Optimised treatment for pre-existing diabetic macular oedema during cataract surgery

2021 ◽  
Author(s):  
Danny Ng
Keyword(s):  
Cataract Surgery ◽  
Macular Oedema ◽  
Diabetic Macular Oedema

scholarly journals Five-year outcomes of eyes initially enrolled in the 2-year BEVORDEX trial of bevacizumab or dexamethasone implants for diabetic macular oedema

2021 ◽  
pp. bjophthalmol-2021-319839
Author(s):  
Elisa E Cornish ◽  
Kelvin YC Teo ◽  
Mark C Gillies ◽  
Lyndell L Lim ◽  
Vuong Nguyen ◽  
...  
Keyword(s):  
Cataract Surgery ◽  
Macular Oedema ◽  
Clinical Care ◽  
Diabetic Macular Oedema ◽  
Standard Of Care ◽  
Similar Proportion ◽  
Treatment Groups ◽  
Post Trial ◽  
Intravitreal Dexamethasone ◽  
Anatomical Outcomes

BackgroundThe BEVORDEX trial compared outcomes of eyes with diabetic macular oedema (DMO) randomised to receive either intravitreal dexamethasone (DEX-) implant or bevacizumab over 2 years. We assessed long-term efficacy and safety outcomes 5 years from enrolment.MethodsPatients received standard clinical care after they finished the study. Their files were reviewed for visual and anatomical outcomes, post-trial treatments and complications.ResultsThree-year and five-year data were available for 82% and 59% of eyes enrolled in the BEVORDEX study, respectively. Visual acuity gains at end of trial were generally lost by both treatment groups at 5 years but the macular thickness did not change from end of trial to 5 years. A similar proportion of eyes from each treatment group gained ≥10 letters at 5 years from enrolment in the BEVORDEX trial.Eyes that were initially randomised to the DEX-implant group had significantly fewer treatments but were more likely to develop proliferative diabetic retinopathy (PDR) over the 5-year period compared with eyes initially randomised to bevacizumab. The proportion of eyes that had cataract surgery by 5 years was similar between initial treatment groups.ConclusionsEyes in the BEVORDEX trial had similar 5-year rates of cataract surgery, however, more eyes converted to PDR in the group initially treated with DEX-implant. Eyes that were initially treated for 2 years with either intravitreal DEX-implant of bevacizumab followed by standard of care had similar visual and anatomical outcomes at 5 years.

scholarly journals Prospective randomised clinical trial of intravitreal bevacizumab versus triamcinolone in eyes with diabetic macular oedema undergoing cataract surgery: 6-month results

2019 ◽  
pp. bjophthalmol-2018-313437 ◽  
Author(s):  
Rathika Kandasamy ◽  
Marios Constantinou ◽  
Sophie L Rogers ◽  
Sukhpal Singh Sandhu ◽  
Sanjeewa Wickremasinghe ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Cataract Surgery ◽  
Macular Oedema ◽  
Diabetic Macular Oedema ◽  
Intravitreal Bevacizumab ◽  
Randomised Clinical Trial ◽  
Sustained Improvement ◽  
Significant Difference ◽  
To Receive ◽  
Significant Cataract

AimTo report the 6-month results of a clinical trial that compared intravitreous bevacizumab (BVB) 1.25 mg versus triamcinolone acetonide (TA) 4 mg when administered as an adjunct during cataract surgery to patients with diabetic macular oedema (DMO).MethodsProspective, double-masked, single-centre (Royal Victorian Eye and Ear Hospital, Melbourne) clinical trial. Patients with visually significant cataract and centre-involving DMO (either current or prior) were randomised (1: 1) to receive either intravitreous BVB 1.25 mg or TA 4 mg at the time of cataract surgery and if required at review. Main outcome measures were changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) from baseline to the 6-month time point of this 12-month study.Results61 eyes of 58 patients were enrolled. At baseline, both groups were similar in terms of BCVA and CMT (p>0.2). At 6 months, there was no significant difference in vision between the groups, with mean letter gain of +21.4 (95% CI +14.5 to +28.4) in the TA group and +17.3 (95% CI +12.1 to +22.6) in the BVB group (p=0.35). The TA group had a significant sustained anatomical improvement at 6 months, with a reduction in CMT (−51.4 µm; 95% CI −98.2 to -4.7) compared with thickening in the BVB group (+15.6 µm; 95% CI −26.4 to +57.7, p=0.04).ConclusionsWhen given as an adjunct to cataract surgery, both TA and BVB improved visual outcomes at 6 months postoperatively. However, only TA resulted in sustained improvement in CMT, with the majority not requiring any further treatment postoperatively.

scholarly journals Influence of cataract and small incision cataract surgery on the macular thickness measurements: an optical coherence tomography-based study

2018 ◽  
Vol 6 (4) ◽  
pp. 1277
Author(s):  
Anu F. Anand ◽  
C. V. Anthrayose Kakkanatt ◽  
Monsy T. Mathai ◽  
Minu Sasikumar
Keyword(s):  
Optical Coherence Tomography ◽  
Cataract Surgery ◽  
Optic Disc ◽  
Macular Oedema ◽  
Diabetic Macular Oedema ◽  
Optical Coherence ◽  
Small Incision Cataract Surgery ◽  
Small Incision ◽  
Macular Diseases ◽  
Thickness Measurements

