scholarly journals Comparison of efficacy and safety of the combined laser treatment technology versus conventional laser photocoagulation in diabetic macular edema management

2017 ◽  
Vol 20 (1) ◽  
pp. 68-74
Author(s):  
Aleksander Victorovich Doga ◽  
Galina Fedorovna Kachalina ◽  
Elena Konstantinovna Pedanova ◽  
Dmitry Anatolievich Buryakov
Keyword(s):  
Laser Treatment ◽  
Macular Oedema ◽  
Laser Photocoagulation ◽  
Diabetic Macular Oedema ◽  
Control Group ◽  
Efficacy And Safety ◽  
Treatment Technology ◽  
The Mean ◽  
Conventional Laser

Aim. To evaluate the efficacy and safety of the novel combined laser treatment technology compared with those of the conventional laser photocoagulation in diabetic macular oedema management. Material and methods. Fifty eyes of 44 patients with clinically significant diabetic macular oedema were enrolled. Patients of the main group (25 eyes) underwent combined laser treatment, whereas patients in the control group (25 eyes) underwent modified ETDRS (mETDRS) focal/grid photocoagulation. Results. Mean central point thickness (CPT) in the main group decreased from 411.24 126 m to 359.86 120.4 m (p 0.05), with a subsequent increase in the mean best-corrected visual acuity (BCVA) from 0.52 0.2 at baseline to 0.71 0.2 (p 0.05) at the 12-month follow-up. The mean central retinal sensitivity (RS) improved from 11.27 3.8 dB to 13.24 3.2 dB (p 0.05). In the control group, our results showed similar improvement in BCVA and CPT values at the 12-month follow-up (from 0.59 0.12 to 0.72 0.23 and from 424.17 68.12 m to 387.51 93.45 m, respectively, p 0.05). The RS value, on the contrary, decreased from 12.32 0.90 dB to 10.14 0.71 dB (p 0.05). Conclusions. The combined laser technology is a safe treatment technique that allows to minimise the extent of laser-induced chorioretinal complex damage due to the contribution of subthreshold micropulse laser photocoagulation. The efficacy of this novel technology is comparable with that of the mETDRS technique in the resolution of macular oedema and BCVA increase. This technology also provides an advantage of RS improvement and the possibility of safe and repetitive treatment sessions.

Hyperreflective cystoid spaces in diabetic macular oedema: prevalence and clinical implications

2020 ◽  
pp. bjophthalmol-2020-317191
Author(s):  
Aude Couturier ◽  
Valerie Mane ◽  
Carlo Alessandro Lavia ◽  
Ramin Tadayoni
Keyword(s):  
Macular Oedema ◽  
Optical Coherence Tomography Angiography ◽  
Diabetic Macular Oedema ◽  
Functional Improvement ◽  
Vascular Endothelial ◽  
Hard Exudates ◽  
Corrected Visual Acuity ◽  
The Mean ◽  
Endothelial Growth Factor

AimsTo analyse the prevalence and evolution of hyper-reflective cystoid spaces with decorrelation signal detected using optical coherence tomography angiography (OCTA) in diabetic macular oedema (DMO).MethodsA retrospective study of consecutive eyes with DMO imaged using OCTA over a 1-year period was conducted. All eyes with hyper-reflective cystoid spaces at baseline and at least 3 months of follow-up were included in a longitudinal analysis.ResultsThe prevalence of hyperreflective cystoid spaces with decorrelation signal was of 37% (61/165) in DMO eyes. Hyperreflective foci within hyperreflective cystoid spaces were observed in 85% of eyes. The longitudinal study included 33 eyes (10 observed and 23 treated with intravitreal anti-vascular endothelial growth factor), with a median follow-up of 15 months. The hyperreflective cystoid spaces resolved in 85% of eyes. The mean best-corrected visual acuity remained stable during the follow-up, even in the eyes achieving a resolution of the hyperreflective cystoid spaces. Hard exudates appeared in the area of resolved hyperreflective cystoid spaces in 33% of eyes.ConclusionHyperreflective cystoid spaces detected by OCTA affected more than one-third of the DMO eyes. Their disappearance was not associated with any functional improvement and led to the formation of new hard exudate deposits in about one-third of the eyes.

