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Liao A, Fortes B, Au A, Hou K. Management of diabetic tractional retinal detachments: surgical experiences from a large tertiary academic institution. Curr Opin Ophthalmol 2025; 36:177-181. [PMID: 39950590 DOI: 10.1097/icu.0000000000001124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2025]
Abstract
PURPOSE OF REVIEW Management of diabetic tractional retinal detachments (TRDs) remains technically challenging. The purpose of this review is to provide an updated overview of current surgical techniques and important considerations when treating this condition. RECENT FINDINGS Recent advances in imaging have provided critical insights into hyaloid status and tractional forces in diabetic TRDs, greatly aiding surgical planning. Updates in vitrectomy instruments have also greatly improved anatomic success rates. However, a comprehensive preoperative evaluation and plan remains key in optimizing visual outcomes for this difficult condition. SUMMARY The surgical management of diabetic TRDs requires several key elements for successful outcomes. Timely intervention and presurgical planning are crucial, particularly in rapidly progressing cases. The use of advanced imaging and instruments enhances visualization and precision during surgery. Finally, a collaborative multispecialty approach with clear communication with patients about their prognosis is fundamental to effective care. These strategies collectively improve patient outcomes and promote visual recovery in those affected by diabetic TRDs.
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Affiliation(s)
- Albert Liao
- Retina Division, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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Tokuc EO, Karabas L, Kanar HS, Kaplan FB, Seyyar SA, Uslubas I. Visual and anatomical outcomes of primary retinectomy for diabetic tractional retinal detachment. BMC Ophthalmol 2025; 25:216. [PMID: 40247269 PMCID: PMC12004879 DOI: 10.1186/s12886-025-04065-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2025] [Accepted: 04/11/2025] [Indexed: 04/19/2025] Open
Abstract
PURPOSE Uncontrolled proliferative diabetic retinopathy (PDR) can cause fibrovascular growth and retinal traction, leading to tractional retinal detachment (TRD). The role of primary retinectomy in diabetic TRD remains unclear, as most studies focus on rhegmatogenous retinal detachment (RRD) with PVR. This study aims to investigate the impact of retinectomy on anatomical and visual outcomes in patients undergoing pars plana vitrectomy (PPV) for diabetic TRD. METHOD Patients who underwent primary retinectomy during PPV for diabetic TRD were retrospectively evaluated. Best corrected visual acuity (BCVA) before surgery and at the final follow-up, retinectomy characteristics, and final retinal attachment status were documented. TRD score, the quadrant and extent of the retinectomy, presence of macular displacement at final follow-up, and postoperative complications were evaluated. The relationship between the quadrants and extent of the retinectomy and visual acuity was also assessed. RESULT Thirty-eight eyes of 38 patients with mean age 60.55 ± 10.00 years were included. Mean follow-up was 23.53 ± 27.40 months. The most common locations of the retinectomy sites were extended posterior to the equator (39.5%), around the equatorial zone (34.2%), and peripheral retina (26.3%). The mean BCVA improved from 1.71 ± 0.53 logMAR to 1.48 ± 0.74 logMAR at the final follow-up. At the final visit 65.8% of patients experienced improved or maintained BCVA. Temporal retinectomy showed worse visual outcomes in the Chi-square test but not in binary logistic regression analysis. Furthermore, 26 (68.4%) eyes were attached without tamponade, 10 (26.3%) were attached under silicone oil and 2 (5.6%) remained detached under silicone oil. CONCLUSION These findings suggest that retinectomy, when deemed necessary in eyes with diabetic TRD, may not lead to poor functional and anatomical outcomes, contrary to some previous assumptions.
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Affiliation(s)
- Ecem Onder Tokuc
- Department of Ophthalmology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey.
| | - Levent Karabas
- Department of Ophthalmology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Hatice Selen Kanar
- Department of Ophthalmology, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Fatih Bilgehan Kaplan
- Department of Ophthalmology, Kirklareli Training and Research Hospital, Kirklareli, Turkey
| | - Sevim Ayça Seyyar
- Department of Ophthalmology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - Isıl Uslubas
- Clinic of Ophthalmology, Kocaeli City Hospital, Kocaeli, Turkey
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Kaźmierczak K, Żuchowski P, Stafiej J, Malukiewicz G. Functional and structural outcomes and complications after pars plana vitrectomy for severe features of proliferative diabetic retinopathy in type 1 and type 2 diabetes mellitus. PLoS One 2023; 18:e0288805. [PMID: 37471387 PMCID: PMC10358898 DOI: 10.1371/journal.pone.0288805] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 07/03/2023] [Indexed: 07/22/2023] Open
Abstract
PURPOSE To evaluate the functional and structural outcomes as well as postoperative complications after pars plana vitrectomy (PPV) for severe features of proliferative diabetic retinopathy (PDR) in type 1 and type 2 diabetes mellitus (DM) patients. METHODS Twenty two eyes of type 1 diabetics (DM1 group) and 27 eyes of type 2 diabetics (DM2 group) were included. Best corrected visual acuity (BCVA), intraocular pressure (IOP), postoperative structural changes in optical coherence tomography (OCT) and postoperative complications such as recurrent vitreous haemorrhage, diabetic macular oedema, secondary glaucoma and persistent tractional retinal detachment (TRD) were assessed and compared between the two groups. RESULTS Complete reattachment of retina was achieved in 88.9% from the DM1 group and in 95.5% from the DM2 group and remained attached in follow-up. BCVA in DM2 group was significantly lower preoperatively (p = 0.04). Mean postoperative BCVA significantly improved in both studied groups, but it was more evident in eyes of type 2 diabetics compared to type 1 diabetics. In eyes in the DM1 group there was perceptible stabilisation of BCVA. Poor visual acuity or lack of improvement in BCVA in the DM1 group was related to preoperative subretinal haemorrhage in macular region, and TRD involving macula, whereas in the DM2 group-to preoperative subretinal haemorrhage and neovascular glaucoma. The postoperative structural changes (disruption of EZ and ELM) were observed more often in DM2 group, but had the greatest impact on BCVA in eyes of type 1 DM. Complications after PPV for PDR were rare and hadn't a significant influence on the final functional outcomes in both groups. CONCLUSIONS Functional improvement after PPV for severe features of proliferative diabetic retinopathy were more noticeable in patients with type 2 DM. Postoperative structural changes had more negative impact on BCVA in type 1 diabetics.
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Affiliation(s)
- Karolina Kaźmierczak
- Department of Ophthalmology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Paweł Żuchowski
- Clinic of Rheumatology and Connective Tissue Diseases, Jan Biziel University Hospital No. 2, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Joanna Stafiej
- Department of Ophthalmology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Grażyna Malukiewicz
- Department of Ophthalmology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
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Dervenis P, Dervenis N, Smith JM, Steel DH. Anti-vascular endothelial growth factors in combination with vitrectomy for complications of proliferative diabetic retinopathy. Cochrane Database Syst Rev 2023; 5:CD008214. [PMID: 37260074 PMCID: PMC10230853 DOI: 10.1002/14651858.cd008214.pub4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Vitrectomy is an established treatment for the complications of proliferative diabetic retinopathy (PDR). However, a number of complications can occur during and after vitrectomy for PDR. These include bleeding and the creation of retinal holes during surgery, and bleeding, retinal detachment and scar tissue on the retina after surgery. These complications can limit vision, require further surgery and delay recovery. The use of anti-vascular endothelial growth factor (anti-VEGF) agents injected into the eye before surgery has been proposed to reduce the occurrence of these complications. Anti-VEGF agents can reduce the amount and vascularity of abnormal new vessels associated with PDR, facilitating their dissection during surgery, reducing intra- and postoperative bleeding, and potentially improving outcomes. OBJECTIVES To assess the effects of perioperative anti-VEGF use on the outcomes of vitrectomy for the treatment of complications for proliferative diabetic retinopathy (PDR). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; which contains the Cochrane Eyes and Vision Trials Register; 2022, Issue 6); Ovid MEDLINE; Ovid Embase; the ISRCTN registry; ClinicalTrials.gov and the WHO ICTRP. The date of the search was 22 June 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) that looked at the use of anti-VEGFs and the incidence of complications in people undergoing vitrectomy for PDR. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed and extracted the data. We used the standard methodological procedures expected by Cochrane. The critical outcomes of the review were the mean difference in best corrected visual acuity (BCVA) between study arms at six (± three) months after the primary vitrectomy, the incidence of early postoperative vitreous cavity haemorrhage (POVCH, within four weeks postoperatively), the incidence of late POVCH (occurring more than four weeks postoperatively), the incidence of revision surgery for POVCH within six months, the incidence of revision surgery for recurrent traction/macular pucker of any type and/or rhegmatogenous retinal detachment within six months and vision-related quality of life (VRQOL) measures. Important outcomes included the proportion of people with a visual acuity of counting fingers (1.8 logMAR or worse), the number of operative retinal breaks reported and the frequency of silicone oil tamponade required at time of surgery. MAIN RESULTS The current review includes 28 RCTs that looked at the pre- or intraoperative use of intravitreal anti-VEGFs to improve the outcomes of pars plana vitrectomy for complications of PDR. The studies were conducted in a variety of countries (11 from China, three from Iran, two from Italy, two from Mexico and the remaining studies from South Korea, the UK, Egypt, Brazil, Japan, Canada, the USA, Indonesia and Pakistan). The inclusion criteria for entry into the studies were the well-recognised complications of proliferative retinopathy: non-clearing vitreous haemorrhage, tractional retinal detachment involving the macula or combined tractional rhegmatogenous detachment. The included studies randomised a total of 1914 eyes. We identified methodological issues in all of the included studies. Risk of bias was highest for masking of participants and investigators, and a number of studies were unclear when describing randomisation methods and sequence allocation. Participants receiving intravitreal anti-VEGF in addition to pars plana vitrectomy achieved better BCVA at six months compared to people undergoing vitrectomy alone (mean difference (MD) -0.25 logMAR, 95% confidence interval (CI) -0.39 to -0.11; 13 studies, 699 eyes; low-certainty evidence). Pre- or intraoperative anti-VEGF reduced the incidence of early POVCH (12% versus 31%, risk ratio (RR) 0.44, 95% CI 0.34 to 0.58; 14 studies, 1038 eyes; moderate-certainty evidence). Perioperative anti-VEGF use was also associated with a reduction in the incidence of late POVCH (10% versus 23%, RR 0.47, 95% CI 0.30 to 0.74; 11 studies, 579 eyes; high-certainty evidence). The need for revision surgery for POVCH occurred less frequently in the anti-VEGF group compared with control, but the confidence intervals were wide and compatible with no effect (4% versus 13%, RR 0.44, 95% CI 0.15 to 1.28; 4 studies 207 eyes; moderate-certainty evidence). Similar imprecisely measured effects were seen for revision surgery for rhegmatogenous retinal detachment (5% versus 11%, RR 0.50, 95% CI 0.15 to 1.66; 4 studies, 145 eyes; low-certainty evidence). Anti-VEGFs reduce the incidence of intraoperative retinal breaks (12% versus 31%, RR 0.37, 95% CI 0.24 to 0.59; 12 studies, 915 eyes; high-certainty evidence) and the need for silicone oil (19% versus 41%, RR 0.46, 95% CI 0.27 to 0.80; 10 studies, 591 eyes; very low-certainty evidence). No data were available on quality of life outcomes or the proportion of participants with visual acuity of counting fingers or worse. AUTHORS' CONCLUSIONS The perioperative use of anti-VEGF reduces the risk of late POVCH, probably results in lower early POVCH risk and may improve visual outcomes. It also reduces the incidence of intraoperative retinal breaks. The evidence is very uncertain about its effect on the need for silicone oil tamponade. The reported complications from its use appear to be low. Agreement on variables included and outcome standardisation is required in trials studying vitrectomy for PDR.
