scholarly journals MODERN ASPECTS OF DIABETIC RETINOPATHY AND DIABETIC MACULAR OEDEMA TREATMENT

2012 ◽  
Vol 67 (1) ◽  
pp. 61-65 ◽  
Author(s):  
V. V. Neroev
Keyword(s):  
Diabetic Retinopathy ◽  
Macular Oedema ◽  
Diabetic Macular Oedema ◽  
Central Zone ◽  
Laser Coagulation ◽  
Diabetic Patients ◽  
International Studies ◽  
Efficacy And Safety ◽  
Multicenter Studies ◽  
Surgical Interventions

Main reasons of eyesight deterioration in diabetic patients are diabetic retinopathy (DR) and diabetic macular oedema (DMO). International multicenter studies have shown that retinal laser coagulation in the event of DMO decreases the risk of eyesight loss in 50% , though only in 16% patients it was also possible to improve their eyesight. Use of vascular endothelial growth factor inhibitor – Ranibizumab – have opened a new era in DMA treatment. It’s efficacy and safety have been proven in several international studies. This article contains our own data upon the use of Lucentis in patients with DMO. Intravitreal Lucentis injections and subsequent retinal lasercoagulation in the macular zone were performed on 43 eyes; follow up period – 6 months. Additional injections were required in 19 cases, average amount of injections – 1,4. Mean corrected visual acuity before the treatment was 0,37±0,06, after7 days, 1, 3 and 6 months - respectively 0,41±0,06, 0,49±0,06, 0,51±0,07 and 0,52±0,07 (р0,05). Mean retina thickness in central zone was 428±25 mkm before treatment, 391±24 mkm 7 days after the last injection 349±23, 313±21 and 308±20mkm (р0,05) after 1, 3 and 6 months. In addition to that Lucentis use in preoperative period in patients with non-complicated proliferative DR allowed to decrease the risk of hemorrhagic complications. Thereby, intravitreal injections of Lucentis improve functional result of treatment of patients with DMO, increase efficacy and safety of surgical interventions in patients with complicated forms of proliferating DR.

scholarly journals Optical Coherence Tomography Angiography in Diabetic Patients: A Systematic Review

Biomedicines ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 88
Author(s):  
Ana Boned-Murillo ◽  
Henar Albertos-Arranz ◽  
María Dolores Diaz-Barreda ◽  
Elvira Orduna-Hospital ◽  
Ana Sánchez-Cano ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Optical Coherence Tomography ◽  
Diabetic Retinopathy ◽  
Macular Oedema ◽  
Literature Search ◽  
Optical Coherence Tomography Angiography ◽  
Diabetic Macular Oedema ◽  
Oct Angiography ◽  
Diabetic Patients ◽  
Optical Coherence

Background: Diabetic retinopathy (DR) is the leading cause of legal blindness in the working population in developed countries. Optical coherence tomography (OCT) angiography (OCTA) has risen as an essential tool in the diagnosis and control of diabetic patients, with and without DR, allowing visualisation of the retinal and choroidal microvasculature, their qualitative and quantitative changes, the progression of vascular disease, quantification of ischaemic areas, and the detection of preclinical changes. The aim of this article is to analyse the current applications of OCTA and provide an updated overview of them in the evaluation of DR. Methods: A systematic literature search was performed in PubMed and Embase, including the keywords “OCTA” OR “OCT angiography” OR “optical coherence tomography angiography” AND “diabetes” OR “diabetes mellitus” OR “diabetic retinopathy” OR “diabetic maculopathy” OR “diabetic macular oedema” OR “diabetic macular ischaemia”. Of the 1456 studies initially identified, 107 studies were screened after duplication, and those articles that did not meet the selection criteria were removed. Finally, after looking for missing data, we included 135 studies in this review. Results: We present the common and distinctive findings in the analysed papers after the literature search including the diagnostic use of OCTA in diabetes mellitus (DM) patients. We describe previous findings in retinal vascularization, including microaneurysms, foveal avascular zone (FAZ) changes in both size and morphology, changes in vascular perfusion, the appearance of retinal microvascular abnormalities or new vessels, and diabetic macular oedema (DME) and the use of deep learning technology applied to this disease. Conclusion: OCTA findings enable the diagnosis and follow-up of DM patients, including those with no detectable lesions with other devices. The evaluation of retinal and choroidal plexuses using OCTA is a fundamental tool for the diagnosis and prognosis of DR.

Long-term outcomes with as-needed aflibercept in diabetic macular oedema: 2-year outcomes of the ENDURANCE extension study

2017 ◽  
Vol 102 (5) ◽  
pp. 631-636 ◽  
Author(s):  
Charles C Wykoff ◽  
William C Ou ◽  
Rahul N Khurana ◽  
David M Brown ◽  
W Lloyd Clark ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Macular Oedema ◽  
Diabetic Macular Oedema ◽  
Phase Iii ◽  
Extension Study ◽  
Efficacy And Safety ◽  
Open Label ◽  
Intravitreal Aflibercept ◽  
The Mean

