scholarly journals Retrospective Analysis of Treatment Patterns in Pseudophakic Diabetic Macular Oedema Eyes Treated with Anti-VEGF

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Di Zou ◽  
Imran Jawaid ◽  
Winfried M. Amoaku
Keyword(s):  
Macular Oedema ◽  
Functional Outcomes ◽  
Diabetic Macular Oedema ◽  
Prescribing Patterns ◽  
First Line ◽  
Real World Data ◽  
Treatment Delivery ◽  
First Line Therapy ◽  
Anti Vegf ◽  
Endothelial Growth Factor

Background/Objectives. Currently, in England, antivascular endothelial growth factor (anti-VEGF) is the first-line treatment for diabetic macular oedema (DMO) where central macular thickness (CMT) is ≥400 microns. In pseudophakic eyes with suboptimal response to first-line therapy, intravitreal corticosteroids may also be used. In practice, despite rigorous anti-VEGF therapy, suboptimal response occurs in nearly half of all eyes with DMO. The objective of this study was to investigate structural and functional outcomes and examine anti-VEGF treatment delivery in pseudophakic eyes receiving anti-VEGF injections for DMO. Methods. We performed a retrospective review of outcomes in 81 pseudophakic eyes with DMO that received at least 6 anti-VEGF injections. We reviewed baseline and posttreatment optical coherence tomography images, visual acuity, prescribing patterns, time taken to deliver anti-VEGF injections, and structural and functional outcomes. Results. It took an average of 913 ± 454.1 days to deliver a mean of 11.1 ± 4.7 anti-VEGF injections. Time from baseline to receiving the first 6 anti-VEGF injections was longer than 9 months in 74.7% (n = 59/79) of eyes. There was a mean gain of 1.6 letters (−0.03 logMAR) from baseline to the end point. After 5 anti-VEGF intravitreal injections, the mean CMT was 391.9 μm from 474.4 μm at baseline ( p < 0.0001 ). In 52 of 79 eyes (65.8%), more than one type of anti-VEGF agent was used. Conclusions. The anti-VEGF treatment used to treat these eyes with DMO was suboptimal, a finding consistent with recently published “real-world” data. There was a strong tendency for patients to be switched within the class to a second anti-VEGF agent.

Recommendations for the management of diabetic macular oedema with intravitreal dexamethasone implant: A national Delphi consensus study

2021 ◽  
pp. 112067212110528
Author(s):  
Laurent Kodjikian ◽  
Stephanie Baillif ◽  
Aude Couturier ◽  
Catherine Creuzot-Garcher ◽  
Marie-Noelle Delyfer ◽  
...  
Keyword(s):  
Macular Oedema ◽  
Diabetic Macular Oedema ◽  
Daily Practice ◽  
Dexamethasone Implant ◽  
Consensus Approach ◽  
Delphi Consensus ◽  
First Line ◽  
Anti Vegf ◽  
Intravitreal Dexamethasone Implant ◽  
Intravitreal Dexamethasone

Purpose The intravitreal dexamethasone implant (DEX-I) is an alternative to anti-VEGF for the first-line treatment of diabetic macular oedema (DME). However, several questions remain regarding its routine use and its place in certain situations not always specified in current recommendations. A national consensus approach was, therefore, initiated by French retinal experts. Methods An iterative Delphi consensus approach was used. A steering committee (SC) of seven experts analysed data from the literature to formulate statements divided into five key areas of treatment. These statements were submitted to the independent and anonymous electronic vote of 87 French retina experts among whom 39 expressed their opinion and therefore constituted the voting panel. Results After two rounds of voting, 22 and 7 of 38 statements received a strong consensus and a good consensus, respectively. The consensus level was higher for statements regarding first-line indications and safety of DEX-I compared to those regarding efficacy assessment, reprocessing time or pathophysiological biomarkers. The panellists recommended the preferential use of DEX-I for patients with limited availability for multiple injections, those who needed to undergo cataract surgery or who had a recent cardiovascular history, and as a therapeutic alternative to anti-VEGF in patients with a history of vitrectomy, retinal serous detachment, hyper-reflective points or dry exudates in optical coherence tomography (OCT). However, some statements proposed by SC experts were not validated. Conclusion This study provides some key recommendations to clinicians treating diabetic macular oedema, which may be useful when using intravitreal dexamethasone implants in daily practice.

