scholarly journals Effect of Intravitreous Aflibercept vs Vitrectomy With Panretinal Photocoagulation on Visual Acuity in Patients With Vitreous Hemorrhage From Proliferative Diabetic Retinopathy

JAMA ◽  
2020 ◽  
Vol 324 (23) ◽  
pp. 2383
Author(s):  
Andrew N. Antoszyk ◽  
Adam R. Glassman ◽  
Wesley T. Beaulieu ◽  
Lee M. Jampol ◽  
Chirag D. Jhaveri ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Proliferative Diabetic Retinopathy ◽  
Vitreous Hemorrhage ◽  
Panretinal Photocoagulation

Endolaserless Vitrectomy With Intravitreal Aflibercept Injection for Proliferative Diabetic Retinopathy-Related Vitreous Hemorrhage (LASER LESS TRIAL)

2018 ◽  
Vol 2 (3) ◽  
pp. 127-137
Author(s):  
Dennis M. Marcus ◽  
Harinderjit Singh ◽  
Davis C. Starnes ◽  
Harveen Walia ◽  
Amina Farooq ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Proliferative Diabetic Retinopathy ◽  
Vitreous Hemorrhage ◽  
Panretinal Photocoagulation ◽  
Short Term ◽  
Safety And Efficacy ◽  
Intravitreal Aflibercept ◽  
Central Subfield Thickness ◽  
Endothelial Growth Factor

Purpose: For proliferative diabetic retinopathy (PDR) eyes not requiring vitrectomy, Diabetic Retinopathy Clinical Research Protocol S and the CLARITY trial demonstrated better visual function and anatomical outcomes with less proliferative and diabetic macular edema consequences in the antivascular endothelial growth factor groups compared to the panretinal photocoagulation groups. Intravitreal aflibercept injection (IAI) may represent a useful therapy with vitrectomy for PDR-related vitreous hemorrhage (VH) as a viable alternative to intraoperative endolaser during vitrectomy. We will determine the safety and efficacy when aflibercept is used for PDR-related VH with endolaserless vitrectomy. Methods: Evaluation of endolaserless vitrectomy and 2 mg IAI for PDR-related VH. Eyes receive 1 preoperative and intraoperative IAI followed by randomization to a q8week group receiving 4 postoperative q4week IAI followed by q8week IAI or q16week group receiving 2 postoperative q4week IAI followed by q16week IAI. Main Outcome Measures: Herein, we present pooled safety and efficacy outcomes through 4 months. Results: Twenty-one of 24 eyes were randomized. Preoperative average visual acuity (VA) was 36 letters (20/200). At 4-month follow-up, 18 of 21 randomized eyes showed an average VA of 72 letters (20/40) with an average visual gain of 38 (range, 0-84 gain) letters. Average optical coherence tomography (OCT) central subfield thickness (CST) at 1-month postoperative follow-up was 311 µm. Average OCT CST at 4-month follow-up was 272 µm (average thinning of 38 µm). No significant short-term ocular or systemic adverse events were observed through 4 months. Conclusions: Endolaserless vitrectomy with IAI for PDR-related VH demonstrates short-term safety with significant VA improvement.

scholarly journals Risk Factors of Neovascular Glaucoma After 25-gauge Vitrectomy for Proliferative Diabetic Retinopathy with Vitreous Hemorrhage: A Retrospective Multicenter Study

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Kei Takayama ◽  
Hideaki Someya ◽  
Hiroshi Yokoyama ◽  
Yoshihiro Takamura ◽  
Masakazu Morioka ◽  
...  
Keyword(s):  
Risk Factors ◽  
Diabetic Retinopathy ◽  
Proliferative Diabetic Retinopathy ◽  
Multicenter Study ◽  
Vitreous Hemorrhage ◽  
Neovascular Glaucoma ◽  
Panretinal Photocoagulation ◽  
Uncontrolled Diabetes ◽  
Surgical Options ◽  
25 Gauge Vitrectomy

Abstract Neovascular glaucoma (NVG) is a terminal severe complication in eyes with proliferative diabetic retinopathy (PDR), and PDR eyes with vitreous hemorrhage (VH) which undergo vitrectomy may have higher risk of postoperative NVG. The incidence and the prognostic factor of postoperative NVG after 25-gauge vitrectomy with advanced surgical options remain unclear. We retrospectively reviewed medical records of 268 eyes of 268 consecutive PDR patients with VH who underwent 25-gauge vitrectomy and 12 months follow-up at seven centers. Preoperative ocular factors (visual acuity, tractional retinal detachment, panretinal photocoagulation [PRP]), demographics and clinical factors (sex, age, diabetic duration, HbA1c, hypertension, anticoagulant medication, and kidney function), surgical procedures, and postoperative complications were compared between patients who developed postoperative NVG (9.3%) and those who did not. NVG eyes was significantly younger (P = 0.026), had shorter diabetic duration (P = 0.022), higher HbA1c (P = 0.028), absence of PRP (P = 0.039) and higher frequency of postoperative VH (P = 0.0075) than non-NVG eyes. Logistic regression analysis identified postoperative VH (P = 0.014), shorter diabetic duration (P = 0.029), and no PRP (P = 0.028) as prognostic factors for postoperative NVG. This multicenter study indicates that younger age, uncontrolled diabetes, no PRP, and postoperative VH are risk factors of post-vitrectomy NVG.

