Diabetic Macular Edema in Diabetological Practices

2020 ◽  
Vol 237 (11) ◽  
pp. 1320-1325
Author(s):  
Georg Michelson ◽  
Thomas Forst
Keyword(s):  
Macular Edema ◽  
Medical Device ◽  
Diabetic Macular Edema ◽  
Retinal Thickness ◽  
Anti Vegf ◽  
Patient File ◽  
Attending Physicians

AbstractUsing mobile OCT equipment and remote ophthalmological diagnosis of n = 1538 diabetics in 17 diabetes practices in Germany, we found diabetic macular edema in 10.1% of the patients and retinal bleedings or microaneurysms in 15.6%. In 1.62% of the diabetics examined, the size of the edema was > 0.4 mm², in 7% the retinal thickness was > 300 µm and thus in need of treatment. An intravitreal anti-VEGF injection was administered prior to the examination in only 10% of the patients with diabetic macular edema. By means of mobile tele-eye consultation and remote ophthalmological diagnosis using the cloud-based patient file certified as medical device IIa, patients with diabetic macular edema were identified and informed on site quickly and definitively. The data and images were made available to all attending physicians and ophthalmic surgeons.

scholarly journals Comparison of outcomes between intravitreal ranibizumab and intravitreal aflibercept for diabetic macular edema with “Treat-and-Extend” regimen

2020 ◽  
Author(s):  
Masahiko Sugimoto ◽  
Shinichiro Chujo ◽  
Taku Sasaki ◽  
Atsushi Ichio ◽  
Ryohei Miyata ◽  
...  
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Retinal Thickness ◽  
Intravitreal Ranibizumab ◽  
Treat And Extend ◽  
Corrected Visual Acuity ◽  
Anti Vegf ◽  
Intravitreal Aflibercept ◽  
Treatment Naïve ◽  
Treat And Extend Regimen

Abstract Background To compare the effectiveness of intravitreal ranibizumab (IVR) and intravitreal aflibercept (IVA) performed with the Treat-and-Extend (TAE) regimen on eyes with diabetic macular edema (DME).Patients and methods This was a retrospective study of 125 eyes of 125 treatment naïve DME patients who received anti-VEGF injections at 3 consecutive monthly intervals as the loading phase. Of these 125 eyes, 26 eyes completed the treatment with the TAE regimen for at least 24 months. Among the 26 eyes, 13 eyes of 13 patients (mean age, 70.9±6.0 years) received intravitreal injections of 0.5 mg ranibizumab and 13 eyes of 13 patients (65.9±8.6 years) received 2 mg aflibercept. The changes in the best-corrected visual acuity (BCVA), central retinal thickness (CRT), diabetic retinopathy severity (DRS), and total injection numbers were compared between the two anti-VEGF agents.Results No significant differences were detected in the baseline demographics. At 24 months, the BCVA was significantly improved in both groups; from 0.31±0.19 to 0.10±0.12 logMAR units for IVR and 0.41±0.19 to 0.16±0.28 logMAR units for IVA ( P=1.29x10 -9 ). The CRT was significantly reduced in both groups; 440.9±69.3 to 307.5±66.4 μm for IVR and 473.9±71.5 to 317.8±71.2 μm for IVA ( P=3.55x10 -9 ). No significant differences were detected in the improvements of the BCVA and the CRT in both groups, and the total injection numbers were significant fewer for the IVA group (11.0±1.2) than the IVR group (12.0±1.0). The DRS was significantly improved in both groups ( P =0.0004 for IVR and P =0.009 for IVA).Conclusion No significant differences were detected in the improvements of the BCVA or CRT and injection numbers between IVR and IVA groups treated with the TAE regimen. These results indicate that the results of the treatment with both agents with the TAE regimen were equally effective.

scholarly journals Switch to Aflibercept in Diabetic Macular Edema Patients Unresponsive to Previous Anti-VEGF Therapy

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Filipe Mira ◽  
Manuel Paulo ◽  
Filipe Henriques ◽  
João Figueira
Keyword(s):  
Visual Acuity ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Retrospective Review ◽  
Retinal Thickness ◽  
Central Retinal Thickness ◽  
Functional Improvement ◽  
Anti Vegf ◽  
The Mean