scholarly journals Subthreshold 577 nm laser photocoagulation vesus conventional 532 nm laser photocoagulation for diabetic macular oedema

2021 ◽  
Vol 3 (3) ◽  
pp. 123-140
Author(s):  
Linda Sui-Lin Ong ◽  
Tajunisah Mohd Iqbal ◽  
Kenneth Choong-Sian Fong
Keyword(s):  
Diode Laser ◽  
Macular Oedema ◽  
Laser Photocoagulation ◽  
Retinal Thickness ◽  
Diabetic Macular Oedema ◽  
Macular Thickness ◽  
Clinically Significant ◽  
Clinically Significant Macular Oedema ◽  
532 Nm

Purpose: To evaluate the visual and anatomic outcomes of the subthreshold micropulse 577 nm yellow diode laser (MYL) and to compare its efficacy with the conventional green 532 nm diode laser (CGL) in Asian eyes with diabetic macular oedema (DME).Study design: Prospective randomized controlled clinical trialMethods: Sixty-seven eyes of 43 patients with clinically significant macular oedema (CSME) were randomized to receive either MYL (n = 37) or CGL (n = 30) at baseline and were followed up for 12 months. Titration in the MYL group was performed with 15% duty cycle, 300 ms duration, and double the threshold power, while the modified Early Treatment of Diabetic Retinopathy Study (mETDRS) protocol was used for the CGL arm with the power titrated to a barely visible burn. Parameters noted included best-corrected visual acuity (BCVA) (logMAR), central subfoveal thickness (CST), macular volume (MV), and average macular thickness (AMT) using optical coherence tomography, and presence of visible laser scars on colour fundus photographs and fundus autofluorescence, at baseline and at 12 months.Results: At 12 months follow-up, BCVA improved by 4.7 and 8.8 letters, respectively, for the MYL and CGL treatment arms (p < 0.05). There was a significant reduction in all retinal thickness parameters (CST, MV, and AMT) when compared to baseline in both laser treatment arms at 12 months. There was no significant difference in either BCVA or retinal thickness parameters between the two treatment arms at 1, 3, 6, 9, or 12-month follow-up. Laser scars were observed in 26.7% of patients in the MYL group compared to 75% of patients in the CGL group (p = 0.029).Conclusions: MYL is an effective, safe, and patient-friendly treatment option for clinically significant macular oedema, with improvement in BCVA, reduction in macular thickness, and less scarring after treatment at 12 months.

scholarly journals Evaluation of 0.2 µg/day fluocinolone acetonide (ILUVIEN) implant in a cohort of previously treated patients with diabetic macular oedema (DMO): a 36-month follow-up clinical case series

2020 ◽  
Vol 5 (1) ◽  
pp. e000484
Author(s):  
Muna Ahmed ◽  
Christine Putri ◽  
Hibba Quhill ◽  
Fahd Quhill
Keyword(s):  
Clinical Practice ◽  
Real World ◽  
Macular Oedema ◽  
Case Series ◽  
Diabetic Macular Oedema ◽  
Fluocinolone Acetonide ◽  
Previously Treated Patients ◽  
Previously Treated ◽  
The Mean

