a routine standard of care. Mathematically calculating the true angle for turning the head to optimize the peripheral visual field has not been studied to date. The purpose of this study was to explore the utility of turning the head during perimetry to maximize the testable visual field. METHODS Six healthy study participants aged 18-52 were enrolled, prospectively; the dominant eye of each participant was tested. In total, 60-4 visual fields were obtained from each participant's dominant eye with the head in primary position. Then, the 60-4 tests were repeated with the head turned prescribed degrees toward and away from the tested eye ("manual method"). Based on a photograph of the participant's face, a convolutional neural network (CNN) was used to predict the optimal head turn angle for maximizing the field, and the test was repeated in this position ("automated method"). RESULTS Maximal visual field exposure was found at a head turn of 15° away from the tested eye using the manual method and was found at an average head turn of 12.6° using the automated method; maximum threshold values were similar between manual and automated methods. The mean of threshold in these subjects at the standard direction and the predicted optimum direction was 1,302, SD = 69.35, and 1,404, SD = 67.37, respectively ( P = 0.02). CONCLUSIONS Turning the head during perimetry maximizes the testable field area by minimizing the influence of prominent facial anatomy. In addition, our CNN can accurately predict each individual's optimal angle of head turn for maximizing the visual field.
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Pandya M, Banait S, Daigavane S. Insights Into Visual Rehabilitation: Pan-Retinal Photocoagulation for Proliferative Diabetic Retinopathy. Cureus 2024; 16:e54273. [PMID: 38496130 PMCID: PMC10944551 DOI: 10.7759/cureus.54273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 02/15/2024] [Indexed: 03/19/2024] Open
Abstract
This review comprehensively explores pan-retinal photocoagulation (PRP) as a pivotal intervention in visually rehabilitating individuals afflicted with proliferative diabetic retinopathy (PDR). The review begins by elucidating the significance of PDR within the spectrum of diabetic retinopathy (DR), emphasizing the progressive nature of the disease and the consequential impact on visual health. A detailed analysis of PRP follows, encompassing its definition, purpose, and historical development, shedding light on the procedural intricacies and mechanisms of action. The postoperative care and follow-up section underscores the necessity of vigilant monitoring for complications, visual recovery, and the importance of regular ophthalmic check-ups. The subsequent discussion delves into patient education and counseling, stressing the need to manage expectations, encourage lifestyle modifications, and highlight the significance of follow-up appointments. The review concludes with insights into future directions, including advancements in laser technology and emerging therapies, offering a glimpse into the evolving landscape of DR management. By addressing ongoing challenges and embracing innovative approaches, this review provides a comprehensive guide for clinicians, researchers, and healthcare practitioners who visually rehabilitate individuals struggling with PDR.
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Affiliation(s)
- Meghavi Pandya
- Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Shashank Banait
- Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Sachin Daigavane
- Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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3
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Jamali Dogahe S, Garmany A, Sadegh Mousavi S, Khanna CL. Predicting 60-4 visual field tests using 3D facial reconstruction. Br J Ophthalmol 2023; 108:112-116. [PMID: 36428007 PMCID: PMC10209349 DOI: 10.1136/bjo-2022-321651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 11/11/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite, the potential clinical utility of 60-4 visual fields, they are not frequently used in clinical practice partly, due to the purported impact of facial contour on field defects. The purpose of this study was to design and test an artificial intelligence-driven platform to predict facial structure-dependent visual field defects on 60-4 visual field tests. METHODS Subjects with no ocular pathology were included. Participants were subject to optical coherence tomography, 60-4 Swedish interactive thresholding algorithm visual field tests and photography. The predicted visual field was compared with observed 60-4 visual field results in subjects. Average and point-specific sensitivity, specificity, precision, negative predictive value, accuracy, and F1-scores were primary outcome measures. RESULTS 30 healthy were enrolled. Three-dimensional facial reconstruction using a convolution neural network (CNN) was able to predict facial contour-dependent 60-4 visual field defects in 30 subjects without ocular pathology. Overall model accuracy was 97%±3% and 96%±3% and the F1-score, dependent on precision and sensitivity, was 58%±19% and 55%±15% for the right eye and left eye, respectively. Spatial-dependent model performance was observed with increased sensitivity and precision within the far inferior nasal field reflected by an average F1-score of 76%±20% and 70%±29% for the right eye and left eye, respectively. CONCLUSIONS This pilot study reports the development of a CNN-enhanced platform capable of predicting 60-4 visual field defects in healthy controls based on facial contour. Further study with this platform may enhance understanding of the influence of facial contour on 60-4 visual field testing.
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Affiliation(s)
| | - Armin Garmany
- Graduate School of Biomedical Sciences, Alix School of Medicine, Medical Scientist Training Program, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Cheryl L Khanna
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
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4
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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] [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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5
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Levine SR, Myers MG, Barunas R, Chang DS, Dutta S, Maddess T, Liebmann JM, Sherman S, Eydelman M, Sun JK, Chambers W, Wickström K, Luhmann UFO, Pallinat M, Glassman A, Aiello LP, Markel DS, Gardner TW. Report From the 2022 Mary Tyler Moore Vision Initiative Diabetic Retinal Disease Clinical Endpoints Workshop. Transl Vis Sci Technol 2023; 12:33. [PMID: 38015167 PMCID: PMC10691397 DOI: 10.1167/tvst.12.11.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/27/2023] [Indexed: 11/29/2023] Open
Abstract
The Mary Tyler Moore Vision Initiative Diabetic Retinal Disease (DRD) Clinical Endpoints Workshop was held on October 22, 2022 to accelerate progress toward establishment of useful clinical and research endpoints and development of new therapeutics that have important relevance across the full spectrum of DRD pathology. More than 90 patient representatives, clinicians, scientists, funding and regulatory agencies, diagnostic, therapeutic and biotech industry representatives discussed the needs for new diagnostic and therapeutic approaches to prevent and restore retinal neurovascular unit integrity. Phase I of the MTM Vision Initiative plans, notably updating the DRD staging system and severity scale, establishing a human ocular biorepository and resource, and clinical endpoints and biomarker development and validation, was emphasized.