scholarly journals Anti-VEGF Therapy and the Retina: An Update

2015 ◽  
Vol 2015 ◽  
pp. 1-13 ◽  
Author(s):  
Vikas Tah ◽  
Harry O. Orlans ◽  
Jonathan Hyer ◽  
Edward Casswell ◽  
Nizar Din ◽  
...  
Keyword(s):  
Macular Oedema ◽  
Diabetic Macular Oedema ◽  
Visual Outcome ◽  
Retinal Diseases ◽  
Ocular Angiogenesis ◽  
Vein Occlusion ◽  
Anti Vegf ◽  
Sight Loss ◽  
Endothelial Growth Factor ◽  
The Impact

Ocular angiogenesis and macular oedema are major causes of sight loss across the world. Aberrant neovascularisation, which may arise secondary to numerous disease processes, can result in reduced vision as a result of oedema, haemorrhage, and scarring. The development of antivascular endothelial growth factor (anti-VEGF) agents has revolutionised the treatment of retinal vasogenic conditions. These drugs are now commonly employed for the treatment of a plethora of ocular pathologies including choroidal neovascularisation, diabetic macular oedema, and retinal vein occlusion to name a few. In this paper, we will explore the current use of anti-VEGF in a variety of retinal diseases and the impact that these medications have had on visual outcome for patients.

scholarly journals Visual acuity outcomes and anti-VEGF therapy intensity in diabetic macular oedema: a real-world analysis of 28 658 patient eyes

2020 ◽  
pp. bjophthalmol-2020-315933 ◽  
Author(s):  
Thomas A Ciulla ◽  
John S Pollack ◽  
David F Williams
Keyword(s):  
Visual Acuity ◽  
Electronic Medical Records ◽  
Macular Oedema ◽  
Medical Records ◽  
Diabetic Macular Oedema ◽  
Treatment Intensity ◽  
Anti Vegf ◽  
Injection Frequency ◽  
Treatment Naïve ◽  
Endothelial Growth Factor

Background/AimTo assess visual acuity (VA) outcomes and antivascular endothelial growth factor (anti-VEGF) treatment intensity in diabetic macular oedema (DMO).MethodsRetrospective analysis was performed in treatment-naïve patients with DMO from 2013 to 2018 using a database of aggregated de-identified electronic medical records (Vestrum Health).ResultsAt 1 year, 28 658 patient eyes underwent a mean of 6.4 anti-VEGF injections, gaining a mean of +4.2 letters (95% confidence interval for mean gain: +4.0 to +4.5 letters, p<0.001). When stratified by anti-VEGF medication and by years 2013–2018, no clinically meaningful differences in injection frequency or 1-year VA change resulted. At 1 year, 50% of eyes received ≤6 injections, while <20% received 10–13 injections, representing monthly treatment. Mean letters gained at 1 year generally showed a linear relationship with mean number of anti-VEGF injections, beyond two injections. Eyes with good baseline VA (≥20/40) generally were at risk of VA loss at 1 year; those with moderately severe baseline impairment (20/70 to 20/200) who received ≥10 injections improved by a mean of +10.3 letters.ConclusionIn clinical practice, patients with DMO undergo fewer anti-VEGF injections and exhibit worse visual gains compared with patients in randomised clinical trials. Visual outcomes correlate with treatment intensity at 1 year, with ceiling effects related to baseline VA.

scholarly journals Real-world management of treatment-naïve diabetic macular oedema: 2-year visual outcome focusing on the starting year of intervention from STREAT-DMO study

2020 ◽  
Vol 104 (12) ◽  
pp. 1755-1761
Author(s):  
Masahiko Shimura ◽  
Shigehiko Kitano ◽  
Daisuke Muramatsu ◽  
Harumi Fukushima ◽  
Yoshihiro Takamura ◽  
...  
Keyword(s):  
Real World ◽  
Macular Oedema ◽  
Diabetic Macular Oedema ◽  
Clinical Intervention ◽  
Visual Outcome ◽  
Interventional Treatment ◽  
First Line Therapy ◽  
Anti Vegf ◽  
Initial Intervention ◽  
Treatment Naïve