Purpose. The aim was to evaluate the efficacy of aflibercept in patients with diabetic macular edema (DME) unresponsive to prior anti-VEGF therapy. Methods. Retrospective review of DME unresponsive to previous anti-VEGF switched to aflibercept with 3 months of follow-up. Changes in best correct visual acuity (BCVA), central retinal thickness (CRT), and frequency of injections were analyzed. The percentage of subjects who had ≥20/40 (logMAR equivalent 0.3) and ≤20/200 (logMAR equivalent 1) was evaluated. Results. A total of 32 eyes from 26 patients were included. Mean age was 65 ± 10 years old. The mean number of previous anti-VEGF injections was 5.34 ± 2.38, and the mean number of aflibercept injections at the end of the study was 2.00 ± 0.00. The CRT at baseline was 501.47 ± 150.51 μm and 367.97 ± 124.61 μm at 3 months of follow-up (P<0.001). The logMAR BCVA at baseline was 0.71 ± 0.36 and 0.65 ± 0.33 at the end of the follow-up (P=0.037). At baseline, 12.5% of patients had ≥20/40 compared with 25% at the end of follow-up. At baseline, 28.13% of patients had 20/200 or inferior vision compared with 15.63% at the end of the follow-up. Conclusions. DME patients unresponsive to previous multiple ranibizumab injections demonstrate a significant anatomical and functional improvement with the switch to aflibercept.

scholarly journals Első tapasztalataink diabeteses maculopathia Navilas® 577s mikropulzuslézer-készülékkel történő kezelésével

2020 ◽  
Vol 161 (49) ◽  
pp. 2078-2085
Author(s):  
Mónika Ecsedy ◽  
Illés Kovács ◽  
Róbert Gergely ◽  
Katalin Gombos ◽  
Judit Meisel ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Retinal Thickness ◽  
Primary Treatment ◽  
Fundus Photography ◽  
Thickness Change ◽  
Anti Vegf ◽  
Number Of Injections

Összefoglaló. Bevezetés és célkitűzés: A Navilas® 577s mikropulzuslézerrel végzett kezelés biztonságosságának és hatásosságának vizsgálata diabeteses maculaoedemában. Módszer: Retrospektív vizsgálatunkba diabeteses maculaoedema miatt gondozott és legalább 6 hónapos utánkövetéssel rendelkező, korábban Navilas® 577s mikropulzuslézer-kezelésen átesett 28 beteg 46 szemét válogattuk be. Minden szemen optikaikoherencia-tomográfia (OCT) vastagsági térkép navigált, nonkontakt, küszöb alatti mikropulzuslézer-kezelés történt egy alkalommal. A kezelést megelőzően és az azt követő 6. hónapban rögzítettük a látóélesség, a centrális retinavastagság értékeit és az éreredetű endothelialis növekedési faktort (VEGF) gátló injekciók számát. A követési idő végén megvizsgáltuk a szemfenéki képnek a digitális fundusfotográfia és az átmetszeti OCT-képek segítségével észlelhető változásait. Eredmények: A vizsgált szemek közül 30 esetben a lézerkezelést korábbi centrális maculaoedema miatt VEGF-gátló injekciós kezelés előzte meg, míg 16 szem esetében primer lézerkezelés történt. A Navilas® 577s mikropulzuslézer-kezelést követően 6 hónappal sem a látóélesség, sem a centrális maculavastagság nem változott szignifikánsan egyik csoportban sem (p>0,05). Ugyanakkor a korábban injekciós kezelésben részesült szemek esetében a lézerkezelést megelőző 6 hónapban adott injekciók száma az átlagos 2,63 ± 1,18 értékről átlagosan 0,5 ± 0,73 értékre csökkent (p<0,001). A fundusfotókon és az átmetszeti OCT-scaneken a lézerkezelést követően egyetlen szem esetében sem találtunk látható pigmentelváltozásokat vagy hegesedést. Következetetés: Megfigyeléseink szerint a Navilas® 577s mikropulzuslézer-kezelés biztonságos a diabeteses maculaoedemás betegek kezelésében, továbbá a VEGF-gátlóval kezelt szemeken szerepet játszhat az injekciók számának csökkentésében. Orv Hetil. 2020; 161(49): 2078–2085. Summary. Introduction and objective: To assess the safety and efficacy of Navilas® 577s micropulse subthreshold laser in the treatment of non-center involved diabetic macular edema. Method: In this retrospective study, we included 46 eyes of 28 patients with diabetic macular edema, who were treated at least 6 months ago with Navilas® 577s micropulse laser. Laser treatment was navigated by optical coherence tomography (OCT) macular thickness map in subthreshold micropulse mode at one occasion. Data from visual acuity testing, retinal thickness, and the number of anti-vascular endothelial growth factor (VEGF) injections needed 6 months before and after treatment were registered. At the end of the follow-up, digital fundus photography and OCT radial scans were performed to evaluate any possible anatomical changes. Results: 30 eyes had previous anti-VEGF treatment for central macular edema, and in 16 eyes we performed the laser as primary treatment. At the end of the follow-up, no significant visual acuity or central retinal thickness change were observed (p>0.05). On the other hand, in the anti-VEGF pretreated group the number of injections decreased significantly from 2.63 ± 1.18 to 0.5 ± 0.73 (p<0.001). We did not find any pigmentary changes or visible signs of scaring on final fundus photography pictures or OCT radial scans. Conclusion: Navilas® 577s subthreshold microsecond laser proved to be a safe option in the treatment of diabetic macular edema. It can be very useful in anti-VEGF treated eyes by decreasing the number of injections needed. Orv Hetil. 2020; 161(49): 2078–2085.

