scholarly journals Intravitreal Bevacizumab (Avastin) for Diabetic Retinopathy: The 2010 GLADAOF Lecture

2011 ◽  
Vol 2011 ◽  
pp. 1-13 ◽  
Author(s):  
J. Fernando Arevalo ◽  
Juan G. Sanchez ◽  
Andres F. Lasave ◽  
Lihteh Wu ◽  
Mauricio Maia ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Retinopathy ◽  
Laser Photocoagulation ◽  
Case Series ◽  
Intravitreal Bevacizumab ◽  
Panretinal Photocoagulation ◽  
Insulin Administration ◽  
Tractional Retinal Detachment ◽  
Selective Therapy ◽  
Vitrectomy Surgery

This paper demonstrates multiple benefits of intravitreal bevacizumab (IVB) on diabetic retinopathy (DR) including diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) at 24 months of followup. This is a retrospective multicenter interventional comparative case series of intravitreal injections of 1.25 or 2.5 mg of bevacizumab for DME, PDR without tractional retinal detachment (TRD), and patients who experienced the development or progression of TRD after an intravitreal injection of 1.25 or 2.5 mg of bevacizumab before vitrectomy for the management of PDR. The results indicate that IVB injections may have a beneficial effect on macular thickness and visual acuity (VA) in diffuse DME. Therefore, in the future this new therapy could complement focal/grid laser photocoagulation in DME. In PDR, this new option could be an adjuvant agent to panretina photocoagulation so that more selective therapy may be applied. Finally, TRD in PDR may occur or progress after IVB used as an adjuvant to vitrectomy. Surgery should be performed 4 days after IVB. Most patients had poorly controlled diabetes mellitus associated with elevated HbA1c, insulin administration, PDR refractory to panretinal photocoagulation, and longer time between IVB and vitrectomy.

scholarly journals The Effect of HbA1c Variability as a Risk Measure for Microangiopathy in Type 1 Diabetes Mellitus

Diagnostics ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 1151
Author(s):  
Pedro Romero-Aroca ◽  
Raul Navarro-Gil ◽  
Albert Feliu ◽  
Aida Valls ◽  
Antonio Moreno ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Diabetic Retinopathy ◽  
Type 1 Diabetes Mellitus ◽  
Risk Measure ◽  
Case Series ◽  
Multivariate Statistical ◽  
Case Series Study ◽  
Prospective Case Series

Background: To measure the relationship between variability in HbA1c and microalbuminuria (MA) and diabetic retinopathy (DR) in the long term. Methods: A prospective case-series study, was conducted on 366 Type 1 Diabetes Mellitus patients with normoalbuminuria and without diabetic retinopathy at inclusion. The cohort was followed for a period of 12 years. The Cox survival analysis was used for the multivariate statistical study. The effect of variability in microangiopathy (retinopathy and nephropathy) was evaluated by calculating the standard deviation of HbA1c (SD-HbA1c), the coefficient of variation of HbA1c (CV-HbA1c), average real variability (ARV-HbA1c) and variability irrespective of the mean (VIM-HbA1c) adjusted for the other known variables. Results: A total of 106 patients developed diabetic retinopathy (29%) and 73 microalbuminuria (19.9%). Overt diabetic nephropathy, by our definition, affected only five patients (1.36%). Statistical results show that the current age, mean HbA1c, SD-HbA1c and ARV-HbA1c are significant in the development of diabetic retinopathy. Microalbuminuria was significant for current age, mean HbA1c, CV-HbA1c and ARV-HbA1c. Conclusions: By measuring the variability in HbA1c, we can use SD-HbA1c and ARV-HbA1c as possible targets for judging which patients are at risk of developing DR and MA, and CV-HbA1c as the target for severe DR.

scholarly journals The Role of Hypertension and Dyslipidaemia in the Progression of Diabetic Retinopathy in Type 2 Diabetes

2019 ◽  
Vol 4 (4) ◽  
Keyword(s):  
Quality Of Life ◽  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Diabetic Retinopathy ◽  
Laser Photocoagulation ◽  
Vitreoretinal Surgery ◽  
Additional Burden

Despite the introduction of retinal laser photocoagulation and vitreoretinal surgery, diabetic retinopathy (DR) remains a significant source of sight disorders and blindness amongst individuals with Type 2 Diabetes Mellitus (T2DM) [1]. Visual impairment and blindness can add an additional burden to individuals with T2DM, thereby, affecting their quality of life and ability to self-manage their diabetes [2]. The number of people registered blind and those with moderate to severe sight complications due to DR rose from 0.2 million to 0.4 and 1.4 million to 2.6 million respectively between 1990 to 2015 [3].

