scholarly journals Flavoprotein Fluorescence Correlation with Visual Acuity Response in Patients Receiving Anti-VEGF Injection for Diabetic Macular Edema

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Jorge S. Andrade Romo ◽  
Giselle Lynch ◽  
Kevin Liu ◽  
Daniel Kim ◽  
Michael Jansen ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Therapeutic Response ◽  
Diagnostic Methods ◽  
Fundus Photography ◽  
Additional Information ◽  
Structural Improvement ◽  
Anti Vegf ◽  
Patients With Diabetes

Anti-VEGF treatment of diabetic macular edema (DME) complicating diabetic retinopathy (DR) has greatly improved structural and visual outcomes for patients with diabetes mellitus. However, up to 50% of patients are either nonresponsive or refractory to anti-VEGF treatment (no improvement in BCVA or central macular thickness (CMT)). It is believed that factors such as mitochondrial structural and functional damage, due to oxidative stress, are partially responsible for this lack of improvement. Flavoprotein fluorescence (FPF) has been shown to be a sensitive marker of mitochondrial function and has been found to correlate with the degree of diabetic retinopathy. FPF may also provide additional information regarding therapeutic response of patients receiving anti-VEGF treatment for DME. Eight patients with DR and DME with clinically significant DME (CSDME) who underwent anti-VEGF (bevacizumab) treatment were imaged before injection and at follow-up visit using FPF in addition to standard color fundus photography and OCT CMT. A strong correlation r=0.98 (p=0.000015) between the FPF decrease and the BCVA improvement was observed; BCVA improved as FPF values decreased. Notably, in the same patients, the correlation between OCT CMT decrease and BCVA improvement (r=0.688) was not found to be significant (p=0.13). These findings suggest that FPF can detect improvement in metabolic function preceding structural improvement and even with small changes in edema. Additionally, FPF may be supplementary to current diagnostic methods for earlier detection of therapeutic response to anti-VEGF treatment in patients with DME.

scholarly journals Novel imaging biomarkers in diabetic retinopathy and diabetic macular edema

2020 ◽  
Vol 12 ◽  
pp. 251584142095051 ◽  
Author(s):  
Ashish Markan ◽  
Aniruddha Agarwal ◽  
Atul Arora ◽  
Krinjeela Bazgain ◽  
Vipin Rana ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Vision Loss ◽  
Imaging Modality ◽  
Microvascular Complications ◽  
Response To Treatment ◽  
Fundus Photography ◽  
Imaging Biomarkers ◽  
Potential Contribution

Diabetic retinopathy is one of the major microvascular complications of diabetes mellitus. The most common causes of vision loss in diabetic retinopathy are diabetic macular edema and proliferative diabetic retinopathy. Recent developments in ocular imaging have played a significant role in early diagnosis and management of these complications. Color fundus photography is an imaging modality, which is helpful for screening patients with diabetic eye disease and monitoring its progression as well as response to treatment. Fundus fluorescein angiography (FFA) is a dye-based invasive test to detect subtle neovascularization, look for areas of capillary non-perfusion, diagnose macular ischemia, and differentiate between focal and diffuse capillary bed leak in cases of macular edema. Recent advances in retinal imaging like the introduction of spectral-domain and swept source-based optical coherence tomography (OCT), fundus autofluorescence (FAF), OCT angiography, and ultrawide field imaging and FFA have helped clinicians in the detection of certain biomarkers that can identify disease at an early stage and predict response to treatment in diabetic macular edema. This article will summarize the role of different imaging biomarkers in characterizing diabetic retinopathy and their potential contribution in its management.

scholarly journals Clinical Characteristics of Patients with Newly Diagnosed Diabetic Macular Edema in Turkey: A Real-Life Registry Study—TURK-DEM