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Affiliation(s)
| | - Martin G. Myers
- University of Michigan Caswell Diabetes Institute, Ann Arbor, MI, USA
| | - Ryan Barunas
- JDRF Northeast Ohio & Michigan Chapter, Southfield, MI, USA
| | | | | | - Ted Maddess
- John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Jeffrey M. Liebmann
- Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA
| | | | | | - Jennifer K. Sun
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | | | | | - Ulrich F. O. Luhmann
- Roche Pharmaceutical Research and Early Development, Translational Medicine Ophthalmology, Roche Innovation Center, Basel, Switzerland
| | | | | | | | - Dorene S. Markel
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Thomas W. Gardner
- Mary Tyler Moore Vision Initiative, Greenwich, CT, USA
- Department of Ophthalmology & Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
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Bouazza M, Razzak A, Amri G, Zadnass M, Rayad R, Oubaaz A. [Medico-surgical management of intravitreal hemorrhage in diabetic patients]. J Fr Ophtalmol 2023; 46:851-856. [PMID: 37598102 DOI: 10.1016/j.jfo.2023.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/04/2023] [Accepted: 02/09/2023] [Indexed: 08/21/2023]
Abstract
Vitreous hemorrhage (VH) is the main complication of proliferative diabetic retinopathy and remains the primary indication for vitrectomy in diabetic patients. The objective of our study is to compare our medical and surgical management of VH with data from the literature and to report the functional results of our series. We studied a series of 284 cases collected over 2 years in two tertiary care centers. In our series, 90.1% of patients had type 2 diabetes, and 70% had glycosylated hemoglobin greater than 7.5%. On fundus examination, 35.2% presented with stage 1 VH, 42.6% with stage 2, 3.6% with stage 3 and 5.2% with stage 4. Ocular ultrasound performed when fundus exam was difficult diagnosed an associated tractional retinal detachment in 8.8% of patients. Medical treatment was sufficient in 77.8% of patients, while 22.2% of our patients underwent vitrectomy, argon laser endophotocoagulation and postoperative anti-VEGF injection. Peeling of tractional fibrovascular membranes and or associated epiretinal membranes was performed in 69.8% of cases. Iatrogenic tears were noted in 11.8% of patients. In this study, 31.5% of patients underwent intraocular gas tamponade, while 23.8% of cases underwent silicone oil tamponade. Postoperative visual acuity improved by at least 2 lines in 60% of our patients, and the VH recurred in 24.2% of cases after surgery.
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Affiliation(s)
- M Bouazza
- Service d'ophtalmologie, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Cheikh-Khalifa International University Hospital, Casablanca, Maroc.
| | - A Razzak
- Service d'ophtalmologie, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Cheikh-Khalifa International University Hospital, Casablanca, Maroc
| | - G Amri
- Service d'ophtalmologie, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Cheikh-Khalifa International University Hospital, Casablanca, Maroc
| | - M Zadnass
- Service d'ophtalmologie, Hassan II University, hôpital 20 Août 1953, Casablanca, Maroc
| | - R Rayad
- Service d'ophtalmologie, Hassan II University, hôpital 20 Août 1953, Casablanca, Maroc
| | - A Oubaaz
- Service d'ophtalmologie, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Cheikh-Khalifa International University Hospital, Casablanca, Maroc
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7
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Kasetty VM, Marcus DM. Reply to Letter to the Editor: Endolaserless Vitrectomy With Aflibercept Monotherapy for Proliferative Diabetic Retinopathy-Related Vitreous Hemorrhage. Ophthalmic Surg Lasers Imaging Retina 2023; 54:610-611. [PMID: 37847160 DOI: 10.3928/23258160-20230827-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Affiliation(s)
| | - Dennis M Marcus
- Medical College of Georgia, Augusta University; Southeast Retina Center; Eye Health America; Augusta, Georgia
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8
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Bahr TA, Bakri SJ. Update on the Management of Diabetic Retinopathy: Anti-VEGF Agents for the Prevention of Complications and Progression of Nonproliferative and Proliferative Retinopathy. Life (Basel) 2023; 13:life13051098. [PMID: 37240743 DOI: 10.3390/life13051098] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/05/2023] [Accepted: 04/23/2023] [Indexed: 05/28/2023] Open
Abstract
Diabetic retinopathy (DR) is a microvascular disease caused by poorly controlled blood glucose, and it is a leading cause of vision loss in people with diabetes. In this review we discuss the current management of DR with particular focus on the use of intraocular anti-vascular endothelial growth factor (anti-VEGF) agents. Intraocular anti-VEGF agents were first studied in the 1990s, and now several of these agents are either FDA approved or used off-label as first-line treatments for DR. Recent evidence shows that anti-VEGF agents can halt the progression of markers of DR severity, reduce the risk of DR worsening, and reduce the onset of new macular edema. These significant benefits have been demonstrated in patients with proliferative DR and the milder nonproliferative DR (NPDR). A wealth of evidence from recent trials and meta-analyses has detailed the intraoperative and postoperative benefits of adjunctive anti-VEGF therapy prior to pars plana vitrectomy (PPV) for proliferative DR with vitreous hemorrhage. In this review, we also discuss literature comparing various anti-VEGF injection regimens including monthly, quarterly, as-needed, and treat and extend protocols. Combination protocols with panretinal photocoagulation (PRP) or PPV are also discussed. Current evidence suggests that anti-VEGF therapies are effective therapy for NPDR and PDR and may also provide significant benefits when used adjunctively with other DR treatment modalities such as PRP or PPV.
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Affiliation(s)
- Tyler A Bahr
- Mayo Clinic, Department of Ophthalmology, 200 First St SW, Rochester, MN 55902, USA
| | - Sophie J Bakri
- Mayo Clinic, Department of Ophthalmology, 200 First St SW, Rochester, MN 55902, USA
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Martinez-Zapata MJ, Salvador I, Martí-Carvajal AJ, Pijoan JI, Cordero JA, Ponomarev D, Kernohan A, Solà I, Virgili G. Anti-vascular endothelial growth factor for proliferative diabetic retinopathy. Cochrane Database Syst Rev 2023; 3:CD008721. [PMID: 36939655 PMCID: PMC10026605 DOI: 10.1002/14651858.cd008721.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
BACKGROUND Proliferative diabetic retinopathy (PDR) is an advanced complication of diabetic retinopathy that can cause blindness. It consists of the presence of new vessels in the retina and vitreous haemorrhage. Although panretinal photocoagulation (PRP) is the treatment of choice for PDR, it has secondary effects that can affect vision. Anti-vascular endothelial growth factor (anti-VEGF), which produces an inhibition of vascular proliferation, could improve the vision of people with PDR. OBJECTIVES To assess the effectiveness and safety of anti-VEGFs for PDR and summarise any relevant economic evaluations of their use. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register; 2022, Issue 6); Ovid MEDLINE; Ovid Embase; the ISRCTN registry; ClinicalTrials.gov, and the WHO ICTRP. We did not use any date or language restrictions. We last searched the electronic databases on 1 June 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing anti-VEGFs to another active treatment, sham treatment, or no treatment for people with PDR. We also included studies that assessed the combination of anti-VEGFs with other treatments. We excluded studies that used anti-VEGFs in people undergoing vitrectomy. