scholarly journals HbA1c as a predictor for response of bevacizumab in diabetic macular oedema

2020 ◽  
Vol 5 (1) ◽  
pp. e000449
Author(s):  
Sadhana Sharma ◽  
Sagun Narayan Joshi ◽  
Pratap Karki
Keyword(s):  
Glycaemic Control ◽  
Macular Oedema ◽  
Vision Loss ◽  
Diabetic Macular Oedema ◽  
Intravitreal Bevacizumab ◽  
Glycosylated Haemoglobin ◽  
Baseline Hba1c ◽  
Good Glycaemic Control ◽  
The Mean ◽  
Study Participants

ObjectiveTo study the influence of glycosylated haemoglobin (HbA1c) on response of bevacizumab in patients with diabetic macular oedema.Methods and AnalysisA total of 37 eyes of 37 patients with vision loss due to diabetic macular oedema treated with bevacizumab were included in this study. Participants received monthly intravitreal bevacizumab (0.05 mL/1.25 mg) for 3 months.ResultsThere were 17 patients with baseline HbA1c ≤7% (<53mmol/mol) and 20 patients with baseline HbA1c >7% (>53mmol/mol) treated with bevacizumab included in the study. The mean improvement in visual acuity at 3 months was 0.50 logMAR in HbA1c ≤7%(<53mmol/mol) group and 0.33 logMAR in HbA1c >7%(>53mmol/mol) group (95% CI,-0.05-0.38; p=0.13). The mean central macular thickness (CMT) reduction was −229.76 µm in patients with a baseline HbA1c ≤7% (<53 mmol/mol) and −145.20 µm in patients with HbA1c of >7% (>53mmol/mol) (95% CI,12.98-156.14; p=0.022).ConclusionOur study suggests that baseline glycaemic control can affect the treatment outcome of intravitreal bevacizumab in the management of diabetic macular oedema and the response was found to be better in patients with good glycaemic control (low HbA1c).

Intravitreal Bevacizumab for Treatment of Diabetic Macular Oedema

2013 ◽  
Vol 07 (01) ◽  
pp. 45 ◽  
Author(s):  
Ramin Ramin ◽  
Mohsen Azarmina ◽  
Masoud Soheilian ◽  
◽  
◽  
...  
Keyword(s):  
Macular Oedema ◽  
Vision Loss ◽  
Diabetic Macular Oedema ◽  
Intravitreal Bevacizumab ◽  
Results Of Treatment ◽  
Literature Searches ◽  
Working Age ◽  
Short And Long Term ◽  
Almost All

Diabetic macular oedema (DMO) is a leading cause of vision loss in the working-age population worldwide. Numerous early studies suggest an important role for intravitreal anti-VEGF agents such as bevacizumab in the management of DMO. We reviewed manuscripts that had investigated pharmacokinetic, efficacy, safety, dose and frequency of intravitreal bevacizumab (IVB) injections as well as effect of macular ischaemia, initial macular thickness and optical coherence tomography (OCT) patterns of DMO on the final results of treatment with IVB. In summery literature searches disclosed that almost all studies published up to now provided evidence supporting use of IVB for treatment of either naïve or persistent DMO in short and long term up to 2 years.

scholarly journals An Overview of Intravitreal Aflibercept in Diabetic Macular Oedema

2015 ◽  
Vol 09 (01) ◽  
pp. 37
Author(s):  
Jean-François Korobelnik ◽  
Sebastian Wolf ◽  
◽  
◽  
◽  
...  
Keyword(s):  
Macular Oedema ◽  
Vision Loss ◽  
Safety Data ◽  
Diabetic Macular Oedema ◽  
Intravitreal Bevacizumab ◽  
Standard Of Care ◽  
Intravitreal Ranibizumab ◽  
Intravitreal Aflibercept ◽  
Working Age

