scholarly journals Choroidal Vascularity Index as a Biomarker for Visual Response to Antivascular Endothelial Growth Factor Treatment in Diabetic Macular Edema

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Ningxin Dou ◽  
Shanshan Yu ◽  
Ching-Kit Tsui ◽  
Boyu Yang ◽  
Jianqiang Lin ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Growth Factor ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Subretinal Fluid ◽  
Visual Response ◽  
Anti Vegf ◽  
Antivascular Endothelial Growth Factor ◽  
Endothelial Growth Factor ◽  
Growth Factor Treatment

Purpose. To investigate the choroidal vascularity index (CVI) as a prognostic factor for the visual efficacy of antivascular endothelial growth factor (VEGF) treatment in diabetic macular edema (DME). Methods. We retrospectively reviewed 92 DME eyes receiving anti-VEGF treatment, which were stratified as responders (≥5 letters gained) and nonresponders (<5 letters gained or lost). Baseline systematic features and optical coherence tomography features, including the CVI, adjusted ellipsoid zone (EZ) reflectivity, subretinal fluid (SRF), and disorganization of the retinal inner layers (DRIL), were evaluated between the two groups. Results. The baseline CVI was significantly lower in nonresponders than in responders ( 0.66 ± 0.05 , 0.69 ± 0.05 , and 0.72 ± 0.05 , p = 0.014 ). After adjusting for other factors, the baseline CVI, DRIL, SRF, and adjusted EZ reflectivity were significantly associated with visual outcomes (CVI: odds   ratio   OR = 0.17 , p = 0.006 ; adjusted EZ reflectivity: OR = 0.56 , p = 0.007 ; DRIL: OR = 6.71 , p = 0.001 ; and SRF: OR = 0.29 , p = 0.008 ). Conclusion. DME patients with a higher CVI, higher adjusted EZ reflectivity, the presence of SRF, and the absence of DRIL at baseline were more likely to gain >5 letters in visual acuity after anti-VEGF treatment. CVI may serve as a novel biomarker for visual response to anti-VEGF treatment in DME.

Evaluation of Patients Receiving Intravitreal Antivascular Endothelial Growth Factor for Diabetic Macular Edema in Clinical Practice in the United States

2020 ◽  
pp. 247412642095306
Author(s):  
John D. Pitcher ◽  
Andrew A. Moshfeghi ◽  
Genevieve Lucas ◽  
Nick Boucher ◽  
Hadi Moini ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Growth Factor ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
The United States ◽  
Treatment Frequency ◽  
Anti Vegf ◽  
Injection Frequency ◽  
Antivascular Endothelial Growth Factor ◽  
Endothelial Growth Factor

Purpose: We assessed the effect of treatment frequency with intravitreal antivascular endothelial growth factor (anti-VEGF) agents on visual acuity (VA) in diabetic macular edema (DME). Methods: This retrospective analysis assessed electronic medical records of eyes newly diagnosed with DME and treated with an anti-VEGF agent at US clinics using the Vestrum Health (Naperville, Illinois) treatment and outcomes database. Eyes were divided into 2 injection frequency subcohorts (≤ 6 vs > 6 injections/y); treatment frequency and change in mean VA (Early Treatment Diabetic Retinopathy Study letters) were evaluated. Results: Among 155 240 eyes assessed, 3028 met inclusion criteria for analysis in year 1 and 1292 in year 2. During year 1 of treatment, 57% (n = 1725) received > 6 injections; most continued to receive the same injection frequency during year 2. Mean VA gain from baseline at year 1 was lower in the ≤ 6 than in the > 6 injections/year subcohort (3.7 vs 8.0 letters, respectively; P < .001). Mean VA change from the end of year 1 to year 2 for eyes receiving ≤ 6 injections in year 1 generally remained unchanged, irrespective of year 2 dosing frequency. In eyes that received > 6 injections in year 1, mean VA loss was significantly greater for eyes receiving less-frequent dosing in year 2 than in those maintained on > 6 injections. Conclusions: More than 50% of eyes with DME in routine clinical practice that completed at least 1 year of follow-up received > 6 injections of an anti-VEGF agent during the first year, resulting in better VA gains than eyes treated less frequently.

Results of dexamethasone intravitreal implant (Ozurdex) in diabetic macular edema patients: Early versus late switch

2020 ◽  
pp. 112067212092996 ◽  
Author(s):  
Jorge Ruiz-Medrano ◽  
Ramón Rodríguez-Leor ◽  
Elena Almazán ◽  
Francisco Lugo ◽  
Esther Casado-Lopez ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Growth Factor ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Group Iii ◽  
Corrected Visual Acuity ◽  
Antivascular Endothelial Growth Factor ◽  
Previously Treated ◽  
Endothelial Growth Factor ◽  
Best Corrected Visual Acuity

