Combination Antivascular Endothelial Growth Factor and Modified Panretinal Photocoagulation in Management of Proliferative Diabetic Retinopathy

2020 ◽  
Vol 4 (5) ◽  
pp. 401-410
Author(s):  
Amy Q. Lu ◽  
Bozho Todorich
Keyword(s):  
Diabetic Retinopathy ◽  
Growth Factor ◽  
Proliferative Diabetic Retinopathy ◽  
Case Series ◽  
Disease Suppression ◽  
Final Visit ◽  
Panretinal Photocoagulation ◽  
Anti Vegf ◽  
Antivascular Endothelial Growth Factor ◽  
Endothelial Growth Factor

Purpose: This work evaluates the effects of combined intravitreal antivascular endothelial growth factor (anti-VEGF) and modified panretinal photocoagulation (PRP) for management of proliferative diabetic retinopathy (PDR). Methods: This retrospective case series included 37 eyes of 33 patients with high-risk PDR. Anti-VEGF injections (≥ 2) were followed by modified, midperipheral PRP performed in 2 or more sessions. Visual and anatomic outcomes were tracked for 1 year after treatment. Regression analysis was performed for factors predictive of final outcomes. Results: Mean visual acuity (VA) at initial and final visit were 20/50 and 20/40 ( P = .22), respectively, over a mean follow-up duration of 341.4 days. Central foveal thickness decreased from 321.8 µm to 258.6 µm ( P = .01). Resolution of PDR was achieved in 94.6% of eyes, with 5.4% of eyes requiring additional anti-VEGF for persistent neovascularization. Final VA was significantly associated with baseline VA, VA at 1 month, and any adverse anatomical events. Treatment noncompliance was present in 24.3%; compliance decreased with increasing medical comorbidities, but was not significantly associated with final VA. Conclusions: Combination of anti-VEGF and modified PRP preserved VA and yielded PDR regression in the majority of eyes. This combination provides rapid PDR regression with anti-VEGF while achieving durable disease suppression in this real-world cohort without traditional PRP.

scholarly journals Antivascular endothelial growth factor agents pretreatment before vitrectomy for complicated proliferative diabetic retinopathy: a meta-analysis of randomised controlled trials

2017 ◽  
Vol 102 (8) ◽  
pp. 1077-1085 ◽  
Author(s):  
Xin-yu Zhao ◽  
Song Xia ◽  
You-xin Chen
Keyword(s):  
Diabetic Retinopathy ◽  
Growth Factor ◽  
Proliferative Diabetic Retinopathy ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Anti Vegf ◽  
Antivascular Endothelial Growth Factor ◽  
Randomised Controlled ◽  
Endothelial Growth Factor

Background/aimsTo evaluate the efficacy of antivascular endothelial growth factor (anti-VEGF) agents pretreatment before vitrectomy for patients with complicated proliferative diabetic retinopathy (PDR).MethodsThe PubMed, Embase and the Cochrane Central Register of Controlled Trials were searched up to June 2017 to identify related studies. The Peferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. The StataSE V.12.0 software was used to analyse the relevant data. The weighted mean difference, relative risk and their 95% CIs were used to assess the strength of the association.Results14 randomised controlled trials involving 613 patients were assessed, the anti-VEGF pretreatment group included 289 patients and the control group included 324 patients. Our analysis indicated that anti-VEGF pretreatment before vitrectomy for complicated PDR could facilitate much easier surgery regarding less intraoperative bleeding, less endodiathermy, shorter duration of surgery, less iatrogenic retinal breaks, less frequency of using silicone oil and relaxing retinotomy (P<0.05). Additionally, anti-VEGF pretreatment could also achieve better postoperative best-corrected visual acuity, less early recurrent vitreous haemorrhage (VH) and quicker absorption of recurrent VH (P<0.05). However, the incidence of late recurrent VH, recurrent retinal detachment or related secondary surgery could not be reduced (P>0.05).ConclusionThe pretreatment of anti-VEGF agents before vitrectomy for patients with complicated PDR might facilitate much easier surgery and better visual rehabilitation, reduce the rate of early recurrent VH and accelerate its absorption. Moreover, future better-designed studies with larger sample sizes are required to further evaluate the efficacy of different anti-VEGF agents and reach a firmer conclusion.

scholarly journals Incidence and Risk Factors for Tractional Macular Detachment after Anti-Vascular Endothelial Growth Factor Agent Pretreatment before Vitrectomy for Complicated Proliferative Diabetic Retinopathy