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies for inclusion, extracted data, and assessed the risk of bias (RoB) for all included trials. We calculated the risk ratio (RR) or the mean difference (MD), and 95% confidence intervals (CI). We used GRADE to assess the certainty of evidence. MAIN RESULTS We included 15 new studies in this update, bringing the total to 23 RCTs with 1755 participants (2334 eyes). Forty-five per cent of participants were women and 55% were men, with a mean age of 56 years (range 48 to 77 years). The mean glycosylated haemoglobin (Hb1Ac) was 8.45% for the PRP group and 8.25% for people receiving anti-VEGFs alone or in combination. Twelve studies included people with PDR, and participants in 11 studies had high-risk PDR (HRPDR). Twelve studies were of bevacizumab, seven of ranibizumab, one of conbercept, two of pegaptanib, and one of aflibercept. The mean number of participants per RCT was 76 (ranging from 15 to 305). Most studies had an unclear or high RoB, mainly in the blinding of interventions and outcome assessors. A few studies had selective reporting and attrition bias. No study reported loss or gain of 3 or more lines of visual acuity (VA) at 12 months. Anti-VEGFs ± PRP probably increase VA compared with PRP alone (mean difference (MD) -0.08 logMAR, 95% CI -0.12 to -0.04; I2 = 28%; 10 RCTS, 1172 eyes; moderate-certainty evidence). Anti-VEGFs ± PRP may increase regression of new vessels (MD -4.14 mm2, 95% CI -6.84 to -1.43; I2 = 75%; 4 RCTS, 189 eyes; low-certainty evidence) and probably increase a complete regression of new vessels (RR 1.63, 95% CI 1.19 to 2.24; I2 = 46%; 5 RCTS, 405 eyes; moderate-certainty evidence). Anti-VEGFs ± PRP probably reduce vitreous haemorrhage (RR 0.72, 95% CI 0.57 to 0.90; I2 = 0%; 6 RCTS, 1008 eyes; moderate-certainty evidence). Anti-VEGFs ± PRP may reduce the need for vitrectomy compared with eyes that received PRP alone (RR 0.67, 95% CI 0.49 to 0.93; I2 = 43%; 8 RCTs, 1248 eyes; low-certainty evidence). Anti-VEGFs ± PRP may result in little to no difference in the quality of life compared with PRP alone (MD 0.62, 95% CI -3.99 to 5.23; I2 = 0%; 2 RCTs, 382 participants; low-certainty evidence). We do not know if anti-VEGFs ± PRP compared with PRP alone had an impact on adverse events (very low-certainty evidence). We did not find differences in visual acuity in subgroup analyses comparing the type of anti-VEGFs, the severity of the disease (PDR versus HRPDR), time to follow-up (< 12 months versus 12 or more months), and treatment with anti-VEGFs + PRP versus anti-VEGFs alone. The main reasons for downgrading the certainty of evidence included a high RoB, imprecision, and inconsistency of effect estimates. AUTHORS' CONCLUSIONS Anti-VEGFs ± PRP compared with PRP alone probably increase visual acuity, but the degree of improvement is not clinically meaningful. Regarding secondary outcomes, anti-VEGFs ± PRP produce a regression of new vessels, reduce vitreous haemorrhage, and may reduce the need for vitrectomy compared with eyes that received PRP alone. We do not know if anti-VEGFs ± PRP have an impact on the incidence of adverse events and they may have little or no effect on patients' quality of life. Carefully designed and conducted clinical trials are required, assessing the optimal schedule of anti-VEGFs alone compared with PRP, and with a longer follow-up.
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Affiliation(s)
- Maria José Martinez-Zapata
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | | | - Arturo J Martí-Carvajal
- Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE (Cochrane Ecuador), Quito, Ecuador
- Universidad Francisco de Vitoria, Facultad de Medicina Cochrane Madrid, Madrid, Spain
- Cátedra Rectoral de Medicina Basada en la Evidencia, Universidad de Carabobo, Valencia, Venezuela
| | - José I Pijoan
- Hospital Universitario Cruces, Barakaldo, Spain
- BioCruces-Bizkaia Research Institute, CIBER Epidemiología y Salud Pública (CIBERESP), Barakaldo, Spain
| | - José A Cordero
- Blanquerna School of Health Sciences, Universitat Ramon Llull, Barcelona, Spain
| | - Dmitry Ponomarev
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Ashleigh Kernohan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ivan Solà
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Gianni Virgili
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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10
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Kasetty VM, Starnes DC, Sood N, Qin LG, Moses MM, Frazier HK, Singh H, Marcus DM. Complications, Compliance, and 3-Year Outcomes After Endolaserless Vitrectomy With Aflibercept Monotherapy for Proliferative Diabetic Retinopathy-Related Vitreous Hemorrhage. Ophthalmic Surg Lasers Imaging Retina 2023; 54:89-96. [PMID: 36780633 DOI: 10.3928/23258160-20221216-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND AND OBJECTIVE To report the 3-year outcomes for endolaserless vitrectomy with intravitreal aflibercept injection (IAI) monotherapy for proliferative diabetic retinopathy (PDR)-related vitreous hemorrhage (VH). MATERIALS AND METHOD Eyes underwent endolaserless vitrectomy and received one preoperative and intraoperative IAI followed by randomization to a q8week or q16week IAI group. Additional IAI was administered as needed. RESULTS 31/40 eyes were randomized (14 q8week eyes, 17 q16week eyes). Through 152 weeks, q8week and q16week eyes received 18.6 and 12.1 IAI, respectively. Q8week eyes observed a 34 letter visual acuity (VA) increase (P = 0.003) compared to a 27 letter increase in the q16week group (P = 0.013). CONCLUSIONS Endolaserless vitrectomy with aflibercept monotherapy for PDR-related VH provides significant long-term visual gains. Frequent IAI is required for fewer proliferative consequences. [Ophthalmic Surg Lasers Imaging Retina 2023;54:89-96.].
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11
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Bjornstad P, Dart A, Donaghue KC, Dost A, Feldman EL, Tan GS, Wadwa RP, Zabeen B, Marcovecchio ML. ISPAD Clinical Practice Consensus Guidelines 2022: Microvascular and macrovascular complications in children and adolescents with diabetes. Pediatr Diabetes 2022; 23:1432-1450. [PMID: 36537531 DOI: 10.1111/pedi.13444] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Petter Bjornstad
- Section of Endocrinology, Department of Pediatrics, Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Allison Dart
- Department of Pediatrics, Divison of Nephrology, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Kim C Donaghue
- Department of Pediatrics, Division of Endocrinology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - Axel Dost
- Department of Pediatrics, Division of Endocrinology, Jena University Hospital, Jena, Germany
| | - Eva L Feldman
- Department of Medicine, Division of Neurology, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Gavin S Tan
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore.,Department of Ophthalmology and Visual Sciences, Duke-NUS Medical School, National University of Singapore, Singapore
| | - R Paul Wadwa
- Section of Endocrinology, Department of Pediatrics, Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Bedowra Zabeen
- Department of Paediatrics and Changing Diabetes in Children Program, Bangladesh Institute of Research and Rehabilitation in Diabetes Endocrine and Metabolic Disorders, Dhaka, Bangladesh
| | - M Loredana Marcovecchio
- Department of Paediatrics, University of Cambridge, and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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12
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Arrigo A, Aragona E, Bandello F. VEGF-targeting drugs for the treatment of retinal neovascularization in diabetic retinopathy. Ann Med 2022; 54:1089-1111. [PMID: 35451900 PMCID: PMC9891228 DOI: 10.1080/07853890.2022.2064541] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Diabetic retinopathy (DR) is the most common microangiopathic complication of diabetes mellitus, representing a major cause of visual impairment in developed countries. Proliferative DR (PDR) represents the last stage of this extremely complex retinal disease, characterized by the development of neovascularization induced by the abnormal production and release of vascular endothelial growth factor (VEGF). The term VEGF includes different isoforms; VEGF-A represents one of the most important pathogenic factors of DR. Anti-VEGF intravitreal therapies radically changed the outcome of DR, due to combined anti-angiogenic and anti-edematous activities. Nowadays, several anti-VEGF molecules exist, characterized by different pharmacological features and duration. With respect to PDR, although anti-VEGF treatments represented a fundamental step forward in the management of this dramatic complication, a big debate is present in the literature regarding the role of anti-VEGF as substitute of panretinal photocoagulation or if these two approaches may be used in combination. In the present review, we provided an update on VEGF isoforms and their role in DR pathogenesis, on current anti-VEGF molecules and emerging new drugs, and on the current management strategies of PDR. There is an overall agreement regarding the relative advantage provided by anti-VEGF, especially looking at the management of PDR patients requiring vitrectomy, with respect to laser. Based on the current data, laser approaches might be avoided when a perfectly planned anti-VEGF therapeutic strategy can be adopted. Conversely, laser treatment may have a role for those patients unable to guarantee enough compliance to anti-VEGF injections.Key messagesVEGF increased production, stimulated by retinal hypoperfusion and ischaemia, is a major pathogenic factor of neovascular complication onset in diabetic retinopathy and of DR stages progression.Nowadays, several anti-VEGF molecules are available in clinical practice and other molecules are currently under investigation. Each anti-VEGF molecule is characterized by different targets and may interact with multiple biochemical pathways within the eye.All the data agreed in considering anti-VEGF molecules as a first line choice for the management of diabetic retinopathy. Laser treatments may have a role in selected advanced cases and for those patients unable to guarantee enough compliance to intravitreal treatments schemes.