Diabetic macular oedema (DMO) is responsible for much of the vision loss associated with diabetic retinopathy, which is the leading cause of blindness in working-age adults. Approximately 21 million people worldwide have DMO. The standard of care for DMO has been laser photocoagulation: this option has only a limited ability to reverse vision loss and is associated with a risk of scarring and complications. Corticosteroids have also been used in DMO treatment, but are associated with side effects such as elevated intraocular pressure and cataract. Knowledge of the role of vascular endothelial growth factor (VEGF) in the pathogenesis of DMO has led to the widespread use of anti-VEGF agents. Intravitreal bevacizumab, which is not approved for any retinal disorders, is used off-label for the treatment of DMO. Intravitreal ranibizumab (IVT-AFL) (once monthly) and intravitreal aflibercept (once every 2 months after a loading dose) have been approved for the treatment of DMO. This review summarises the clinical evidence supporting the role of IVT-AFL in the treatment of DMO. Analysis of efficacy and safety data suggests that aflibercept could be used as a first-line treatment in DMO.

One-year real-life results on effect of intravitreal aflibercept in patients with diabetic macular oedema switched from ranibizumab

2020 ◽  
pp. 112067212092727
Author(s):  
Marko Lukic ◽  
Gwyn Williams ◽  
Zaid Shalchi ◽  
Praveen J Patel ◽  
Philip G Hykin ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Early Treatment ◽  
Macular Oedema ◽  
Real Life ◽  
Diabetic Macular Oedema ◽  
Foveal Thickness ◽  
Macular Volume ◽  
Central Foveal Thickness ◽  
The Mean

Purpose To assess visual and optical coherence tomography–derived anatomical outcomes of treatment with intravitreal aflibercept (Eylea®) for diabetic macular oedema in patients switched from intravitreal ranibizumab (Lucentis®). Design Retrospective, cohort study. Participants Ninety eyes (of 67 patients) receiving intravitreal anti–vascular endothelial growth factor therapy were included. Methods This is a retrospective, real-life, cohort study. Each patient had visual acuity measurements and optical coherence tomography scans performed at baseline and 12 months after the first injection of aflibercept was given. Main Outcome Measures We measured visual acuities in Early Treatment Diabetic Retinopathy Study letters, central foveal thickness and macular volume at baseline and at 12 months after the first aflibercept injection was given. Results Ninety switched eyes were included in this study. The mean (standard deviation) visual acuity was 63 (15.78) Early Treatment Diabetic Retinopathy Study letters. At baseline, the mean (standard deviation) central foveal thickness was 417.7 (158.4) μm and the mean macular volume was 9.96 (2.44) mm3. Mean change in visual acuity was +4 Early Treatment Diabetic Retinopathy Study letters (p = 0.0053). The mean change in macular volume was −1.53 mm 3 in SW group (p = 0.21), while the change in central foveal thickness was −136.8 μm (p = 0.69). Conclusion There was a significant improvement in visual acuity and in anatomical outcomes in the switched group at 12 months after commencing treatment with aflibercept for diabetic macular oedema.

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

Cells ◽  
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.

Hyperreflective cystoid spaces in diabetic macular oedema: prevalence and clinical implications

2020 ◽  
pp. bjophthalmol-2020-317191
Author(s):  
Aude Couturier ◽  
Valerie Mane ◽  
Carlo Alessandro Lavia ◽  
Ramin Tadayoni
Keyword(s):  
Macular Oedema ◽  
Optical Coherence Tomography Angiography ◽  
Diabetic Macular Oedema ◽  
Functional Improvement ◽  
Vascular Endothelial ◽  
Hard Exudates ◽  
Corrected Visual Acuity ◽  
The Mean ◽  
Endothelial Growth Factor

AimsTo analyse the prevalence and evolution of hyper-reflective cystoid spaces with decorrelation signal detected using optical coherence tomography angiography (OCTA) in diabetic macular oedema (DMO).MethodsA retrospective study of consecutive eyes with DMO imaged using OCTA over a 1-year period was conducted. All eyes with hyper-reflective cystoid spaces at baseline and at least 3 months of follow-up were included in a longitudinal analysis.ResultsThe prevalence of hyperreflective cystoid spaces with decorrelation signal was of 37% (61/165) in DMO eyes. Hyperreflective foci within hyperreflective cystoid spaces were observed in 85% of eyes. The longitudinal study included 33 eyes (10 observed and 23 treated with intravitreal anti-vascular endothelial growth factor), with a median follow-up of 15 months. The hyperreflective cystoid spaces resolved in 85% of eyes. The mean best-corrected visual acuity remained stable during the follow-up, even in the eyes achieving a resolution of the hyperreflective cystoid spaces. Hard exudates appeared in the area of resolved hyperreflective cystoid spaces in 33% of eyes.ConclusionHyperreflective cystoid spaces detected by OCTA affected more than one-third of the DMO eyes. Their disappearance was not associated with any functional improvement and led to the formation of new hard exudate deposits in about one-third of the eyes.