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Affiliation(s)
- Panagiotis Dervenis
- Moorfields Eye Hospital (City Road), Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Department of Biostatistics, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Nikolaos Dervenis
- 1st Department of Ophthalmology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | | | - David Hw Steel
- Sunderland Eye Infirmary, Sunderland, UK
- Biosciences Institute, Newcastle University, Newcastle Upon Tyne, UK
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Arevalo JF, Beatson B. Pre-operative intravitreal bevacizumab for tractional retinal detachment secondary to proliferative diabetic retinopathy: the Alvaro Rodriguez lecture 2023. Int J Retina Vitreous 2023; 9:29. [PMID: 37072797 PMCID: PMC10111833 DOI: 10.1186/s40942-023-00467-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/04/2023] [Indexed: 04/20/2023] Open
Abstract
The treatment of proliferative diabetic retinopathy (PDR) has evolved significantly since the initial use of panretinal photocoagulation as a treatment in the 1950s. Vascular endothelial growth factor inhibitors have provided an effective alternative without the risk of peripheral vision loss. Despite this, the risk of complications requiring surgical intervention in PDR remains high. Intravitreal bevacizumab has shown promise as a preoperative adjuvant to vitrectomy for PDR complications, albeit with a purported risk for tractional retinal detachment (TRD) progression in eyes with significant fibrous proliferation. Here we will discuss anti-VEGF agent use in PDR and its role in surgical intervention for PDR complications including TRD.
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Affiliation(s)
- J Fernando Arevalo
- Wilmer Eye Institute, Johns Hopkins School of Medicine, 600 N Wolfe St; Maumenee 713, Baltimore, MD, 21287, USA.
| | - Bradley Beatson
- Wilmer Eye Institute, Johns Hopkins School of Medicine, 600 N Wolfe St; Maumenee 713, Baltimore, MD, 21287, USA
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Martinez-Zapata MJ, Salvador I, Martí-Carvajal AJ, Pijoan JI, Cordero JA, Ponomarev D, Kernohan A, Solà I, Virgili G. Anti-vascular endothelial growth factor for proliferative diabetic retinopathy. Cochrane Database Syst Rev 2023; 3:CD008721. [PMID: 36939655 PMCID: PMC10026605 DOI: 10.1002/14651858.cd008721.pub3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
BACKGROUND Proliferative diabetic retinopathy (PDR) is an advanced complication of diabetic retinopathy that can cause blindness. It consists of the presence of new vessels in the retina and vitreous haemorrhage. Although panretinal photocoagulation (PRP) is the treatment of choice for PDR, it has secondary effects that can affect vision. Anti-vascular endothelial growth factor (anti-VEGF), which produces an inhibition of vascular proliferation, could improve the vision of people with PDR. OBJECTIVES To assess the effectiveness and safety of anti-VEGFs for PDR and summarise any relevant economic evaluations of their use. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register; 2022, Issue 6); Ovid MEDLINE; Ovid Embase; the ISRCTN registry; ClinicalTrials.gov, and the WHO ICTRP. We did not use any date or language restrictions. We last searched the electronic databases on 1 June 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing anti-VEGFs to another active treatment, sham treatment, or no treatment for people with PDR. We also included studies that assessed the combination of anti-VEGFs with other treatments. We excluded studies that used anti-VEGFs in people undergoing vitrectomy. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies for inclusion, extracted data, and assessed the risk of bias (RoB) for all included trials. We calculated the risk ratio (RR) or the mean difference (MD), and 95% confidence intervals (CI). We used GRADE to assess the certainty of evidence. MAIN RESULTS We included 15 new studies in this update, bringing the total to 23 RCTs with 1755 participants (2334 eyes). Forty-five per cent of participants were women and 55% were men, with a mean age of 56 years (range 48 to 77 years). The mean glycosylated haemoglobin (Hb1Ac) was 8.45% for the PRP group and 8.25% for people receiving anti-VEGFs alone or in combination. Twelve studies included people with PDR, and participants in 11 studies had high-risk PDR (HRPDR). Twelve studies were of bevacizumab, seven of ranibizumab, one of conbercept, two of pegaptanib, and one of aflibercept. The mean number of participants per RCT was 76 (ranging from 15 to 305). Most studies had an unclear or high RoB, mainly in the blinding of interventions and outcome assessors. A few studies had selective reporting and attrition bias. No study reported loss or gain of 3 or more lines of visual acuity (VA) at 12 months. Anti-VEGFs ± PRP probably increase VA compared with PRP alone (mean difference (MD) -0.08 logMAR, 95% CI -0.12 to -0.04; I2 = 28%; 10 RCTS, 1172 eyes; moderate-certainty evidence). Anti-VEGFs ± PRP may increase regression of new vessels (MD -4.14 mm2, 95% CI -6.84 to -1.43; I2 = 75%; 4 RCTS, 189 eyes; low-certainty evidence) and probably increase a complete regression of new vessels (RR 1.63, 95% CI 1.19 to 2.24; I2 = 46%; 5 RCTS, 405 eyes; moderate-certainty evidence). Anti-VEGFs ± PRP probably reduce vitreous haemorrhage (RR 0.72, 95% CI 0.57 to 0.90; I2 = 0%; 6 RCTS, 1008 eyes; moderate-certainty evidence). Anti-VEGFs ± PRP may reduce the need for vitrectomy compared with eyes that received PRP alone (RR 0.67, 95% CI 0.49 to 0.93; I2 = 43%; 8 RCTs, 1248 eyes; low-certainty evidence). Anti-VEGFs ± PRP may result in little to no difference in the quality of life compared with PRP alone (MD 0.62, 95% CI -3.99 to 5.23; I2 = 0%; 2 RCTs, 382 participants; low-certainty evidence). We do not know if anti-VEGFs ± PRP compared with PRP alone had an impact on adverse events (very low-certainty evidence). We did not find differences in visual acuity in subgroup analyses comparing the type of anti-VEGFs, the severity of the disease (PDR versus HRPDR), time to follow-up (< 12 months versus 12 or more months), and treatment with anti-VEGFs + PRP versus anti-VEGFs alone. The main reasons for downgrading the certainty of evidence included a high RoB, imprecision, and inconsistency of effect estimates. AUTHORS' CONCLUSIONS Anti-VEGFs ± PRP compared with PRP alone probably increase visual acuity, but the degree of improvement is not clinically meaningful. Regarding secondary outcomes, anti-VEGFs ± PRP produce a regression of new vessels, reduce vitreous haemorrhage, and may reduce the need for vitrectomy compared with eyes that received PRP alone. We do not know if anti-VEGFs ± PRP have an impact on the incidence of adverse events and they may have little or no effect on patients' quality of life. Carefully designed and conducted clinical trials are required, assessing the optimal schedule of anti-VEGFs alone compared with PRP, and with a longer follow-up.