Purpose To assess the functional and anatomical outcomes of intravitreal dexamethasone implant Ozurdex® in eyes with diabetic macular edema that did not adequately respond to vascular endothelial growth factor inhibitors. Methods Multicenter, retrospective, and real-life case series study conducted on consecutive diabetic macular edema patients who underwent treatment with one or more dexamethasone implant injections and were followed up for a minimum of 12 months. Subjects were divided into three groups: I—naïve patients, II—previously treated eyes that received three intravitreal antivascular endothelial growth factor inhibitors injections before the study (early switch), and III—previously treated eyes that received >3 intravitreal antivascular endothelial growth factor inhibitors injections before the study (late switch). Primary endpoints were best-corrected visual acuity and central retinal thickness at month 12. Results A total of 129 eyes (21 naïve and 108 previously treated, Group II: 32 and Group III: 76) were included. At month 12, best-corrected visual acuity significantly improved from 0.27 ± 0.23 and 0.31 ± 0.22 at baseline to 0.36 ± 0.25 and 0.37 ± 0.23 at month 12 in naïve and previously treated eyes, respectively, and p = 0.0063 and 0.0060, respectively. Central retinal thickness, in naïve and previously treated eyes, was significantly reduced from 483.0 ± 143.4 and 431.3 ± 115.5 µm, at baseline, to 278.8 ± 72.1 and 269.3 ± 66.2 µm, at month 12, respectively, and p < 0.0001 each, respectively. Best-corrected visual acuity improvement was significantly greater in both absolute and percentage values, p = 0.0393 and 0.0118, respectively, in Group II than in Group III. Conclusion In eyes with insufficient response to antivascular endothelial growth factor inhibitors, switching to dexamethasone at the time to 3-monthly antivascular endothelial growth factor inhibitors injections provided better functional outcomes than those that received >3 antivascular endothelial growth factor inhibitors injections.

scholarly journals Visual Outcomes Based on Early Response to Anti-Vascular Endothelial Growth Factor Treatment for Diabetic Macular Edema

2018 ◽  
Vol 239 (2-3) ◽  
pp. 94-102 ◽  
Author(s):  
Yoshito Koyanagi ◽  
Shigeo Yoshida ◽  
Yoshiyuki Kobayashi ◽  
Yuki Kubo ◽  
Takahito Nakama ◽  
...  
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Growth Factor ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Early Response ◽  
Vascular Endothelial ◽  
Visual Outcomes ◽  
Endothelial Growth Factor ◽  
Growth Factor Treatment

Treatment of Eyes With Diabetic Macular Edema That Had a Suboptimal Response to Antivascular Endothelial Growth Factor Therapy: 2-mg Intravitreal Triamcinolone Acetonide vs 0.7-mg Dexamethasone Implant

2020 ◽  
Vol 4 (5) ◽  
pp. 372-376
Author(s):  
Brandon Kuley ◽  
Philip P. Storey ◽  
Maitri Pancholy ◽  
Turner D. Wibbelsman ◽  
Anthony Obeid ◽  
...  
Keyword(s):  
Growth Factor ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Intravitreal Triamcinolone ◽  
Treatment Groups ◽  
Antivascular Endothelial Growth Factor ◽  
Factor Therapy ◽  
Growth Factor Therapy ◽  
Endothelial Growth Factor

Purpose: This article compares 2-mg intravitreal triamcinolone (IVT) and 0.7-mg dexamethasone (DEX) implant for the treatment of diabetic macular edema in eyes that had a suboptimal response to antivascular endothelial growth factor therapy. Methods: A single-center, retrospective review was conducted of patients receiving either IVT between January 1, 2013, and January 1, 2018, or patients receiving DEX between October 1, 2015, and January 1, 2018. Visual acuity and central macular thickness (CMT) were recorded at visit of first injection and all subsequent visits. Results: Twenty-five eyes were included in the DEX group and 32 eyes were included in the IVT group. Change in vision from baseline was similar between DEX and IVT at 6-month follow-up (1.1 lines vs 2.3 lines, respectively; P = .24). Mean decrease in CMT from baseline was not different at 6-month follow-up (DEX: 120 µm vs IVT: 185 µm; P = .17). Conclusions: DEX and 2-mg IVT both achieved improvement in vision and CMT with no significant differences between treatment groups at 6-month follow-up.

scholarly journals Combination Treatment of Diabetic Macular Edema with Anti-Vascular Endothelial Growth Factor and Steroids: Analysis of DRCR.net Protocol U

2018 ◽  
Vol 1 ◽  
pp. 2
Author(s):  
Cindy Ung ◽  
Kareem Moussa ◽  
Yoshihiro Yonekawa
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Growth Factor ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Diabetic Patients ◽  
Vascular Endothelial ◽  
First Line ◽  
Second Line Therapy ◽  
Anti Vegf ◽  
Endothelial Growth Factor

Diabetic macular edema (DME) is the main cause of visual impairment in diabetic patients. Intravitreal anti-vascular endothelial growth factor (VEGF) therapy is considered the first-line treatment option in the management of DME with corticosteroids used as second-line therapy. The DRCR.net Protocol U study was a Phase II trial that sought to compare the combination of a steroid and anti-VEGF therapy to anti-VEGF monotherapy regarding visual acuity and anatomic outcomes. This review highlights the strengths, weaknesses, and clinical implications of this study.

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