Renal Biomarkers for Treatment Effect of Ranibizumab for Diabetic Macular Edema

Aims. To investigate the correlations between renal biomarkers and the treatment outcomes of ranibizumab for diabetic macular edema (DME). Methods. This hospital-based study retrospectively enrolled 88 eyes from 67 patients who had received one-year intravitreal ranibizumab treatment for DME. Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) at baseline and during the follow-up period were recorded. BCVA and OCT characteristics at baseline and their changes after ranibizumab treatment were compared between different proteinuria and estimated glomerular filtration rate (eGFR) groups. Results. Of the 88 eyes studied, those with moderately increased proteinuria had a thicker central subfield foveal thickness (CFT) and a higher proportion of intraretinal cysts than those with no proteinuria (P=0.012 and 0.045, respectively) at baseline. After one year of ranibizumab treatment, the reduction in CFT was greater in patients with severely increased proteinuria than those with normal to mildly increased proteinuria (P=0.030). On the other hand, patients with an eGFR <30 tended to have poorer visual improvements than those with normal eGFR (P=0.044). Conclusions. After ranibizumab treatment for DME, patients with severe proteinuria tended to gain better anatomical improvement, while those with poor eGFR tended to have poorer visual improvement.

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Comparison of aflibercept and ranibizumab in diabetic macular edema associated with subretinal detachment

European Journal of Ophthalmology ◽

10.1177/1120672119827855 ◽

2019 ◽

Vol 30 (2) ◽

pp. 363-369 ◽

Cited By ~ 1

Author(s):

Abdullah Ozkaya ◽

Gokhan Demir ◽

Asli Kirmaci

Keyword(s):

Visual Acuity ◽

Retinal Detachment ◽

Macular Edema ◽

Diabetic Macular Edema ◽

Secondary Outcome ◽

Intravitreal Ranibizumab ◽

Corrected Visual Acuity ◽

Intravitreal Aflibercept ◽

Best Corrected Visual Acuity

Purpose: To compare the efficacy of ranibizumab and aflibercept in the treatment of diabetic macular edema associated with subfoveal retinal detachment. Methods: This is a retrospective, comparative study. The treatment-naïve diabetic macular edema patients who had diabetic macular edema associated with subfoveal retinal detachment and underwent intravitreal aflibercept or intravitreal ranibizumab treatment were included. The patients were treated on a pro re nata treatment regimen after a loading dose of 3-monthly injections and the follow-up time was 12 months. The primary outcome measure of this study was the presence of subfoveal retinal detachment after treatment at different time points. The secondary outcome measures were the change in best corrected visual acuity and central retinal thickness. Results: A total of 46 eyes of 46 patients were included. The aflibercept group consisted of 20 and the ranibizumab group consisted of 26 eyes. During the follow-up period of 12 months, subfoveal retinal detachment was completely resolved in 75% versus 57.7% of the eyes at month 3 (p = 0.2), 90% versus 76.9% at month 6 (p = 0.2), 90% versus 65.4% at month 9 (p = 0.05), and 100% versus 80.8% at month 12 (p = 0.03) in the intravitreal aflibercept versus intravitreal ranibizumab groups. The change in best corrected visual acuity was not statistically different between the groups at months 3, 6, 9, and 12, respectively (p > 0.05 for all). Conclusion: Both intravitreal aflibercept and intravitreal ranibizumab were effective in regards to anatomical and functional outcomes of diabetic macular edema patients associated with subfoveal retinal detachment. Interestingly, intravitreal aflibercept seemed more effective than intravitreal ranibizumab in the resolution of subfoveal retinal detachment at month 12.