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Affiliation(s)
- Alessandro Arrigo
- IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Emanuela Aragona
- IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Bandello
- IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Maatouk CM, Sastry R, Singh RP. Long term outcomes following anti-VEGF therapy for diabetic macular edema. EXPERT REVIEW OF OPHTHALMOLOGY 2022. [DOI: 10.1080/17469899.2022.2131539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Christopher M. Maatouk
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- The Cole Eye Center for Ophthalmic Bioinformatics, Cleveland, OH, USA
| | - Resya Sastry
- The Cole Eye Center for Ophthalmic Bioinformatics, Cleveland, OH, USA
- Creighton University School of Medicine, Omaha, NE, USA
| | - Rishi P. Singh
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Cleveland Clinic Martin Hospital, Stuart, FL, USA
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Blonde L, Umpierrez GE, Reddy SS, McGill JB, Berga SL, Bush M, Chandrasekaran S, DeFronzo RA, Einhorn D, Galindo RJ, Gardner TW, Garg R, Garvey WT, Hirsch IB, Hurley DL, Izuora K, Kosiborod M, Olson D, Patel SB, Pop-Busui R, Sadhu AR, Samson SL, Stec C, Tamborlane WV, Tuttle KR, Twining C, Vella A, Vellanki P, Weber SL. American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. Endocr Pract 2022; 28:923-1049. [PMID: 35963508 PMCID: PMC10200071 DOI: 10.1016/j.eprac.2022.08.002] [Citation(s) in RCA: 132] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The objective of this clinical practice guideline is to provide updated and new evidence-based recommendations for the comprehensive care of persons with diabetes mellitus to clinicians, diabetes-care teams, other health care professionals and stakeholders, and individuals with diabetes and their caregivers. METHODS The American Association of Clinical Endocrinology selected a task force of medical experts and staff who updated and assessed clinical questions and recommendations from the prior 2015 version of this guideline and conducted literature searches for relevant scientific papers published from January 1, 2015, through May 15, 2022. Selected studies from results of literature searches composed the evidence base to update 2015 recommendations as well as to develop new recommendations based on review of clinical evidence, current practice, expertise, and consensus, according to established American Association of Clinical Endocrinology protocol for guideline development. RESULTS This guideline includes 170 updated and new evidence-based clinical practice recommendations for the comprehensive care of persons with diabetes. Recommendations are divided into four sections: (1) screening, diagnosis, glycemic targets, and glycemic monitoring; (2) comorbidities and complications, including obesity and management with lifestyle, nutrition, and bariatric surgery, hypertension, dyslipidemia, retinopathy, neuropathy, diabetic kidney disease, and cardiovascular disease; (3) management of prediabetes, type 2 diabetes with antihyperglycemic pharmacotherapy and glycemic targets, type 1 diabetes with insulin therapy, hypoglycemia, hospitalized persons, and women with diabetes in pregnancy; (4) education and new topics regarding diabetes and infertility, nutritional supplements, secondary diabetes, social determinants of health, and virtual care, as well as updated recommendations on cancer risk, nonpharmacologic components of pediatric care plans, depression, education and team approach, occupational risk, role of sleep medicine, and vaccinations in persons with diabetes. CONCLUSIONS This updated clinical practice guideline provides evidence-based recommendations to assist with person-centered, team-based clinical decision-making to improve the care of persons with diabetes mellitus.
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Affiliation(s)
| | | | - S Sethu Reddy
- Central Michigan University, Mount Pleasant, Michigan
| | | | | | | | | | | | - Daniel Einhorn
- Scripps Whittier Diabetes Institute, La Jolla, California
| | | | | | - Rajesh Garg
- Lundquist Institute/Harbor-UCLA Medical Center, Torrance, California
| | | | | | | | | | | | - Darin Olson
- Colorado Mountain Medical, LLC, Avon, Colorado
| | | | | | - Archana R Sadhu
- Houston Methodist; Weill Cornell Medicine; Texas A&M College of Medicine; Houston, Texas
| | | | - Carla Stec
- American Association of Clinical Endocrinology, Jacksonville, Florida
| | | | - Katherine R Tuttle
- University of Washington and Providence Health Care, Seattle and Spokane, Washington
| | | | | | | | - Sandra L Weber
- University of South Carolina School of Medicine-Greenville, Prisma Health System, Greenville, South Carolina
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15
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Antioxidant and anti-apoptotic effects of tocotrienol-rich fraction against streptozotocin-induced diabetic retinopathy in rats. Biomed Pharmacother 2022; 153:113533. [DOI: 10.1016/j.biopha.2022.113533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/08/2022] [Accepted: 08/08/2022] [Indexed: 11/22/2022] Open
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Transnasal sphenopalatine ganglion block for pain relief during panretinal photocoagulation laser for diabetic retinopathy: a pre and post interventional study. Sci Rep 2022; 12:10964. [PMID: 35768623 PMCID: PMC9243058 DOI: 10.1038/s41598-022-14745-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
This study was performed to utilize transnasal Sphenopalatine Ganglion (SPG) block for pain reliving during panretinal photocoagulation (PRP) in diabetic patients with diabetic retinopathy. This pre and post interventional study was performed on 20 patients with proliferative diabetic retinopathy. The first PRP treatment session of all the patients is performed with no transnasal SPG block, but before holding the second session, all the patients underwent transnasal SPG block and pain levels during and after PRP were compared to each other. Before the transnasal SPG block, each nostril of all the cases was inspected for finding any obstruction in each PRP session. Transnasal SPG block was also performed in with 2% lidocaine. The mean age of the included cases was 52.84 ± 8.62 years old (from 36 to 72 years old). All the cases underwent two PRP lasers treatment sessions with the same characteristic (spot size, power and duration) for each patient. In the first and second PRP treatment sessions, the mean NRS scores were obtained immediately after the PRP laser (8.4 vs. 4.2), 15 min (8.2 vs. 4.2), 1 h (8.0 vs. 4.1), and 24 h (5.4 vs. 3.6) after the PRP respectively. The mean NRS scores significantly reduced during the second PRP treatment session compared to the first session (p < 0.001). Transnasal SPG block is a safe and effective strategy used for relieving pain caused by the PRP laser treatment in patients with diabetic retinopathy.