Background: Optical Coherence Tomography (OCT) is a noninvasive imaging technique for analysing retinal architecture. It is a common investigation for various optic disc and macular diseases like glaucoma and diabetic macular oedema nowadays. OCT image quality is affected by many factors especially media opacity due to cataract. This study was done to compare macular thickness measurements by OCT in the presence of cataract and after removal of the cataract by Small Incision Cataract Surgery (SICS).Methods: A prospective observational study was designed which included 99 eyes of 99 patients with no optic disc and retinal pathology who underwent uncomplicated small incision cataract surgery. Routine ophthalmological evaluation including scans using macular analysis protocols of Cirrus HD OCT were done on the first visit to outpatient department and repeated on the day of surgery, one week and three weeks after surgery. The difference between the visits were analysed by Student’s t-test for paired samples.Results: The best corrected visual acuity and signal strength of OCT scans improved significantly after surgery. Among the macular parameters the temporal inner, nasal inner and nasal outer area thicknesses showed significant improvement from preoperative to postoperative values. The foveal thickness, nasal inner and nasal outer thicknesses changed significantly between two postoperative visits.Conclusions: The presence of cataract and small incision cataract surgery affects the macular measurements performed with Cirrus HD OCT. This should be taken into consideration while managing macular diseases like diabetic macular oedema.

scholarly journals Long-term outcomes of phakic patients with diabetic macular oedema treated with intravitreal fluocinolone acetonide (FAc) implants

Eye ◽  
2015 ◽  
Vol 29 (9) ◽  
pp. 1173-1180 ◽  
Author(s):  
Y Yang ◽  
◽  
C Bailey ◽  
F G Holz ◽  
N Eter ◽  
...  
Keyword(s):  
Cataract Surgery ◽  
Macular Oedema ◽  
Diabetic Macular Oedema ◽  
Cataract Extraction ◽  
Fluocinolone Acetonide ◽  
Long Term Outcomes ◽  
Phase 3 ◽  
Corrected Visual Acuity ◽  
Working Age

Abstract Purpose Diabetic macular oedema (DMO) is a leading cause of blindness in working-age adults. Slow-release, nonbioerodible fluocinolone acetonide (FAc) implants have shown efficacy in the treatment of DMO; however, the National Institute for Health and Care Excellence recommends that FAc should be used in patients with chronic DMO considered insufficiently responsive to other available therapies only if the eye to be treated is pseudophakic. The goal of this analysis was to examine treatment outcomes in phakic patients who received 0.2 μg/day FAc implant. Methods This analysis of the phase 3 FAME (Fluocinolone Acetonide in Diabetic Macular Edema) data examines the safety and efficacy of FAc implants in patients who underwent cataract extraction before (cataract before implant (CBI) group) or after (cataract after implant (CAI) group) receiving the implant. The data were further examined by DMO duration. Results Best corrected visual acuity (BCVA) after 36 months was comparable in the CAI and CBI groups. Both the percentage of patients gaining ≥3 lines of vision and mean change in BCVA letter score were numerically greater in the CAI group. In addition, most patients who underwent cataract surgery experienced a net gain in BCVA from presurgery baseline as well as from original study baseline. Conclusions These data support the use of 0.2 μg/day FAc implants in phakic as well as in pseudophakic patients. These findings will serve as a pilot for design of future studies to evaluate the potential protective effect of FAc implants before cataract surgery in patients with DMO and cataract.

Outcomes of cataract surgery in eyes with diabetic macular oedema: Data from the Fight Retinal Blindness! Registry

2020 ◽  
Vol 48 (4) ◽  
pp. 462-469 ◽  
Author(s):  
Sanjeeb Bhandari ◽  
Anne C. Biechl ◽  
Vuong Nguyen ◽  
David Squirrell ◽  
Hemal Mehta ◽  
...  
Keyword(s):  
Cataract Surgery ◽  
Macular Oedema ◽  
Diabetic Macular Oedema

scholarly journals Visual outcomes in Patients with Diabetic Macular Oedema undergoing Cataract Surgery with or without Intravitreal Bevacizumab

1970 ◽  
Vol 12 (3) ◽  
pp. 135-139
Author(s):  
Mazhar Hassan Hassan ◽  
Aziz Ur Rehman ◽  
Umair Qidwai ◽  
Rashid Alvi ◽  
Nasir Bhatti ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Cataract Surgery ◽  
Macular Oedema ◽  
Diabetic Macular Oedema ◽  
Intravitreal Bevacizumab ◽  
Control Group ◽  
Open Label ◽  
Intravitreal Bevacizumab Injection ◽  
Randomised Controlled ◽  
Bevacizumab Injection

Aims: To evaluate the efficacy of a single intravitreal bevacizumab injection after cataract surgery for the management of postoperative decrease in vision in patients with diabetic macular oedema.Methods: In this randomised controlled open-label parallel group study of 60 patients with diabetic macular oedema and lens opacity (grade ≥3), 30 eyes received a single intravitreal bevacizumab injection after cataract surgery, and 30 control eyes did not receive bevacizumab. The primary endpoint was change in best-corrected visual acuity 6 weeks after operation compared with that at baseline using the Snellen visual acuity chart.Results: Postoperative visual acuity was significantly different between the group receiving bevacizumab and the control group (p<0.005). All patients in the bevacizumab group had postoperative visual acuities above 6/18 with 27 patients having visual acuities of 6/12 or better compared with 6 patients in the control group. None of the patients in the bevacizumab group had visual acuities less than 6/18 compared with 11 patients in the control group.Conclusion: Intravitreal bevacizumab after cataract surgery appears to be beneficial for preventing postoperative visual loss in eyes with diabetic retinopathy by reducing the risk of macular thickening.

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