Efficacy and safety of vitamin supplements with resveratrol in diabetic macular edema: Long-term results of a comparative study

2021 ◽  
pp. 112067212110576
Author(s):  
Irini Chatziralli ◽  
Eleni Dimitriou ◽  
Alexandros Chatzirallis ◽  
Evaggelia Aissopou ◽  
Dimitrios Kazantzis ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Retinal Thickness ◽  
Efficacy And Safety ◽  
Vitamin Supplements ◽  
Anti Vegf ◽  
Group I ◽  
The Mean ◽  
Group Ii

Purpose To investigate the adjunct efficacy and safety of vitamin supplements, including resveratrol, in patients with diabetic macular edema (DME) treated with intravitreal anti-vascular endothelial factor (anti-VEGF) agents. Methods Participants in this prospective study were 45 patients with DME, who were treated with either intravitreal anti-VEGF injections (n = 23, Group I) or with combination of intravitreal anti-VEGF injections and vitamin supplements, including resveratrol (n = 22, Group II). All patients underwent visual acuity measurement, slit-lamp examination and spectral domain-optical coherence tomography (SD-OCT) at baseline and monthly after the loading phase of three-monthly anti-VEGF injections, following a PRN protocol. Results There was a statistically significant improvement in visual acuity in both groups at month 12 compared to baseline, although the mean change in visual acuity did not differ between the two groups (p = 0.183). Accordingly, there was a statistically significant decrease in central retinal thickness in both groups at month 12 compared to baseline, while the mean difference in central retinal thickness was significantly greater in the “combination” group. The mean number of intravitreal anti-VEGF injection was less in Group II (6.45 ± 1.12 in Group II vs. 7.39 ± 1.31 in Group I, p = 0.018). Conclusions Vitamin supplements with resveratrol was found to be an effective adjunct to intravitreal anti-VEGF injections in patients with DME, offering better anatomic restoration with less injections at the 12-month follow-up.

scholarly journals Vitreomacular interface after anti-VEGF injections in diabetic macular edema

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Carlos E. Veloso ◽  
Daniel N. Brocchi ◽  
Rishi P. Singh ◽  
Márcio B. Nehemy
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Retinal Thickness ◽  
Short Term ◽  
Vitreomacular Adhesion ◽  
Corrected Visual Acuity ◽  
Anti Vegf ◽  
Vitreomacular Interface ◽  
The Mean

Abstract Background The purpose of this study was to evaluate the incidence of vitreomacular adhesion (VMA) release after anti-VEGF therapy for the treatment of diabetic macular edema (DME) and to evaluate further changes in outcome. Methods This was a retrospective study that enrolled 66 eyes of 66 patients with DME who presented with VMA diagnosed by spectral-domain optical coherence tomography (OCT) at baseline. VMA was classified as focal (attachment: ≤ 1500 μm) or broad (attachment: > 1500 μm). All patients received at least three monthly intravitreal injections of an anti-VEGF agent. Follow-up visits were performed 1 month after each injection to evaluate the incidence of VMA release. Results The mean patient age was 61.4 years (range: 29 to 78 years), and 72.7 % were male. The mean best-corrected visual acuity was 0.62 logMAR, and the mean central retinal thickness (CRT) was 473 μm at baseline. The mean length of follow-up was 18.5 months, and the mean number of injections was 5.8. The intravitreal drugs used were aflibercept (40.9 %), ranibizumab (37.9 %) and bevacizumab (21.2 %). Forty-seven eyes had broad VMA, and 19 had focal VMA. Twenty-two eyes (33.3 %) developed VMA release following a mean of 5.7 injections (range: 3–13). Sixteen eyes (72.7 %) with focal VMA and 6 eyes (27.3 %) with broad VMA at baseline developed VMA release. Twenty-one eyes that developed VMA release showed an improvement in CRT following VMA release (mean: -106 μm; range: 22 to 289 μm). Conclusions VMA release occurs in approximately 1/3 of patients with DME following anti-VEGF therapy. Most of them show a short-term decrease in CRT.

