Intravitreal aflibercept partially reverses severe non-proliferative diabetic retinopathy in  treatment-naïve patients

Objective To evaluate whether diabetic retinopathy can be reversed after aflibercept, based on improvements in diabetic macular edema, hard exudates (HEs) of the posterior pole, and retinal microaneurysms (MAs). Methods This was a single-center retrospective study of 30 patients (34 eyes) with severe non-proliferative diabetic retinopathy (NPDR) who were treated between August and October 2018. Best-corrected visual acuity (BCVA), central foveal thickness (CFT), area of HEs, and number of MAs were compared before and after treatment. Results The mean patient age was 61.4 ± 7.1 years; 14 patients (46.7%) were men. The mean number of injections per patient was 3.5 ± 0.5. The time between the last injection and the last follow-up was 82 days (range, 78–110 days). Six months after the first intravitreal injection, significant improvement was observed in BCVA (from 0.70 ± 0.18 to 0.42 ± 0.19 logMAR), CFT (from 377.17 ± 60.41 to 261.21 ± 31.50 µm), and number of MAs (from 182.2 ± 77.4 to 101.5 ± 59.6). Observations over 6 months after the first intravitreal injection showed a statistically significant reduction in the area of HEs (P = 0.007). No adverse events occurred during the treatment period. Conclusion Diabetic retinopathy might be partially reversed by aflibercept treatment, as indicated by BCVA, CFT, number of MAs, and area of HEs.

Download Full-text

Analysis of quantitative correlations between microaneurysm, ischaemic index and new vessels in ultrawide-field fluorescein angiography images using automated software

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-313596 ◽

2019 ◽

pp. bjophthalmol-2018-313596 ◽

Cited By ~ 2

Author(s):

Gisung Son ◽

Yoon Jeon Kim ◽

Yu Sub Sung ◽

Bumwoo Park ◽

June-Gone Kim

Keyword(s):

Diabetic Retinopathy ◽

Fluorescein Angiography ◽

Proliferative Diabetic Retinopathy ◽

Diabetic Macular Oedema ◽

Posterior Pole ◽

Peripheral Retina ◽

Foveal Thickness ◽

Central Foveal Thickness ◽

Treatment Naïve ◽

Automated Software

Background/AimTo analyse ultrawide-field fluorescein angiography (UWF-FA) images of diabetic retinopathy using a novel software that automatically calculates microaneurysm (MA) and non-perfusion area.MethodsTwo hundred UWF-FA images of treatment-naïve diabetic retinopathy (38 proliferative diabetic retinopathy and 162 non-proliferative diabetic retinopathy) from 120 patients (mean age 54.22; 80 male) were analysed using novel software to determine the number of MAs, area of capillary non-perfusion (ischaemic index) and number of neovascularisations. Each result was compared according to its retinal regions.ResultsFor the total retina, the mean number of MAs was 292.02 (±175.57) and the ischaemic index was 59.42% (±14.78%). Most MAs were located in the mid-peripheral retina (80.54%); however, the density of MAs was highest in the posterior pole (p<0.001). The ischaemic index was highest in the peripheral retina (89.19%), followed by mid-periphery (50.65%) and posterior pole (1.85%). Patients with diabetic macular oedema (DME) presented more MA and a greater ischaemic index (p<0.001, each) than those without DME.ConclusionThe automated software allowed prompt and quantitative analysis of UWF-FA images of DMR. MAs were most frequent in the nasal and mid-peripheral retina, with their density being highest in the posterior pole and nasal retina. Ischaemic index increased with distance from the posterior pole, showing strong correlation with central foveal thickness in all retinal areas except the posterior pole.

Download Full-text

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

European Journal of Ophthalmology ◽

10.1177/1120672120927275 ◽

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.