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Affiliation(s)
- Maria José Martinez-Zapata
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | | | - Arturo J Martí-Carvajal
- Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE (Cochrane Ecuador), Quito, Ecuador
- Universidad Francisco de Vitoria, Facultad de Medicina Cochrane Madrid, Madrid, Spain
- Cátedra Rectoral de Medicina Basada en la Evidencia, Universidad de Carabobo, Valencia, Venezuela
| | - José I Pijoan
- Hospital Universitario Cruces, Barakaldo, Spain
- BioCruces-Bizkaia Research Institute, CIBER Epidemiología y Salud Pública (CIBERESP), Barakaldo, Spain
| | - José A Cordero
- Blanquerna School of Health Sciences, Universitat Ramon Llull, Barcelona, Spain
| | - Dmitry Ponomarev
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Ashleigh Kernohan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ivan Solà
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Gianni Virgili
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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Qu J, Chen X, Liu Q, Wang F, Li M, Zhou Q, Yao J, Li X. Prophylactic intravitreal injection of aflibercept for preventing postvitrectomy hemorrhage in proliferative diabetic retinopathy: A randomized controlled trial. Front Public Health 2023; 10:1067670. [PMID: 36711366 PMCID: PMC9875129 DOI: 10.3389/fpubh.2022.1067670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction The aim of this study was to assess the effects of preoperative intravitreal aflibercept (IVA) injection on the incidence of postoperative vitreous hemorrhage (VH) after vitrectomy for proliferative diabetic retinopathy (PDR). Methods This study involved a prospective, randomized clinical trial. One hundred twenty-eight eyes of 128 patients of PDR who underwent pars plana vitrectomy (PPV) were enrolled. Sixty-four eyes were assigned randomly to either the IVA group (IVA injection 1 to 5 days before PPV) or the control group (no IVA injection). The primary outcome was the incidence of VH at 1 month after PPV. Secondary outcome measures were best-corrected visual acuity (BCVA) changes from baseline to at 1 week, 1 month, 2 months, and 3 months after surgery. Results The VH incidences in the IVA group and the control group were 14.8 and 39.3% at week 1, 8.6 and 31.7% at month 1, 11.7 and 30.5% at month 2, and 8.6 and 30.5% at month 3, respectively. Intergroup differences showed a significantly decreased VH rate in the IVA group compared with that in the control group at week 1, month 1, and month 3 (p = 0.021, 0.006, and 0.047, respectively). Compared to the baseline, neither the mean BCVA nor the BCVA change in the Logarithm of the Minimum Angle of Resolution (logMAR) scale did differ significantly between the two groups at each visit point. There are a greater number of eyes with BCVA improvement of more than 2 logMAR in the IVA group than in the control group at week 1 (8 vs. 2, p = 0.048). Conclusions This study found that the adjunctive use of preoperative IVA reduces early and late postoperative VH in vitrectomy for PDR.
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Affiliation(s)
- Jinfeng Qu
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China
| | - Xiuju Chen
- Department of Ophthalmology, Xiamen Eye Center of Xiamen University, Xiamen, China
| | - Qinghuai Liu
- Department of Ophthalmology, Nanjing Medical University Affiliated Nanjing Hospital, Jiangsu, China
| | - Fang Wang
- Department of Ophthalmology, The Tenth Affiliated Hospital of Shanghai Tongji University, Shanghai, China
| | - Mingxin Li
- Department of Ophthalmology, The Affiliated Hospital of Xuzhou Medical University, Jiangsu, China
| | - Qiong Zhou
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Jin Yao
- Department of Ophthalmology, The Affiliated Eye Hospital of Nanjing Medical University, Jiangsu, China
| | - Xiaoxin Li
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China,Department of Ophthalmology, Xiamen Eye Center of Xiamen University, Xiamen, China,*Correspondence: Xiaoxin Li ✉
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Gunasekaran T, Gunasekaran Y, Tze Hui P. Review of Studies Comparing Panretinal Photocoagulation and Anti-Vascular Endothelial Growth Factor Therapy in the Treatment of Proliferative Diabetic Retinopathy. Cureus 2022; 14:e22471. [PMID: 35371631 PMCID: PMC8943265 DOI: 10.7759/cureus.22471] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2022] [Indexed: 11/08/2022] Open
Abstract
Diabetic retinopathy (DR) is among the leading causes of blindness at the global level. A review of studies between 2015 and 2018 found that about 1.7% of the general population with any type of diabetes mellitus suffered from proliferative diabetic retinopathy (PDR). Since the 1960s, panretinal photocoagulation (PRP) has been the mainstay of treatment for PDR. During this period, PRP has been credited with a significant degree of success and a relatively low complication rate. However, the advent of anti-vascular endothelial growth factor (anti-VEGF) therapy with the beginning of the new millennium provided a treatment modality that was noninferior to PRP. A decade-long period of comparisons and debates between these two treatment modalities repeatedly favored anti-VEGF over PRP, as studies demonstrated that the former provided potentially superior outcomes to PRP. The aim of this review is to briefly discuss and compare the relevant studies and evidence supporting these two treatments.
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Liu J, Zhang W, Xie P, Yuan S, Jiang L, Liu Q, Hu Z. The relationship between renal function and surgical outcomes of patients with proliferative diabetic retinopathy. Front Endocrinol (Lausanne) 2022; 13:984561. [PMID: 36093071 PMCID: PMC9453752 DOI: 10.3389/fendo.2022.984561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/09/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The relationship between renal function and diabetic retinopathy has been controversial. This study is to investigate the influence of renal function on the complex and surgical outcomes of proliferative diabetic retinopathy (PDR). METHODS This was a post hoc analysis of the CONCEPT clinical trial. A total of 45 eyes with PDR underwent vitrectomy were included. Based on the estimated glomerular filtration rate (eGFR), they were divided into abnormal renal function group (ARF group) and normal renal function group (NRG group). Baseline PDR complex, intraoperative outcomes (Intraoperative bleeding, frequency of endodiathermy, surgical time, iatrogenic hole, and tamponade) and postoperative outcomes (logMAR best-corrected visual acuity, vitreous re-hemorrhage, and macular edema, follow up at postoperative 1 month and 3 months) were estimated. Vitreous, aqueous humor and serum were collected at the vitrectomy day and Vascular endothelia growth factor-A levels were quantified for all included patients using liquid chip method. RESULTS There was no significant difference in baseline PDR complex, intraoperative and postoperative outcomes between ARF group and NRG group (all P > 0.05). At the vitrectomy day, there was also no difference of Vascular endothelia growth factor-A levels in vitreous, aqueous humor and serum between the two groups (all P > 0.05). CONCLUSION Our results showed that the renal function seems not parallel to the severity of PDR, neither to the surgical outcomes. This might be interpreted by the similar Vascular endothelia growth factor-A levels in vitreous, aqueous humor and serum between the two groups.
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Affiliation(s)
- Jin Liu
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Department of Ophthalmology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Weiwei Zhang
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ping Xie
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Songtao Yuan
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lin Jiang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qinghuai Liu
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Qinghuai Liu, ; Zizhong Hu,
| | - Zizhong Hu
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Qinghuai Liu, ; Zizhong Hu,
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Dervenis P, Dervenis N, Steel D, Sandinha T, Tranos P, Vasilakis P, Liampas I, Doxani C, Zintzaras E. Intravitreal bevacizumab prior to vitrectomy for proliferative diabetic retinopathy: a systematic review. Ther Adv Ophthalmol 2021; 13:25158414211059256. [PMID: 34901749 PMCID: PMC8655445 DOI: 10.1177/25158414211059256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 10/25/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Diabetic retinopathy is a leading cause of visual loss in the working population. Pars plana vitrectomy has become the mainstream treatment option for severe proliferative diabetic retinopathy (PDR) associated with significant vitreous haemorrhage and/or tractional retinal detachment. Despite the advances in surgical equipment, diabetic vitrectomy remains a challenging operation, requiring advanced microsurgical skills, especially in the presence of tractional retinal detachment. Preoperative intravitreal bevacizumab has been widely employed as an adjuvant to ease surgical difficulty and improve postoperative prognosis.Aims: This study aims to assess the effectiveness of preoperative intravitreal bevacizumab in reducing intraoperative complications and improving postoperative outcomes in patients undergoing vitrectomy for the complications of PDR. Methods: A literature search was conducted using the PubMed, Cochrane, and ClinicalTrials.gov databases to identify all related studies published before 31/10/2020. Prespecified outcome measures were operation time, intraoperative iatrogenic retinal breaks, best-corrected visual acuity in the last follow-up visit, the presence of any postoperative vitreous haemorrhage and the need to re-operate. Evidence synthesis was performed using Fixed or Random Effects models, depending on the heterogeneity of the included studies. Heterogeneity was assessed using Q-statistic and I2. Additional meta-regression models, subgroup analyses and sensitivity analyses were performed as appropriate. Results: Thirteen randomized control trials, with a total of 688 eyes were included in this review. Comparison of the intraoperative data showed that bevacizumab reduced operation time (p < 0.001), minimized iatrogenic retinal breaks (p < 0.001), provided better long-term visual acuity outcomes (p = 0.005), and prevented vitreous haemorrhage (p < 0.001) and the need for reoperation (p = 0.001 < 0.05). Findings were strongly corroborated by additional sensitivity and subgroup analyses. Conclusion: Preoperative administration of bevacizumab is effective in reducing intraoperative complications and improving the postoperative prognosis of diabetic vitrectomy. PROSPERO registration number: CRD42021219280
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Affiliation(s)
- Panagiotis Dervenis
- Laboratory of Biomathematics, School of Medicine, University of Thessaly, Larissis 33, Tirnavos, 40100, Greece
| | - Nikolaos Dervenis
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | | | - Teresa Sandinha
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | | | | | - Ioannis Liampas
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Chrysoula Doxani
- Laboratory of Biomathematics, School of Medicine, University of Thessaly, Larissa, Greece
| | - Elias Zintzaras
- Institute for Clinical Research and Health Policy Studies, Center for Clinical Evidence Synthesis, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
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11
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Karimov M, Akhundova L. Anti-Vascular Endothelial Growth Factor Therapy as an Adjunct to Diabetic Vitrectomy. Open Ophthalmol J 2021. [DOI: 10.2174/1874364102115010137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction:
The purpose of this work is to study the efficacy of the preoperative intravitreal administration of bevacizumab as an adjunct to vitrectomy in patients with Proliferative Diabetic Retinopathy (PDR).