scholarly journals Evaluation of 0.2 µg/day fluocinolone acetonide (ILUVIEN) implant in a cohort of previously treated patients with diabetic macular oedema (DMO): a 36-month follow-up clinical case series

2020 ◽  
Vol 5 (1) ◽  
pp. e000484
Author(s):  
Muna Ahmed ◽  
Christine Putri ◽  
Hibba Quhill ◽  
Fahd Quhill
Keyword(s):  
Clinical Practice ◽  
Real World ◽  
Macular Oedema ◽  
Case Series ◽  
Diabetic Macular Oedema ◽  
Fluocinolone Acetonide ◽  
Previously Treated Patients ◽  
Previously Treated ◽  
The Mean

ObjectiveTo assess the real-world effectiveness and safety of single injection of a fluocinolone acetonide (FAc) implant in previously treated patients with recurrent diabetic macular oedema (DMO) over a 36-month follow-up period.Methods and AnalysisThis is a retrospective study conducted at a single ophthalmology department at the Royal Hallamshire Hospital, Sheffield, UK. Data were collected using electronic medical records to identify all patients treated with a FAc implant for DMO between March 2014 and November 2014, followed with a 36-month clinic follow-up. Outcomes measured included mean change in best-recorded visual acuity (BRVA) and central macular thickness (CMT) over the period of 36 months, treatment burden pre-implant and post-implant, and functional and anatomical responder rates.ResultsTwenty-six eyes (n=22 patients) were treated with single intravitreal FAc implant followed with 36 months of follow-up. At 24 and 36 months, 86.4% and 75.0% of patients maintained or gained vision post-FAc implant in routine clinical practice. The mean BRVA increased from 41.8 to 54.6 letters at month 24 and 45.8 letters at month 36, with 50.0% and 33.3% of patients achieving a ≥15 letter improvement at months 24 and 36, respectively. The mean CMT reduced from 600.8 µm at baseline to 351.0 µm and 392.5 µm at months 24 and 36, respectively. Overall, a mean of one treatment every 13.33 months post-FAc implant (vs 3.24 months pre-FAc implant) was reported. Eleven eyes had an increased intraocular pressure of ≥10 mm Hg and 12 eyes had an increase to ≥25 mm Hg from baseline.ConclusionThese results further support the effectiveness and safety of FAc implant in previously treated patients with persistent or recurrent DMO in a real-world clinical practice.

The Treatment of Diabetic Macular Oedema with ILUVIEN® Intravitreal Implant Following Prior Anti-VEGF Therapy – Case Study

2014 ◽  
Vol 08 (02) ◽  
pp. 140
Author(s):  
Fahd Quhill ◽  
Keyword(s):  
Macular Oedema ◽  
Vision Loss ◽  
Diabetic Macular Oedema ◽  
Fluocinolone Acetonide ◽  
Vascular Endothelial ◽  
Foveal Thickness ◽  
Intravitreal Implant ◽  
The Uk ◽  
Endothelial Growth Factor

Diabetic macular oedema (DMO) is the main cause of vision loss in diabetic retinopathy. The ILUVIEN® intravitreal implant, which contains fluocinolone acetonide and is administered by injection into the vitreous cavity, should be considered if the patient is not responding to anti-vascular endothelial growth factor (VEGF) therapy, and the patient fulfils the recommendations of the National Institute for Health and Care Excellence (NICE) Technology Appraisal 301. The efficacy and safety of the ILUVIEN implant has been demonstrated in clinical studies, and a pre-planned subgroup analysis has shown that it is particularly beneficial in patients with chronic DMO. This case study is the first report in the UK of the effectiveness of the ILUVIEN implant in a patient in whom therapy with ranibizumab did not result in sustained improvements in terms of visual outcomes and foveal thickness.

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