Download Full-text

Correlation of Volume of Macular Edema with Retinal Tomography Features in Diabetic Retinopathy Eyes

Journal of Personalized Medicine ◽

10.3390/jpm11121337 ◽

2021 ◽

Vol 11 (12) ◽

pp. 1337

Author(s):

Santosh Gopi Krishna Gadde ◽

Arpita Kshirsagar ◽

Neha Anegondi ◽

Thirumalesh B. Mochi ◽

Stephane Heymans ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Macular Edema ◽

Response To Treatment ◽

Foveal Thickness ◽

Naive Group ◽

Central Foveal Thickness ◽

Edema Volume ◽

Raster Scan ◽

Treatment Naïve

Optical coherence tomography (OCT) enables the detection of macular edema, a significant pathological outcome of diabetic retinopathy (DR). The aim of the study was to correlate edema volume with the severity of diabetic retinopathy and response to treatment with intravitreal injections (compared to baseline). Diabetic retinopathy (DR; n = 181) eyes were imaged with OCT (Heidelberg Engineering, Germany). They were grouped as responders (a decrease in thickness after intravitreal injection of Bevacizumab), non-responders (persistent edema or reduced decrease in thickness), recurrent (recurrence of edema after injection), and treatment naïve (no change in edema at follow-up without any injection). The post-treatment imaging of eyes was included for all groups, except for the treatment naïve group. All eyes underwent a 9 × 6 mm raster scan to measure the edema volume (EV). Central foveal thickness (CFT), central foveal volume (CFV), and total retinal volume (TRV) were obtained from the early treatment diabetic retinopathy study (ETDRS) map. The median EV increased with DR severity, with PDR having the greatest EV (4.01 mm3). This correlated positively with TRV (p < 0.001). Median CFV and CFT were the greatest in severe NPDR. Median EV was the greatest in the recurrent eyes (4.675 mm3) and lowest (1.6 mm3) in the treatment naïve group. Responders and non-responders groups had median values of 3.65 and 3.93 mm3, respectively. This trend was not observed with CFV, CFT, and TRV. A linear regression yielded threshold values of CFV (~0.3 mm3), CFT (~386 µm), and TRV (~9.06 mm3), above which EV may be detected by the current scanner. In this study, EV provided a better distinction between the response groups when compared to retinal tomography parameters. The EV increased with disease severity. Thus, EV can be a more precise parameter to identify subclinical edema and aid in better treatment planning.

Download Full-text

Intravitreal aflibercept for diabetic macular oedema: Moorfields’ real-world 12-month visual acuity and anatomical outcomes

European Journal of Ophthalmology ◽

10.1177/1120672119833270 ◽

2019 ◽

Vol 30 (3) ◽

pp. 557-562 ◽

Cited By ~ 3

Author(s):

Marko Lukic ◽

Gwyn Williams ◽

Zaid Shalchi ◽

Dawn Sim ◽

Praveen J Patel ◽

...

Keyword(s):

