A Randomized, Dose-Escalation Study of Subconjunctival and Intravitreal Injections of Sirolimus in Patients with Diabetic Macular Edema

Ophthalmology ◽  
2012 ◽  
Vol 119 (1) ◽  
pp. 124-131 ◽  
Author(s):  
Pravin U. Dugel ◽  
Mark S. Blumenkranz ◽  
Julia A. Haller ◽  
George A. Williams ◽  
Wayne A. Solley ◽  
...  
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Dose Escalation ◽  
Intravitreal Injections ◽  
Dose Escalation Study

scholarly journals Phase 1 Dose-Escalation Study of Plasma Kallikrein Inhibitor THR-149 for the Treatment of Diabetic Macular Edema

2021 ◽  
Vol 10 (14) ◽  
pp. 28
Author(s):  
Pravin U. Dugel ◽  
Arshad M. Khanani ◽  
Brian B. Berger ◽  
Sunil Patel ◽  
Mitchell Fineman ◽  
...  
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Dose Escalation ◽  
Phase 1 ◽  
Plasma Kallikrein ◽  
Dose Escalation Study ◽  
Kallikrein Inhibitor

Surgical Therapy in Diabetic Macular Edema and Diabetic Intravitreal Hemorrhage

2018 ◽  
pp. 194-201
Keyword(s):  
Risk Factors ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Surgical Therapy ◽  
Current Literature ◽  
Preventive Measures ◽  
Timing Of Surgery ◽  
Intravitreal Injections ◽  
Complications Of Diabetes

Diabetic macular edema and diabetic intravitreal hemorrhage are frequent complications of diabetes. In selected cases of diabetic macular edema which is primarily treated with intravitreal injections, surgery may be performed. In this review, the role of surgery in diabetic macular edema will be discussed in light of the current literature. Moreover, changes in the timing of surgery in diabetic intravitreal hemorrhage since DRVS and risk factors and the efficacy of preventive measures for post vitrectomy intravitreal hemorrhage will be discussed.

scholarly journals Intravitreal injections of bevacizumab plus methotrexate versus bevacizumab alone for the treatment of diabetic macular edema: A randomized, sham-controlled trial

2020 ◽  
Vol 32 (2) ◽  
pp. 164
Author(s):  
Behrooz Oliya ◽  
Farhad Fazel ◽  
Majid Mirmohammadkhani ◽  
Mohammadreza Fazel ◽  
Ghasem Yadegarfar ◽  
...  
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Controlled Trial ◽  
Intravitreal Injections

The effect of recurrent povidone-iodine usage on conjunctival flora in diabetic patients undergoing intravitreal injections

2020 ◽  
pp. 112067212090203
Author(s):  
Adi Einan-Lifshitz ◽  
Nir Sorkin ◽  
Gill Smollan ◽  
Irit Barequet
Keyword(s):  
Macular Edema ◽  
Intravitreal Injection ◽  
Diabetic Macular Edema ◽  
Povidone Iodine ◽  
Intravitreal Injections ◽  
Diabetic Patients ◽  
The Third ◽  
Conjunctival Flora ◽  
The Mean ◽  
First Time

Purpose: The purpose was to evaluate the change in the microbiological profile of diabetic patients undergoing intravitreal injections for diabetic macular edema. Methods: Patients were included in this prospective study when referred for the first time for intravitreal injection to treat diabetic macular edema. For each patient, conjunctival cultures were taken from the lower fornix of each eye prior to the povidone-iodine application and the intravitreal injection. An additional culture was taken from the treated eye 20 min after the injection. The same culture protocol was used for the two following injections of these patients. A later conjunctival culture was also taken a month after the last injection. Results: Twenty-one eyes of 21 patients were included. The mean duration of diabetes was 13.7 ± 7.9 years. Prior to the first intravitreal injection, 33% of cultures were positive. Prior to the third intravitreal injection, 26% of cultures were positive ( p = 0.63), and 1 month after the last injection, 18% of cultures were positive ( p = 0.495). The mean HbA1C was 8.1% ± 1.7%. HbA1C of patients with positive cultures was 8.0% ± 1.1% at the first intravitreal injection and 8.2% ± 1.0% at the third intravitreal injection. This was compared with HBA1C in eyes with negative cultures: 7.4% ± 1.2% ( p = 0.45) and 7.1% ± 1.0% ( p = 0.14), respectively. Conclusion: Repeated intravitreal injection for diabetic macular edema with application of povidone-iodine 5% in diabetic patients did not lead to a significant change in the percentage of positive conjunctival cultures. Patients with higher HbA1C had a slight, non-statistically significant trend for positive cultures.

scholarly journals Hypertensive cerebral hemorrhage with undetectable plasma vascular endothelial growth factor levels in a patient receiving intravitreal injection of aflibercept for bilateral diabetic macular edema: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Miwako Yoshimoto ◽  
Nobuhiko Takeda ◽  
Takayuki Yoshimoto ◽  
Shun Matsumoto
Keyword(s):  
Blood Pressure ◽  
Vascular Endothelial Growth Factor ◽  
Growth Factor ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Cerebral Hemorrhage ◽  
Intravitreal Injections ◽  
Vascular Endothelial ◽  
Factor Level ◽  
Endothelial Growth Factor