Methods:
This retrospective comparative study was performed on 118 eyes (118 patients) with proliferative diabetic retinopathy (PDR), which underwent vitrectomy surgery at the Department of Diabetic Eye Disease at Zarifa Aliyeva National Ophthalmology Centre (Baku, Azerbaijan) in 2015-2019. The main group (the bevacizumab group) included 48 eyes with PDR that received intravitreal administration of bevacizumab (Avastin; Genentech Inc., USA) within one week before vitrectomy; the control group included 70 eyes that did not receive a bevacizumab injection for at least 3 months before the vitrectomy. The minimum follow-up was 12 months.
Results:
In both groups, complete retinal attachment after primary vitrectomy was achieved in all eyes (100%). Clinically significant intraoperative haemorrhage was observed in the preoperative bevacizumab injection group in 31.2% and the control group- 51.4%, p = 0.030. The preoperative bevacizumab injection reduced the risk of clinically significant haemorrhage by 2.3 times and the need for endodiathermy by 2.7 times (p = 0.031 and p = 0.024, respectively). Early vitreous cavity haemorrhage was observed in 15.0% in the bevacizumab group and in 35.5% in the control group (p = 0.038). The preoperative injection of bevacizumab before vitrectomy reduced the risk of vitreous cavity haemorrhage in the early postoperative period by 3.0 times (p = 0.036).
Conclusion:
The preoperative use of bevacizumab as an adjunct to diabetic vitrectomy can help reduce the incidence of intraoperative and early postoperative vitreous cavity haemorrhage, which leads to better functional results in the early postoperative period. Over the long-term follow-up period, the effect of the preoperative bevacizumab injections decreases.
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12
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Wang DY, Zhao XY, Zhang WF, Meng LH, Chen YX. Perioperative anti-vascular endothelial growth factor agents treatment in patients undergoing vitrectomy for complicated proliferative diabetic retinopathy: a network meta-analysis. Sci Rep 2020; 10:18880. [PMID: 33144606 PMCID: PMC7641141 DOI: 10.1038/s41598-020-75896-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 10/06/2020] [Indexed: 11/21/2022] Open
Abstract
Currently, controversies regarding the optimal time-point of anti-vascular endothelial growth factor (VEGF) pretreatment before pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR) still exist. To clarify this, we conducted a network meta-analysis, 26 randomized controlled trials including 1806 PDR patients were included. Compared with the sham group, performing anti-VEGF injection at preoperative (Pre-Op) 6 to 14 days could significantly improve post-operative best-corrected visual acuity (BCVA) and decrease the incidence of recurrent vitreous hemorrhage (VH). Meanwhile, it could significantly reduce the duration of surgery. Performing anti-VEGF injection at Pre-Op more than 14 days, 6 to 14 days or 1 to 5 days could significantly reduce the incidence of intra-operative bleeding, while no significant benefit existed at the end of PPV (P > 0.05). No significant difference existed between all those strategies and sham group in reducing the rate of silicone oil tamponade. Based on currently available evidence, performing the anti-VEGF pretreatment at pre-operative 6 to 14 days showed best efficacy in improving post-operative BCVA, reducing the duration of surgery and incidence of recurrent VH, it also achieves satisfactory effect in reducing the incidence of intra-operative bleeding.
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Affiliation(s)
- Dong-Yue Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
- Peking Union Medical College (PUMC), PUMC & Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xin-Yu Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China.
- Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Wen-Fei Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
- Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Li-Hui Meng
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
- Peking Union Medical College (PUMC), PUMC & Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - You-Xin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China.
- Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, 100730, China.
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13
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Naderan M, Sabzevary M, Rezaii K, Banafshehafshan A, Hantoushzadeh S. Intravitreal anti-vascular endothelial growth factor medications during pregnancy: current perspective. Int Ophthalmol 2020; 41:743-751. [PMID: 33044671 DOI: 10.1007/s10792-020-01610-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/01/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE Anti-vascular endothelial growth factor (VEGF) medications are widely used for treatment of a number of vitreoretinal disorders. However, the evidence for their effect on fetal and maternal health during pregnancy is very limited. The goal of this article is to accumulate evidence for the indications of anti-VEGF medications during pregnancy and their effects on maternal and fetal health. METHODS Review of literature regarding anti-VEGF administration during pregnancy and using PubMed database without language or date limit. RESULTS The main indications for treatment with intravitreal anti-VEGF medications include choroidal neovascularization (CNV) followed by retinal vascular occlusion (RVO) and complications of diabetes such as neovascular glaucoma, diabetic retinopathy (DR) and diabetic macular edema (DME). Among anti-VEGF medications, only ranibizumab and bevacizumab have been used during pregnancy with latter by far more than the former. CONCLUSION Women of childbearing age should be consulted regarding the potential adverse effects of anti-VEGF medications on fetal health and the risk of early pregnancy loss. They should be strongly encouraged to use appropriate contraceptive methods during treatment. A timely obstetrics consultation may help in this situation. Attempt for pregnancy should be withheld for at least 3 months following last injection of ranibizumab and aflibercept, and for at least 6 months following last injection of bevacizumab.
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Affiliation(s)
- Morteza Naderan
- Department of Ophthalmology, Farabi Eye Hospital Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin square, South Karegar street, Tehran, Iran.
| | - Masomeh Sabzevary
- Maternal, Fetal, and Neonatal Research Center, Yas Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Keivan Rezaii
- Department of Ophthalmology, Farabi Eye Hospital Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin square, South Karegar street, Tehran, Iran
| | - Ali Banafshehafshan
- Department of Ophthalmology, Farabi Eye Hospital Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin square, South Karegar street, Tehran, Iran
| | - Seddigheh Hantoushzadeh
- Maternal, Fetal, and Neonatal Research Center, Valiasr Hospital, Imam Khomeini Hospital Complexs, Tehran University of Medical Sciences, Tehran, Iran
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Baek SK, Lee MW, Lee YH. Effect of Intrasilicone Bevacizumab Injection in Diabetic Tractional Retinal Detachment Surgery: A Retrospective Case-Control Study. J Clin Med 2020; 9:jcm9103114. [PMID: 32993113 PMCID: PMC7601065 DOI: 10.3390/jcm9103114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/18/2020] [Accepted: 09/23/2020] [Indexed: 11/20/2022] Open
Abstract
Tractional retinal detachment (TRD) causes visual loss in diabetes mellitus patients. Silicone oil can be used as a tamponade to repair retinal detachment; however, intrasilicone injection is challenging. We aimed to evaluate the effect of intrasilicone bevacizumab injection in TRD surgery. This was a single-hospital, retrospective, case-control study of 44 patients (46 eyes). We reviewed medical histories and ophthalmic examination results. We administered silicone oil to 26 eyes (group I), and a combination of silicone oil and intravitreal bevacizumab injection to 20 eyes (group II). The main outcome measures were the logarithm of the minimum angle of resolution (logMAR) visual acuity and central macular thickness. Mean change in logMAR visual acuity was larger (p = 0.029) in group II (−0.99 ± 0.73) than in group I (−0.56 ± 0.80), 12 months postoperatively. Compared to group I, group II exhibited a lower mean (471.54 ± 120.14 μm vs. 363.40 ± 59.57 µm, respectively; p = 0.001), and mean change (−22.39 ± 203.99 μm vs. −72.40 ± 139.35 µm, respectively; p = 0.027), in central macular thickness, 1 month postoperatively. Intrasilicone bevacizumab injection immediately after vitrectomy may rapidly reduce central macular thickness and increase final visual acuity. Prospective studies are necessary to demonstrate long-term safety and efficacy.
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Affiliation(s)
| | | | - Young-Hoon Lee
- Correspondence: ; Tel.: +82-10-3410-0329; Fax: +82-42-600-9250
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15
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Ding Y, Yao B, Hang H, Ye H. Multiple factors in the prediction of risk of recurrent vitreous haemorrhage after sutureless vitrectomy for non-clearing vitreous haemorrhage in patients with diabetic retinopathy. BMC Ophthalmol 2020; 20:292. [PMID: 32677996 PMCID: PMC7367221 DOI: 10.1186/s12886-020-01532-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/26/2020] [Indexed: 01/19/2023] Open
Abstract
Background We aimed to analyse multiple factors in the prediction of risk of postoperative recurrent vitreous haemorrhage (RVH) for non-clearing vitreous haemorrhage in patients with diabetic retinopathy (DR) who underwent sutureless vitrectomy with 23- (23G) or 25-gauge (25G) narrow-gauge systems. Methods A retrospective consecutive case series design was used. DR patients who underwent sutureless vitrectomy for non-clearing vitreous haemorrhage between June 2017 and October 2019 were enrolled. All operations were performed at a tertiary hospital. Patient demographics and risk factors, including age, gender, duration of diabetes, preoperative fasting blood sugar levels (FBSL), systolic blood pressure (SBP), serum creatinine (Cr), urea, triamcinolone acetonide (TA), electrical coagulation, air-fluid exchange, pan-retinal photocoagulation status (PRP), anti-vascular endothelial growth factor drug (anti-VEGF), and other factors, were recorded. Patients were divided into two groups based on the timing of their postoperative RVH: immediate postoperative RVH (within 2 weeks after operation) and delayed postoperative RVH (beyond 2 weeks after operation). Results Overall, 167 eyes (167patients) were enrolled. Seventy eyes were underwent 23G and 25G sutureless vitrectomy performed in 97 eyes, respectively. Postoperative RVH developed in 18 eyes (25.7%) in Group 23G and in 20 eyes (21.6%) in Group 25G (P = 0.540). Of these, 3 eyes (4.3%) had severed RVH in Group 23G compared with 5 eyes (5.2%) in Group 25G (P = 0.584). Delayed postoperative RVH occurred in 6 eyes (8.6%) in Group 23G and 8 eyes (8.2%) in Group 25G (P = 0.789). A binomial logistic regression analysis revealed that age, duration of diabetes, and Cr level were significantly associated with RVH in both Group 23G (P < 0.05) and Group 25G (P < 0.05). Conclusions The incidence and severity of RVH were 25.7 and 4.3%, respectively, in Group 23G and 21.6 and 5.2%, respectively, in Group 25G. Thus, the 23G sutureless vitrectomy approach was as safe as the 25G sutureless vitrectomy approach for treating vitreous haemorrhage in patients with DR. A younger age, shorter duration of diabetes, and higher Cr levels were risk factors for postoperative RVH in sutureless vitrectomy.