Background/aimsTo evaluate the efficacy and safety of individualised 2.0 mg intravitreal aflibercept retreatment for diabetic macular oedema (DME) through the fifth year of management.MethodsThis is a phase IV, 2-year, open-label extension study. Sixty patients completing the 3-year VISTA DME (Study of Intravitreal Aflibercept Injection in Patients With Diabetic Macular Edema) phase III trial enrolled in the ENDURANCE (Long-Term Efficacy and Safety of Intravitreal Aflibercept for the Treatment of DME in Subjects Who Completed the VISTA DME Trial) extension study. All patients received aflibercept in the presence of clinically relevant DME. Intervals between visits were prescribed according to disease activity. The main outcome measure was mean aflibercept injections given through 2 years.ResultsA mean of 7.7 aflibercept injections were administered through 2 years. Fifteen (25%) patients required no retreatment and 48% (n=29) of patients received five or fewer injections through 2 years. Among patients who received at least one aflibercept retreatment during ENDURANCE, the mean number of injections through 2 years was 9.5. The mean visual acuity and central retinal thickness gains achieved during VISTA DME were maintained and stable during ENDURANCE. The most notable safety signal was progression of diabetic retinopathy. Six (10%) patients converted from non-proliferative to proliferative diabetic retinopathy (PDR), and a total of eight patients experienced PDR events occurring at a mean of 387 days following the previous aflibercept treatment.ConclusionThe need for aflibercept retreatment was substantially reduced in the fourth and fifth years of aflibercept dosing for DME following initiation of therapy in the VISTA DME trial. While vision gains achieved during the 3-year VISTA DME trial were maintained through ENDURANCE with a reduced treatment burden, clinically relevant worsening of diabetic retinopathy was observed with progression to PDR in 10% of the eyes.Trial registration numberNCT02299336

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

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.

scholarly journals Rho-Kinase Inhibitors for the Treatment of Refractory Diabetic Macular Oedema

Cells ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 1683
Author(s):  
Milagros Mateos-Olivares ◽  
Luis García-Onrubia ◽  
Fco. Javier Valentín-Bravo ◽  
Rogelio González-Sarmiento ◽  
Maribel Lopez-Galvez ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Macular Oedema ◽  
Standard Therapy ◽  
Vision Loss ◽  
Therapeutic Potential ◽  
Rho Kinase ◽  
Diabetic Macular Oedema ◽  
New Drugs ◽  
Anti Vegf

Diabetic macular oedema (DMO) is one of the leading causes of vision loss associated with diabetic retinopathy (DR). New insights in managing this condition have changed the paradigm in its treatment, with intravitreal injections of antivascular endothelial growth factor (anti-VEGF) having become the standard therapy for DMO worldwide. However, there is no single standard therapy for all patients DMO refractory to anti-VEGF treatment; thus, further investigation is still needed. The key obstacles in developing suitable therapeutics for refractory DMO lie in its complex pathophysiology; therefore, there is an opportunity for further improvements in the progress and applications of new drugs. Previous studies have indicated that Rho-associated kinase (Rho-kinase/ROCK) is an essential molecule in the pathogenesis of DMO. This is why the Rho/ROCK signalling pathway has been proposed as a possible target for new treatments. The present review focuses on the recent progress on the possible role of ROCK and its therapeutic potential in DMO. A systematic literature search was performed, covering the years 1991 to 2021, using the following keywords: “rho-Associated Kinas-es”, “Diabetic Retinopathy”, “Macular Edema”, “Ripasudil”, “Fasudil” and “Netarsudil”. Better insight into the pathological role of Rho-kinase/ROCK may lead to the development of new strategies for refractory DMO treatment and prevention.

Non-mydriatic ultrawide field scanning laser ophthalmoscopy compared with dilated fundal examination for assessment of diabetic retinopathy and diabetic macular oedema in Chinese individuals with diabetes mellitus

2018 ◽  
Vol 103 (9) ◽  
pp. 1327-1331 ◽  
Author(s):  
Simon K H Szeto ◽  
Raymond Wong ◽  
Jerry Lok ◽  
Fangyao Tang ◽  
Zihan Sun ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Clinical Examination ◽  
Macular Oedema ◽  
Chinese Population ◽  
Retrospective Cohort ◽  
Diabetic Macular Oedema ◽  
Scanning Laser ◽  
Scanning Laser Ophthalmoscopy ◽  
Chinese Cohort ◽  
Clinical Grading

AimsTo evaluate the performance of ultrawide field scanning laser ophthalmoscopy (UWF-SLO) for assessing diabetic retinopathy (DR) and diabetic macular oedema (DME) in a Chinese population, compared with clinical examination.MethodsThis is a retrospective cohort study. A series of 322 eyes from 164 patients with DM were included. Each patient underwent both dilated fundal examination with DR and DME grading by retina specialist and non-mydriatic 200° UWF-SLO (Daytona, Optos, Dunfermline, UK). The severity of DR and DME from UWF-SLO images was further graded by ophthalmologists, according to both international clinical DR and DME disease severity scales and the standard 7-field Early Treatment Diabetic Retinopathy Study (ETDRS) scale. Any DR, DME and vision-threatening DR (VTDR) were treated as endpoints for this study.Results23 out of 322 images (7.14%), including all four cases with proliferative DR on clinical examinations, were determined as ungradable. When the international scale was used for grading UWF-SLO images, the sensitivity of any DR, DME and VTDR was 67.7%, 67.4% and 72.6%, respectively; the specificity of any DR, DME and VTDR was 97.8%, 97.3% and 97.8%, respectively. The agreement with clinical grading in picking up any DR, DME and VTDR was substantial, with κ-values of 0.634, 0.694 and 0.707, respectively. The performance of UWF-SLO was shown to be lower when ETDRS scale was used for grading the images.ConclusionThe performance of non-mydriatic UWF-SLO is comparable in identifying DR with that of clinical examination in a Chinese cohort. However, whether UWF-SLO can be considered as tool for screening DR is still undetermined.

scholarly journals Diabetic macular oedema: under-represented in the genetic analysis of diabetic retinopathy

2018 ◽  
Vol 96 ◽  
pp. 1-51 ◽  
Author(s):  
Suzanne Broadgate ◽  
Christine Kiire ◽  
Stephanie Halford ◽  
Victor Chong
Keyword(s):  
Diabetic Retinopathy ◽  
Genetic Analysis ◽  
Macular Oedema ◽  
Diabetic Macular Oedema
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