Background/aimsTo investigate the yearly change of real-world outcomes for best corrected visual acuity (BCVA) after 2-year clinical intervention for treatment-naïve diabetic macular oedema (DMO).MethodsRetrospective analysis of aggregated, longitudinal medical records obtained from 27 retina specialised institutions in Japan from Survey of Treatment for DMO database. A total of 2049 treatment-naïve centre involving DMO eyes of which the initial intervention started between 2010 and 2015, and had been followed for 2 years, were eligible. As interventions, antivascular endothelial growth factor (VEGF) agents, local corticosteroids, macular photocoagulation and vitrectomy were defined. In each eye, baseline and final BCVA, the number of each intervention for 2 years was extracted. Each eye was classified by starting year of interventional treatment.ResultsAlthough baseline BCVA did not change by year, 2-year improvement of BCVA had been increased, and reached to +6.5 letters in the latest term. There is little difference among starting year about proportions of eyes which BCVA gained >15 letters, in contrast to those which lost >15 letters were decreased by year. The proportion of eyes receiving anti-VEGF therapy was dramatically increased, while those receiving the other therapies were gradually decreased. The proportion of eyes which maintained socially good vision of BCVA>20/40 has been increased and reached to 59.0% in the latest term.ConclusionFor recent years, treatment patterns for DMO have been gradually but certainly changed; as a result, better visual gain, suppression of worsened eyes and better final BCVA have been obtained. Anti-VEGF therapy has become the first-line therapy and its injection frequency has been increasing.

scholarly journals Burden of diabetic macular oedema in patients receiving antivascular endothelial growth factor therapy in South Korea: a healthcare resource use and cost analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e042484
Author(s):  
Ha-Lim Jeon ◽  
Hyesung Lee ◽  
Dongwon Yoon ◽  
Yeonkyung Lee ◽  
Jae Hui Kim ◽  
...  
Keyword(s):  
Growth Factor ◽  
Resource Use ◽  
Macular Oedema ◽  
Healthcare Resource ◽  
Diabetic Macular Oedema ◽  
Medical Costs ◽  
Healthcare Resource Use ◽  
Anti Vegf ◽  
Antivascular Endothelial Growth Factor ◽  
Endothelial Growth Factor

ObjectiveTo examine healthcare resource utilisation (HRU) and direct medical costs for patients with diabetic macular oedema (DME) treated with antivascular endothelial growth factor (anti-VEGF) in Korea by comparing with those for (1) patients with diabetes mellitus (DM) without retinopathy and (2) patients with neovascular age-related macular degeneration (nAMD) treated with anti-VEGF.DesignRetrospective cohort study.SettingThe Korean National Health Insurance (NHI) database from 1 January 2014 to 31 December 2016.ParticipantsWe identified 1398 patients older than 30 years of age who received anti-VEGF treatment for DME in 2015 after excluding patients who had a diagnosis of nAMD in 2015 and any cancer in the preceding year.Main outcome measuresOne-year healthcare resource use and direct medical costs of patients with DME treated with anti-VEGF.ResultsIn total, 1398 patients with DME receiving anti-VEGF, 12 813 patients with DM without retinopathy and 12 222 patients with nAMD receiving anti-VEGF were identified. Hospital admissions and outpatient visits were highest in patients with DME, while the number of licensed anti-VEGF injections in those with DME was about half that of those with nAMD (2.1 vs 3.9 per patient per year). Mean 1-year medical costs were also higher in patients with DME (US$6723) than in those with DM without retinopathy (US$2687) and nAMD (US$4980). In a multivariable analysis with matched cohorts, DME was associated with 66% higher medical costs for comorbid diseases (adjusted OR (aOR), 1.66; 95% CI 1.45 to 1.90) and 50% lower anti-VEGF injections (aOR, 0.50; 95% CI 0.46 to 0.54) compared with nAMD.ConclusionsThe overall HRU and economic burden for DME treated with anti-VEGF were higher than for DM without retinopathy or for nAMD treated with anti-VEGF. Meanwhile, the lower number of licensed anti-VEGF injections compared with nAMD may reflect a potential lack of ophthalmological treatment for DME supported by the NHI in Korea.

Management of Diabetic Macular Oedema – Challenges and Solutions Along the Patient Journey

2013 ◽  
Vol 07 (02) ◽  
pp. 115
Author(s):  
Albert J Augustin ◽  
Sue Lightman ◽  
Anat Loewenstein ◽  
José Cunha-Vaz
Keyword(s):  
Macular Oedema ◽  
Diabetic Macular Oedema ◽  
Clinical Trial Data ◽  
Fluocinolone Acetonide ◽  
Patient Journey ◽  
Anti Vegf ◽  
Long Duration ◽  
Intravitreal Implant ◽  
Disease Stages ◽  
Endothelial Growth Factor