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Affiliation(s)
- Yuhua Ding
- Department of Ophthalmology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Bangtao Yao
- Department of Ophthalmology, Lishui District People's Hospital, Lishui branch of Southeast University Affiliated Zhongda Hospital, Nanjing, Jiangsu Province, China
| | - Hui Hang
- Department of Ophthalmology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
| | - Hui Ye
- Department of Ophthalmology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
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16
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Araújo RS, Silva GA. PlGF silencing combined with PEDF overexpression: Modeling RPE secretion as potential therapy for retinal neovascularization. Mol Biol Rep 2020; 47:4413-4425. [PMID: 32385771 DOI: 10.1007/s11033-020-05496-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/03/2020] [Indexed: 12/21/2022]
Abstract
Ocular neovascularization is a defining feature of several blinding diseases. We have previously described the effectiveness of long-term pigment epithelium-derived factor (PEDF) expression in the retina of diabetic mice in ameliorating some diabetic retinopathy hallmarks. In this study, we aimed to investigate if the antiangiogenic potential of PEDF overexpression was enhanced in combination with placental growth factor (PlGF) silencing. Human RPE cells were transfected with a self-replicating episomal vector (pEPito) for PEDF overexpression and/or a siRNA targeting PlGF gene. Conditioned media from PEDF overexpression, from PlGF inhibition and from their combination thereof were used to culture human umbilical vein endothelial cells, and their proliferation rate, migration capacity, apoptosis and ability to form tube-like structures were analyzed in vitro. We here demonstrate that pEPito-driven PEDF overexpression in combination with PlGF silencing in RPE cells does not affect their viability and results in an enhanced antiangiogenic activity in vitro. We observed a significant decrease in the migration and proliferation of endothelial cells, and an increase in apoptosis induction as well as a significant inhibitory effect on tube formation. Our findings demonstrate that simultaneous PEDF overexpression and PlGF silencing strongly impairs angiogenesis compared with the single approaches, providing a rationale for combining these therapies as a new treatment for retinal neovascularization.
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Affiliation(s)
- Rute S Araújo
- CEDOC - Chronic Diseases Research Center, NOVA Medical School, Universidade Nova de Lisboa, Campo Mártires da Pátria 130, 1169-056, Lisboa, Portugal.,Bioengineering- Cell Therapies and Regenerative Medicine PhD Program, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001, Lisboa, Portugal
| | - Gabriela A Silva
- CEDOC - Chronic Diseases Research Center, NOVA Medical School, Universidade Nova de Lisboa, Campo Mártires da Pátria 130, 1169-056, Lisboa, Portugal. .,NOVA Medical School, Universidade Nova de Lisboa, Campo Mártires da Pátria 130, 1169-056, Lisboa, Portugal.
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17
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Cabrera AP, Mankad RN, Marek L, Das R, Rangasamy S, Monickaraj F, Das A. Genotypes and Phenotypes: A Search for Influential Genes in Diabetic Retinopathy. Int J Mol Sci 2020; 21:E2712. [PMID: 32295293 PMCID: PMC7215289 DOI: 10.3390/ijms21082712] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 12/13/2022] Open
Abstract
Although gene-environment interactions are known to play an important role in the inheritance of complex traits, it is still unknown how a genotype and the environmental factors result in an observable phenotype. Understanding this complex interaction in the pathogenesis of diabetic retinopathy (DR) remains a big challenge as DR appears to be a disease with heterogenous phenotypes with multifactorial influence. In this review, we examine the natural history and risk factors related to DR, emphasizing distinct clinical phenotypes and their natural course in retinopathy. Although there is strong evidence that duration of diabetes and metabolic factors play a key role in the pathogenesis of DR, accumulating new clinical studies reveal that this disease can develop independently of duration of diabetes and metabolic dysfunction. More recently, studies have emphasized the role of genetic factors in DR. However, linkage analyses, candidate gene studies, and genome-wide association studies (GWAS) have not produced any statistically significant results. Our recently initiated genomics study, the Diabetic Retinopathy Genomics (DRGen) Study, aims to examine the contribution of rare and common variants in the development DR, and how they can contribute to clinical phenotype, rate of progression, and response to available therapies. Our preliminary findings reveal a novel set of genetic variants associated with proangiogenic and inflammatory pathways that may contribute to DR pathogenesis. Further investigation of these variants is necessary and may lead to development of novel biomarkers and new therapeutic targets in DR.
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Affiliation(s)
- Andrea P. Cabrera
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA; (A.P.C.); (R.N.M.); (L.M.); (R.D.); (F.M.)
| | - Rushi N. Mankad
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA; (A.P.C.); (R.N.M.); (L.M.); (R.D.); (F.M.)
| | - Lauren Marek
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA; (A.P.C.); (R.N.M.); (L.M.); (R.D.); (F.M.)
| | - Ryan Das
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA; (A.P.C.); (R.N.M.); (L.M.); (R.D.); (F.M.)
| | - Sampath Rangasamy
- Translational & Genomics Research Institute, Phoenix, AZ 85004, USA;
| | - Finny Monickaraj
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA; (A.P.C.); (R.N.M.); (L.M.); (R.D.); (F.M.)
- New Mexico VA Health Care System, Albuquerque, NM 87108, USA
| | - Arup Das
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA; (A.P.C.); (R.N.M.); (L.M.); (R.D.); (F.M.)
- New Mexico VA Health Care System, Albuquerque, NM 87108, USA
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Change of Vascular Endothelial Growth Factor Levels following Vitrectomy in Eyes with Proliferative Diabetic Retinopathy. J Ophthalmol 2019; 2019:6764932. [PMID: 31772768 PMCID: PMC6854928 DOI: 10.1155/2019/6764932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/25/2019] [Accepted: 10/04/2019] [Indexed: 11/26/2022] Open
Abstract
Purpose To study the change of concentrations of vascular endothelial growth factor (VEGF) in vitreous cavity after vitrectomy in eyes with proliferative diabetic retinopathy (PDR). Methods In this retrospective study, intravitreal fluid samples were taken at baseline (beginning of the vitrectomy) and postoperatively (several days later after vitrectomy) at the time of prophylactic injection of bevacizumab in forty-eight eyes of forty-eight patients with PDR. Postvitrectomy fluid samples were divided into four groups according to the time interval between the vitrectomy and the injection (group 1, 3–5 days; group 2, 6–10 days; group 3, 11–15 days; group 4, 16–21 days; twelve eyes in each group). Postvitrectomy fluid sample was paired with baseline sample for each eye. VEGF concentrations in the samples were determined by enzyme-linked immunosorbent assay. Recurrent vitreous hemorrhage and neovascular glaucoma within six months postvitrectomy were also analyzed. Results Overall, the intravitreal VEGF level after vitrectomy (median, 36.95 pg/ml; range, 3.2–1,299.4 pg/ml) was significantly less than the VEGF level at baseline (median, 704.5 pg/ml; range, 30.6–1,981.1 pg/ml). Postoperative and baseline VEGF levels were significantly correlated (r = 0.499, p < 0.01). Both the absolute value of postoperative VEGF concentrations and the postop/baseline VEGF ratios declined with time and dramatically decreased in groups 3 and 4. In only two eyes, the postoperative VEGF level was even higher than the baseline VEGF level (postop/baseline VEGF ratio >1), and recurrent vitreous hemorrhage developed within six months in these two eyes. Conclusions After vitrectomy for PDR, intravitreal VEGF levels decreased substantially in the majority of patients, while persistent high-VEGF level occurred in a few individuals. Postoperative VEGF levels and postop/baseline VEGF ratio declined with time. The postop/preop VEGF ratio may serve as a predictor for late complications.