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Effect of Calcium Dobesilate (CaD) on Diabetic Macular Edema Treated by Intravitreal Ranibizumab

10.21203/rs.3.rs-830956/v1 ◽

2021 ◽

Author(s):

Dongxuan Wang ◽

Hui Wang ◽

Shuang Wu ◽

Xueqiu Yang ◽

Jiansen Xu

Keyword(s):

Macular Edema ◽

Diabetic Macular Edema ◽

Calcium Dobesilate ◽

Intravitreal Ranibizumab ◽

Corrected Visual Acuity ◽

The Mean ◽

Pro Re Nata ◽

Dose Injection ◽

Control Study

Abstract Background: Calcium dobesilate (CaD) had been used in the treatment of diabetic retinopathy (DR) due to its potential in protecting against retinal vascular damage. However, it did not reduce the risk of development of diabetic macular edema (DME). The aim of this study was to investigate the effect of CaD plus intravitreal ranibizumab in the treatment of DME.Methods: This retrospective, observational, consecutive case control study enrolled patients newly diagnosed with DME who received intravitreal ranibizumab (IVR) administration with 3-monthly loading dose injection followed by pro re nata (3+PRN) regimen with or without CaD orally daily for at least 12-month follow-up. Medical records and optical coherence tomography (OCT) results were reviewed and compared at baseline and at 3, 6, and 12 months after injection.Results: A total of 102 eyes from 102 patients were enrolled in this study. Fifty-four patients received IVR combined with CaD orally (IVR+CaD group), while forty-eight patients received IVR solely (IVR group). No statistically significant differences were found in the general condition of patients between the two groups at baseline (P > 0.05). At every follow-up, 3, 6 and 12 months after injection, the best corrected visual acuity (BCVA) improved and the central macular thickness (CMT) decreased in both groups when compared with those at baseline (P < 0.05), while there were no significant differences in BCVA improvement and CMT reduction between the two groups (P > 0.05). The mean number of ranibizumab injections in R+C group was significantly lower than that in R group (5.4 ± 1.1 injections versus 6.7 ± 1.6 injections, P<0.05) within 1-year treatment. No adverse events were found in neither groups.Conclusions: Adding oral CaD to intravitreal ranibizumab was demonstrated to have similar effectiveness and safety for improving visual function and restoring the anatomy of the retina in macular with fewer injections in DME patients.

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Effectiveness of Intravitreal Ranibizumab in Nonvitrectomized and Vitrectomized Eyes with Diabetic Macular Edema: A Two-Year Retrospective Analysis

10.21203/rs.2.9466/v1 ◽

2019 ◽

Author(s):

Ozgun Melike Gedar Totuk ◽

Ayse Yagmur Kanra ◽

Mohammed Nadim Bromand ◽

Guler Kilic ◽

Sevil Ari Yaylali ◽

...

Keyword(s):

Macular Edema ◽

Diabetic Macular Edema ◽

Medical Records ◽

Response To Treatment ◽

Intravitreal Ranibizumab ◽

Female Ratio ◽

Corrected Visual Acuity ◽

Baseline Values ◽

Male To Female

Abstract Background: To compare the effectiveness of intravitreal ranibizumab (IVR) injections for the treatment of diabetic macular edema (DME) in eyes with and without previous vitrectomy. Methods: The medical records of 30 eyes (13 vitrectomized, 17 nonvitrectomized) of 28 patients (mean age, 59.09.6 years; male to female ratio 1:1) who were diagnosed with DME and had received IVR treatment were reviewed retrospectively. The best-corrected visual acuity (BCVA), central macular thickness (CMT), and total macular volume (TMV) were measured at baseline and at months 6, 12, 18, and 24 of the follow-up. The number of IVR injections, the duration between diagnosis of DME and IVR injection, and hemoglobin A1c (HbA1c) level at baseline were also recorded. Results: Baseline demographics, HbA1c, BCVA, CMT, and TMV values were similar between the vitrectomized and nonvitrectomized groups (p>0.05). The duration between diagnosis of DME and IVR injections was longer in the nonvitrectomized group than in the vitrectomized group (165 years vs. 134 years, respectively; p=0.045). IVR injection was performed 6.3 times in vitrectomized eyes and 6.1 times in nonvitrectomized eyes during the 24-month period (p>0.05). BCVA improved significantly during the 24-month period in both groups. The improvement in BCVA was significant at month 6 in nonvitrectomized eyes, while there was no significant improvement in vitrectomized eyes before month 18. Compared to the baseline values, the decrease in both CMT and TMV was significant in months 6, 12, 18, and 24 in the nonvitrectomized group (p<0.05). In the vitrectomized group both CMT and TMV improved significantly only in months 18 and 24 (p<0.05). Conclusion: IVR treatment for DME is equally effective in both vitrectomized and nonvitrectomized eyes. However, the response to treatment is seen later in vitrectomized eyes compared to nonvitrectomized eyes.