Visual Acuity ◽

Diabetic Retinopathy ◽

Standard Deviation ◽

Early Treatment ◽

Macular Oedema ◽

Diabetic Macular Oedema ◽

Foveal Thickness ◽

Central Foveal Thickness ◽

Intravitreal Aflibercept ◽

The Mean

Objectives: To assess structural and functional outcomes of treatment with intravitreal aflibercept (Eylea®) for diabetic macular oedema in treatment-naive patients. Design: This is a retrospective, real-life, cohort study. Participants and Methods: In all, 92 diabetic patients (102 eyes) receiving intravitreal anti–vascular endothelial growth factor therapy were included. A total of 99 aflibercept-treated eyes were included in the statistical analysis. Each patient had corrected visual acuity in Early Treatment Diabetic Retinopathy Study letters and optical coherence tomography central foveal thickness and macular volume performed at baseline and 12 months. Patients were initiated on a loading phase of five monthly intravitreal aflibercept injections, followed by injections if needed as per clinicians’ discretion. Results: The mean number of aflibercept injections received was 6.92. At baseline, the mean visual acuity (standard deviation; Snellen) was 59.7 (16.1) (20/63) Early Treatment Diabetic Retinopathy Study letters, the mean central foveal thickness (standard deviation) was 431 (129) µm, while the mean macular volume (standard deviation) was 9.53 (1.79) mm3. At 12 months, the mean visual acuity (standard deviation; Snellen) was 69.6 (15.2; 20/40) Early Treatment Diabetic Retinopathy Study letters (p < .0001). Mean central foveal thickness (standard deviation) was 306 (122) μm (p < .0001) and mean macular volume (standard deviation) was 8.43 (1.58) mm3 (p < .0001) at 12 months; 33 (33.67%) eyes gained ⩾15 Early Treatment Diabetic Retinopathy Study letters at month 12, and 50 (55.55%) eyes had a decrease in central foveal thickness of ⩾100 µm. Conclusion: There was a significant improvement in visual acuity and in anatomical outcomes in aflibercept-treated eyes at 12 months after commencing treatment for diabetic macular oedema in real-life settings.

Download Full-text

Intravitreal aflibercept for diabetic macular oedema in real-world: 36-month visual acuity and anatomical outcomes

European Journal of Ophthalmology ◽

10.1177/1120672120925034 ◽

2020 ◽

pp. 112067212092503

Author(s):

Marko Lukic ◽

Gwyn Williams ◽

Zaid Shalchi ◽

Praveen J Patel ◽

Philip G Hykin ◽

...

Keyword(s):

Visual Acuity ◽

Diabetic Retinopathy ◽

Standard Deviation ◽

Early Treatment ◽

Diabetic Macular Oedema ◽

Foveal Thickness ◽

Central Foveal Thickness ◽

Intravitreal Aflibercept ◽

The Mean ◽

Anatomical Outcomes

Background/aims To assess structural and functional outcomes of treatment with intravitreal aflibercept (®Eylea) for diabetic macular oedema in treatment-naïve patients. Methods Sixty-four eyes receiving intravitreal anti-vascular endothelial growth factor therapy were included in the data analysis of this retrospective, real-life study which follow-up was 3 years. Each patient had corrected visual acuity in Early Treatment Diabetic Retinopathy Study letters and optical coherence tomography central foveal thickness and macular volume performed at baseline, 12, 24 and 36 months. Patients were initiated on a loading phase of five 1-monthly intravitreal aflibercept injections, followed by injections if needed as per clinicians’ discretion. Results The mean number of aflibercept injections received over 3 years was 12.59. At baseline, the mean visual acuity (standard deviation) (Snellen) was 61.45 (16.30) (20/63) Early Treatment Diabetic Retinopathy Study letters, the mean central foveal thickness (standard deviation) was 422 (138) µm, while the mean macular volume (standard deviation) was 9.51 (2.01) mm3. At 36 months, the mean visual acuity (standard deviation) (Snellen) was 68.34 (13.66) (20/50) Early Treatment Diabetic Retinopathy Study letters (p = .0003). Mean central foveal thickness (standard deviation) was 303 (106) µm (p < .0001) and mean macular volume (standard deviation) was 8.35 (1.62) mm3 (p = .0022) at 36 months. Sixteen (25%) eyes gained ≥15 ETDRS letters at month 36, and 33 (52%) eyes had a decrease in central foveal thickness of ≥ 100 µm at the same time. Conclusion There was a significant improvement in visual acuity and in anatomical outcomes in aflibercept-treated eyes at 36 months after commencing treatment for diabetic macular oedema in real-life settings. The good vision and anatomical outcomes were maintained over second and third year of treatment with mean 2.93 and 2.57 intravitreal injections, respectively.