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Optical Coherence Tomography Combined with Fluorescein Fundus Angiography under Intelligent Algorithm to Evaluate the Clinical Efficacy of Ranibizumab Combined with Panretinal Photocoagulation in the Treatment of Macular Edema of Diabetic Retinopathy Patients. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2933663. [PMID: 35547563 PMCID: PMC9085305 DOI: 10.1155/2022/2933663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/30/2022] [Accepted: 04/01/2022] [Indexed: 11/17/2022]
Abstract
This study aimed at investigating the clinical effect of ranibizumab combined with panretinal photocoagulation in the treatment of macular edema in diabetic retinopathy (DR) patients. A parametric deformation model was constructed, and based on this, it was evaluated using optical coherence tomography (OCT) combined with fluorescein fundus angiography (FFA). 56 DR patients (80 eyes) who needed surgery were selected for OCT and FFA scanning, and 0.5 mg ranibizumab was administered intravitreal injection before surgery. It should observe the OCT and FFA image characteristics of patients. In addition, the vision correction status before the surgery, 1 month, 3 months, and 6 months after the surgery, the thickness of the macular retina, operation time, the number of intraoperative electrocoagulation, and complications of patients were recorded. It was found that 82.85% of patients had improved visual acuity after surgery. Compared with preoperative, the average logarithm of the minimum angle of resolution (logMAR) of patients at 6 months after surgery increased significantly (
). With the increase of the grade of fibrosis and the grade of hemorrhage, the logMAR visual acuity recovery at 6 months after the surgery became worse; the macular retinal thickness at 6 months after the surgery decreased significantly (
). With the increase of the grade of fibrous proliferation and the grade of bleeding, the operation time, the number of electrocoagulation, and the possibility of iatrogenic holes of patient would increase. It can be known that ranibizumab combined with panretinal photocoagulation surgery could not only reduce the macular edema but also effectively reduce the intraoperative bleeding, simplify the removal of proliferative membranes, decrease the number of electrocoagulation, and shorten the operation time, enhancing the visual function of patients.
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LONGITUDINAL ANALYSIS OF DIABETIC CHOROIDOPATHY IN PROLIFERATIVE DIABETIC RETINOPATHY TREATED WITH PANRETINAL PHOTOCOAGULATION USING WIDEFIELD SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY. Retina 2022; 42:417-425. [PMID: 34861657 PMCID: PMC8860863 DOI: 10.1097/iae.0000000000003375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Widefield swept-source optical coherence tomography (OCT) imaging was used to characterize choroidal thickness and vascularity at baseline in proliferative diabetic retinopathy (PDR) and longitudinally after panretinal photocoagulation (PRP). METHODS Patients with treatment-naive PDR were imaged at baseline and at 1 week, 1 month, and 3 months after PRP. Previously validated algorithms were used to calculate the mean choroidal thickness (MCT) and choroidal vascularity index (CVI) in 5 regions of 12 mm × 12 mm scans. RESULTS Fourteen PDR eyes were included. Baseline MCT in PDR eyes did not differ significantly from normal eyes, but CVI measurements in PDR eyes were lower in all regions (P < 0.001-0.008). After PRP, MCT measurements in PDR eyes were significantly lower at 1 month and 3 months in all regions (P < 0.001-0.005) except the fovea (P = 0.074). However, CVI measurements did not change over time in any region after PRP. CONCLUSION The choroid in PDR eyes has a smaller CVI than that in normal eyes. After PRP, the choroidal thickness decreases outside the fovea, but the CVI remains constant, which suggests that a relative decrease in choroidal vascularity persists. These widefield swept-source OCT results are consistent with choroidal alterations found in histopathological reports of diabetic choroidopathy.
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It is time for a moonshot to find “Cures” for diabetic retinal disease. Prog Retin Eye Res 2022; 90:101051. [DOI: 10.1016/j.preteyeres.2022.101051] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/19/2022] [Accepted: 01/31/2022] [Indexed: 12/13/2022]
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20
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Luo Y, Yin J, Fang R, Liu J, Wang L, Zhang H, Zhang M, Lei Z, Liang S, Cui W, Zhang Z, Wu K, Hui X. The tumour neovasculature-homing dimeric peptide GX1 demonstrates antiangiogenic activity in the retinal neovasculature. Eur J Pharmacol 2021; 912:174574. [PMID: 34662566 DOI: 10.1016/j.ejphar.2021.174574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 12/13/2022]
Abstract
Identification of molecules specific to the retinal neovasculature will promote antiangiogenic therapy with enhanced targeting ability. The specificity of phage-displayed peptide GX1 (a cyclic 7-mer peptide motif CGNSNPKSC) to gastric cancer neovasculature has been extensively confirmed both in vitro and in vivo. To investigate the potential application of GX1 in antiangiogenic therapy targeting retinal angiogenesis-related diseases, we performed immunohistochemistry and immunofluorescence analyses. GX1 demonstrated positive staining in the retinal neovasculature in an oxygen-induced mouse model of retinopathy (OIR) as well as in rat retinal microvasculature endothelial cells (RMECs), confirming the major role of the GX1 receptor during retinal angiogenesis. Dimeric GX1 was synthesized to increase the binding affinity to the GX1 receptor, and the antiangiogenic effects were examined in RMECs in vitro and the retinal neovasculature in the OIR in vivo. Cell proliferation was evaluated using a Cell Counting Kit-8 (CCK-8) assay, revealing that compared with the GX1 monomer, dimeric GX1 significantly inhibited RMEC proliferation (P < 0.05). This finding may be attributed to the enhanced (P < 0.05) apoptosis induced by dimeric GX1 in RMECs based on results obtained from TUNEL, flow cytometric and cell cycle analyses. In RMECs, in vitro cell migration and tube formation were significantly inhibited following exposure to dimeric GX1. Intravitreal administration of dimeric GX1 resulted in a greater reduction in the retinal neovascularization in vivo than administration of the GX1 monomer (P < 0.05). In conclusion, dimeric GX1 showed greater inhibition of angiogenesis than monomeric GX1 and could be a promising agent for antiangiogenic therapy in retinal angiogenesis-related diseases.
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Affiliation(s)
- Yingying Luo
- Department of Geriatric Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Xi'an, 710061, China
| | - Jipeng Yin
- State Key Laboratory of Cancer Biology & Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Shaanxi Xi'an, 710032, China
| | - Rutang Fang
- State Key Laboratory of Cancer Biology & Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Shaanxi Xi'an, 710032, China; Department of Gastroenterology, Affiliated No. 986 Hospital of Xijing Hospital, Fourth Military Medical University, Shaanxi Xi'an, 710032, China
| | - Jingtao Liu
- Department of Geriatric Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Xi'an, 710061, China; Department of Nuclear Medicine, Affiliated No. 986 Hospital of Xijing Hospital, Fourth Military Medical University, Shaanxi Xi'an, 710032, China
| | - Lu Wang
- Department of Geriatric Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Xi'an, 710061, China
| | - Haiping Zhang
- Department of Geriatric Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Xi'an, 710061, China
| | - Ming Zhang
- Department of Ophthalmology, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Xi'an, 710061, China
| | - Zhijie Lei
- State Key Laboratory of Cancer Biology & Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Shaanxi Xi'an, 710032, China
| | - Shuhui Liang
- State Key Laboratory of Cancer Biology & Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Shaanxi Xi'an, 710032, China
| | - Wei Cui
- Department of Geriatric Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Xi'an, 710061, China
| | - Zhiyong Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Xi'an, 710061, China.
| | - Kaichun Wu
- State Key Laboratory of Cancer Biology & Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Shaanxi Xi'an, 710032, China.
| | - Xiaoli Hui
- Department of Geriatric Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Xi'an, 710061, China.
