Investigation of oxygen saturation under Aflibercept therapy in various forms of diabetic retinopathy with diabetic macular edema

Diabetic macular edema (DME) is the leading cause of blindness in patients with diabetic retinopathy worldwide. Therapeutic alternatives now include focal/grid laser photocoagulation, vitreoretinal surgery, and intraocular injection of anti-angiogenic and steroid molecules. In patients with recalcitrant DME, especially in those cases when anti-vascular endothelial growth factor (VEGF) agents are contraindicated or a treatment regimen with fewer intravitreal injections is required, intravitreal administration of steroids represents a fundamental alternative. Three intravitreal corticosteroid options for DME treatment are currently available including the dexamethasone delivery system, the fluocinolone acetonide insert, and off-label intravitreal triamcinolone acetonide. All of these drugs are associated with the risk of cataract progression and intraocular pressure elevation. In patients unresponsive to anti-VEGF therapy, pseudophakic, at low risk for glaucoma, or who have significant cardiovascular risk, treatment with long-lasting intraocular steroids is suggested.

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Systemic and Genetic Risk Factors in Diabetic Retinopathy and Diabetic Macular Edema

Güncel Retina Dergisi (Current Retina Journal) ◽

10.37783/crj-0077 ◽

2018 ◽

pp. 102-107

Keyword(s):

Risk Factors ◽

Diabetic Retinopathy ◽

Macular Edema ◽

Diabetic Macular Edema ◽

Systemic Risk ◽

Genetic Effect ◽

Current Treatment ◽

Genetic Studies ◽

Patient Subgroups ◽

Systemic Risk Factors

Diabetic retinopathy (DR) is an increasingly common health problem in our country as it is all over the world. DR is a leading cause of loss of vision patients at a productive age. Current treatment of diabetic macular edema (DME) is distressing, expensive, and not suitable for some patient subgroups. For this reason, the development and progression of DR and DME are affected by many systemic risk factors. It is important to increase the understanding of these responsible risk factors and develop preventive strategies. However, the presence of systemic risk factors is inadequate to predict the progression of the disease on an individual basis. It indicates the presence of a genetic effect. In this review, we have summarized the known systemic risk factors as well as the genetic basis of the disease under the light of genetic studies.

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Imaging and Biomarkers in Diabetic Macular Edema and Diabetic Retinopathy

Current Diabetes Reports ◽

10.1007/s11892-019-1226-2 ◽

2019 ◽

Vol 19 (10) ◽

Cited By ~ 7

Author(s):

Changyow C. Kwan ◽

Amani A. Fawzi

Keyword(s):

Diabetic Retinopathy ◽

Macular Edema ◽

Diabetic Macular Edema

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Natural history of diabetic macular edema and factors predicting outcomes in sham-treated patients (MEAD study)

Graefe s Archive for Clinical and Experimental Ophthalmology ◽

10.1007/s00417-019-04464-2 ◽

2019 ◽

Vol 257 (12) ◽

pp. 2639-2653

Author(s):

Young Hee Yoon ◽

◽

David S. Boyer ◽

Raj K. Maturi ◽

Francesco Bandello ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Natural History ◽

Macular Edema ◽

Diabetic Macular Edema ◽

Linear Regression Analysis ◽

Multiple Linear Regression Analysis ◽

Older Age ◽

Antihypertensive Medications ◽

Good Glycemic Control ◽

History Of

Abstract Purpose To describe the natural history of diabetic macular edema (DME) with respect to best-corrected visual acuity (BCVA) and central retinal thickness (CRT) outcomes and to identify baseline patient characteristics and systemic factors associated with improvement or worsening of outcomes in sham-treated patients. Methods The study population was sham-treated patients (n = 350) in the 3-year MEAD registration study of dexamethasone intravitreal implant for treatment of DME. Patients had center-involved DME and received sham intravitreal injections in the study eye at ≥ 6-month intervals. Potential prognostic factors for outcomes were evaluated using multiple linear regression analysis. Results Visual and anatomic outcomes were poorer in patients who left the study early (n = 198) than in study completers (n = 152). Mean change in BCVA from baseline at the last visit with available data was + 0.9 letters; 37.5% of patients had no change in BCVA, 23.2% had gained > 10 letters, and 16.0% had lost > 10 letters. Older age and baseline diabetic retinopathy score > 6 were associated with worse BCVA outcomes; thicker baseline CRT and larger number of hypertension medications used were associated with larger reductions in CRT during the study. Conclusions BCVA and CRT outcomes were variable in this population of DME patients with generally good glycemic control. In DME patients without active treatment, older age and baseline diabetic retinopathy score > 6 were associated with less improvement in BCVA; thicker baseline CRT and a larger number of antihypertensive medications used predicted better improvement in CRT. Trial registration The MEAD study trials are registered at ClinicalTrials.gov with the identifiers NCT00168337 and NCT00168389.

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