Visualoutcome Pada Pasien Retinopati Diabetik Pasca Operasi Pars Plana Vitrektomi Di Rumah Sakit Pertamina Bintang Amin Provinsi Lampung Tahun 2020/2021

2021 ◽  
Vol 1 (4) ◽  
pp. 394-403
Author(s):  
Rahmat Syuhada ◽  
Toni Prasetya ◽  
Ade Utia Detty ◽  
Merryshol Okhi
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Retinopathy ◽  
Pars Plana Vitrectomy ◽  
T Test ◽  
P Value ◽  
Cross Sectional ◽  
Pars Plana ◽  
Vitrectomy Surgery ◽  
Paired T Test ◽  
Diabetes Melitus

ABSTRACT: VISUAL RESULTS OF DIABETES RETINOPATHY PATIENTS POST PARS PLANA VITRECTOMY OPERATION AT PERTAMINA BINTANG AMIN HOSPITAL Background: Diabetic retinopathy is a neovascular complication that is very specific for type 1 diabetes and type 2 diabetes. Based on data according to Basic Health Research (RISKESDAS) in 2018, diabetes mellitus in 2013 reached 1.5% of patients with diabetes, and is increasing. to 2.0% in 2018. Treatment of diabetes mellitus patients with complications of diabetic retinopathy by performing pars plana vitrectomy surgery which is anoperative management that can improve eye visual or restore visual fuction. Research Objectives: To determine the visual outcome in diabetic retinopathy patients after pars plana vitrectomy surgery at Pertamina Bintang Amin Hospital, Lampung Province in 2020.Research Methods: This type of research was cross -sectional. Sampling was done by total sampling. Bivariate data analysis using Paired T-Test.Results: Statistical analysis using Paired T-Test showed the p-value for visualoutcome analysis in diabetic retinopathy patients before and after pars plana vitrectomy surgery was 0.000 (p-value <0.05).Conclusions: There are significant changes in diabetic retinopathy patients visualoutcome before pars plana vitrectomy surgery and after pars plana vitrectomy surgery at Pertamina Hospital Amin Star Lampung Province 2020. Keywords: Diabetic retinopathy, pars plana vitrectomy operation, Visualoutcome INTISARI: VISUALOUTCOME PADA PASIEN RETINOPATI DIABETIK PASCA OPERASI PARS PLANA VITRECTOMY DI RUMAH SAKIT PERTAMINA BINTANG AMIN  Latar Belakang: Retinopati diabetik adalah komplikasi neovaskular yang sangat spesifik untuk diabetes tipe 1 dan diabetes tipe 2. Berdasarkan data menurut Riset Kesehatan Dasar (RISKESDAS) pada tahun 2018, penyakit diabetes melitus di tahun 2013 mencapai 1,5% pasien pengidap diabetes, dan meningkat menjadi 2,0% pada tahun 2018. Penanganan pada pasien diabetes melitus dengan komplikasi retinopati diabetik diantaranya adalah dengan dilakukannya operasi pars plana vitrektomi yang merupakan penatalaksanaan operatif yang dapat memperbaiki visus mata atau memulihkan fungsi penglihatan . Tujuan Penelitian: Untuk mengetahui visualoutcome pada pasien retinopati diabetik pasca operasi pars plana vitrektomi di Rumah Sakit Pertamina Bintang Amin Provinsi Lampung Tahun 2020.Metode Penelitian: Jenis penelitian ini adalah potong silang (Cross-sectioal). Pengambilan sampel dilakukan secara total sampling. Analisis data bivariat dengan Paired T-Test.Hasil Penelitian: Analisis statistik menggunakan uji Paired T-Test menunjukkan p-value untuk analisa visualoutcome pada pasien retinopati diabetic sebelum dan sesudah operasi operasi pars plana vitrektomi sebesar 0,000 (p-value < 0,05).Kesimpulan: Terdapat perubahan yang signifikan pada visualoutcome pasien retinopati diabetik sebelum operasi pars plana vitrektomi dan sesudah operasi pars plana vitrektomi di Rumah Sakit Pertamina Bintang Amin Provinsi Lampung Tahun 2020. Kata Kunci: Retinopati Diabetik, Operasi Pars Plana Vitrektomi, Visualoutcome

Bevacizumab-Augmented Retinal Laser Photocoagulation in Proliferative Diabetic Retinopathy: A Randomized Double-Masked Clinical Trial