Study of the effectiveness of antiangiogenic therapy for diabetic macular edema in avitreal eyes in real clinical practice

2021 ◽  
pp. 284-288
Author(s):  
K. A. Ahmed ◽  
◽  
T.N. Semenova ◽  
I.B. Soloveichik ◽  
D.G. Arsyutov ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Clinical Practice ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Retinal Thickness ◽  
Antiangiogenic Therapy ◽  
Corrected Visual Acuity ◽  
Anti Vegf ◽  
Real Clinical Practice ◽  
Best Corrected Visual Acuity

Despite the vitrectomy performed for diabetic macular edema (DME), some patients still have symptoms of the disease due to overproduction of VEGF by the ischemic retina, which requires regular administration of an antiangiogenic drug. Studies of the pharmacokinetics of antiangiogenic drugs after vitrectomy in humans have not been carried out. Data from the DRCR.net (Post-Hawk Protocol I) study and real-life clinical practice studies show similar results for anti-VEGF DMO therapy in vitreous eyes and after vitrectomy (2, 7). Purpose. To assess the effectiveness of antiangiogenic therapy with aflibercept for DMO in avitreal eyes in real clinical practice. Methods. The initial and after vitrectomy best corrected visual acuity (BCVA) and central retinal thickness (CRT) were determined according to OCT data, then these parameters were monitored by 1, 3, 6 and 12 months after the start of antiangiogenic therapy with aflibercept. 14 patients (14 eyes) with persistent DME underwent vitrectomy with removal of the internal limiting membrane, in 5 of them the epiretinal fibrosis was removed and 3 of them with a traction retinal detachment that was also removed with air tamponade. Results. Aflibercept intravitreal injections were started with 5 loading doses by 1-11 months after vitrectomy. On average, after 12 months, patients received 7.2 injections, while there was no need for laser surgery of the macular zone. By the end of the study, the CRT decreased by 255 ±86 µm, the BCVA was 0.35 ± 0.2 in comparison with the initial 0.07±0.03 (on a decimal scale). Conclusions. The effectiveness of the anti-VEGF therapy with aflibercept for DME in avitreal eyes was confirmed by an increase in functional (BCVA) and normalization of morphological (CRT on OCT) parameters after the first injections during the period of loading doses. Previous vitrectomies in patients with DMO do not affect the long-term favorable clinical outcomes of anti-VEGF therapy with aflibercept. Key words: vitrectomy, diabetic macular edema, aflibercept, anti-VEGF, OCT, best corrected visual acuity, central retinal thickness.

Change in Visual Acuity in Relation to Central Macular Thickness after Intravitreal Bevacizumab in Diabetic Macular Edema

2020 ◽  
Vol 36 (3) ◽  
Author(s):  
Muhammad Ali Haider ◽  
Uzma Sattar ◽  
Syeda Rushda Zaidi
Keyword(s):  
Visual Acuity ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Intravitreal Bevacizumab ◽  
Macular Thickness ◽  
Rank Test ◽  
P Value ◽  
Central Macular Thickness ◽  
Anti Vegf ◽  
Quasi Experimental

Purpose: To evaluate the change in visual acuity in relation to decrease in central macular thickness,after a single dose of intravitreal Bevacizumab injection.Study Design: Quasi experimental study.Place and Duration of Study: Punjab Rangers Teaching Hospital, Lahore, from January 2019 to June 2019.Material and Methods: 70 eyes with diabetic macular edema were included in the study. Patients having high refractive errors (spherical equivalent of > ± 7.5D) and visual acuity worse than +1.2 or better than +0.2 on log MAR were excluded. Central macular edema was measured in μm on OCT and visual acuity was documentedusing Log MAR chart. These values were documented before and at 01 month after injection with intravitrealBevacizumab. Wilcoxon Signed rank test was used to evaluate the difference in VA beforeand after the anti-VEGF injection. Difference in visual acuity and macular edema (central) was observed,analyzed and represented in p value. P value was considered statistically significant if it was less than 0.01%.Results: Mean age of patients was 52.61 ± 1.3. Vision improved from 0.90 ± 0.02 to 0.84 ± 0.02 on log MARchart. The change was statistically significant with p value < 0.001. Central macular thickness reduced from 328 ±14 to 283 ± 10.6 μm on OCT after intravitreal anti-VEGF, with significant p value < 0.001.Conclusion: A 45 μm reduction in central macular thickness was associated with 0.1 Log MAR unit improvementin visual acuity after intravitreal Bevacizumab in diabetic macular edema.

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