scholarly journals Triamcinolone and Bevacizumab as Adjunctive Therapies to Panretinal Photocoagulation for Proliferative Diabetic Retinopathy

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
F. Lopez-Lopez ◽  
F. Gomez-Ulla ◽  
M. J. Rodriguez-Cid ◽  
L. Arias
Keyword(s):  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Contrast Sensitivity ◽  
Proliferative Diabetic Retinopathy ◽  
Panretinal Photocoagulation ◽  
Central Macular Thickness ◽  
Intravitreal Triamcinolone ◽  
Corrected Visual Acuity ◽  
Best Corrected Visual Acuity

Purpose. To evaluate efficacy of intravitreal triamcinolone (IVT) and bevacizumab (IVB) as adjunctive treatments to panretinal photocoagulation (PRP) in proliferative diabetic retinopathy (PDR). Methods. In 60 eyes of 45 patients with PDR, PRP (PRP group), PRP with IVT (IVT group), or PRP with IVB (IVB group) was performed. Regression of new vessels (NV), changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), and contrast sensitivity at 1,2, and 6 months were evaluated. Results. Initial mean numbers of active NV and BCVA were 3.45 and 67.35 in the PRP group, 4.35 and 76.65 in the IVT group, and 4.79 and 75.53 in the IVB group. At the 6-month follow-up, numbers of active NV were 2.5 (P=0.064), 1.11 (P=0.000), and 1.11 (P=0.002), and there was a mean loss of 2,6 (P=0.055), 3.9 (P=0.011), and 0.9 letters (P=0.628) in the PRP, IVT, and IVB groups, respectively. Changes in CMT in the PRP and IVT groups were not significant, but significantly increased in the IVB group (P=0.032). Contrast sensitivity remained stable in PRP and IVB groups and slightly decreased in IVT group. Conclusions. Adjunctive use of both triamcinolone and bevacizumab with PRP lead to a greater reduction of active NV than PRP alone in PDR, although no differences were seen between the two of them.

scholarly journals Need for vitreous surgeries in proliferative diabetic retinopathy in 10 years follow-up: India Retinal Disease Study (IRDS) group Report no.2

2020 ◽  
Author(s):  
Rehana Khan ◽  
Janani Surya ◽  
Ramachandran Rajalakshmi ◽  
Padmaja Kumari Rani ◽  
Giridhar Anantharaman ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Cataract Surgery ◽  
Proliferative Diabetic Retinopathy ◽  
Low Risk ◽  
Study Cohort ◽  
Panretinal Photocoagulation ◽  
Vitreous Surgery ◽  
Retinal Surgery

Introduction: To report the 10 - year rate of vitrectomies and the associated factors in people with proliferative diabetic retinopathy (PDR) from a multicentric cohort of people with diabetes mellitus. Methods: Ten centres in India with established vitreoretinal services for over 10 years were invited to provide long-term data on PDR. People with Type 1 or 2 diabetes with a clinical diagnosis of active PDR in one or both eyes were included. Baseline data collected included age, sex, duration of diabetes, source of referral and best-corrected visual acuity and diabetic retinopathy status in both eyes. Available follow-up data included the numbers of panretinal photocoagulation (PRP) sessions, cataract surgery, treatment of diabetic macular edema, use of anti- vascular endothelial growth factor therapy, vitrectomy with or without retinal surgeries over 10 years. Results: Over 10 years, 89 % needed supplemental PRP after initial complete PRP. One – third required retinal surgery, 16 % needed intravitreal injection. Men (74.5%) had significant higher risk for vitreous surgery. Of the group with low risk PDR, 56.8% did not require vitreoretinal surgery, p <0.001. Of the patients who underwent cataract surgery and had intravitreal anti-VEGF injections, 78.5% and 28.2% needed subsequent vitreous surgery (VR), p=0.006 and <0.0001 respectively. Independent predictors of need for vitreo-retinal surgery included those who underwent cataract surgery and those with poor baseline visual acuity (logMAR). Eyes at lower risk for VR surgery included the eyes previously treated with PRP and low-risk PDR at baseline. Conclusion: Despite initial ‘complete’ PRP, one third of our study cohort needed vitrectomies over 10 years, highlighting that these patients require regular follow-up for a long period of time.