ObjectiveTo assess the real-world effectiveness and safety of single injection of a fluocinolone acetonide (FAc) implant in previously treated patients with recurrent diabetic macular oedema (DMO) over a 36-month follow-up period.Methods and AnalysisThis is a retrospective study conducted at a single ophthalmology department at the Royal Hallamshire Hospital, Sheffield, UK. Data were collected using electronic medical records to identify all patients treated with a FAc implant for DMO between March 2014 and November 2014, followed with a 36-month clinic follow-up. Outcomes measured included mean change in best-recorded visual acuity (BRVA) and central macular thickness (CMT) over the period of 36 months, treatment burden pre-implant and post-implant, and functional and anatomical responder rates.ResultsTwenty-six eyes (n=22 patients) were treated with single intravitreal FAc implant followed with 36 months of follow-up. At 24 and 36 months, 86.4% and 75.0% of patients maintained or gained vision post-FAc implant in routine clinical practice. The mean BRVA increased from 41.8 to 54.6 letters at month 24 and 45.8 letters at month 36, with 50.0% and 33.3% of patients achieving a ≥15 letter improvement at months 24 and 36, respectively. The mean CMT reduced from 600.8 µm at baseline to 351.0 µm and 392.5 µm at months 24 and 36, respectively. Overall, a mean of one treatment every 13.33 months post-FAc implant (vs 3.24 months pre-FAc implant) was reported. Eleven eyes had an increased intraocular pressure of ≥10 mm Hg and 12 eyes had an increase to ≥25 mm Hg from baseline.ConclusionThese results further support the effectiveness and safety of FAc implant in previously treated patients with persistent or recurrent DMO in a real-world clinical practice.

Long-term outcomes with as-needed aflibercept in diabetic macular oedema: 2-year outcomes of the ENDURANCE extension study

2017 ◽  
Vol 102 (5) ◽  
pp. 631-636 ◽  
Author(s):  
Charles C Wykoff ◽  
William C Ou ◽  
Rahul N Khurana ◽  
David M Brown ◽  
W Lloyd Clark ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Macular Oedema ◽  
Diabetic Macular Oedema ◽  
Phase Iii ◽  
Extension Study ◽  
Efficacy And Safety ◽  
Open Label ◽  
Intravitreal Aflibercept ◽  
The Mean

Background/aimsTo evaluate the efficacy and safety of individualised 2.0 mg intravitreal aflibercept retreatment for diabetic macular oedema (DME) through the fifth year of management.MethodsThis is a phase IV, 2-year, open-label extension study. Sixty patients completing the 3-year VISTA DME (Study of Intravitreal Aflibercept Injection in Patients With Diabetic Macular Edema) phase III trial enrolled in the ENDURANCE (Long-Term Efficacy and Safety of Intravitreal Aflibercept for the Treatment of DME in Subjects Who Completed the VISTA DME Trial) extension study. All patients received aflibercept in the presence of clinically relevant DME. Intervals between visits were prescribed according to disease activity. The main outcome measure was mean aflibercept injections given through 2 years.ResultsA mean of 7.7 aflibercept injections were administered through 2 years. Fifteen (25%) patients required no retreatment and 48% (n=29) of patients received five or fewer injections through 2 years. Among patients who received at least one aflibercept retreatment during ENDURANCE, the mean number of injections through 2 years was 9.5. The mean visual acuity and central retinal thickness gains achieved during VISTA DME were maintained and stable during ENDURANCE. The most notable safety signal was progression of diabetic retinopathy. Six (10%) patients converted from non-proliferative to proliferative diabetic retinopathy (PDR), and a total of eight patients experienced PDR events occurring at a mean of 387 days following the previous aflibercept treatment.ConclusionThe need for aflibercept retreatment was substantially reduced in the fourth and fifth years of aflibercept dosing for DME following initiation of therapy in the VISTA DME trial. While vision gains achieved during the 3-year VISTA DME trial were maintained through ENDURANCE with a reduced treatment burden, clinically relevant worsening of diabetic retinopathy was observed with progression to PDR in 10% of the eyes.Trial registration numberNCT02299336

scholarly journals Intravitreal Bevacizumab Alone Versus Combined Bevacizumab and Macular Grid Laser Photocoagulation in Diffuse Diabetic Macular Oedema

2020 ◽  
Author(s):  
Fawaz Al Sarireh ◽  
Hamzeh Mohammad Alrawashdeh ◽  
Khalid Al Zubi ◽  
Khalil Al Salem
Keyword(s):  
Visual Acuity ◽  
Laser Treatment ◽  
Macular Oedema ◽  
Laser Photocoagulation ◽  
Diabetic Macular Oedema ◽  
Intravitreal Bevacizumab ◽  
Systemic Complications ◽  
Prospective Longitudinal ◽  
Grid Laser Treatment ◽  
Number Of Injections

