Regression of iris neovascularisation secondary to diabetic retinopathy with subconjunctival anti-VEGF therapy

Purpose: This work aims to investigate real-world treatment patterns and outcomes in eyes with branch retinal vein occlusion in the antivascular endothelial growth factor (anti-VEGF) era. Methods: A retrospective, nonrandomized, comparative study was conducted on eyes diagnosed with branch retinal vein occlusion at a single tertiary center between 2009 and 2017. Medical history, treatment patterns, and visual acuity outcomes were examined. Subanalysis was performed for eyes that met the eligibility criteria for the BRAVO (Ranibizumab for the Treatment of Macular Edema Following Branch Retinal Vein Occlusion) trial. Results: A total of 315 eyes were included, of which 244 were treatment naive. In all eyes, the most common first treatment was the following: intravitreal bevacizumab (38.4%), aflibercept (15.1%), ranibizumab (8.1%), sectoral scatter laser (6.2%), and triamcinolone (3.1%). At 1 year, treatment-naive eyes had received an average of 2.43 anti-VEGF injections. During follow-up, treatment-naive eyes gained an average of 0.21 Early Treatment Diabetic Retinopathy Study lines. Forty eyes that met BRAVO trial criteria received an average of 5.05 anti-VEGF injections in the first year and gained an average of 1.83 Early Treatment Diabetic Retinopathy Study lines. Conclusions: This real-world cohort received fewer anti-VEGF injections at year 1 and experienced less improvement in visual acuity during the course of treatment than clinical trial participants. Trial-eligible patients received more injections and had greater visual gains than those who would not have been eligible for the trial.

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Rho-Kinase Inhibitors for the Treatment of Refractory Diabetic Macular Oedema

Cells ◽

10.3390/cells10071683 ◽

2021 ◽

Vol 10 (7) ◽

pp. 1683

Author(s):

Milagros Mateos-Olivares ◽

Luis García-Onrubia ◽

Fco. Javier Valentín-Bravo ◽

Rogelio González-Sarmiento ◽

Maribel Lopez-Galvez ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Macular Oedema ◽

Standard Therapy ◽

Vision Loss ◽

Therapeutic Potential ◽

Rho Kinase ◽

Diabetic Macular Oedema ◽

New Drugs ◽

Anti Vegf

Diabetic macular oedema (DMO) is one of the leading causes of vision loss associated with diabetic retinopathy (DR). New insights in managing this condition have changed the paradigm in its treatment, with intravitreal injections of antivascular endothelial growth factor (anti-VEGF) having become the standard therapy for DMO worldwide. However, there is no single standard therapy for all patients DMO refractory to anti-VEGF treatment; thus, further investigation is still needed. The key obstacles in developing suitable therapeutics for refractory DMO lie in its complex pathophysiology; therefore, there is an opportunity for further improvements in the progress and applications of new drugs. Previous studies have indicated that Rho-associated kinase (Rho-kinase/ROCK) is an essential molecule in the pathogenesis of DMO. This is why the Rho/ROCK signalling pathway has been proposed as a possible target for new treatments. The present review focuses on the recent progress on the possible role of ROCK and its therapeutic potential in DMO. A systematic literature search was performed, covering the years 1991 to 2021, using the following keywords: “rho-Associated Kinas-es”, “Diabetic Retinopathy”, “Macular Edema”, “Ripasudil”, “Fasudil” and “Netarsudil”. Better insight into the pathological role of Rho-kinase/ROCK may lead to the development of new strategies for refractory DMO treatment and prevention.

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Situational analysis of diabetic retinopathy treatment Services in Ghana

BMC Health Services Research ◽

10.1186/s12913-021-06608-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Agatha Mensah-Debrah ◽

Kwesi Nyan Amissah Arthur ◽

David Ben Kumah ◽

Kwadwo Owusu Akuffo ◽

Isaiah Osei Duah ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Vitreoretinal Surgery ◽

Health Facilities ◽

Service Utilisation ◽

Eye Care ◽

Treatment Service ◽

Treatment Services ◽

Disadvantaged Population ◽

Anti Vegf ◽

Geographical Regions

Abstract Background Although the equitable distribution of diabetic retinopathy (DR) services across Ghana remains paramount, there is currently a poor understanding of nationwide DR treatment services. This study aims to conduct a situation analysis of DR treatment services in Ghana and provide evidence on the breadth, coverage, workload, and gaps in service delivery for DR treatment. Methods A cross-sectional study was designed to identify health facilities which treat DR in Ghana from June 2018 to August 2018. Data were obtained from the facilities using a semi-structured questionnaire which included questions identifying human resources involved in DR treatment, location of health facilities with laser, vitreoretinal surgery and Anti–vascular endothelial growth factor therapy (Anti-VEGF) for DR treatment, service utilisation and workload at these facilities, and the average price of DR treatment in these facilities. Results Fourteen facilities offer DR treatment in Ghana; four in the public sector, seven in the private sector and three in the Christian Health Association of Ghana (CHAG) centres. There was a huge disparity in the distribution of facilities offering DR services, the eye care cadre, workload, and DR treatment service (retinal laser, Anti-VEGF, and vitreoretinal surgery). The retinal laser treatment price was independent of all variables (facility type, settings, regions, and National Health Insurance Scheme coverage). However, settings (p = 0.028) and geographical regions (p = 0.010) were significantly associated with anti-VEGF treatment price per eye. Conclusion Our results suggest a disproportionate distribution of DR services in Ghana. Hence, there should be a strategic development and implementation of an eye care plan to ensure the widespread provision of DR services to the disadvantaged population as we aim towards a disadvantaged population as we aim towards a universal health coverage.