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Comparative Analysis of the Effects of the Anti-VEGF Drug and Glucocorticoid by Injection before the End of Vitrectomy for Proliferative Diabetic Retinopathy. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:1285372. [PMID: 34721617 PMCID: PMC8553454 DOI: 10.1155/2021/1285372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/30/2021] [Indexed: 11/18/2022]
Abstract
Objective To explore the effects of the anti-VEGF drug and glucocorticoid by injection before the end of vitrectomy for proliferative diabetic retinopathy (PDR). Methods Eighty PDR patients who underwent vitrectomy in our hospital (July 2020–June 2022) were selected as the research objects and randomized into group A (n = 40) and group B (n = 40) according to the order of admission. Before the end of surgery, group B was injected with glucocorticoid (triamcinolone acetonide) into the vitreous cavity, and group A was injected with anti-VEGF drug (conbercept). The ophthalmic parameters, incidence of complications, diabetes indexes, and surgical indexes of the two groups were compared. Results The best corrected visual acuity (BCVA), central macular thickness (CMT), macular blood flow density and intraocular pressure in group A were remarkably better than those in group B (P < 0.001). The incidence of complications (P < 0.05) and VEG/F level (P < 0.001) in group A were obviously lower than those in group B. There was no significant difference in fasting blood glucose (FBG) and surgical indexes between the two groups (P > 0.05). Conclusion Conbercept injection before the end of vitrectomy can improve the ophthalmic parameters, reduce the level of VEGF, and lower the possibility of postsurgical complications. Therefore, the low-cost and efficient anti-VEGF drug should be promoted and applied in practice.
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22
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Crabtree GS, Chang JS. Management of Complications and Vision Loss from Proliferative Diabetic Retinopathy. Curr Diab Rep 2021; 21:33. [PMID: 34477996 DOI: 10.1007/s11892-021-01396-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Diabetes can be associated with profound visual loss due to several mechanisms. As the duration of diabetes and blood glucose levels increase, these changes become more severe. The proliferation of new blood vessels, vitreous hemorrhage, and tractional retinal detachments may ultimately result and can be devastating to visual function. New advances, including anti-vascular endothelial growth factor (VEGF) medications and innovative microsurgical instruments, have provided additional methods for the management of diabetic retinopathy in the clinic and in the operating room, leading to improved outcomes. RECENT FINDINGS Advances in earlier treatment of proliferative diabetic retinopathy, especially with anti-VEGF injections, allow for a reduction in severity, improved vision, and more controlled and successful surgery. Modern surgical techniques and instrumentation have also allowed for improved patient outcomes. Future research into sustained delivery and release of anti-VEGF, reducing the need for frequent in-office injections, may prove to be additionally beneficial. Over the last decade, anti-VEGF has become an increasingly common treatment modality for the management of proliferative diabetic retinopathy, vitreous hemorrhages, and tractional retinal detachments. Further research is needed to determine the ideal method of delivery and timing of the treatment.
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Affiliation(s)
- Gordon S Crabtree
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, 2870 University Ave, Suite 206, Madison, WI, 53705, USA
| | - Jonathan S Chang
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, 2870 University Ave, Suite 206, Madison, WI, 53705, USA.
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Fallico M, Maugeri A, Lotery A, Longo A, Bonfiglio V, Russo A, Avitabile T, Pulvirenti A, Furino C, Cennamo G, Barchitta M, Agodi A, Reibaldi M. Intravitreal anti-vascular endothelial growth factors, panretinal photocoagulation and combined treatment for proliferative diabetic retinopathy: a systematic review and network meta-analysis. Acta Ophthalmol 2021; 99:e795-e805. [PMID: 33326183 DOI: 10.1111/aos.14681] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/17/2020] [Accepted: 10/22/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE To conduct a systematic review with network meta-analysis (NMA) of randomized clinical trials (RCTs) comparing panretinal photocoagulation (PRP) versus anti-vascular endothelial growth factor (VEGF) treatment alone or in combination with PRP, for proliferative diabetic retinopathy (PDR). METHODS PubMed, Medline and Embase databases were searched for RCTs comparing PRP versus intravitreal anti-VEGF therapy and/or combined PRP and intravitreal anti-VEGF for PDR. The primary outcome measures were the mean best corrected visual acuity (BCVA) change and the regression of neovascularization. Mean change of central macular thickness (CMT), the subgroup analyses of patients without diabetic macular oedema (DME) and the rate of vitreous haemorrhage and vitrectomy were secondary outcomes. Frequentist NMAs were performed. RESULTS Twelve RCTs were included. For the 12-month mean BCVA change, NMA showed a better visual outcome in both the anti-VEGF group and combined group compared to PRP [anti-VEGF vs PRP, mean difference (MD) = 3.42; standard error (SE) = 1.5; combined vs PRP, MD = 3.92; SE = 1.65], with no difference between combined group and anti-VEGF (MD = -0.50; SE = 1.87). No difference in neovascularization regression was found between PRP and anti-VEGF alone or in combination with PRP, but there was significant inconsistency (p = 0.016). Subgroup analyses in patients without DME yielded no difference for the 12-month visual outcome between the three interventions, but with significant inconsistency (p = 0.005). CONCLUSION This NMA showed limited evidence of comparable efficacy in terms of neovascularization regression between PRP and anti-VEGF therapy alone or in combination with PRP, but better visual outcomes were associated with anti-VEGF use. Intravitreal anti-VEGF therapy could be a valid therapeutic option in association with PRP.