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Preoperative Bevacizumab for Tractional Retinal Detachment in Proliferative Diabetic Retinopathy: A Prospective Randomized Clinical Trial. Am J Ophthalmol 2019; 207:279-287. [PMID: 31095954 DOI: 10.1016/j.ajo.2019.05.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/29/2019] [Accepted: 05/03/2019] [Indexed: 11/23/2022]
Abstract
PURPOSE To assess the effectiveness and safety of an intravitreal injection of 1.25 mg bevacizumab (IVB) as a preoperative adjunct to small-gauge pars plana vitrectomy (PPV) compared with PPV alone in eyes with tractional retinal detachment secondary to proliferative diabetic retinopathy. METHODS This prospective, double-masked, randomized, multicenter, active-controlled clinical trial enrolled 224 eyes of 224 patients between November 2013 and July 2015. All eyes underwent a baseline examination including best-corrected visual acuity, color photos, optical coherence tomography, and fluorescein angiography. Data were collected on intraoperative bleeding, total surgical time, early (<1 month) postoperative vitreous hemorrhage, and mean change in best-corrected visual acuity at 12 months. P < .05 was considered statistically significant. RESULTS A total of 214 patients (214 eyes) were randomized in a 1:1 ratio to PPV plus IVB ([study group] 102 eyes) or PPV plus sham ([control] 112 eyes). Iatrogenic retinal breaks were noted intraoperatively in 35 eyes (34.3%) in the study group, and 66 eyes (58.9%) in the control group (P = .001). Grade 2 intraoperative bleeding was noted in 32 (31.3%) eyes in the study group and 58 (51.7 %) eyes in the control group (P = .001). Endodiathermy was necessary in 28 (27.4 %) eyes in the study group, compared with 75 (66.9%) eyes in the control group (P = .0001). Mean surgical time was 71.3 ± 32.1 minutes in the study group and 83.6 ± 38.7 minutes in the control group (P = .061). CONCLUSION Preoperative IVB seems to reduce intraoperative bleeding, improving surgical field visualization, and reducing intraoperative and postoperative complications. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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20
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Sasongko MB, Wardhana FS, Febryanto GA, Agni AN, Supanji S, Indrayanti SR, Widayanti TW, Widyaputri F, Widhasari IA, Lestari YD, Adriono GA, Sovani I, Kartasasmita AS. The estimated healthcare cost of diabetic retinopathy in Indonesia and its projection for 2025. Br J Ophthalmol 2019; 104:487-492. [PMID: 31285276 DOI: 10.1136/bjophthalmol-2019-313997] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/10/2019] [Accepted: 06/10/2019] [Indexed: 01/24/2023]
Abstract
PURPOSE To estimate the total healthcare cost associated with diabetic retinopathy (DR) in type 2 diabetes in Indonesia and its projection for 2025. METHODS A prevalence-based cost-of-illness model was constructed from previous population-based DR study. Projection for 2025 was derived from estimated diabetes population in 2025. Direct treatment costs of DR were estimated from the perspective of healthcare. Patient perspective costs were obtained from thorough interview including only transportation cost and lost of working days related to treatment. We developed four cost-of-illness models according to DR severity level, DR without necessary treatment, needing laser treatment, laser +intravitreal (IVT) injection and laser + IVT +vitrectomy. All costs were estimated in 2017 US$. RESULTS The healthcare costs of DR in Indonesia were estimated to be $2.4 billion in 2017 and $8.9 billion in 2025. The total cost in 2017 consisted of the cost for no DR and mild-moderate non-proliferative DR (NPDR) requiring eye screening ($25.9 million), severe NPDR or proliferative DR (PDR) requiring laser treatment ($0.25 billion), severe NPDR or PDR requiring both laser and IVT injection ($1.75 billion) and advance level of PDR requiring vitrectomy ($0.44 billion). CONCLUSIONS The estimated healthcare cost of DR in Indonesia in 2017 was considerably high, nearly 2% of the 2017 national state budget, and projected to increase significantly to more than threefold in 2025. The highest cost may incur for DR requiring both laser and IVT injection. Therefore, public health intervention to delay or prevent severe DR may substantially reduce the healthcare cost of DR in Indonesia.
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Affiliation(s)
- Muhammad Bayu Sasongko
- Department of Ophthalmology, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada-Dr Sardjito General Hospital, Yogyakarta, Indonesia
| | - Firman Setya Wardhana
- Department of Ophthalmology, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada-Dr Sardjito General Hospital, Yogyakarta, Indonesia
| | - Gandhi Anandika Febryanto
- Department of Ophthalmology, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada-Dr Sardjito General Hospital, Yogyakarta, Indonesia
| | - Angela Nurini Agni
- Department of Ophthalmology, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada-Dr Sardjito General Hospital, Yogyakarta, Indonesia
| | - Supanji Supanji
- Department of Ophthalmology, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada-Dr Sardjito General Hospital, Yogyakarta, Indonesia
| | - Sarah Rizqia Indrayanti
- Department of Ophthalmology, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada-Dr Sardjito General Hospital, Yogyakarta, Indonesia
| | - Tri Wahyu Widayanti
- Department of Ophthalmology, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada-Dr Sardjito General Hospital, Yogyakarta, Indonesia
| | - Felicia Widyaputri
- Department of Ophthalmology, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada-Dr Sardjito General Hospital, Yogyakarta, Indonesia
| | - Idhayu Anggit Widhasari
- Department of Ophthalmology, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada-Dr Sardjito General Hospital, Yogyakarta, Indonesia
| | - Yeni Dwi Lestari
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia-Dr Ciptomangunkusumo National Hospital, Jakarta, Indonesia
| | - Gitalisa Andayani Adriono
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia-Dr Ciptomangunkusumo National Hospital, Jakarta, Indonesia
| | - Iwan Sovani
- Department of Ophthalmology, Faculty of Medicine, Universitas Padjajaran-Cicendo National Eye Hospital, Bandung, Indonesia
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21
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Zhang LS, Zhou YD, Peng YQ, Zeng HL, Yoshida S, Zhao TT. Identification of altered microRNAs in retinas of mice with oxygen-induced retinopathy. Int J Ophthalmol 2019; 12:739-745. [PMID: 31131231 DOI: 10.18240/ijo.2019.05.07] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 02/25/2019] [Indexed: 02/06/2023] Open
Abstract
AIM To identify disease-related miRNAs in retinas of mice with oxygen-induced retinopathy (OIR), and to explore their potential roles in retinal pathological neovascularization. METHODS The retinal miRNA expression profile in mice with OIR and room air controls at postnatal day 17 (P17) were determined through miRNA microarray analysis. Several miRNAs were significantly up- and down-regulated in retinas of mice with OIR compared to controls by quantitative real-time reverse transcription-polymerase chain reaction (qRT-PCR). Two databases including Targetscan7.1 and MirdbV5 were used to predict target genes that associated with those significantly altered miRNAs in retinas of mice with OIR. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were also conducted to identify possible biological functions of the target genes. RESULTS In comparison with room air controls, 3 and 8 miRNAs were significantly up- and down-regulated, respectively, in retinas of mice with OIR. The qRT-PCR data confirmed that mmu-miR-350-3p and mmu-miR-202-3p were significantly up-regulated, while mmu-miR-711 and mmu-miR-30c-1-3p were significantly down-regulated in mice with OIR compared to controls. GO analysis demonstrated that the identified target genes were related to functions such as cellular macromolecule metabolic process. KEGG pathway analysis showed a group of pathways, such as Wnt signaling pathway, transcriptional misregulation in cancer, Mucin type O-glycan biosynthesis, and mitogen-activated protein kinase (MAPK) signaling pathway might be involved in pathological process of retinal neovascularization. CONCLUSION Our findings suggest that the differentially expressed miRNAs in retinas of mice with OIR might provide potential therapeutic targets for treating retinal neovascularization.
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Affiliation(s)
- Lu-Si Zhang
- Department of Ophthalmology, the Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China.,Hunan Clinical Research Center of Ophthalmic Disease, Changsha 410011, Hunan Province, China
| | - Ye-Di Zhou
- Department of Ophthalmology, the Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China.,Hunan Clinical Research Center of Ophthalmic Disease, Changsha 410011, Hunan Province, China
| | - Ying-Qian Peng
- Department of Ophthalmology, the Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China.,Hunan Clinical Research Center of Ophthalmic Disease, Changsha 410011, Hunan Province, China
| | - Hui-Lan Zeng
- Department of Ophthalmology, the Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China.,Hunan Clinical Research Center of Ophthalmic Disease, Changsha 410011, Hunan Province, China
| | - Shigeo Yoshida
- Department of Ophthalmology, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Tan-Tai Zhao
- Department of Ophthalmology, the Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China.,Hunan Clinical Research Center of Ophthalmic Disease, Changsha 410011, Hunan Province, China
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22
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Iyer SSR, Regan KA, Burnham JM, Chen CJ. Surgical management of diabetic tractional retinal detachments. Surv Ophthalmol 2019; 64:780-809. [PMID: 31077688 DOI: 10.1016/j.survophthal.2019.04.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/24/2019] [Accepted: 04/30/2019] [Indexed: 01/06/2023]
Abstract
Tractional retinal detachment is an end-stage form of diabetic retinopathy that occurs when contractile forces in the vitreous and neovascular tissue lead to the detachment of the neurosensory retina. We review the literature related to the management of this disease. Preoperative planning includes appropriate patient selection, diagnostic and prognostic imaging, and medical optimization with reduction of systemic risk factors. Use of antivascular endothelial growth factor for preoperative treatment has had significant benefits for tractional retinal detachment repair in improving surgical efficiency and outcomes. Advances in microsurgical instrumentation are discussed, with attention to small-gauge vitrectomy with improved flow dynamics, viewing strategies, and lighting allowing bimanual surgery. Special emphasis is placed on bimanual surgical technique, choice of tamponade, and the avoidance of iatrogenic damage. Complications and special considerations are further explored. Based on our compilation of relevant literature, we propose a surgical algorithm for the management of these complex patients.