2019 ◽  
Vol 8 (11) ◽  
pp. 1960
Author(s):  
Andrea Russo ◽  
Antonio Longo ◽  
Teresio Avitabile ◽  
Vincenza Bonfiglio ◽  
Matteo Fallico ◽  
...  
Keyword(s):  
Risk Factors ◽  
Vascular Endothelial Growth Factor ◽  
Diabetic Retinopathy ◽  
Growth Factor ◽  
Proliferative Diabetic Retinopathy ◽  
Vitreous Hemorrhage ◽  
Vascular Endothelial ◽  
Macular Detachment ◽  
Anti Vegf ◽  
Endothelial Growth Factor

The study’s purpose was to determine the incidence, risk factors, and outcomes of tractional macular detachment after anti-vascular endothelial growth factor (VEGF) pretreatment before vitrectomy for complicated proliferative diabetic retinopathy. Patients who underwent primary vitrectomy for complicated proliferative diabetic retinopathy, from January 2012 to 31 December 2018, were enrolled. Ophthalmic and pre-operative data were extracted from electronic record systems. All eyes with a valuable Optical Coherence Tomography (OCT)performed within 5 days before injection of anti-VEGF and on the day of vitrectomy were included. Multivariable logistic regression showed that significant risk factors for developing tractional macular detachment included days between anti-VEGF and vitrectomy (OR, 0.71 [95% CI 0.65–0.76]; p < 0.001), vitreous hemorrhage (OR, 0.23 [95% CI 0.11–0.49]; p < 0.001), and age (OR, 1.05 [95% CI 1.02–1.08]; p < 0.001). Decision-tree analysis showed that the stronger predictors of tractional macular detachment were the time between anti-VEGF injection and vitrectomy (p < 0.001). Secondary predictors were the presence of vitreous hemorrhage (p = 0.012) in eyes that underwent vitrectomy between 6 and 10 days after anti-VEGF injection and younger age (p = 0.031) in eyes that underwent vitrectomy 10 days after anti-VEGF injection. Tractional macular detachment occurs in 10% of eyes after anti-VEGF injection, the main risk factors being days between anti-VEGF injection and vitrectomy, vitreous hemorrhage, and age.

Outcomes of eyes with retinal vein occlusion that are lost to follow-up after antivascular endothelial growth factor therapy

2021 ◽  
pp. bjophthalmol-2021-319180
Author(s):  
Mirataollah Salabati ◽  
Raziyeh Mahmoudzadeh ◽  
Jae-Chiang Wong ◽  
Dillan Patel ◽  
Samir N Patel ◽  
...  
Keyword(s):  
Growth Factor ◽  
Retinal Vein Occlusion ◽  
Case Series ◽  
Final Visit ◽  
Return Visit ◽  
Vein Occlusion ◽  
Antivascular Endothelial Growth Factor ◽  
Lost To Follow Up ◽  
Endothelial Growth Factor

Background/aimsTo evaluate the outcomes of eyes with macular oedema due to retinal vein occlusion (RVO) that are lost to follow-up (LTFU) after antivascular endothelial growth factor (VEGF) injections.MethodA retrospective, single-centre, consecutive case series of RVO patients receiving injections who were LTFU >6 months was conducted. Data were collected from the visit before LTFU; return visit; 3 months, 6 months and 12 months after return; and the final visit.ResultsNinety eyes of 83 patients were included. Fifty (55.5%) eyes had branch RVO and 40 (44.5%) had central RVO. Mean LTFU duration was 277.8 days with additional mean follow-up for 748.1 days after return. Mean logarithm of the minimum angle of resolution visual acuity (VA) (Snellen) at the visit before LTFU was 0.72 (20/105) which worsened on return [1.04 (20/219), p<0.001) and remained worse at all timepoints after return: 0.92 (20/166) at 3 months (p<0.001), 0.97 (20/187) at 6 months (p<0.001), 0.94 (20/174) at 12 months (p<0.001) and 1.01 (20/205) at final visit (p<0.001). Mean central foveal thickness (CFT) increased from 252 µm at the visit before LTFU to 396 µm at the return visit (p<0.001). No difference in CFT was noted by 3 months (258 µm, p=0.71), 6 months (241 µm, p=0.54) or 12 months after return (250 µm, p=0.95). CFT was thinner at the final visit (215 µm, p=0.018).ConclusionRVO patients receiving anti-VEGF injections who were LTFU experienced a decline in VA that did not return to the levels seen before LTFU despite improvement in CFT after restarting therapy, underscoring the importance of ongoing treatment.

scholarly journals Tear fluid vascular endothelial growth factor level as a marker of effectiveness of proliferative diabetic retinopathy combined treatment