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Bora Eldem ◽  
Sengul Ozdek ◽  
Ali Osman Saatci ◽  
Emin Ozmert ◽  
Esat Ulay ◽  
...  
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Laser Photocoagulation ◽  
Large Scale ◽  
Real Life ◽  
Diagnostic Methods ◽  
Newly Diagnosed ◽  
Anti Vegf ◽  
Diagnostic Characteristics ◽  
The Right

Purpose. To evaluate the clinical and diagnostic characteristics of patients with newly diagnosed diabetic macular edema (DME) in Turkey in a real-life setting. Methods. A total of 945 consecutive patients (mean (SD) age: 61.3 (9.9) years, 55.2% male) with newly diagnosed DME were included. Data on patient demographics, comorbidities, ocular history, ophthalmic examination findings including type of DME, central macular thickness (CMT) via time domain (TD) and spectral domain (SD) optical coherence tomography (OCT), and planned treatments were recorded. Results. OCT (98.8%) and fundoscopy (92.9%) were the two most common diagnostic methods. Diffuse and focal DMEs were detected in 39.2% and 36.9% of cases, respectively. Laser photocoagulation (32.1%) and antivascular endothelial growth factors (anti-VEGF; 31.8%) were the most commonly planned treatments. The median CMT in the right eye was significantly greater in untreated than in treated patients [376.5 μm (range: 160–840) versus 342 μm (range: 146–999) (p=0.002)] and in the left eye [370 μm (range: 201–780) versus 329 μm (range: 148–999) (p<0.001)]. Conclusions. This study is the first large-scale real-life registry of DME patients in Turkey. SD-OCT and fundoscopy were the most common diagnostic methods. Laser photocoagulation and anti-VEGF therapy were the most common treatments.

scholarly journals Első tapasztalataink diabeteses maculopathia Navilas® 577s mikropulzuslézer-készülékkel történő kezelésével

2020 ◽  
Vol 161 (49) ◽  
pp. 2078-2085
Author(s):  
Mónika Ecsedy ◽  
Illés Kovács ◽  
Róbert Gergely ◽  
Katalin Gombos ◽  
Judit Meisel ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Retinal Thickness ◽  
Primary Treatment ◽  
Fundus Photography ◽  
Thickness Change ◽  
Anti Vegf ◽  
Number Of Injections