A symposium hosted by the European Society of Ophthalmology discussed challenges in the management of diabetic macular oedema (DMO). Clinical evidence suggests that the longer the duration of DMO, the worse the response to anti-vascular endothelial growth factor (anti-VEGF) agents and better the response to corticosteroids. This is explained by the fact that inflammation is involved in the perpetuation of retinal changes in diabetes. At early disease stages, VEGF is primarily responsible for retinal changes; however, chronic microglia activation resulting from retinal damage leads to cytokine production by retinal cells and subsequent inflammatory cascades. Steroids are most effective at this stage. Clinical trial data have demonstrated the efficacy of the Iluvien® fluocinolone acetonide (FA) intravitreal implant, which retains its efficacy in disease of long duration. However, it is important to remember two things: that diabetes is a multifactorial disease with potential complications and to monitor for safety effects. In terms of the latter, anti-VEGF agents are associated with potential systemic effects, whereas steroids raise intraocular pressure and are associated with increased incidence of cataract.

scholarly journals Changing Perspectives in Diabetic Macular Oedema – Recognising and Understanding Chronic Diabetic Macular Oedema

2014 ◽  
Vol 08 (02) ◽  
pp. 145
Author(s):  
Usha Chakravarthy ◽  
Albert Augustin ◽  
Yit Yang ◽  
Michael Diestelhorst ◽  
Pascale Massin ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Macular Oedema ◽  
Diabetic Macular Oedema ◽  
Clinical Trial Data ◽  
Fluocinolone Acetonide ◽  
Phase Iii ◽  
Real World Data ◽  
First Line Therapy ◽  
Line Therapy ◽  
Phase Iii Trials

The satellite symposium moderated by Usha Chakravarthy entitled ‘Changing Perspectives in Diabetic Macular Oedema: Recognising and Understanding Chronic Diabetic Macular Oedema’ was convened at the 2014 EURETINA Congress. The symposium discussed the multiple processes involved in chronic diabetic macular oedema (DMO) and the use of medications, in particular, corticosteroids in its management. As DMO progresses, inflammatory cytokines are up-regulated relative to vascular endothelial growth factor (VEGF) and these promote various pathways that ultimately result in retinal damage in chronic disease. It is important therefore that treatments for chronic DMO address this altered inflammatory cytokine profile to effectively manage the condition. ILUVIEN®, a 190 μg intravitreal implant in applicator (with a daily release rate of 0.2 μg/day fluocinolone acetonide [FAc] implant) is a second-line therapy indicated for the treatment of chronic DMO. This implant has been shown in phase III trials to lead to marked improvements in visual acuity and in retinal thickness in patients with chronic DMO that were insufficiently response to first-line therapy (i.e. laser). Clinical trial data strongly support the use of the FAc implant in chronic DMO and now ‘real world’ data from its use in regular clinical practice are becoming available and interim results complement those reported in a clinical trial setting.

scholarly journals Treatment choices for diabetic macular oedema: a guideline for when to consider an intravitreal corticosteroid, including adaptations for the COVID-19 era

2021 ◽  
Vol 6 (1) ◽  
pp. e000696
Author(s):  
Louise Downey ◽  
Nachiketa Acharya ◽  
Helen Devonport ◽  
Richard Gale ◽  
Maged Habib ◽  
...  
Keyword(s):  
Corticosteroid Therapy ◽  
Macular Oedema ◽  
Diabetic Macular Oedema ◽  
Improve Patient Care ◽  
Vascular Endothelial ◽  
Treatment Burden ◽  
Anti Vegf ◽  
Decision Points ◽  
Injection Frequency ◽  
Endothelial Growth Factor

First-line treatment of centrally involved diabetic macular oedema (CI-DMO) is often with an anti-vascular endothelial growth factor (anti-VEGF) agent. Although this can provide efficacy in the majority of eyes, a sizeable proportion do not respond sufficiently and many continue to receive anti-VEGF therapy after it may be optimal. This imposes a treatment burden on both patients and clinicians and, most importantly of all, can be sight threatening. Changing treatment to an intravitreal corticosteroid implant at the appropriate time may help optimise patient outcomes and reduce injection frequency, thereby reducing treatment burden.Eight retina specialists convened to discuss how to ensure eyes with CI-DMO receiving intravitreal anti-VEGF therapy are evaluated for a potential change to intravitreal corticosteroid therapy at the most effective time in their treatment journey. They concluded that clear criteria on when to consider changing treatment would be helpful and so developed a consensus guideline covering key decision points such as when and how to assess response to anti-VEGF therapy, when to consider a change to corticosteroid therapy and when and how to assess the response to corticosteroid therapy.The guideline was developed before the COVID-19 pandemic but, with the additional challenges arising from this including even greater pressure on clinic capacity, it is more important than ever to reconsider current working practices and adopt changes to improve patient care while also easing pressure on clinic capacity, reducing hospital visits and maintaining patient safety. This publication therefore also includes suggestions for adapting the guidelines in the COVID-19 era.

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