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Affiliation(s)
- Siva S R Iyer
- Department of Ophthalmology, University of Florida College of Medicine, Gainesville, Florida, USA.
| | - Kathleen A Regan
- Department of Ophthalmology, University of Florida College of Medicine, Gainesville, Florida, USA
| | | | - Ching J Chen
- Department of Ophthalmology, University of Mississippi School of Medicine, Jackson, Mississippi, USA
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23
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Hu Z, Su Y, Xie P, Chen L, Ji J, Feng T, Wu S, Liang K, Liu Q. OCT angiography-based monitoring of neovascular regression on fibrovascular membrane after preoperative intravitreal conbercept injection. Graefes Arch Clin Exp Ophthalmol 2019; 257:1611-1619. [PMID: 31053944 DOI: 10.1007/s00417-019-04315-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 02/26/2019] [Accepted: 04/01/2019] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To quantify the preoperative neovascular change pattern on the fibrovascular membrane (FVM) within 7 days after intravitreal injection of conbercept (IVC) using optical coherence tomography angiography (OCTA) in proliferative diabetic retinopathy (PDR). METHODS Prospective, observational study of PDR patients with visible FVM receiving or not receiving IVC. Neovascular changes were assessed by OCTA pre-IVC and 1, 3, 5, and 7 days post-IVC. Vessel skeleton density (SD) and vessel density (VD) were quantified by an intensity-based optical microangiography algorithm. The interclass correlation coefficient (ICC) was calculated to assess the agreement between measurements. The SD and VD were compared between follow-ups using repeated-measures analysis in the IVC group. RESULTS The ICC was 0.992 (95% confidence interval [CI]: 0.982-0.996) for SD and 0.926 (95% CI: 0.838-0.912) for VD of neovascularization. The neovascularization on FVM significantly regressed in the IVC group (n = 16) compared with no IVC (n = 8) (p = 0.001 for SD and p < 0.001 for VD). The comparisons between consecutive follow-ups showed a statistically significant reduction in SD and VD at 1 and 3 days post-IVC. However, from day 3 onward, the SD and VD remained unchanged. There was no development or progression of tractional retinal detachment within the 7-day period after IVC. CONCLUSION OCTA-based quantification of the neovascularization on FVM in PDR is feasible, with high inter-reader agreement. The regression of neovascularization reaches a plateau 3 days after IVC. CLINICAL TRIAL REGISTRATION This trial is registered with the Chinese Clinical Trial Registry ( http://www.chictr.org.cn , registration number ChiCTR-IPR-17014160).
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Affiliation(s)
- Zizhong Hu
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, Jiangsu, 210029, People's Republic of China
| | - Yun Su
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, Jiangsu, 210029, People's Republic of China
| | - Ping Xie
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, Jiangsu, 210029, People's Republic of China
| | - Lu Chen
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, Jiangsu, 210029, People's Republic of China
| | - Jiangdong Ji
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, Jiangsu, 210029, People's Republic of China
| | - Ting Feng
- School of Electronic and Optic Engineering, Nanjing University of Science and Technology, Nanjing, 21000, China
| | - Shaowei Wu
- School of Electronic and Optic Engineering, Nanjing University of Science and Technology, Nanjing, 21000, China
| | - Kang Liang
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, Jiangsu, 210029, People's Republic of China
| | - Qinghuai Liu
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, Jiangsu, 210029, People's Republic of China.
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24
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Yang KB, Zhang H, Li SJ, Cao JJ, Cheng LN, Lin YX, Tian ZC, Li J, Gu F, Liu ZL. Conbercept and Ranibizumab Pretreatments in Vitrectomy with Silicone Oil Infusion for Severe Diabetic Retinopathy. J Ocul Pharmacol Ther 2019; 35:161-167. [PMID: 30668279 DOI: 10.1089/jop.2018.0093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Kai-Bo Yang
- Department of Ophthalmology, The First Hospital of China Medical University, Shenyang, China
| | - Han Zhang
- Department of Ophthalmology, The First Hospital of China Medical University, Shenyang, China
| | - Si-Jia Li
- Department of Ophthalmology, The First Hospital of China Medical University, Shenyang, China
| | - Jiao-Jiao Cao
- Department of Ophthalmology, The First Hospital of China Medical University, Shenyang, China
| | - Lu-Na Cheng
- Department of Ophthalmology, The First Hospital of China Medical University, Shenyang, China
| | - Yu-xi Lin
- Department of Ophthalmology, The First Hospital of China Medical University, Shenyang, China
| | - Zhe-Chen Tian
- Department of Ophthalmology, The First Hospital of China Medical University, Shenyang, China
| | - Jun Li
- Department of Ophthalmology, The First Hospital of China Medical University, Shenyang, China
| | - Feng Gu
- Department of Ophthalmology, The First Hospital of China Medical University, Shenyang, China
| | - Zhe-Li Liu
- Department of Ophthalmology, The First Hospital of China Medical University, Shenyang, China
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25
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Li Y, Zhou Y. Interleukin-17: The Role for Pathological Angiogenesis in Ocular Neovascular Diseases. TOHOKU J EXP MED 2019; 247:87-98. [PMID: 30773517 DOI: 10.1620/tjem.247.87] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Ocular neovascular diseases are featured by abnormal angiogenesis in the eye, and they seriously threaten the human visual health. These diseases include proliferative diabetic retinopathy (PDR), age-related macular degeneration (AMD), retinopathy of prematurity (ROP), and retinal vein occlusion (RVO). In fact, ocular neovascular diseases represent the leading causes of vision impairment and blindness worldwide. Ocular neovascularization, the process of pathological vessel formation in eye, underlies ocular neovascular diseases. Cytokines have important regulatory roles in neovascularization through immunological networks. Interleukin (IL)-17, the signature cytokine produced by T helper 17 (Th17) cells, has proven to be involved in ocular neovascularization. However, roles of IL-17 in ocular neovascular diseases still remain controversial. This review provides an overview of the functional roles of IL-17 in ocular neovascular diseases from basic research to clinical evidence by focusing on PDR, AMD, ROP, and RVO. The possible roles of IL-17 in neovascularization are achieved through a regulatory network of cytoskeleton remodeling, vascular endothelial growth factor (VEGF), VEGF-related cytokines, and complement components. Current applications as well as potential therapies targeting IL-17 with genome editing systems are also outlined and discussed. Targeting IL-17 might be a promising therapeutic strategy against ocular neovascular diseases.
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Affiliation(s)
- Yuanjun Li
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University.,Department of Ophthalmology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital
| | - Yedi Zhou
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University.,Hunan Clinical Research Center of Ophthalmic Disease
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26
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Characteristics and Outcomes of Pars Plana Vitrectomy for Proliferative Diabetic Retinopathy Patients in a Limited Resource Tertiary Center over an Eight-Year Period. J Ophthalmol 2019; 2019:9481902. [PMID: 31007953 PMCID: PMC6441510 DOI: 10.1155/2019/9481902] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 02/26/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose To report characteristics and visual results in patients with PDR-associated complications following pars plana vitrectomy (PPV) in a tertiary center over an eight-year period. Methods Medical records of diabetic retinopathy patients receiving PPV between January 2007 and December 2014 for PDR-related complications were reviewed. Results A total of 890 consecutive PDR patients were included in the study. PPVs were performed for tractional retinal detachment (36.6%), persistent vitreous hemorrhage (VH) (35.4%), combined tractional and rhegmatogenous retinal detachment (14.5%), and vitreoretinal abnormalities (13.5%), respectively. Preoperative intravitreal bevacizumab injection (IVB) within two weeks prior to PPV and 23G vitrectomy systems was found to decrease the risk for intraoperative retinal break development (P=0.045 and P=0.015, respectively). The incidence of early dense postoperative VH decreased significantly with the administration of preoperative or intraoperative IVB at the end of PPV. Postoperative visual results significantly correlated with the initial visual acuity level, intraoperative retinal break development, and retained silicone oil tamponade at the final visit (P < 0.001, P=0.040, and P=0.044, respectively). Administration of adjuvant IVB either before or at the end of PPV had no significant association with the final visual outcomes. Conclusions This study reported an improvement in visual acuity in nearly half of patients receiving PPV for PDR-associated complications in a limited resource center. The incidence of intraoperative retinal break and early postoperative VH decreased significantly with the application of IVB injections. Poor final visual outcomes were related to the lower initial visual acuity levels, intraoperative retinal breaks, and postoperative retained silicone oil.
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27
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Savastano MC, Savastano A, Rizzo S. Pharmacological Adjuncts to Vitrectomy Surgery. Curr Pharm Des 2019; 24:4843-4852. [PMID: 30706802 DOI: 10.2174/1381612825666190130125136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 01/24/2019] [Indexed: 11/22/2022]
Abstract
Pharmacological adjuncts to vitrectomy surgery are useful tools to better deal with surgery. Their introduction has enriched the therapeutic choice before, during and after operations. Although several classifications could be made to frame adjuncts to vitrectomy, we preferred to divide the pharmacological adjuncts to vitrectomy surgery for therapeutic use in the pre-operatory procedure (neo-adjuvant), for intraoperative use and for post-operatory practice (adjuvant). This type of classification allowed us to explore all the adjuncts based on the timing of their use. The actual interest in vitrectomy surgery is giving rise to considerable interest in new molecules with and without the pharmacological effect that will soon be available for the aid of vitreoretinal surgery.