Introduction: Diabetes Mellitus (DM) is a common disease with multiple systemic complications. Diabetic macular oedema is the main threat to vision in patients with diabetic retinopathy, which results from the increased permeability of the inner and outer blood-retinal barrier. Macular argon laser photocoagulation was the only treatment of diabetic macular oedema in the past. Now-a-days, both intravitreal anti-Vascular Endothelial Growth Factor (VEGF) and macular grid laser photocoagulation are used in the management of diffuse and focal Diabetic Macular Oedema (DME). Aim: To assess the changes in both visual acuity and Central Macular Thickness (CMT) in patients with DME after intravitreal injection of bevacizumab only or in combination with macular grid laser treatment. Materials and Methods: A prospective longitudinal cohort study included 89 eyes of 52 patients with DME, who were categorised into two interventional groups. The first group received only intravitreal bevacizumab for the first three months, then Pro Re Nata (PRN), while the second group received intravitreal bevacizumab, similar to the first group, in addition to macular grid laser treatment two weeks after the initial injection. Participants were followed-up at 12 months, and the visual acuity, CMT, and the total number of injections were documented. Patients were followed-up but data was gathered on baseline and at the 12th month were compared. Results: In comparison to the initial presentation, a significant decrease in CMT was noticed in both groups (163.47±83.60 μm vs. 126.45±52.45 μm, respectively). Moreover, a significant improvement in visual acuity of both groups (p<0.023 and p<0.016, respectively) and significantly fewer injections being required in the second group were noticed. Conclusion: Combining intravitreal bevacizumab with macular grid laser treatment can lead to stabilisation and improvement of visual acuity with a smaller number of injections which was statistically significant.

Subthreshold micropulse diode laser photocoagulation for clinically significant diabetic macular oedema: a three-year follow up

2007 ◽  
Vol 35 (7) ◽  
pp. 640-644 ◽  
Author(s):  
Sobha Sivaprasad ◽  
Ranjit Sandhu ◽  
Anamika Tandon ◽  
Khalid Sayed-Ahmed ◽  
Dominic A McHugh
Keyword(s):  
Diode Laser ◽  
Macular Oedema ◽  
Laser Photocoagulation ◽  
Diabetic Macular Oedema ◽  
Clinically Significant

scholarly journals OP0270 LONG-TERM EFFICACY AND SAFETY OF BOSENTAN IN PATIENTS WITH DIGITAL ULCERS RELATED TO SYSTEMIC SCLEROSIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 164-164
Author(s):  
N. Cristina ◽  
L. Groseanu ◽  
F. Berghea ◽  
A. Balanescu ◽  
V. Bojinca ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Control Group ◽  
Digital Ulcers ◽  
Efficacy And Safety ◽  
Term Efficacy ◽  
Elevated Liver Enzymes ◽  
Significant Difference ◽  
The Mean

