Predictive imaging biomarkers relevant for functional and anatomical outcomes during ranibizumab therapy of diabetic macular oedema

2017 ◽  
Vol 102 (2) ◽  
pp. 195-203 ◽  
Author(s):  
Bianca S Gerendas ◽  
Sonja Prager ◽  
Gabor Deak ◽  
Christian Simader ◽  
Jan Lammer ◽  
...  
Keyword(s):  
Macular Oedema ◽  
Negative Impact ◽  
Positive Impact ◽  
Combined Therapy ◽  
Subretinal Fluid ◽  
Diabetic Macular Oedema ◽  
Therapy Response ◽  
Predictor Variables ◽  
Imaging Biomarkers ◽  
Anatomical Outcomes

Background/aimsThe objective is to identify imaging biomarkers in optical coherence tomography predicting functional/anatomical outcomes in diabetic macular oedema (DMO).MethodsThe presented study is a post hoc analysis of the RESTORE/RESTORE-extension studies. Best-corrected visual acuity (BCVA) was analysed using general estimating equation models using treatment group/morphological features as predictor variables. In addition, linear multiple regression models analysed BCVA gain up to 12 and 36 months with BCVA/morphological baseline characteristics as independent predictor variables. The correlations between central retinal thickness (CRT)/BCVA were calculated as Spearman’s/Pearson’s correlation coefficients.ResultsA weak negative linear correlation between CRT/BCVA was observed in all study arms at baseline (r=−0.34, p<0.001) and at month 36 (r=−0.26, p<0.001). Patients with baseline height of intraretinal cystoid fluid (IRC) ≤380 µm had better baseline BCVA compared with patients with IRC height >380 µm (64.84±10.63 vs 61.66±9.92 letters; p=0.0071, respectively), which was maintained until the end of month 12 (70.5±12.33 vs 67.0±14.09 letters; p=0.0252, respectively). With laser, there was a trend for patients with subretinal fluid (SRF) at baseline to lose BCVA letters at month 12 (−5.38±16.54 vs 2.49±9.72 letters; p=0.1038), whereas ranibizumab patients trended towards higher BCVA gains (10.28±7.14 vs 6.76±7.67; p=0.0563), compared with those without SRF. With combined therapy, all patients had similar BCVA gains regardless of SRF (p=0.3768).ConclusionWith ranibizumab treatment, the height of IRC spaces at baseline was a better predictor of functional/anatomical improvement than CRT alone. There was also a trend for SRF to show a positive impact on ranibizumab therapy response and a negative impact on laser therapy response.

scholarly journals Clinically meaningful visual improvements and predictors of early vision gains with ranibizumab for diabetic macular oedema

2019 ◽  
Vol 4 (1) ◽  
pp. e000335
Author(s):  
Lawrence Morse ◽  
Linda Yau ◽  
Lisa Tuomi
Keyword(s):  
Macular Oedema ◽  
Subretinal Fluid ◽  
Diabetic Macular Oedema ◽  
Phase Iii ◽  
Early Vision ◽  
Intravitreal Ranibizumab ◽  
Meaningful Improvement ◽  
Link Type ◽  
Kaplan Meier ◽  
Younger Age

ObjectiveTo determine the time to first clinically meaningful improvement in best-corrected visual acuity (BCVA) in patients treated with ranibizumab for diabetic macular oedema (DME) and identify predictors of early visual improvement.Methods and analysisWe retrospectively analysed the phase III RIDE (NCT00473382) and RISE (NCT00473330) trials, in which 759 patients with DME were randomised to monthly intravitreal ranibizumab 0.3 mg (n=250), ranibizumab 0.5 mg (n=252) or sham treatment (n=257). After month 24, 191 sham-treated patients crossed over to monthly ranibizumab 0.5 mg through month 36, while ranibizumab-treated patients continued treatment. Kaplan-Meier analyses assessed time to achieve ≥15 or ≥10 Early Treatment Diabetic Retinopathy Study (ETDRS) letter gains from baseline or ≥20/40 Snellen equivalent BCVA in each treatment arm. Baseline predictors of ≥15 ETDRS letter gains at month 6 were identified by logistic regression.ResultsMedian time to first ≥15 ETDRS letter gain was significantly shorter in patients who received ranibizumab (0.3 mg, 11.1 months; 0.5 mg, 10.9 months) than sham-treated patients who crossed over to ranibizumab 0.5 mg at month 24 (35.7 months; both p<0.0001). Half of ranibizumab-treated patients achieved ≥20/40 BCVA within 2.3 (0.3 mg) and 1.9 months (0.5 mg). Baseline predictors of early vision improvement among ranibizumab-treated patients were BCVA ≤55 ETDRS letters, younger age and presence of subretinal fluid.ConclusionPrompt ranibizumab therapy for DME was associated with rapid, clinically meaningful vision gains that were maintained over 36 months of treatment. Lower BCVA, younger age and presence of subretinal fluid were predictive of early vision improvement.