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Affiliation(s)
- Matteo Fallico
- Department of Ophthalmology University of Catania Catania Italy
| | - Andrea Maugeri
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” University of Catania Catania Italy
| | - Andrew Lotery
- Faculty of Medicine University of Southampton Southampton UK
| | - Antonio Longo
- Department of Ophthalmology University of Catania Catania Italy
| | - Vincenza Bonfiglio
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section University of Palermo Palermo Italy
| | - Andrea Russo
- Department of Ophthalmology University of Catania Catania Italy
| | | | - Alfredo Pulvirenti
- Department of Clinical and Experimental Medicine University of Catania Catania Italy
| | - Claudio Furino
- Department of Ophthalmology University of Bari Bari Italy
| | - Gilda Cennamo
- Department of Public Health University of Naples Federico II Naples Italy
| | - Martina Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” University of Catania Catania Italy
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia” University of Catania Catania Italy
| | - Michele Reibaldi
- Department of Surgical Sciences Eye Clinic Section University of Turin Turin Italy
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Glassman AR, Beaulieu WT, Maguire MG, Antoszyk AN, Chow CC, Elman MJ, Jampol LM, Salehi-Had H, Sun JK. Visual Acuity, Vitreous Hemorrhage, and Other Ocular Outcomes After Vitrectomy vs Aflibercept for Vitreous Hemorrhage Due to Diabetic Retinopathy: A Secondary Analysis of a Randomized Clinical Trial. JAMA Ophthalmol 2021; 139:725-733. [PMID: 33956075 DOI: 10.1001/jamaophthalmol.2021.1110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Importance Although there were no differences in mean visual acuity (VA) over 24 weeks after vitrectomy with panretinal photocoagulation (PRP) vs aflibercept in a randomized clinical trial among eyes with vitreous hemorrhage due to proliferative diabetic retinopathy (PDR), post hoc analyses may influence treatment choices. Objective To compare exploratory outcomes between treatment groups that may affect treatment choices for patients with vitreous hemorrhage due to PDR. Design, Setting, and Participants This post hoc analysis of a randomized clinical trial conducted at 39 DRCR Retina Network sites included adults with vision loss due to PDR-related vitreous hemorrhage for whom vitrectomy was considered. Data were collected from November 2016 to January 2020. Interventions Random assignment to 4 monthly injections of aflibercept vs vitrectomy with PRP. Both groups could receive aflibercept or vitrectomy during follow-up based on protocol-specific criteria. Main Outcomes and Measures Visual acuity area under the curve (adjusted for baseline VA) and clearance of vitreous hemorrhage. Results A total of 205 eyes were included in the analysis (115 male [56%] and 90 [44%] female participants; mean [SD] age, 57 [11] years). Among 89 eyes with a baseline VA of 20/32 to 20/160 (47 receiving aflibercept, including 4 [9%] that had undergone vitrectomy; 42 undergoing vitrectomy, including 3 [7%] that had received aflibercept), the adjusted mean difference in VA letter score over 24 weeks between the aflibercept and vitrectomy groups was -4.3 (95% CI, -10.6 to 1.9) compared with -16.7 (95% CI, -24.4 to -9.1) among 59 eyes with baseline VA worse than 20/800 (P = .02 for interaction; 26 in the aflibercept group, including 6 [23%] that had undergone vitrectomy; 33 in the vitrectomy group, including 8 [24%] that had received aflibercept). In the full cohort, the median time to clearance of the initial vitreous hemorrhage was 36 (interquartile range [IQR], 24-52) weeks in the aflibercept group vs 4 (IQR, 4-4) weeks in the vitrectomy group (difference, 32 [95% CI, 20-32] weeks; P < .001). Conclusions and Relevance Both initial aflibercept and vitrectomy with PRP are viable treatment approaches for PDR-related vitreous hemorrhage. Although this study did not find a significant difference between groups in the primary outcome of mean VA over 24 weeks of follow-up, eyes receiving initial vitrectomy with PRP had faster recovery of vision over 24 weeks when baseline VA was worse than 20/800 and faster vitreous hemorrhage clearance. Approximately one-third of the eyes in each group received the alternative treatment (aflibercept or vitrectomy with PRP). These factors may influence treatment decisions for patients initiating therapy for PDR-related vitreous hemorrhage. Trial Registration ClinicalTrials.gov Identifier: NCT02858076.
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Affiliation(s)
| | | | - Maureen G Maguire
- Department of Ophthalmology, University of Pennsylvania, Philadelphia
| | - Andrew N Antoszyk
- Charlotte Eye Ear Nose & Throat Associates, PA, Charlotte, North Carolina
| | | | | | - Lee M Jampol
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Jennifer K Sun
- Joslin Diabetes Center, Beetham Eye Institute, Harvard Department of Ophthalmology, Boston, Massachusetts
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25
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Zhang W, Zhao G, Fan W, Zhao T. Panretinal photocoagulation after or prior to intravitreal conbercept injection for diabetic macular edema: a retrospective study. BMC Ophthalmol 2021; 21:160. [PMID: 33789617 PMCID: PMC8015169 DOI: 10.1186/s12886-021-01920-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/12/2021] [Indexed: 12/30/2022] Open
Abstract
Background Panretinal photocoagulation treatment (PRP) have been known as a standard treatment for proliferative diabetic retinopathy (PDR) or severe nonproliferative diabetic retinopathy (sNPDR). However, there is no consensus on when PRP should be administrated if anti-VEGF treatment is needed for the concurrent diabetic macular edema (DME). This study is to evaluate the difference between two groups of PRP prior to, or after intravitreal conbercept (IVC) for patients with PDR or sNPDR combined with DME. Methods This was a retrospective study. Fifty-eight eyes with DME secondary to PDR or sNPDR were divided into two groups; the PRP after (PRP-after group), or prior to (PRP-prior group), IVC. Changes in number of IVC injections, best corrected visual acuity (BCVA), and central subfield macular thickness (CSMT) were compared after 4 weeks, 12 weeks, 1 year, and 2 years from the first IVC injection. Results The mean number of injections in PRP-after group was 4.8 (1 year) and 6.4 (2 year), lower than 6.4 (1 year) and 8.5 (2 year) in PRP-prior group (both p = 0.002). There was no significant difference in change in BCVA and CSMT between two groups after each follow-up. Conclusion PRP after IVC requires less injections but also yields similar visual and anatomic outcome comparing with PRP prior to IVC in patients with diabetic retinopathy combined with DME. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-021-01920-8.
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Affiliation(s)
- Wei Zhang
- Department of Ophthalmology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Rd, Nanjing, 210006, China
| | - Guiyang Zhao
- Department of Ophthalmology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Rd, Nanjing, 210006, China
| | - Weijie Fan
- Department of Ophthalmology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Rd, Nanjing, 210006, China
| | - Taihong Zhao
- Department of Ophthalmology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Rd, Nanjing, 210006, China
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Apte RS, Hwang CK. Practicality of Prophylactic Aflibercept to Reduce Diabetic Retinopathy Progression. JAMA Ophthalmol 2021; 139:713-714. [PMID: 33784736 DOI: 10.1001/jamaophthalmol.2021.0624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Rajendra S Apte
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Christopher K Hwang
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine in St Louis, St Louis, Missouri
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27
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Pan WW, Gardner TW, Harder JL. Integrative Biology of Diabetic Retinal Disease: Lessons from Diabetic Kidney Disease. J Clin Med 2021; 10:1254. [PMID: 33803590 PMCID: PMC8003049 DOI: 10.3390/jcm10061254] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 01/13/2023] Open
Abstract
Diabetic retinal disease (DRD) remains the most common cause of vision loss in adults of working age. Progress on the development of new therapies for DRD has been limited by the complexity of the human eye, which constrains the utility of traditional research techniques, including animal and tissue culture models-a problem shared by those in the field of kidney disease research. By contrast, significant progress in the study of diabetic kidney disease (DKD) has resulted from the successful employment of systems biology approaches. Systems biology is widely used to comprehensively understand complex human diseases through the unbiased integration of genetic, environmental, and phenotypic aspects of the disease with the functional and structural manifestations of the disease. The application of a systems biology approach to DRD may help to clarify the molecular basis of the disease and its progression. Acquiring this type of information might enable the development of personalized treatment approaches, with the goal of discovering new therapies targeted to an individual's specific DRD pathophysiology and phenotype. Furthermore, recent efforts have revealed shared and distinct pathways and molecular targets of DRD and DKD, highlighting the complex pathophysiology of these diseases and raising the possibility of therapeutics beneficial to both organs. The objective of this review is to survey the current understanding of DRD pathophysiology and to demonstrate the investigative approaches currently applied to DKD that could promote a more thorough understanding of the structure, function, and progression of DRD.
