scholarly journals Role of hyper-reflective spots in predicting outcomes of intravitreal therapy in diabetic macular edema: A systematic review and meta-analysis

2021 ◽  
Author(s):  
Pratyusha Ganne ◽  
Nagesha C Krishnappa ◽  
Ganne Chaitanya ◽  
Siddharth K Karthikeyan
Keyword(s):  
Systematic Review ◽  
Macular Edema ◽  
Publication Bias ◽  
Diabetic Macular Edema ◽  
Meta Analysis ◽  
Rank Correlation ◽  
Visual Outcome ◽  
Intravitreal Therapy ◽  
Anti Vegf

Purpose: Predicting response to intravitreal therapy in DME has become a challenging task. Individual studies have shown that HRS could be a reliable biomarker. This systematic review aimed to determine if there was a quantitative reduction in hyperreflective spots (HRS) following intravitreal therapy in diabetic macular edema (DME), if the type of intravitreal therapy (anti-VEGF versus steroid) had differential effects on quantitative HRS change and finally, if HRS at the start of therapy was associated with improvement in visual acuity (VA) or reduction in central macular thickness (CMT). We also aimed at bringing out the lacunae in the existing literature on HRS in DME and propose goals for future studies. Methods: PubMed/MEDLINE, Scopus, ProQuest, CINAHL, Wiley online and Web of Science were searched based on MOOSE guidelines for non-randomized studies evaluating HRS as a biomarker in DME (between 1st January 2011 and 1st July 2020). Publication bias was analyzed using Begg and Mazumdar rank correlation test and funnel plots. Heterogeneity was assessed using the I2 statistic. Meta-analysis was done using a random-effects model. Results: A total of 1168 eyes from 19 studies were eligible for inclusion. Pooled standardized mean differences showed that intravitreal therapy was associated with a reduction in quantitative HRS (z=-6.3, CI95%=-1.09 to -0.55, p<0.0001). Extreme between-study heterogeneity was observed (I2=93.2%) with significant publication bias. There was no difference in outcomes between anti-VEGF and steroid therapies (p=0.23). No definite conclusions could be drawn regarding the predictive value of HRS in determining the final VA and CMT. Conclusion: This review could conclude that there is a definite reduction in quantitative HRS following either form of intravitreal therapy. Our conclusion about the role of HRS in predicting visual outcome and CMT change was limited by the number of analyzable studies owing to the wide variation in the study designs, methods and reporting.

Depression and risk of disability pension: A systematic review and meta-analysis

2019 ◽  
pp. 009121741983741 ◽  
Author(s):  
Sohrab Amiri ◽  
Sepideh Behnezhad
Keyword(s):  
Systematic Review ◽  
Confidence Interval ◽  
Publication Bias ◽  
Risk Ratio ◽  
Disability Pension ◽  
Common Mental Disorder ◽  
Meta Analysis ◽  
Psychological Consequences ◽  
Treatment Of Depression

Background and objective Depression is a common mental disorder that leads to undesirable consequences. The study of the role of depression in disability pension can provide valuable insights. This study was conducted with the goal of systematic review and meta-analysis of the relationship between depression and disability pension. Methods PubMed, Scopus, PsycInfo, and Google Scholar databases were systematically searched until March 2018. Fifteen prospective cohort studies were selected and included in the meta-analysis. The random-effects method was used to combine the studies. Subgroup analysis was performed, and publication bias was also examined. Results Depression was a risk factor for disability pension (pooled risk ratio =1.68 and 95% confidence interval = 1.50–1.88). In men, pooled risk ratio was 1.82 for the effect of depression on the risk of disability pension (95% confidence interval = 1.45–2.28). In women, pooled risk ratio was 1.62 (95% confidence interval = 1.31–2.02). The results showed that there is publication bias. Conclusions Depression is a factor for retirement due to disability. Therefore, the prevention and treatment of depression can reduce socioeconomic and psychological consequences imposed on society.

scholarly journals Clinical efficacy of antiangiogenic therapy for diabetic macular edema in real clinical practice (2-year results)

2021 ◽  
Vol 14 (2) ◽  
pp. 42-49
Author(s):  
A. Zh. Fursova ◽  
A. S. Derbeneva ◽  
M. S. Tarasov ◽  
M. V. Vasil’eva ◽  
J. A. Gamza ◽  
...  
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Clinical Efficacy ◽  
Initial Level ◽  
Antiangiogenic Therapy ◽  
Visual Outcome ◽  
First Year ◽  
Anti Vegf ◽  
Flexible Planning ◽  
Second Year

Purpose:to evaluate the clinical efficacy of anti-VEGF therapy of patients with diabetic macular edema (DMO) in T & E regimen for 96 weeks. Materials and methods. The study included 59 patients (101 eyes) with DMO. The average number of intravitreal injections of anti-VEGF agent (IIAVA) — aflibercept given during the whole period was 12.87 ± 3.56, including 7.78 ± 1.20 in the first year, and 4.82 ± 2.66 in the second year. Results.All patients showed an increase in visual functions (+0.33, p < 0.001) with a maximum achieved after 5 injections (+0.24; p = 0.001). Central macular thickness decreased from 397.36 ± 100,00 μm at the initial level to 276.59 ± 52.90 after 5 loading injections (-120.8 μm), to 263.85 ± 45.20 (-133, 91 μm) after 1 year and to 248.6 ± 46.9 (-148.76 μm) after 2 years. A resorption of retinal neuroepithelial detachment was observed in 84.16 % of cases as soon as loading injections were given, and reached 100 % of cases by the 48th week of observation. Strong inverse correlations were revealed between the initial presence of medium and large intraretinal cysts and visual acuity, both initial and final (-0.35 and -0.42, p < 0.01). The disorganization of retina inner layers at the initial level was a predictor of a worse visual outcome at the end of the observation period. By the end of this period, 44 patients (43.5 %) received IIAVA with an interval of 12 weeks, the maximum interval between injections was 16 weeks and was achieved in 19 (28.01 %) eyes. Conclusion.The results of a 2-year retrospective study of the efficacy of aflibercept in DME showed that T&E regimen can be used with highfunctional results. Due to flexible planning of the number of IIAVA in the second year, over-treatment could be avoided without reducing the expected efficacy.

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