Download Full-text

Low Luminance Visual Acuity and Low Luminance Deficit in Proliferative Diabetic Retinopathy

Journal of Clinical Medicine ◽

10.3390/jcm10020358 ◽

2021 ◽

Vol 10 (2) ◽

pp. 358

Author(s):

Eleni Karatsai ◽

Piyali Sen ◽

Sarega Gurudas ◽

Sobha Sivaprasad

Keyword(s):

Visual Acuity ◽

Diabetic Retinopathy ◽

Proliferative Diabetic Retinopathy ◽

Low Luminance ◽

Pan Retinal Photocoagulation ◽

Treatment Naïve ◽

The Mean ◽

Post Hoc ◽

To Receive ◽

Retinal Photocoagulation

This study aimed to determine the relation of best corrected visual acuity (BCVA) and low luminance visual acuity (LLVA) in proliferative diabetic retinopathy (PDR) following treatment with either aflibercept or pan-retinal photocoagulation (PRP). The study was conducted as a post-hoc analysis of the CLARITY trial in which naïve and PRP treated PDR patients were randomised to receive either aflibercept or PRP. BCVA and LLVA were assessed at baseline and at week 52. Our analyses showed that the BCVA and LLVA correlate well in treatment naïve PDR with an average low luminance deficit of 11.79 Early Treatment Diabetic Retinopathy Score (ETDRS) letters. However, LLVA at lower levels of BCVA showed more variance. Post aflibercept therapy, the mean change in BCVA and LLVA at 52 weeks after aflibercept was +2.1 (SD 6.05) letters and +0.39 (SD 5.6) letters, respectively. Similarly, after PRP, it was −2.5 (SD 4.9) letters and −1.9 (SD 8.7) letters, respectively. When comparing treatment arms, BCVA change was found to be statistically significant (p < 0.001) whereas LLVA was not (p = 0.11). These findings show that LLVA does not respond as well as BCVA following any treatment for PDR, even though BCVA and LLVA both test foveal function.

Download Full-text

Intravitreal Ranibizumab Injection As A Treatment For Diabetic Macular Edema

Sriwijaya Journal of Ophthalmology ◽

10.37275/sjo.v3i2.44 ◽

2020 ◽

Vol 3 (2) ◽

pp. 51-57

Author(s):

Defayudina Dafilianty Rosataria ◽

Ramzi Amin

Keyword(s):

Visual Acuity ◽

Diabetic Retinopathy ◽

Macular Edema ◽

Intravitreal Injection ◽

Diabetic Macular Edema ◽

Proliferative Diabetic Retinopathy ◽

Early Stage ◽

Hard Exudates ◽

Anti Vegf ◽

History Of

ABSTRACT Introduction : In general, diabetic retinopathy is classified into early stage, namely non proliferative diabetic retinopathy (NPDR), and advanced stage, proliferative diabetic retinopathy (PDR). Diabetic macular edema is the most common cause of visual impairment in cases of early stage or NPDR. Purpose : To describe Diabetic Macular Edema (DME) with intravitreal injection of anti-VEGF as a treatment. Case report : 43 old female, came with chief complaint of blurred vision on her right eye since six months ago. Blurring is felt slowly. Patient has a history of uncontrolled diabetes since 10 years and a history of hypercholesterolemia since 1 year ago. visual acuity of the right eye is 4/60. On posterior segment examination, neovascularization of the papilla was found. Decreased foveal reflex (+), hard exudates (+) within 500 µm from the central macula. Microaneurism (+), dot hemorrhage (+), blot (+) in 4 quadrants, hard exudates (+) in 2 quadrants in her right eye. The patient was planned for intravitreal injection of anti-VEGF on her right eye. Conclusion : Intravitreal injection of anti-VEGF can improve visual acuity and reduce exudate and hemorrhage in retina from ophthalmoscope and fundus photography examination. In addition, the investigation with OCT was found to improve with reduced macular thickness.

Download Full-text

Effectiveness and Safety of Intravitreal Injection of Conbercept as an Initial Treatment for Exudative Circumscribed Choroidal Hemangioma

Ophthalmologica ◽

10.1159/000505753 ◽

2020 ◽

Vol 243 (6) ◽

pp. 436-443

Author(s):

Kunbei Lai ◽

Yajun Gong ◽

Fabao Xu ◽

Longhui Li ◽

Chuangxin Huang ◽

...