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Affiliation(s)
- Warren W. Pan
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, MI 48105, USA; (W.W.P.); (T.W.G.)
| | - Thomas W. Gardner
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, MI 48105, USA; (W.W.P.); (T.W.G.)
- Department of Internal Medicine (Metabolism, Endocrinology and Diabetes), University of Michigan Medical School, Ann Arbor, MI 48109, USA
- Department of Molecular and Integrative Physiology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Jennifer L. Harder
- Department of Internal Medicine (Nephrology), University of Michigan Medical School, Ann Arbor, MI 48109, USA
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28
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Antoszyk AN, Glassman AR, Beaulieu WT, Jampol LM, Jhaveri CD, Punjabi OS, Salehi-Had H, Wells JA, Maguire MG, Stockdale CR, Martin DF, Sun JK. Effect of Intravitreous Aflibercept vs Vitrectomy With Panretinal Photocoagulation on Visual Acuity in Patients With Vitreous Hemorrhage From Proliferative Diabetic Retinopathy: A Randomized Clinical Trial. JAMA 2020; 324:2383-2395. [PMID: 33320223 PMCID: PMC7739132 DOI: 10.1001/jama.2020.23027] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
IMPORTANCE Vitreous hemorrhage from proliferative diabetic retinopathy can cause loss of vision. The best management approach is unknown. OBJECTIVE To compare initial treatment with intravitreous aflibercept vs vitrectomy with panretinal photocoagulation for vitreous hemorrhage from proliferative diabetic retinopathy. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial at 39 DRCR Retina Network sites in the US and Canada including 205 adults with vison loss due to vitreous hemorrhage from proliferative diabetic retinopathy who were enrolled from November 2016 to December 2017. The final follow-up visit was completed in January 2020. INTERVENTIONS Random assignment of eyes (1 per participant) to aflibercept (100 participants) or vitrectomy with panretinal photocoagulation (105 participants). Participants whose eyes were assigned to aflibercept initially received 4 monthly injections. Both groups could receive aflibercept or vitrectomy during follow-up based on protocol criteria. MAIN OUTCOMES AND MEASURES The primary outcome was mean visual acuity letter score (range, 0-100; higher scores indicate better vision) over 24 weeks (area under the curve); the study was powered to detect a difference of 8 letters. Secondary outcomes included mean visual acuity at 4 weeks and 2 years. RESULTS Among 205 participants (205 eyes) who were randomized (mean [SD] age, 57 [11] years; 115 [56%] men; mean visual acuity letter score, 34.5 [Snellen equivalent, 20/200]), 95% (195 of 205) completed the 24-week visit and 90% (177 of 196, excluding 9 deaths) completed the 2-year visit. The mean visual acuity letter score over 24 weeks was 59.3 (Snellen equivalent, 20/63) (95% CI, 54.9 to 63.7) in the aflibercept group vs 63.0 (Snellen equivalent, 20/63) (95% CI, 58.6 to 67.3) in the vitrectomy group (adjusted difference, -5.0 [95% CI, -10.2 to 0.3], P = .06). Among 23 secondary outcomes, 15 showed no significant difference. The mean visual acuity letter score was 52.6 (Snellen equivalent, 20/100) in the aflibercept group vs 62.3 (Snellen equivalent, 20/63) in the vitrectomy group at 4 weeks (adjusted difference, -11.2 [95% CI, -18.5 to -3.9], P = .003) and 73.7 (Snellen equivalent, 20/40) vs 71.0 (Snellen equivalent, 20/40) at 2 years (adjusted difference, 2.7 [95% CI, -3.1 to 8.4], P = .36). Over 2 years, 33 eyes (33%) assigned to aflibercept received vitrectomy and 34 eyes (32%) assigned to vitrectomy received subsequent aflibercept. CONCLUSIONS AND RELEVANCE Among participants whose eyes had vitreous hemorrhage from proliferative diabetic retinopathy, there was no statistically significant difference in the primary outcome of mean visual acuity letter score over 24 weeks following initial treatment with intravitreous aflibercept vs vitrectomy with panretinal photocoagulation. However, the study may have been underpowered, considering the range of the 95% CI, to detect a clinically important benefit in favor of initial vitrectomy with panretinal photocoagulation. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02858076.
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Affiliation(s)
| | | | | | - Lee M. Jampol
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Chirag D. Jhaveri
- Retina Research Center, Austin, Texas
- Dell Medical School, University of Texas, Austin
| | - Omar S. Punjabi
- Charlotte Eye, Ear, Nose & Throat Associates, Charlotte, North Carolina
| | | | | | | | | | | | - Jennifer K. Sun
- Joslin Diabetes Center, Beetham Eye Institute, Department of Ophthalmology, Harvard University, Boston, Massachusetts
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A critical review: Psychophysical assessments of diabetic retinopathy. Surv Ophthalmol 2020; 66:213-230. [PMID: 32866468 DOI: 10.1016/j.survophthal.2020.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 08/23/2020] [Accepted: 08/24/2020] [Indexed: 02/08/2023]
Abstract
Diabetic retinal disease remains a leading cause of vision loss despite currently available screening methods, ocular treatments, and efforts to control metabolic dysfunction. It is now understood that diabetes damages the entire retina and the cellular components of the neurovascular unit. Multiple studies have demonstrated impairment of various aspects of retinal function across the spectrum of retinopathy severity. Here we review these tests, the principles underlying their use, clinical data from multiple publications, the strengths and limitations of the studies, and prospects for their application to understand the pathophysiology of diabetic retinal disease and monitor its response to therapy. We focus on visual acuity, contrast sensitivity, color vision, visual field, and dark adaptation and their use to understand the pathophysiology of diabetic retinopathy and as potential endpoints for clinical trials.
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Amato A, Nadin F, Borghesan F, Cicinelli MV, Chatziralli I, Sadiq S, Mirza R, Bandello F. Widefield Optical Coherence Tomography Angiography in Diabetic Retinopathy. J Diabetes Res 2020; 2020:8855709. [PMID: 33299892 PMCID: PMC7707991 DOI: 10.1155/2020/8855709] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/06/2020] [Accepted: 11/07/2020] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To summarize the role of widefield optical coherence tomography angiography (WF-OCTA) in diabetic retinopathy (DR), extending from the acquisition strategies to the main clinical findings. METHODS A PubMed-based search was carried out using the terms "Diabetic retinopathy", "optical coherence tomography angiography", "widefield imaging", and "ultra-widefield imaging". All studies published in English up to August 2020 were reviewed. RESULTS WF-OCTA can be obtained with different approaches, offering advantages over traditional imaging in the study of nonperfusion areas (NPAs) and neovascularization (NV). Quantitative estimates and topographic distribution of NPA and NV are useful for treatment monitoring and artificial intelligence-based approaches. Curvature, segmentation, and motion artifacts should be assessed when using WF-OCTA. CONCLUSIONS WF-OCTA harbors interesting potential in DR because of its noninvasiveness and capability of objective metrics of retinal vasculature. Further studies will facilitate the migration from traditional imaging to WF-OCTA in both the research and clinical practice fields.
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Affiliation(s)
- Alessia Amato
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Nadin
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federico Borghesan
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Vittoria Cicinelli
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Irini Chatziralli
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | - Saena Sadiq
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Rukhsana Mirza
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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