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Efficacy of One-Year Treatment with Aflibercept for Diabetic Macular Edema with Practical Protocol

BioMed Research International ◽

10.1155/2017/7879691 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Tomomi Kaiho ◽

Toshiyuki Oshitari ◽

Tomoaki Tatsumi ◽

Yoko Takatsuna ◽

Miyuki Arai ◽

...

Keyword(s):

Macular Edema ◽

Diabetic Macular Edema ◽

Serous Retinal Detachment ◽

Predictive Marker ◽

Photoreceptor Outer Segment ◽

Corrected Visual Acuity ◽

Intravitreal Aflibercept ◽

The Mean ◽

One Year

The purpose of this study was to determine the efficacy of one-year treatment of diabetic macular edema (DME) with intravitreal aflibercept (IVA) injections on a practical protocol. The medical records of 51 eyes of 43 patients who were diagnosed with DME and had received IVA treatments were reviewed. The best-corrected visual acuity (BCVA) and the central macular thickness (CMT) were measured at the baseline and at 1, 3, 6, and 12 months after the IVA. The mean number of IVA injections was 3.8±2.4. The mean BCVA was significantly better and the CMT was thinner after the IVA at all follow-up times (P<0.05). The BCVA was better in eyes with a serous retinal detachment (SRD) than without a SRD (P<0.01). There was a significant correlation between the photoreceptor outer segment (PROS) length and BCVA at the baseline and at 12 months after the IVA (P<0.05). A fewer number of IVA injections significantly improved the BCVA and the CMT in eyes with DME after one-year treatment. IVA was more effective in the SRD+ group than in the SRD− group. The PROS length may be a predictive marker for visual outcomes after one-year treatment with IVA for DME (IRB#2272).

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Effectiveness of Intravitreal Ranibizumab in Nonvitrectomized and Vitrectomized Eyes with Diabetic Macular Edema: A Two-Year Retrospective Analysis

Journal of Ophthalmology ◽

10.1155/2020/2561251 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Ozgun Melike Gedar Totuk ◽

Ayse Yagmur Kanra ◽

Mohammed Nadim Bromand ◽

Guler Kilic Tezanlayan ◽

Sevil Ari Yaylalı ◽

...

Keyword(s):

Macular Edema ◽

Diabetic Macular Edema ◽

Medical Records ◽

Response To Treatment ◽

Intravitreal Ranibizumab ◽

Female Ratio ◽

Corrected Visual Acuity ◽

The Mean ◽

Male To Female

The aim of this study was to compare the effectiveness of intravitreal ranibizumab (IVR) injections for the treatment of diabetic macular edema (DME) in eyes with and without previous vitrectomy. The medical records of 28 eyes (11 vitrectomized and 17 nonvitrectomized) of 28 patients (mean age, 59.0 ± 9.6 years; male to female ratio 1 : 1) who were diagnosed with DME and had received IVR treatment were reviewed retrospectively. The indications of vitrectomy in 11 vitrectomized eyes were intravitreal hemorrhage (n = 8) and epiretinal membrane (n = 3). The best-corrected visual acuity (BCVA), central macular thickness (CMT), and total macular volume (TMV) were measured at baseline and at months 6, 12, 18, and 24 of the follow-up. The number of IVR injections, the duration between diagnosis of DME and IVR injection, and the hemoglobin A1c (HbA1c) level at baseline were also recorded. Baseline demographics, HbA1c, BCVA, CMT, and TMV values were similar between two groups (p>0.05). The duration between diagnosis of DME and IVR injections was similar in both groups (16 ± 5 months vs. 13 ± 4 months, respectively; p=0.11). IVR injection was performed 6.3 times in vitrectomized eyes and 6.1 times in nonvitrectomized eyes during the 24-month period (p>0.05). The mean BCVA improved significantly during the 24-month period in both groups. The improvements in BCVA, in CMT, and in TMV were more significant at month 6 (p=0.036) group, at month 12 (p=0.013), at month 12 (p=0.021), and month 24 (p=0.021) in nonvitrectomized eyes, respectively, while there was no difference in improvements of BCVA, CMT, and TMV in vitrectomized group at each visit. Treatment effected by time in terms of BCVA, CMT, and TMV values in all groups (p=0.0004, p<0.0001, p<0.0001, respectively), not by time-group interaction and group (all p values >0.05). In conclusion, IVR treatment for DME is equally effective in both groups. However, the response to treatment is seen earlier in nonvitrectomized eyes compared to vitrectomized eyes.