Keyword(s):

Intravitreal Injection ◽

Tumor Size ◽

Initial Treatment ◽

Laser Photocoagulation ◽

Functional Responses ◽

Foveal Thickness ◽

Choroidal Hemangioma ◽

Central Foveal Thickness ◽

The Mean

Objective: To investigate the effectiveness and safety of intravitreal injection of conbercept (IVC) as the initial treatment for exudative circumscribed choroidal hemangioma (CCH). Methods: Forty-two eyes of 42 patients received 3 monthly IVC (0.5 mg/0.05 mL) as the initial treatment. Three months later, the patients were assessed for further treatment including observation, reinjection of conbercept, laser photocoagulation (if the lesion was 3,000 μm away from the macular fovea), or photodynamic therapy (PDT; if the lesion was under the macular fovea). Anatomical and functional responses including best corrected visual acuity (BCVA), central foveal thickness (CFT), and tumor size were analyzed. Results: Twenty-three patients (54.76%) were sensitive to the monotherapy of IVC. Fourteen patients (33.33%) were insensitive to IVC and underwent rescue laser photocoagulation, and 5 patients (11.90%) underwent rescue PDT due to insensitivity to IVC treatment at 3 months. For subgroup analysis, although no statistical difference was found for BCVA at any follow-up time point compared to baseline, an increasing tendency of BCVA was found in the IVC group (p> 0.05). The mean CFT decreased significantly from 427.13 ± 214.74 μm at baseline to 259.83 ± 61.68 μm at 6 months in the IVC group (p< 0.05). No influence on tumor size was found in the IVC group. Conclusion: IVC as the initial treatment might be an option for exudative CCH.

Download Full-text

OCT retinal angiography features in patients with rheumatoid arthritis: A pilot study

European Journal of Ophthalmology ◽

10.1177/11206721211035626 ◽

2021 ◽

pp. 112067212110356

Author(s):

Pierluigi Iacono ◽

Stefano Da Pozzo ◽

Alberto Bedendo ◽

Alessandro Arrigo ◽

Mariacristina Parravano ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Foveal Avascular Zone ◽

Value Assessment ◽

Foveal Thickness ◽

Central Foveal Thickness ◽

Retinal Capillary ◽

Capillary Plexus ◽

Potential Applications ◽

Treatment Naïve ◽

Retinal Microcirculation

Purpose: To evaluate the superficial (SCP) and deep retinal capillary plexus (DCP) by mean of optical coherence tomography angiography (OCTA) in treatment-naïve patients affected by rheumatoid arthritis (RA). Methods: Between March 2019 and January 2020, patients with recent diagnosis of “definite RA” based on 2010 Rheumatoid Arthritis Classification Criteria were included in a Prospective, observational single center case-control study carried out at G.B. Bietti Foundation. Data were compared with those of 16 healthy age- and sex-matched subjects. Values of the vessel density (VD) of SCP and DCP, central foveal thickness (CFT), foveal avascular zone (FAZ) were collected by mean of OCTA. Main outcome measure was the VD alteration of SCP and DCP in treatment-naïve RA-patients. Results: No difference in age, sex-distribution, best-corrected visual acuity, CFT was registered between the two groups. OCTA data analysis showed in RA-patients a statistically significant reduction in the VD in the mean global area, inner ring, especially in the superior quadrant of the SCP. A trend of VD reduction was also registered in temporal, nasal, and inferior quadrants, respectively, although it did not reach a statistically significant value. Assessment of VD of DCP and FAZ area did not evidence any difference among the groups. Conclusions: OCTA allows to highlight the vascular remodeling of the retinal microcirculation in RA-patients, even in early stages of the disease, demonstrating a reduction of VD. Outcomes of the current investigation can provide new insight in the pathogenetic mechanism of RA and extend the potential applications of this diagnostic tool.

Download Full-text