Összefoglaló. Bevezetés és célkitűzés: A Navilas® 577s mikropulzuslézerrel végzett kezelés biztonságosságának és hatásosságának vizsgálata diabeteses maculaoedemában. Módszer: Retrospektív vizsgálatunkba diabeteses maculaoedema miatt gondozott és legalább 6 hónapos utánkövetéssel rendelkező, korábban Navilas® 577s mikropulzuslézer-kezelésen átesett 28 beteg 46 szemét válogattuk be. Minden szemen optikaikoherencia-tomográfia (OCT) vastagsági térkép navigált, nonkontakt, küszöb alatti mikropulzuslézer-kezelés történt egy alkalommal. A kezelést megelőzően és az azt követő 6. hónapban rögzítettük a látóélesség, a centrális retinavastagság értékeit és az éreredetű endothelialis növekedési faktort (VEGF) gátló injekciók számát. A követési idő végén megvizsgáltuk a szemfenéki képnek a digitális fundusfotográfia és az átmetszeti OCT-képek segítségével észlelhető változásait. Eredmények: A vizsgált szemek közül 30 esetben a lézerkezelést korábbi centrális maculaoedema miatt VEGF-gátló injekciós kezelés előzte meg, míg 16 szem esetében primer lézerkezelés történt. A Navilas® 577s mikropulzuslézer-kezelést követően 6 hónappal sem a látóélesség, sem a centrális maculavastagság nem változott szignifikánsan egyik csoportban sem (p>0,05). Ugyanakkor a korábban injekciós kezelésben részesült szemek esetében a lézerkezelést megelőző 6 hónapban adott injekciók száma az átlagos 2,63 ± 1,18 értékről átlagosan 0,5 ± 0,73 értékre csökkent (p<0,001). A fundusfotókon és az átmetszeti OCT-scaneken a lézerkezelést követően egyetlen szem esetében sem találtunk látható pigmentelváltozásokat vagy hegesedést. Következetetés: Megfigyeléseink szerint a Navilas® 577s mikropulzuslézer-kezelés biztonságos a diabeteses maculaoedemás betegek kezelésében, továbbá a VEGF-gátlóval kezelt szemeken szerepet játszhat az injekciók számának csökkentésében. Orv Hetil. 2020; 161(49): 2078–2085. Summary. Introduction and objective: To assess the safety and efficacy of Navilas® 577s micropulse subthreshold laser in the treatment of non-center involved diabetic macular edema. Method: In this retrospective study, we included 46 eyes of 28 patients with diabetic macular edema, who were treated at least 6 months ago with Navilas® 577s micropulse laser. Laser treatment was navigated by optical coherence tomography (OCT) macular thickness map in subthreshold micropulse mode at one occasion. Data from visual acuity testing, retinal thickness, and the number of anti-vascular endothelial growth factor (VEGF) injections needed 6 months before and after treatment were registered. At the end of the follow-up, digital fundus photography and OCT radial scans were performed to evaluate any possible anatomical changes. Results: 30 eyes had previous anti-VEGF treatment for central macular edema, and in 16 eyes we performed the laser as primary treatment. At the end of the follow-up, no significant visual acuity or central retinal thickness change were observed (p>0.05). On the other hand, in the anti-VEGF pretreated group the number of injections decreased significantly from 2.63 ± 1.18 to 0.5 ± 0.73 (p<0.001). We did not find any pigmentary changes or visible signs of scaring on final fundus photography pictures or OCT radial scans. Conclusion: Navilas® 577s subthreshold microsecond laser proved to be a safe option in the treatment of diabetic macular edema. It can be very useful in anti-VEGF treated eyes by decreasing the number of injections needed. Orv Hetil. 2020; 161(49): 2078–2085.

scholarly journals Ranibizumab Treatment and Protocols in Diabetic Retinopathy and Diabetic Macular Edema

2018 ◽  
pp. 143-146
Keyword(s):  
Diabetic Retinopathy ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Treatment Efficacy ◽  
Combined Treatment ◽  
Optimal Dose ◽  
Intravitreal Ranibizumab ◽  
Anti Vegf ◽  
Common Causes ◽  
Ranibizumab Treatment

Diabetic macular edema (DME) is one of the most common causes of visual loss in patients with diabetic retinopathy (DRP). The prognosis of central involved diabetic macular edema has improved after anti-VEGF treatments. Intravitreal ranibizumab was the first anti-VEGF agent approved by the FDA for the treatment of diabetic macular edema. Despite the fact that it is a pathogenic treatment, it has brought some challenging situations on its own. In most studies, optimal dose and combined treatment were evaluated in terms of treatment efficacy. Recent studies revealed that ranibizumab treatment is effective in DRP and proliferative DRP regression as well as in diabetic macular edema treatment. In this article, we aimed to review the effects of Ranibizumab treatment on visual acuity, central macular thickness in patients with diabetic retinopathy, and diabetic macular edema through studies.

Effectiveness of intravitral anti-vegf therapy application in treatment of diabetic macular edema

2021 ◽  
pp. 9-11
Author(s):  
M.M. Bikbov ◽  
◽  
K.I. Kudoyarova ◽  
R.M. Zainullin ◽  
T.R. Gilmansin ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Visual Acuity ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Randomized Clinical Trials ◽  
Normal Values ◽  
Anti Vegf ◽  
Intravitreal Aflibercept ◽  
Patients With Diabetes