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Effectiveness of Intravitreal Ranibizumab in Nonvitrectomized and Vitrectomized Eyes with Diabetic Macular Edema: A Two-Year Retrospective Analysis

10.21203/rs.2.9466/v2 ◽

2019 ◽

Author(s):

Ozgun Melike Gedar Totuk ◽

Ayse Yagmur Kanra ◽

Mohammed Nadim Bromand ◽

Guler Kilic ◽

Sevil Ari Yaylali ◽

...

Keyword(s):

Macular Edema ◽

Diabetic Macular Edema ◽

Response To Treatment ◽

Intravitreal Ranibizumab ◽

Female Ratio ◽

Corrected Visual Acuity ◽

Baseline Values ◽

The Mean ◽

Male To Female

Abstract Background: To compare the effectiveness of intravitreal ranibizumab (IVR) injections for the treatment of diabetic macular edema (DME) in eyes with and without previous vitrectomy. Methods: The medical records of 30 eyes (13 vitrectomized, 17 nonvitrectomized) of 28 patients (mean age, 59.0±9.6 years; male to female ratio 1:1) who were diagnosed with DME and had received IVR treatment were reviewed retrospectively. The indications of vitrectomy in 13 vitrectomized eyes were intravitreal hemorrhage (n=8), vitreomacular traction (n=1), and epiretinal membrane (n=4). The best-corrected visual acuity (BCVA), central macular thickness (CMT), and total macular volume (TMV) were measured at baseline and at months 6, 12, 18, and 24 of the follow-up. The number of IVR injections, the duration between diagnosis of DME and IVR injection, and hemoglobin A1c ( HbA1c ) level at baseline were also recorded. Retreatment criteria included persistence of submacular fluid, intraretinal cysts, or CMT of more than 300 μm. Results: Baseline demographics, HbA1c, BCVA, CMT, and TMV values were similar between the vitrectomized and nonvitrectomized groups (p>0.05). The duration between diagnosis of DME and IVR injections was longer in the nonvitrectomized group than in the vitrectomized group (16±5 months vs. 13±4 months, respectively; p=0.045). IVR injection was performed 6.3 times in vitrectomized eyes and 6.1 times in nonvitrectomized eyes during the 24-month period (p>0.05). The mean BCVA improved significantly during the 24-month period in both groups (for vitrectomized group from 0.51±0.26 logMAR to 0.40±0.22 logMAR; for nonvitrectomized group from 0.72±0.28 logMAR to 0.50±0.22 logMAR). The improvement in BCVA was significant at month 6 in nonvitrectomized eyes, while there was no significant improvement in vitrectomized eyes before month 18. Compared to the baseline values, the decrease in both CMT and TMV was significant in months 6, 12, 18, and 24 in the nonvitrectomized group (p<0.05). In the vitrectomized group both CMT and TMV improved significantly only in months 18 and 24 (p<0.05). Conclusion: IVR treatment for DME is equally effective in both vitrectomized and nonvitrectomized eyes. However, the response to treatment is seen later in vitrectomized eyes compared to nonvitrectomized eyes.