Background:Two pivotal studies, RAPIDS-1 and RAPIDS-2 revealed that bosentan reduces the development of new digital ulcers (DUs) in patients with systemic sclerosis (SSc). However data regarding the long-term use of this dual endothelin antagonist receptor in the treatment of DUs is scarce.Objectives:The aim of the present study was to evaluate long term efficacy and safety profile of bosentan in patients with DUs related to SSc.Methods:A prospective observational case-control study, conducted between 2014 and 2020 enrolled 65 SSc patients with ≥1 active DUs at baseline, who received bosentan therapy. Demographic and clinical features, including DUs incidence and patients subjective perception of DU pain and/or Raynaud’s Phenomenon, were collected. Nailfold videocapillaroscopy was performed in all patients.Results:The study included 51 females and 14 males, with a mean age of 52.6 years, 30 with diffuse subset, most of them with late scleroderma pattern (46/65). Number of DUs at baseline was 4.55 (±2.8), median duration of treatment was 25.95 (±19.4) months. Microangiopathy evolution score (MES) was 5.1 (2.19), visual analog scale (VAS) for DU was 77.9, VAS for Raynaud was 73.4.Patients receiving bosentan had clinically significant reduction in the mean number of DU (p<0.001). The effect was most powerful for the first 6 months of treatment, but the improvement was sustained until 24 months’ follow-up, when the mean DU number reached a plateau that was kept until end of study. 6 month and 24 month evaluations also revealed significant decrease in the VAS for DU (p<0.05) and in the VAS for Raynaud (p<0.01). Statistically significant difference was noted between bosentan-treated and the control group with respect to the decrease in the mean number of digital ulcers. (p=0.005).There was a clear trend towards an improvement in MES score, between baseline and the next follow-up assessments (p=0.003). The difference was statistically significant when compared to control group, but only for the first 18 months of treatment (p<0.001).14 patients (28.75%) discontinued bosentan therapy for administrative reasons. The median time among patients who interrupted the treatment was 6.9 months. An accelerated development of new DU was described 6 months after (p=0.02). Following recommencement of bosentan, the mean number of DU has rapidly decreased (p=0.008). There was no significant difference between patients who temporarily discontinued bosentan for 6 or 12 months.Bosentan was stopped due to lack of efficacy in 2 cases and due to side effects in 7 cases: 4 elevated liver enzymes, 1 severe trombocytopenia, 1 dyspneea agravation and low blood pressure.Conclusion:The present data suggest that treatment with endothelin receptor antagonist bosentan was associated with a significant reduction in the mean number of DU in patients with SSc. The beneficial effect of bosentan persisted throughout the study but was most evident in the first 6 months of treatment. Statistical analysis showed a significant improvement of the microangiopathy evolution score from baseline to end of therapy. 14 patients had a high relapse rate due to potential rebound effect, 6 months after bosentan withdrawal.The drug was reintroduced succesfully for 10 (70%) patients with a significant decrease in the number of DU.References:[1]UK Scleroderma Study Group: digital vasculopathy in systemic sclerosis, Rheumatology, Volume 54, Issue 11, November 2015, Pages 2015[2]Groseanu L, Berghea F, Bojinca V, et al AB0779 Long term follow-up of a systemic sclerosis group treated with bosentan, Annals of the Rheumatic Diseases 2018;77:1523-1524.Disclosure of Interests:None declared

scholarly journals Macular thickness amplitude changes when switching from discontinuous to continuous therapy for diabetic macular oedema

2019 ◽  
Vol 4 (1) ◽  
pp. e000271 ◽  
Author(s):  
Sidney A Schechet ◽  
Olufemi E Adams ◽  
David A Eichenbaum ◽  
Seenu M Hariprasad
Keyword(s):  
Macular Oedema ◽  
Primary Outcome ◽  
Retinal Thickness ◽  
Diabetic Macular Oedema ◽  
Fluocinolone Acetonide ◽  
Continuous Therapy ◽  
Before And After ◽  
The Mean ◽  
Pressure Changes

ObjectiveTo investigate if the mean central retinal thickness (CRT) amplitude, measured between visits, is consistently decreased when switching from discontinuous to continuous therapy for diabetic macular oedema (DME) following fluocinolone acetonide (FAc) administration.Methods and analysisIn this retrospective cohort study, all patients with DME treated with FAc at a single centre were included. The primary outcome was CRT amplitude changes measured at each visit prior to and after FAc administration. Secondary outcomes included average number of DME treatments before and after FAc injection, visual acuity and intraocular pressure changes.ResultsNineteen eyes were included. The mean (SD) follow-up after FAc was 399 (222) days. The mean (SD) CRT amplitude before FAc was 194.6 (114.90) µm, and following FAc administration, the amplitude decreased to 70.8 (94.23) µm (95% CI −189.5 to −58.1; p≤0.001). After FAc, the number of treatments required per month significantly decreased from an average of 1 treatment every 2.7 months to every 6 months (p=0.009).ConclusionIn patients with DME, the CRT amplitude values and number of treatments significantly decrease following FAc administration while maintaining vision. Further studies are needed to evaluate the significance of these interesting findings.

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