Purpose. To study the effectiveness of the use of intravitreal anti-VEGF therapy for macular edema in patients with diabetes. Material and methods. The study involved 42 patients (42 eyes) with macular edema, against the background of compensated type 2 diabetes mellitus. All patients received 5 loading doses of aflibercept with an interval of 1 month. Monthly optical coherence tomography of the macular region of the operated eye was performed, and visual acuity and intraocular pressure were determined. Results. After 5 intravitreal aflibercept injections, the thickness of the retina reached normal values and averaged 183.8 ± 19.9, IOP was within 15.0 mm Hg. Art. in all cases. The percentage of resistance to aflibercept therapy was 14.3%, which is also consistent with the results of randomized clinical trials. Conclusion. Intravitreal administration of aflibercept has been shown to be highly effective in the treatment of diabetic macular edema and allowed to increase visual acuity to 0.5 ± 0.1 after 5 intravitreal injections in 85.7% of patients. Key words: diabetic retinopathy, macular edema, anti-VEGF therapy.

scholarly journals Intravitreal Ranibizumab Injection As A Treatment For Diabetic Macular Edema

2020 ◽  
Vol 3 (2) ◽  
pp. 51-57
Author(s):  
Defayudina Dafilianty Rosataria ◽  
Ramzi Amin
Keyword(s):  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Macular Edema ◽  
Intravitreal Injection ◽  
Diabetic Macular Edema ◽  
Proliferative Diabetic Retinopathy ◽  
Early Stage ◽  
Hard Exudates ◽  
Anti Vegf ◽  
History Of

ABSTRACT Introduction : In general, diabetic retinopathy is classified into early stage, namely non proliferative diabetic retinopathy (NPDR), and advanced stage, proliferative diabetic retinopathy (PDR). Diabetic macular edema is the most common cause of visual impairment in cases of early stage or NPDR. Purpose : To describe Diabetic Macular Edema (DME) with intravitreal injection of anti-VEGF as a treatment. Case report : 43 old female, came with chief complaint of blurred vision on her right eye since six months ago. Blurring is felt slowly. Patient has a history of uncontrolled diabetes since 10 years and a history of hypercholesterolemia since 1 year ago. visual acuity of the right eye is 4/60. On posterior segment examination, neovascularization of the papilla was found. Decreased foveal reflex (+), hard exudates (+) within 500 µm from the central macula. Microaneurism (+), dot hemorrhage (+), blot (+) in 4 quadrants, hard exudates (+) in 2 quadrants in her right eye. The patient was planned for intravitreal injection of anti-VEGF on her right eye. Conclusion : Intravitreal injection of anti-VEGF can improve visual acuity and reduce exudate and hemorrhage in retina from ophthalmoscope and fundus photography examination. In addition, the investigation with OCT was found to improve with reduced macular thickness.  

scholarly journals Aflibercept for diabetic macular edema: a concise review

2017 ◽  
Vol 6 (5) ◽  
pp. 1031
Author(s):  
Sujithera Haridoss ◽  
Soundaram Meenakshi Sundaram ◽  
Melvin George ◽  
Damal Kandadai Sriram
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Laser Photocoagulation ◽  
Vision Loss ◽  
Standard Of Care ◽  
Management Options ◽  
Treatment Regimens ◽  
Anti Vegf ◽  
Patients With Diabetes ◽  
Vasculogenesis And Angiogenesis

Diabetic retinopathy and diabetic macular edema are associated with loss of vision in patients with diabetes worldwide. The treatment requires a multidisciplinary interventional approach. Among the available management options for DME, laser photocoagulation has been the standard of care. Due to its slow progression and inability to reverse the vision loss, an alternative treatment is needed. The role of vascular endothelial growth factors (VEGF) and inflammatory mediators led to the development of anti-VEGF agents, that stimulates retinal vasculogenesis and angiogenesis. Intravitreal aflibercept is an anti-angiogenic soluble decoy receptor with trap technology employed by fusion of multiple endogeneous receptor component, approved for the treatment of DME. Clinical trials of aflibercept comparing it with laser photocoagulation and other anti-VEGF have shown reliable efficacy, providing significantly positive visual and anatomical results. However, treatment regimens with monthly clinical visits and injections, challenge the patients comfort, thereby requiring the need to identify better strategies to lower injection frequencies.

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