scholarly journals Five-year outcomes of eyes initially enrolled in the 2-year BEVORDEX trial of bevacizumab or dexamethasone implants for diabetic macular oedema

2021 ◽  
pp. bjophthalmol-2021-319839
Author(s):  
Elisa E Cornish ◽  
Kelvin YC Teo ◽  
Mark C Gillies ◽  
Lyndell L Lim ◽  
Vuong Nguyen ◽  
...  
Keyword(s):  
Cataract Surgery ◽  
Macular Oedema ◽  
Clinical Care ◽  
Diabetic Macular Oedema ◽  
Standard Of Care ◽  
Similar Proportion ◽  
Treatment Groups ◽  
Post Trial ◽  
Intravitreal Dexamethasone ◽  
Anatomical Outcomes

BackgroundThe BEVORDEX trial compared outcomes of eyes with diabetic macular oedema (DMO) randomised to receive either intravitreal dexamethasone (DEX-) implant or bevacizumab over 2 years. We assessed long-term efficacy and safety outcomes 5 years from enrolment.MethodsPatients received standard clinical care after they finished the study. Their files were reviewed for visual and anatomical outcomes, post-trial treatments and complications.ResultsThree-year and five-year data were available for 82% and 59% of eyes enrolled in the BEVORDEX study, respectively. Visual acuity gains at end of trial were generally lost by both treatment groups at 5 years but the macular thickness did not change from end of trial to 5 years. A similar proportion of eyes from each treatment group gained ≥10 letters at 5 years from enrolment in the BEVORDEX trial.Eyes that were initially randomised to the DEX-implant group had significantly fewer treatments but were more likely to develop proliferative diabetic retinopathy (PDR) over the 5-year period compared with eyes initially randomised to bevacizumab. The proportion of eyes that had cataract surgery by 5 years was similar between initial treatment groups.ConclusionsEyes in the BEVORDEX trial had similar 5-year rates of cataract surgery, however, more eyes converted to PDR in the group initially treated with DEX-implant. Eyes that were initially treated for 2 years with either intravitreal DEX-implant of bevacizumab followed by standard of care had similar visual and anatomical outcomes at 5 years.

scholarly journals Quantitative Assessment of Choroidal Parameters in Patients with Various Types of Diabetic Macular Oedema: A Single-Centre Cross-Sectional Analysis

Biology ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 725
Author(s):  
Diana Anna Dmuchowska ◽  
Patryk Sidorczuk ◽  
Barbara Pieklarz ◽  
Joanna Konopińska ◽  
Zofia Mariak ◽  
...  
Keyword(s):  
Macular Oedema ◽  
Choroidal Thickness ◽  
Subretinal Fluid ◽  
Diabetic Macular Oedema ◽  
Single Centre ◽  
Cross Sectional ◽  
Luminal Area ◽  
Single Centre Study ◽  
Diabetic Choroidopathy ◽  
Sectional Analysis

Diabetic macular oedema (DME) is an outcome of multiple, complex and not fully understood mechanisms. The aim of this study was to define the role of choroidopathy in the pathogenesis of various DME types. The retrospective cross-sectional single-centre study included 140 eyes from 105 patients with DME and 76 eyes from 52 non-diabetic controls. The eyes were stratified according to the type of DME: cystoid, diffuse, and with subretinal fluid. Optical coherence tomography-based choroidal parameters: thickness, volume, choroidal vascularity index (CVI), luminal area (LA), stromal area (SA), and total choroidal area (TCA) were compared. Eyes with DME, regardless of the type thereof, had lower choroidal thickness, volume, and CVI values than the controls. Further, the eyes with some specific DME types differed significantly from the controls in terms of LA and SA. While the eyes with various DME types did not differ significantly in terms of their choroidal thickness, volume and CVI, some between-group differences were found in LA, SA and TCA. Diabetic choroidopathy seems to play a role in the development of DME but is less likely involved in the pathogenesis of specific types thereof.

