Health state utilities in patients with diabetic retinopathy, diabetic macular oedema and age-related macular degeneration: a systematic review

Inhibitors of vascular endothelial growth factors are used to treat a myriad of retinal conditions, including exudative age-related macular degeneration (AMD), diabetic macular oedema (DME) and diabetic retinopathy. Although effective, long-term efficacy is limited by the need for frequent and invasive intravitreal injections. The quest for sustained action therapeutics that can be delivered to target tissue in the least invasive manner is an arduous endeavour that has ended in premature failure for several technologies in Phase II or III trials. Nevertheless, there have been promising preclinical studies, and more are on the horizon: port delivery systems for the treatment of exudative AMD have entered Phase III trials and a wide array of preclinical studies have demonstrated the potential for nanoparticles, such as liposomes, dendrimers and cell penetrating peptides to deliver therapeutics into the posterior segment via minimally invasive routes. In this review, we discuss the challenges posed by ocular barriers for drug penetration and present the recent advancements of the most pertinent drug delivery platforms with a focus on the treatment of exudative AMD and DME.

Download Full-text

Anti-vascular endothelial growth factor treatment for retinal conditions: a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2018-022031 ◽

2019 ◽

Vol 9 (5) ◽

pp. e022031 ◽

Cited By ~ 10

Author(s):

Ba' Pham ◽

Sonia M Thomas ◽

Erin Lillie ◽

Taehoon Lee ◽

Jemila Hamid ◽

...

Keyword(s):

Systematic Review ◽

Visual Acuity ◽

Treatment Regimen ◽

Macular Oedema ◽

Meta Analysis ◽

Diabetic Macular Oedema ◽

Intravitreal Bevacizumab ◽

Age Related Macular Degeneration ◽

Anti Vegf ◽

Age Related

ObjectivesTo evaluate the comparative effectiveness and safety of intravitreal bevacizumab, ranibizumab and aflibercept for patients with choroidal neovascular age-related macular degeneration (cn-AMD), diabetic macular oedema (DMO), macular oedema due to retinal vein occlusion (RVO-MO) and myopic choroidal neovascularisation (m-CNV).DesignSystematic review and random-effects meta-analysis.MethodsMultiple databases were searched from inception to 17 August 2017. Eligible head-to-head randomised controlled trials (RCTs) comparing the (anti-VEGF) drugs in adult patients aged ≥18 years with the retinal conditions of interest. Two reviewers independently screened studies, extracted data and assessed risk of bias.Results19 RCTs involving 7459 patients with cn-AMD (n=12), DMO (n=3), RVO-MO (n=2) and m-CNV (n=2) were included. Vision gain was not significantly different in patients with cn-AMD, DMO, RVO-MO and m-CNV treated with bevacizumab versus ranibizumab. Similarly, vision gain was not significantly different between cn-AMD patients treated with aflibercept versus ranibizumab. Patients with DMO treated with aflibercept experienced significantly higher vision gain at 12 months than patients receiving ranibizumab or bevacizumab; however, this difference was not significant at 24 months. Rates of systemic serious harms were similar across anti-VEGF agents. Posthoc analyses revealed that an as-needed treatment regimen (6–9 injections per year) was associated with a mortality increase of 1.8% (risk ratio: 2.0 [1.2 to 3.5], 2 RCTs, 1795 patients) compared with monthly treatment in cn-AMD patients.ConclusionsIntravitreal bevacizumab was a reasonable alternative to ranibizumab and aflibercept in patients with cn-AMD, DMO, RVO-MO and m-CNV. The only exception was for patients with DME and low visual acuity (<69 early treatment diabetic retinopathy study [ETDRS] letters), where treatment with aflibercept was associated with significantly higher vision gain (≥15 ETDRS letters) than bevacizumab or ranibizumab at 12 months; but the significant effects were not maintained at 24 months. The choice of anti-VEGF drugs may depend on the specific retinal condition, baseline visual acuity and treatment regimen.PROSPERO registration numberCRD42015022041.

Download Full-text

Short‐time effect of intravitreal injections on retinal vascular oxygenation and vessel diameter in patients with diabetic macular oedema or neovascular age‐related macular degeneration

Acta Ophthalmologica ◽

10.1111/aos.14276 ◽

2019 ◽

Vol 98 (3) ◽

Author(s):

Christoph Mitsch ◽

Berthold Pemp ◽

Andreas Pollreisz ◽

Andreas Gleiss ◽

Sonja Karst ◽

...

Keyword(s):

Macular Degeneration ◽

Macular Oedema ◽

Diabetic Macular Oedema ◽

Vessel Diameter ◽

Time Effect ◽

Age Related Macular Degeneration ◽

Intravitreal Injections ◽

Age Related ◽

Short Time

Download Full-text

Risk factors for incident central serous retinopathy: case–control analysis of a US national managed care population

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-313050 ◽

2019 ◽

pp. bjophthalmol-2018-313050 ◽

Cited By ~ 1

Author(s):

Maggie Zhou ◽

Sophie J Bakri ◽

Suzann Pershing

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Macular Degeneration ◽

Macular Oedema ◽

Diabetic Macular Oedema ◽

Case Control ◽

Age Related Macular Degeneration ◽

Central Serous Retinopathy ◽

Lower Odds ◽

Age Related

AimTo evaluate clinical comorbidities and steroid use as risk factors for central serous retinopathy (CSR).MethodsUsing national insurance databases, we conducted a case–control study of beneficiaries with an incident diagnosis of CSR between 2007 and 2015 (n=35 492) and randomly selected controls matched on age-based and sex-based propensity scores (n=1 77 460).ResultsThe mean age (SD) of cases was 49.1 (12.2) years, and the majority (69.2%) were male. Cases were more likely to have received steroids in the past year (OR 1.14, 95% CI 1.09 to 1.19, p<0.001) and to have comorbid Cushing’s syndrome (OR 2.19, 95% CI 1.33 to 3.59, p=0.002), age-related macular degeneration (OR 5.24, 95% CI 5.00 to 5.49, p<0.001), diabetic macular oedema (OR 2.05, 95% CI 1.71 to 2.47, p<0.001) and diabetes mellitus (OR 1.44, 95% CI 1.33 to 1.56, p<0.001). Glaucoma was associated with lower odds of CSR (OR 0.54, 95% CI 0.51 to 0.56, p<0.001). Patients with other previously hypothesised risk factors (including essential hypertension, pregnancy, other autoimmune disease, sleep disorders, Helicobacter pylori infection and gastro-oesophageal reflux disease) had lower odds of CSR.ConclusionsMale middle-aged patients with recent steroid exposure were significantly more likely to develop CSR. Other risk factors include diabetes mellitus, diabetic macular oedema and age-related macular degeneration. Other previously hypothesised risk factors did not appear to confer increased risk. More research is needed to confirm and examine underlying pathophysiology.

Download Full-text