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Intravitreal Anti-Vascular Endothelial Growth Factor Agents for the Treatment of Diabetic Retinopathy: A Review of the Literature

Pharmaceutics ◽

10.3390/pharmaceutics13081137 ◽

2021 ◽

Vol 13 (8) ◽

pp. 1137

Author(s):

Irini Chatziralli ◽

Anat Loewenstein

Keyword(s):

Diabetic Retinopathy ◽

Vitreous Hemorrhage ◽

Fundus Photography ◽

Panretinal Photocoagulation ◽

Wide Field ◽

Vascular Endothelial ◽

Keywords Diabetic Retinopathy ◽

Anti Vegf ◽

The Impact

Background: Diabetic retinopathy (DR) is the leading cause of blindness in the working-age population. The purpose of this review is to gather the existing literature regarding the use of the approved anti-vascular endothelial growth (anti-VEGF) agents in the treatment of DR. Methods: A comprehensive literature review in PubMed engine search was performed for articles written in English language up to 1 July 2021, using the keywords “diabetic retinopathy”, “ranibizumab”, “aflibercept”, and “anti-VEGF”. Emphasis was given on pivotal trials and recent robust studies. Results: Intravitreal anti-VEGF agents have been found to significantly improve visual acuity and reduce retinal thickness in patients with diabetic macular edema (DME) in a long-term follow-up ranging from 1 to 5 years and are considered the standard-of-care in such patients. Regarding DR, intravitreal anti-VEGF agents provided ≥2-step improvement in DR severity on color fundus photography in about 30–35% of patients with NPDR at baseline, in the majority of clinical trials originally designed to evaluate the efficacy of intravitreal anti-VEGF agents in patients with DME. Protocol S and CLARITY study have firstly reported that intravitreal anti-VEGF agents are non-inferior to panretinal photocoagulation (PRP) in patients with proliferative DR (PDR). However, the use of new imaging modalities, such as optical coherence tomography-angiography and wide-field fluorescein angiography, reveals conflicting results about the impact of anti-VEGF agents on the regression of retinal non-perfusion in patients with DR. Furthermore, one should consider the high “loss to follow-up” rate and its devastating consequences especially in patients with PDR, when deciding to treat the latter with intravitreal anti-VEGF agents alone compared to PRP. In patients with PDR, combination of treatment of intravitreal anti-VEGF agents and PRP has been also supported. Moreover, in the specific case of vitreous hemorrhage or tractional retinal detachment as complications of PDR, intravitreal anti-VEGF agents have been found to be beneficial as an adjunct to pars plana vitrectomy (PPV), most commonly given 3–7 days before PPV, offering reduction in the recurrence of vitreous hemorrhage. Conclusions: There is no general consensus regarding the use of intravitreal anti-VEGF agents in patients with DR. Although anti-VEGF agents are the gold standard in the treatment of DME and seem to improve DR severity, challenges in their use exist and should be taken into account in the decision of treatment, based on an individualized approach.

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Clinical analysis and efficacy of bimanual surgical treatment of retinal detachment in severe forms of proliferative diabetic retinopathy with preoperative preparation with anti-VEGF drugs in combination with the use of the Ngenuity ALCON 3D imaging system

Modern technologies in ophtalmology ◽

10.25276/2312-4911-2021-3-195-198 ◽

2021 ◽

pp. 195-198

Author(s):

D.V. Chernykh ◽

Keyword(s):

Visual Acuity ◽

Diabetic Retinopathy ◽

Surgical Treatment ◽

Retinal Detachment ◽

Postoperative Period ◽

3D Imaging ◽

Imaging System ◽

3D Visualization ◽

Preoperative Preparation ◽

Anti Vegf

The purpose of the study was to evaluate the effectiveness of bimanual surgery with anti-VEGF preparation of patients with severe forms of PDR complicated by traction retinal detachment, with intraoperative use of 3D visualization. Material and methods. Operated on 18 patients with a diagnosis of PDR complicated by traction retinal detachment. Of these, there were 7 patients with type 1 diabetes, type 2 diabetes. There were 5 men and 13 women. The average age was 58 + -2 years. All patients underwent a three-port vitrectomy, using an additional light source, with preoperative preparation with anti-VEGF drugs, using bimanual technique and 3D visualization, using air tamponade. Results and its discussion. As a result of the study, it was found that the visual acuity before the treatment was 0.03 [0.01; 0.1], and 4-6 months after the surgical treatment, 0.3 [0.15; 0.5]. The performed statistical analysis made it possible to establish a statistically significant increase in visual acuity 4-6 months after the treatment. (p = 0.001) Achieved complete anatomical retinal fit. With increased visual acuity. There were 5 complications in the postoperative period. Recurrent hemophthalmos was diagnosed in 3 people, which required repeated surgical intervention. In 2 patients in the postoperative period, DMO developed, which required IVI biodegradable dexamethasone implant. Conclusion. Bimanual, surgical treatment of traction retinal detachments, in severe forms of PDLP, with preoperative preparation with anti-VEGF drugs, and the use of the Ngenuity ALCON 3D imaging system, is one of the effective methods of treatment in this group of patients, and is aimed at reducing both intra and postoperative complications. Key words: рroliferative diabetic retinopathy, vitrectomy, 3D imaging, bimanual surgery, anti-VEGF drugs.

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