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Comparison of Perioperative Ranibizumab Injections for Diabetic Macular Edema in Patients Undergoing Cataract Surgery

Journal of Ophthalmology ◽

10.1155/2016/7945619 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Erhan Yumuşak ◽

Kemal Örnek

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

Macular Edema ◽

Diabetic Macular Edema ◽

Intravitreal Ranibizumab ◽

Foveal Thickness ◽

Group 3 ◽

Group 2 ◽

Baseline Visual Acuity

Purpose. To compare the efficacy of perioperative ranibizumab injections on diabetic macular edema (DME) in patients undergoing cataract surgery.Methods. This study included 59 eyes of 59 patients. All patients had advanced cataract with DME and underwent an uneventful phacoemulsification surgery. There were 3 subgroups. The first group received intravitreal ranibizumab injection 2 weeks preoperatively, the second group received intraoperatively, and the third group received 2 weeks postoperatively. Follow-up examinations were performed at 1 week as well as at 1 and 3 months.Results. Baseline visual acuity showed a significant increase in all groups at 1 month. In group 1, compared to baseline value, foveal thickness (FT) increased significantly at 1 month and showed a significant decrease up to month 3. In group 2, FT increased at month 1 and this continued up to month 3. In group 3, FT increased at month 1 and was almost stable up to month 3. There were not any significant differences for visual acuity and FT between the groups.Conclusions. Although intrapostoperative ranibizumab injection for DME seems to be more effective than preoperative injections in patients undergoing cataract surgery, the treatment still needs to be continued following surgery.

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Comparison of the Effectiveness of Intravitreal Ranibizumab for Diabetic Macular Edema in Vitrectomized and Nonvitrectomized Eyes

Ophthalmologica ◽

10.1159/000446992 ◽

2016 ◽

Vol 236 (2) ◽

pp. 67-73 ◽

Cited By ~ 5

Author(s):

Yoshito Koyanagi ◽

Shigeo Yoshida ◽

Yoshiyuki Kobayashi ◽

Yuki Kubo ◽

Muneo Yamaguchi ◽

...

Keyword(s):

Visual Acuity ◽

Macular Edema ◽

Diabetic Macular Edema ◽

Treatment Option ◽

Central Macular Thickness ◽

Intravitreal Ranibizumab ◽

Corrected Visual Acuity ◽

The Mean ◽

The Difference ◽

Best Corrected Visual Acuity

Purpose: To compare the effectiveness of intravitreal ranibizumab (IVR) for diabetic macular edema (DME) between eyes with and without previous vitrectomy. Procedures: We prospectively assessed the best-corrected visual acuity (BCVA) and central macular thickness (CMT) after IVR for 6 months. Results: There were no significant differences in the baseline BCVA and CMT between both groups. In the nonvitrectomized group (n = 15), the mean changes of BCVA and CMT from baseline to month 6 were significant (p < 0.01). In the vitrectomized group (n = 10), the improvement appeared to be slower, and the mean BCVA improvement was not significant (p = 0.5), although the mean CMT decrease was significant (p < 0.05). There were no significant differences in the mean changes of BCVA and CMT between both groups at 6 months. Conclusions: The difference in the effectiveness of IVR between both groups was not significant. IVR can be a treatment option even for vitrectomized DME eyes.

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A Feasibility Randomised Control Trial of Vitrectomy Plus Standard Care Intravitreal Ranibizumab or Aflibercept Injections versus Standard Care Intravitreal Ranibizumab or Aflibercept injections Alone In Patients With Centre Involving Diabetic Macular Edema

10.21203/rs.3.rs-159886/v1 ◽

2021 ◽

Author(s):

Alistair Laidlaw ◽

Chris Hammond ◽

Matthew James Maguire

Keyword(s):