Abstract Background Intravitreal injections of anti-vascular endothelial growth factor are commonly used to treat macular diseases, including diabetic macular edema. Anti-vascular endothelial growth factor drugs can enter the systemic circulation after intravitreal injections and appear to suppress circulating vascular endothelial growth factor levels. However, whether this can cause any systemic adverse events remains unknown. Case presentation A 70-year-old Japanese man diagnosed with diabetic macular edema in both eyes was treated with anti-vascular endothelial growth factor intravitreal injections. One month after receiving two intravitreal injections of aflibercept 1 week apart for diabetic macular edema in both eyes, he complained of a severe acute headache. The patient was diagnosed with hypertensive cerebral hemorrhage of the occipital lobe based on an elevated blood pressure of 195/108 mmHg and the results of computed tomography and magnetic resonance imaging of his brain. The patient was treated with an intravenous injection of nicardipine hydrochloride to lower his systemic blood pressure. Two days after the stroke, the patient began oral treatment with 80 mg/day telmisartan, which was continued for 3 days, and the telmisartan dose was reduced to 40 mg/day thereafter. His blood pressure promptly dropped to 130/80 mmHg, and his severe headache disappeared. One year after the cerebrovascular stroke, the telmisartan was discontinued because his blood pressure stabilized at a normal level. His plasma vascular endothelial growth factor levels were measured via specific enzyme-linked immunosorbent assay before and after the intravitreal injections of aflibercept. Immediately before the injections, the vascular endothelial growth factor level was 28 pg/ml, but it rapidly fell below the detection limit within 1 week, where it remained for over 2 months. Two days before the cerebral hemorrhage, his plasma vascular endothelial growth factor level was below the detection limit, and 2 months later after the stroke, his plasma vascular endothelial growth factor level recovered to 41 pg/ml. Conclusion This case suggests that hypertension and resultant cerebral hemorrhage can occur in patients with diabetic macular edema when plasma vascular endothelial growth factor levels are systemically decreased below the detection limit for a prolonged time after local injections of anti-vascular endothelial growth factor agents into the vitreous cavity. Therefore, severely reduced plasma vascular endothelial growth factor levels could be a higher risk factor to develop generally infrequent stroke. Ophthalmologists should be aware of possible severe reduction of plasma vascular endothelial growth factor levels and resultant increase in blood pressure after intravitreal injections of an anti-vascular endothelial growth factor drug. If the plasma vascular endothelial growth factor levels could be monitored more easily and quickly during the treatment, it would help to prevent adverse events.

INTRAVITREAL INJECTIONS OF ZIV-AFLIBERCEPT FOR DIABETIC MACULAR EDEMA

Retina ◽  
2016 ◽  
Vol 36 (9) ◽  
pp. 1640-1645 ◽  
Author(s):  
Gabriel Costa de Andrade ◽  
João Rafael de Oliveira Dias ◽  
André Maia ◽  
Michel Eid Farah ◽  
Carsten H. Meyer ◽  
...  
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Intravitreal Injections

scholarly journals Large-cube 30° × 25° optical coherence tomography in diabetic macular edema

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Amir Mahdjoubi ◽  
Youcef Bousnina ◽  
Fatma-Samia Bendib ◽  
Faiza Bensmaine ◽  
Wafa Idlefqih ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Diabetic Retinopathy ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Strong Association ◽  
Intravitreal Injections ◽  
Binary Logistic Regression Analysis ◽  
Optical Coherence ◽  
Retinal Edema ◽  
Baseline Visit

Abstract Background To evaluate the contribution of large-cube 30° × 25° optical coherence tomography (OCT) in the characterization of diabetic macular edema (DME) by assessing its extent and the presence of additional retinal edemas and to evaluate the factors that influenced their occurrence. Methods This retrospective study enrolled patients with diabetes who presented with retinal edema detected by horizontal large-cube 30° × 25° (8.7 × 7.3 mm) OCT. Two individualized areas were selected from the thickness map: the area within the 6-mm Early Treatment of Diabetic Retinopathy Study (ETDRS) grid, and that outside the ETDRS grid. Retinal edemas located within the ETDRS grid were designated as “main DME” and those located outside the ETDRS grid were designated as “peripheral retinal edemas.” For each area, OCT features were assessed while the extent of the main DME and the presence of peripheral retinal oedema were analysed in the area outside the ETDRS grid. Finally, part of included eyes was followed by the same protocol, of which a part benefited from intravitreal injections. Results Peripheral events were detected outside the ETDRS area in 279 eyes (74.4%) of the 375 eyes of the 218 patients included in this study: an extension of the main DME outside ETDRS grid in 177 eyes (47.2%) and/or the presence of peripheral retinal edemas in 207 eyes (55.2%). The analysis of associations between main DME and peripheral retinal edemas patterns did not find an association for retinal cyst localization (P = 0.42) while a week association was found fort cyst size (Cramer’s V = 0.188, p = 0.028). Nevertheless, a moderate association was found for the presence of microaneurysms (Cramer’s V = 0.247, p < 0.001) and strong association for hard exudates (Cramer’s V = 0.386, p < 0.001), The binary logistic regression analysis retained the following influencing factors of the occurrence of peripheral events: advanced DR stage (Odds ratio OR = 2.19, p = 0.03), diffuse DME (OR = 7.76, p < 0.001) and its location in outer fields (OR = 7.09, p = 0.006). Likewise, the extension of the main DME outside the ETDRS area in was influenced by the same factors in addition to CMT (OR = 0.98, p = 0.004) while the presence of peripheral retinal edema was influenced by the same factors except the outer location of the Main DME. Finally, from the 94 eyes treated by intravitreal injections, extension of the main DME outside the ETDRS grid was detected in 54 eyes (56.44%) at baseline visit and still remained detectable in 37 eyes (39.36%) after treatment initiation. Conclusions Large-cube 30° × 25° OCT allowed for more precise assessment of DME extension and better detection of retinal thickening mainly in the advanced stages of diabetic retinopathy with significant DME whether at the baseline visit or during follow-up. The combination of this protocol with a wider ETDRS grid would enhance DME detection and topography.

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