Radiomics-based assessment of ultra-widefield leakage patterns and vessel network architecture in the PERMEATE study: insights into treatment durability

2020 ◽  
pp. bjophthalmol-2020-317182
Author(s):  
Prateek Prasanna ◽  
Vishal Bobba ◽  
Natalia Figueiredo ◽  
Duriye Damla Sevgi ◽  
Cheng Lu ◽  
...  
Keyword(s):  
Macular Oedema ◽  
Network Architecture ◽  
Characteristic Curve ◽  
Diabetic Macular Oedema ◽  
Imaging Biomarkers ◽  
Vascular Perfusion ◽  
Distribution Features ◽  
Retinal Vascular Occlusion ◽  
Intravitreal Aflibercept ◽  
Vessel Network

AimTo evaluate the potential of radiomics-based ultra-widefield fluorescein angiography (UWFA)-derived imaging biomarkers in retinal vascular disease for predicting therapeutic durability of intravitreal aflibercept injection (IAI).MethodsThe Peripheral and Macular Retinal Vascular Perfusion and Leakage Dynamics in Diabetic Macular Edema and Retinal Venous Occlusions During Intravitreal Aflibercept Injection (IAI) Treatment for Retinal Edema (PERMEATE) study prospectively evaluated quantitative UWFA dynamics in diabetic macular oedema or macular oedema secondary to retinal vascular occlusion. 27 treatment-naïve eyes were treated with 2 mg IAI q4 weeks for the first 6 months, and then administered q8 weeks. Morphological and graph-based attributes were used to model the spatial distribution of leakage areas, while tortuosity measures were used to model the vessel network disorder. Eyes were grouped based on functional tolerance of the first 8-week treatment interval challenge. ‘Non-rebounders’ (N=15) maintained/improved best-corrected visual acuity (BCVA) following the 8-week challenge. ‘Rebounders’ (N=12) exhibited worsened BVCA. The image biomarkers were used with a machine learning classifier to preliminarily evaluate their ability to predict BCVA stability.ResultsTwo new UWFA image-derived biomarkers were identified and extracted. The cross-validated area under the receiver operating characteristic curve (AUC) was 0.77±0.14 using baseline leakage distribution features and 0.73±0.10 for the UWFA baseline tortuosity measures. Additionally, the change in vascular tortuosity between month 4 and baseline yielded an AUC of 0.73±0.08. Three baseline clinical features of letter score, macular volume and central subfield thickness yielded a corresponding AUC of 0.42±0.09.ConclusionsTwo computer-extracted UWFA radiomics-based descriptors were identified as potential biomarkers for predicting treatment durability and tolerance of longer treatment intervals. Conventional treatment parameters were not significantly different between these same groups.

Combined therapy with intravitreal bevacizumab and posterior subtenon triamcinolone acetonide injection in diabetic macular oedema

2014 ◽  
Vol 92 (7) ◽  
pp. e589-e590 ◽  
Author(s):  
Hoon Dong Kim ◽  
Kui Dong Kang ◽  
Kyung Seek Choi ◽  
Mi Ri Rhee ◽  
Sung Jin Lee
Keyword(s):  
Triamcinolone Acetonide ◽  
Macular Oedema ◽  
Combined Therapy ◽  
Diabetic Macular Oedema ◽  
Intravitreal Bevacizumab

TURN-OVER GURU PADA MADRASAH ALIYAH NAHDLATUL ULAMA

1970 ◽  
Vol 13 (1) ◽  
Author(s):  
Mochamad Iskarim
Keyword(s):  
Data Collection ◽  
Negative Impact ◽  
Positive Impact ◽  
New Teacher ◽  
Qualitative Approach ◽  
Depth Interview ◽  
Nahdlatul Ulama ◽  
Turn Over ◽  
Interview Questionnaire ◽  
Collection Methods

Penelitian ini dimaksudkan untuk mengetahui dampak positif dan negatif dari adanya pergantian (turn-over) guru di Madrasah Aliyah Nahdlatul Ulama Banyuputih kabupaten Batang. Penelitian inimenggunakan pendekatan kualitatif deskriptif analitis dengan metode pengumpulan data berupa wawancara mendalam, angket, dan dokumentasi. Hasil penelitian menunjukkan adanya turn-over yang tinggi pada guru atau pendidik di madrasah tersebut; keuntungan yang bersifat positif justru didapatkan ketika adanya turn-over guru dibandingkan dampak negatifnya; dan kehadiran guru baru menjadi hal yang sangat disukai oleh siswa dalam hal kreativitas, inovasi pembelajaran, motivasi, dan lain sebagainya.The aims of this research were to know the positive and negative impact of teacher turn over at Madrasah Aliyah Nahdlatul Ulama Banyuputih Kabupaten Batang. This research was use analytical descriptive qualitative approach with depth interview, questionnaire and documentation as data collection methods. The results of this research shows that the positive impact occur more than the negative impact when there was teacher turn over; and the presence of a new teacher become student’s favourite on creativity, learning innovation, and motivation aspects.

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