scholarly journals Visual outcomes and complications following One-way Air-fluid exchange technique for vitreous hemorrhage post vitrectomy in proliferative diabetic retinopathy patients

2020 ◽  
Author(s):  
Qun Wang ◽  
Jie Zhao ◽  
Qing Xu ◽  
Cui Han ◽  
Baojie Hou ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Proliferative Diabetic Retinopathy ◽  
Vitreous Hemorrhage ◽  
Fluid Exchange ◽  
Treatment Room ◽  
Procedural Complications ◽  
The One

Abstract Background To evaluate the efficacy and outcomes following one-way surgical technique for the treatment of vitreous hemorrhage post vitrectomy in proliferative diabetic retinopathy (PDR) patients. Methods Those PDR patients who had vitrectomy with balance saline tamponade and then developed vitreous hemorrhage post vitrectomy were included in this study. 47 patients underwent the one-way air-fluid exchange surgical procedure with a 10 ml syringe used to exchange between 4.5–5.5 ml of fluid in the treatment room. After the air-fluid surgical exchange procedure, additional treatments were administered when needed. Best corrected visual acuity (BCVA) and occurrence of intra-procedural and post-procedural complications were collected and analyzed. Results A total of 47 eyes of 47 PDR patients with a mean age of 50.8 ± 12.0 years were reviewed. All 47 eyes had undergone vitrectomy with balance saline tamponade because of PDR. 4 of them were diagnosed with type 1 diabetes mellitus (T1DM), and 43 of them were diagnosed with type 2 diabetes mellitus (T2DM). All the 47 eyes were given the one-way air-fluid exchange procedure in the treatment room. In 4 cases the procedure was administered twice, and in 1 case the procedure was administered three times, followed by additional retinal photocoagulation and one intravitreal injection of Conbercept. The BCVA at the final follow-up was significantly improved from the initial acuity baseline in all cases. No complications were observed during the follow-ups. Conclusion This one-way air-fluid exchange procedure could effectively exchange the vitreous hemorrhage and improve visual acuity without obvious complications in treating vitreous hemorrhage post vitrectomy.

scholarly journals Factors correlated with visual outcomes at two and four years after vitreous surgery for proliferative diabetic retinopathy

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0244281
Author(s):  
Katsuhiro Nishi ◽  
Koichi Nishitsuka ◽  
Teiko Yamamoto ◽  
Hidetoshi Yamashita
Keyword(s):  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Proliferative Diabetic Retinopathy ◽  
Vitreous Hemorrhage ◽  
Severe Case ◽  
Vitreous Surgery ◽  
Data Set ◽  
Postoperative Visual Acuity ◽  
Treatment Provision

Proliferative diabetic retinopathy (PDR) is the most severe case of diabetic retinopathy that can cause visual impairment. This study aimed to reveal the factors correlated with better postoperative visual acuity after a long follow-up in patients who underwent vitrectomy for PDR. We retrospectively analyzed the data set including systemic findings, ocular findings, and surgical factors from registered patients who could be completely followed up for 2 or 4 years after vitrectomy. We ultimately enrolled 128 eyes from 100 patients who underwent vitrectomy for PDR between January 2008 and September 2012 and were followed up for >2 years. Among them, 91 eyes from 70 patients could be followed up for 4 years. Factors related to the postoperative visual acuity of ≥20/40 and ≥20/30 after 2 and 4 years were investigated by logistic regression analysis. Better postoperative visual acuity correlated with the following factors: no rubeosis iridis ([≥20/40 at 2 years; odds ratio {OR}, 0.068; 95% confidence interval {CI}, 0.012–0.39; P = 0.003], [≥20/30 at 2 years; OR, 0.07; 95% CI, 0.01–0.40; P = 0.03], [≥20/30 at 4 years; OR, 0.078; 95% CI, 0.006–0.96; P = 0.04]), no fibrovascular membrane [(≥20/40 at 2 years; OR, 0.22; 95% CI, 0.061–0.81; P = 0.02), (≥20/40 at 4 years; OR, 0.26; 95% CI, 0.07–0.94; P = 0.04), (≥20/30 at 4 years; OR, 0.14; 95% CI, 0.04–0.52; P = 0.004)], existing vitreous hemorrhage (≥20/30 at 2 years; OR, 9.55; 95% CI, 1.03–95.27; P = 0.04), and no reoperation ([≥20/40 at 4 years; OR, 0.15; 95% CI, 0.03–0.78; P = 0.02], [≥20/30 at 4 years; OR, 0.06; 95% CI, 0.07–0.54; P = 0.01]). Treatment provision before disease severity and treatment without complications were associated with good postoperative visual acuity.

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