2012 ◽  
Vol 93 (6) ◽  
pp. 965-969
Author(s):  
A N Samoilov ◽  
I G Mustafin ◽  
A N Korobitsyn
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Growth Factor ◽  
Proliferative Diabetic Retinopathy ◽  
Tear Fluid ◽  
Panretinal Photocoagulation ◽  
Vascular Endothelial ◽  
Intravitreal Ranibizumab ◽  
Endothelial Growth Factor

Aim. To assess the tear fluid level of vascular endothelial growth factor in patients with proliferative diabetic retinopathy in case of panretinal photocoagulation and intravitreal ranibizumab treatment. Methods. Panretinal photocoagulation was performed in 20 patients (40 eyes) with proliferative diabetic retinopathy (first group). In the second group, which included 20 patients (40 eyes) with the same stage of diabetic retinopathy, panretinal photocoagulation was combined with intravitreal ranibizumab treatment. 20 healthy subjects (40 eyes) were examined as a contol group. There were no adverse events registered during the treatment. At the follow-up, 4 patients from the first group were diagnosed with partial intraocular hemorrhage; a posterior vitrectomy was required in 1 eye, in 3 eyes intraocular hemorrhage has resolved spontaneously. A complex of clinical and laboratory examinations included visual acuity testing, biomicroscopy, indirect ophthalmoscopy using Mainster wide field lens, fluorescein angiography, optical coherence tomography, tear fluid ELISA. Results. There was a complete regression of retinal neovascularization (no blood flow in newly grown blood vessels) in 14 (35%) eyes of patients from the first group after the first procedure. In the second group a complete regression of retinal neovascularization was observed in 100% of cases after the first procedure. The tear fluid level of vascular endothelial growth factor increased from 398.6±112.2 to 668.2±102.2 pg/ml (p 0.05) in 40 (100%) eyes of patients from the first group, in the second group the level of vascular endothelial growth factor decreased after the angiogenesis inhibitor injections in 40 eyes (100%) from 332.1±98.2 до 314.6±44.4 pg/ml (p 0.05). 1 month after treatment the visual acuity in the first group the visual acuity improved in 40% of cases (16 eyes), was stable in 45% (18 eyes), decreased in 15% (6 eyes) with the mean value changed from 0.22±0.12 to 0.24±0.08 (p 0.05); in the second group the visual acuity improved in 40% of cases (16 eyes), was stable in 45% (18 eyes), decreased in 15% (6 eyes) with the mean value changed from 0.22±0.12 to 0.24±0.08 (p 0.05). Conclusion. The use of panretinal photocoagulation combined with intravitreal ranibizumab treatment in patients with proliferative diabetic retinopathy decreases the tear fluid vascular endothelial growth factor level, improves the visual acuity and thickness of the retina. There was a marked and prolonged effect after the combined treatment, that allows to recommend this treatment method to all patients with proliferative diabetic retinopathy.

scholarly journals Perioperative anti-vascular endothelial growth factor agents treatment in patients undergoing vitrectomy for complicated proliferative diabetic retinopathy: a network meta-analysis

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Dong-yue Wang ◽  
Xin-yu Zhao ◽  
Wen-fei Zhang ◽  
Li-hui Meng ◽  
You-xin Chen
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Diabetic Retinopathy ◽  
Growth Factor ◽  
Proliferative Diabetic Retinopathy ◽  
Sham Group ◽  
Meta Analysis ◽  
Vascular Endothelial ◽  
Anti Vegf ◽  
Duration Of Surgery ◽  
Endothelial Growth Factor

Abstract Currently, controversies regarding the optimal time-point of anti-vascular endothelial growth factor (VEGF) pretreatment before pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR) still exist. To clarify this, we conducted a network meta-analysis, 26 randomized controlled trials including 1806 PDR patients were included. Compared with the sham group, performing anti-VEGF injection at preoperative (Pre-Op) 6 to 14 days could significantly improve post-operative best-corrected visual acuity (BCVA) and decrease the incidence of recurrent vitreous hemorrhage (VH). Meanwhile, it could significantly reduce the duration of surgery. Performing anti-VEGF injection at Pre-Op more than 14 days, 6 to 14 days or 1 to 5 days could significantly reduce the incidence of intra-operative bleeding, while no significant benefit existed at the end of PPV (P > 0.05). No significant difference existed between all those strategies and sham group in reducing the rate of silicone oil tamponade. Based on currently available evidence, performing the anti-VEGF pretreatment at pre-operative 6 to 14 days showed best efficacy in improving post-operative BCVA, reducing the duration of surgery and incidence of recurrent VH, it also achieves satisfactory effect in reducing the incidence of intra-operative bleeding.

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