2008 ◽  
Vol 18 (2) ◽  
pp. 263-269 ◽  
Author(s):  
A. Mirshahi ◽  
R. Roohipoor ◽  
A. Lashay ◽  
S.-F. Mohammadi ◽  
A. Abdoallahi ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Diabetic Retinopathy ◽  
High Risk ◽  
Laser Treatment ◽  
Proliferative Diabetic Retinopathy ◽  
Laser Photocoagulation ◽  
Intravitreal Bevacizumab ◽  
Complete Regression ◽  
Standard Laser ◽  
Risk Characteristic

Purpose To evaluate the additional therapeutic effect of single intravitreal bevacizumab injection on standard laser treatment in the management of proliferative diabetic retinopathy. Methods A prospective, fellow-eye sham controlled clinical trial was conducted on 80 eyes of 40 high-risk characteristic proliferative diabetic retinopathy type II diabetics. All cases received standard laser treatment according to Early Treatment Diabetic Retinopathy Study protocol. Avastin-assigned eyes received 1.25 mg intravitreal bevacizumab (Genentech Inc., San Francisco, CA) on the first session of their laser treatments. Fluorescein angiography was performed at baseline and at weeks 6 and 16, and proliferative diabetic retinopathy regression was evaluated in a masked fashion. Results The median age was 52 years (range: 39–68) and 30% of the participants were male. All patients were followed for 16 weeks. A total of 87.5% of Avastin-injected eyes and 25% of sham group showed complete regression at week 6 of follow-up (pp<0.005). However, at week 16, PDR recurred in a sizable number of the Avastin-treated eyes, and the complete regression rate in the two groups became identical (25%; p=1.000); partial regression rates were 70% vs 65%. In the subgroup of Avastin-treated eyes, multivariate analysis identified hemoglobin A1c as the strongest predictor of proliferative diabetic retinopathy recurrence (p=0.033). Conclusions Intravitreal bevacizumab remarkably augmented the short-term response to scatter panretinal laser photocoagulation in high-risk characteristic proliferative diabetic retinopathy but the effect was short-lived, as many of the eyes showed rapid recurrence. Alternative dosing (multiple and/or periodic intravitreal Avastin injections) is recommended for further evaluation.

scholarly journals Treatment of diabetic macular edema and proliferative diabetic retinopathy with anti-vascular endothelial growth factor agents under the reimbursement policy of the Taiwan National Health Insurance Bureau: Aflibercept or ranibizumab?

2021 ◽  
Author(s):  
Ming-Chieh Hsieh ◽  
Chieh-Yin Cheng ◽  
Kun-Hsien Li ◽  
Chih-Chun Chuang ◽  
Jian-Sheng Wu ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Proliferative Diabetic Retinopathy ◽  
Case Series ◽  
Incidence Rates ◽  
Panretinal Photocoagulation ◽  
Reimbursement Policy ◽  
Micropulse Laser ◽  
The Mean

Abstract The purpose of this retrospective interventional case series is to compare the functional and anatomical outcomes in eyes with diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) treated intravitreally with aflibercept or ranibizumab under the Taiwan National Insurance Bureau reimbursement policy. 84 eyes were collected and all eyes were imaged with spectral-domain optical coherence tomography (SD-OCT), color fundus photographs (CFPs), and fluorescein angiography (FA). At 24 months after therapy initiation, the logMAR BCVA improved from 0.58 ± 0.33 to 0.47 ± 0.38 (p < 0.01), the CRT decreased from 423.92 ± 135.84 to 316.36 ± 90.02 (p < 0.01), and the number of microaneurysms decreased from 142.14 ± 57.23 to 75.32 ± 43.86 (p < 0.01). The mean injection count was 11.59 ± 6.54. There was no intergroup difference in logMAR BCVA (p = 0.96), CRT (p = 0.69), or injection count (p = 0.81). However, the mean number of microaneurysms was marginally reduced (p = 0.06) in eyes treated with aflibercept at the end of the follow-up, and the incidence rates of supplementary panretinal photocoagulation (PRP) (p = 0.04) and subthreshold micropulse laser (SMPL) therapy sessions (p = 0.01) were also reduced. Multivariate analysis revealed that only initial logMAR BCVA influenced the final VA improvements (odds ratio (OR) 0.49, 95% confidence interval (CI) 0.21 ~ 0.93, p < 0.01); in contrast, age (OR -0.38, 95% CI -6.97~-1.85, p < 0.01) and initial CRT (OR 0.56, 95% CI 0.34 ~ 0.84, p < 0.01) both influenced the final CRT reduction at 24 months. To sum up, both aflibercept and ranibizumab are effective in managing DME with PDR in terms of VA, CRT and MA count. Eyes receiving aflibercept required less supplementary PRP and SMPL treatment than those receiving ranibizumab. The initial VA influenced the final VA improvements at 24 months, while age and initial CRT were prognostic predictors of 24-month CRT reduction.

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