Standard Care ◽

Visual Loss ◽

Rescue Therapy ◽

Macular Thickness ◽

Randomised Control Trial ◽

Intravitreal Ranibizumab ◽

Corrected Visual Acuity ◽

Anti Vegf ◽

One Year

Abstract Background: Most studies indicate that vitrectomy delivers sustained improvements in macular thickness. Evidence on whether acuity is improved is inconsistent. In the presence of traction vitrectomy is thought to be visually effective. In the absence of traction vitrectomy was usually performed as rescue therapy when repeated laser treatments had failed and visual improvement may not have been possible. Studies where vitrectomy was performed early in the disease showed visual benefit. All these data also predate the current gold standard anti VEGF therapy for DME and SD OCT imaging of the vitreo retinal interface. We hypothesise that adding a vitrectomy and internal limiting membrane peel to standard care intravitreal Anti-VEGF injections in the management of CIDME will result in: improved or comparable visual outcomes, fewer anti-VEGF injections and reduced costs. Methodology: VIDEO is a pragmatic stratified, single-masked, randomised, multi centre, controlled, feasibility trial with 12 months follow up. Stratification will be based in the presence or absence of OCT evident vitreomacular traction or epiretinal membrane. The primary outcome is Distance best corrected visual acuity. Secondary outcomes are Number of injections, Rate of completed follow, Rate of recruitment, Central macular thickness on OCT, Area under the curve of CMT, Area under curve of BCVA, Rate of loss of 15 or more letters from baseline, Rate of Rescue therapy, Rate of cataract surgery, Rate of complications. Recruitment target is 100 patients with 1:1 randomisation to the treatment arm (vitrectomy + standard care) or control arm (standard care) with 12 month follow up. Standard care is treat and extend intravitreal anti-VEGF injections. Main inclusion criteria: -Patient over 18 years of age -Patient has capacity to give informed consent -Patient has not previously been enrolled in this study in regards to their other eye - Symptomatic visual loss attributable to diabetic macular oedema for less than one year -Patient has a formal diagnosis of Diabetes Mellitus -Patient has an HbA1c test (a blood test that looks at long term diabetic control) performed within the past 2 months. Ophthalmic criteria: -Symptomatic visual loss attributable to DMO for less than one year. -Best corrected visual acuity of better than 35 ETDRS letters on formal testing -Central macular thickness greater than 350 microns. Discussion: Outcomes should inform the effect size with which to inform the design of a definitive randomised control trial ISRCTN Registry ISRCTN59902040 18.12.20 retrospectively registered http://www.isrctn.com/ISRCTN59902040

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Efficacy and safety of intravitreal dexamethasone implant in treatment naïve eyes with diabetic macular edema: Real world experience

European Journal of Ophthalmology ◽

10.1177/1120672120949761 ◽

2020 ◽

pp. 112067212094976

Author(s):

Dhanashree Ratra ◽

Unnati Sharma ◽

Daleena Dalan

Keyword(s):

Macular Edema ◽

Diabetic Macular Edema ◽

Dexamethasone Implant ◽

Efficacy And Safety ◽

Visual Improvement ◽

Intravitreal Dexamethasone Implant ◽

Treatment Naïve ◽

Intravitreal Dexamethasone ◽

Macular Ischemia

Purpose: To evaluate the efficacy and safety of intravitreal dexamethasone implant in treatment naïve eyes with diabetic macular edema (DME). Methods: A retrospective analysis of treatment naïve eyes with DME which received intravitreal dexamethasone implant between January 2016 and March 2018 was done. Demographic details of the patients, ocular examination findings at baseline and on follow up visits were noted. Morphological features of DME and central macular thickness were noted on optical coherence tomography at each visit. The details regarding additional treatment for macular edema on follow up were noted. Results: Sixty five eyes were included in the study. The mean age was 59.14 ± 9.59 years. The follow up ranged from 6 to 48 months. Psuedophakic eyes showed visual improvement whereas the phakic eyes showed stable vision. The central foveal thickness showed significant reduction ( p = 0.05) in all the eyes. The best corrected visual acuity at final follow up (+0.65 logMAR) was slightly less as compared to baseline (+0.62 logMAR). Retreatment was needed in 37% eyes and antiglaucoma medications in 8% eyes. Cataract progression was noted in 24 eyes (37%); 17 eyes (26.1%) underwent surgery. Notably, 27 eyes (41.5%) had some degree of macular ischemia at baseline. And five eyes (7.7%) showed progression of retinopathy leading to vitreous hemorrhage. Conclusion: Dexamethasone implant is helpful in reducing the macular thickness and stabilizing the vision in treatment naïve DME; requiring less number of treatment sessions. However, it does not prevent progression of diabetic retinopathy. The visual improvement may be affected by cataract and macular ischemia.

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