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28
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Elwan MM, Hagras SM, Ellayeh AA. Trimanual Versus Unimanual 23-Gauge Vitrectomy in Patients With Diabetes: Limitations and Expectations. Ophthalmic Surg Lasers Imaging Retina 2019; 50:42-49. [DOI: 10.3928/23258160-20181212-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 11/02/2018] [Indexed: 11/20/2022]
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29
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Stewart MW, Browning DJ, Landers MB. Current management of diabetic tractional retinal detachments. Indian J Ophthalmol 2018; 66:1751-1762. [PMID: 30451175 PMCID: PMC6256889 DOI: 10.4103/ijo.ijo_1217_18] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 08/01/2018] [Indexed: 12/20/2022] Open
Abstract
Twenty-five percent of diabetes-related vision loss stems from complications of proliferative diabetic retinopathy (PDR). Panretinal photocoagulation has been the preferred treatment of high-risk PDR for decades and more recently intravitreal injections of drugs that inhibit the actions of vascular endothelial growth factor have become popular. But despite these treatments PDR may progress uncontrollably to advanced pathologies such as traction retinal detachments (TRDs), combined traction/rhegmatogenous retinal detachments (TRD/RRDs), vitreous hemorrhages, rubeosis iridis, and traction maculopathies, which produce mild-to-severe loss of vision. TDR have long been the most common indication for PDR-related vitreoretinal surgery. Vitrectomy surgery is indicated for recent (<6 months duration) TRD involving the macula, progressive TRD that threatens the macula, and recent data suggest that chronic macula-involving TRDs (>6 months duration) may also benefit. Combined TRD/RRD represents a particularly challenging surgical condition but advances in surgical instrumentation, dissection techniques, and post-operative tamponade have produced excellent success rates. The recent development of small-gauge vitrectomy systems has persuaded most surgeons to switch platforms since these appear to produce shorter surgical times and quicker post-operative recoveries. Pre-operative injections of bevacizumab are frequently administered for persistent neovascularization to facilitate surgical dissection of pre-retinal fibrosis and reduce the incidence of post-operative hemorrhages. Recent trends toward earlier surgical intervention and expanded indications are likely to continue as surgical instrumentation and techniques are further developed.
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Affiliation(s)
| | - David J Browning
- Charlotte Eye, Ear, Nose, and Throat Associates, Charlotte, NC, USA
| | - Maurice B Landers
- Department of Ophthalmology, Kittner Eye Center, University of North Carolina, Chapel Hill, NC, USA
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30
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BIMANUAL MICROINCISION VITREOUS SURGERY FOR SEVERE PROLIFERATIVE DIABETIC RETINOPATHY. Retina 2018; 38 Suppl 1:S134-S145. [DOI: 10.1097/iae.0000000000002093] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Amissah-Arthur KN, Mensah E. The past, present and future management of sickle cell retinopathy within an African context. Eye (Lond) 2018; 32:1304-1314. [PMID: 29991740 DOI: 10.1038/s41433-018-0162-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/19/2018] [Accepted: 05/28/2018] [Indexed: 11/10/2022] Open
Abstract
Sickle cell retinopathy is a potentially blinding condition that affects young people in the working age group. This review looks at the past, present and future management of sickle cell retinopathy within an African context. After Sickle cell disease was first reported in 1910, some reports from Africa were pivotal in describing the retinal changes associated with the disease. It soon became obvious that there was a varied clinical picture and clinical course. Several landmark studies were carried out in Jamaica to help elucidate the complexities of the disease and outline appropriate clinical management. In most of the developed world, the clinical management of sickle cell disease has improved with concurrent improvement in outcomes. Currently resource constraints in most Sub-Saharan African countries where there is a high burden of disease means that the management of sickle cell retinopathy is fraught with numerous challenges. Future large scale trials in Africa shall hopefully help to better elucidate the mechanisms behind proliferative sickle retinopathy and help in the development of new and improved therapeutic pathways. The use of technology can help immensely in the screening of patients with sickle cell to detect early proliferative changes and if necessary treat accordingly.
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Affiliation(s)
- Kwesi Nyan Amissah-Arthur
- Ophthalmology Unit, Department of Surgery, Korle Bu Teaching Hospital, College of Health Sciences, School of Medicine and Dentistry, University of Ghana, Accra, Ghana.
| | - Evelyn Mensah
- Ophthalmology Department, Central Middlesex Hospital, London North West University Healthcare NHS Trust, London, NW10 7NS, UK
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32
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Faisal SM, Tahir MA, Cheema AM, Anjum MI. Pars plana vitrectomy in vitreous hemorrhage with or without Intravitreal Bevacizumab a comparative overview. Pak J Med Sci 2018; 34:221-225. [PMID: 29643911 PMCID: PMC5857017 DOI: 10.12669/pjms.341.12683] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To compare the success in patients having vitreous hemorrhage undergoing pars plana vitrectomy with or without preoperative intravitreal injection of Bevacizumab. Methods: This Randomized controlled trial was conducted at Department of Ophthalmology, Jinnah Postgraduate Medical Centre. Karachi. Duration of study was six months from January 2010 to June 2010. In this study 56 patients of advanced diabetic eye disease were divided into two groups. Patients in Group-A underwent three ports pars plana vitrectomy with preoperative intravitreal injection of Bevacizumab (Avastin) 1.25mg/0.05ml, 3.5mm from the limbus seven days before surgery and in Group-B patients underwent vitrectomy without preoperative intravitreal Bevacizumab (Avastin). Intraoperative bleeding was monitored in both groups and was graded as no bleeding, mild bleeding and severe bleeding. The results were statistically analyzed through computer software SPSS 17. Results: Twenty eight patients in Group-A who were given an injection of intravitreal Bevacizumab (Avastin) before surgery, intraoperative bleeding monitored was, no bleeding in 17 cases (60.7%), mild was observed in 6 cases (21.4%) and severe bleeding requiring diathermy to stop was observed in only 5 cases (17.9%). 28 patients in Group-B that underwent surgery without Avastin no bleeding was observed in only 2 cases (7.1%), mild in 6 cases (21.4%) and severe in 20 cases (71.4%). Conclusions: Intravitreal injection of Bevacizumab (Avastin) was effective before vitrectomy in the surgical management of Advanced Diabetic Eye disease.
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Affiliation(s)
- Syed Muhammad Faisal
- Syed Muhammad Faisal, MBBS, FCPS (Ophth). Consultant Ophthalmologist, Ali Trust Eye Hospital, Karachi, Pakistan
| | - Muhammad Ali Tahir
- Muhammad Ali Tahir, MBBS, FCPS (Ophth), FCPS (Vitreoretina). Consultant Retinal Surgeon, Department of Ophthalmology, Jinnah Post Graduate Medical Centre, Karachi, Pakistan
| | - Alyscia Miriam Cheema
- Alyscia Miriam Cheema, MBBS, FCPS, FRCS. Associate Professor and Head, Department Of Ophthalmology, Jinnah Post Graduate Medical Centre, Karachi, Pakistan
| | - Muhammad Ijaz Anjum
- Muhammad Ijaz Anjum, MBBS, MCPS, FCPS, FRCS. Chief Consultant, Ali Trust Eye Hospital, Karachi, Pakistan
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33
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Nikkhah H, Karimi S, Ahmadieh H, Azarmina M, Abrishami M, Ahoor H, Alizadeh Y, Behboudi H, Daftarian N, Dehghan MH, Entezari M, Farrahi F, Ghanbari H, Falavarjani KG, Javadi MA, Karkhaneh R, Moradian S, Manaviat MR, Mehryar M, Nourinia R, Parvaresh MM, Ramezani A, Haghi AR, Riazi-Esfahani M, Soheilian M, Shahsavari M, Shahriari HA, Rajavi Z, Safi S, Shirvani A, Rahmani S, Sabbaghi H, Pakbin M, Kheiri B, Ziaei H. Intravitreal Injection of Anti-vascular Endothelial Growth Factor Agents for Ocular Vascular Diseases: Clinical Practice Guideline. J Ophthalmic Vis Res 2018; 13:158-169. [PMID: 29719645 PMCID: PMC5905310 DOI: 10.4103/jovr.jovr_50_18] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 12/17/2017] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To provide the clinical recommendations for the administration of intravitreal anti-vascular endothelial growth factor (VEGF) drugs especially bavacizumab for ocular vascular diseases including diabetic macular edema, neovascular age-related macular degeneration, myopic choroidal neovascularization, retinal vein occlusion and central serous chorioretinopathy. METHODS Twenty clinical questions were developed by the guideline technical committee. Relevant websites and databases were searched to find out the pertinent clinical practice guidelines to answer the questions. The technical committee provided possible answers (scenarios) according to the available evidences for each question. All scenarios along with their levels of evidence and the supported articles were sent to the experts for external review. If the experts did not agree on any of the scenarios for one particular clinical question, the technical committee reviewed all scenarios and their pertinent evidences and made the necessary decision. After that, the experts were asked to score them again. All confirmed scenarios were gathered as the final recommendations. RESULTS All the experts agreed on at least one of the scenarios. The technical committee extracted the agreed scenario for each clinical question as the final recommendation. Finally, 56 recommendations were developed for the procedure of intravitreal anti-VEGF injection and their applications in the management of ocular vascular diseases. CONCLUSION The implementation of this guideline can standardize the management of the common ocular vascular diseases by intravitreal injection of anti-VEGF agents. It can lead to better policy-making and evidence-based clinical decision by ophthalmologists and optimal evidence based eye care for patients.
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Affiliation(s)
- Homayoun Nikkhah
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Karimi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Ahmadieh
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Azarmina
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Abrishami
- Department of Ophthalmology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Ahoor
- Department of Ophthalmology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Yousef Alizadeh
- Department of Ophthalmology, Guilan University of Medical Sciences, Rasht, Iran
| | - Hasan Behboudi
- Department of Ophthalmology, Guilan University of Medical Sciences, Rasht, Iran
| | - Narsis Daftarian
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Dehghan
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Entezari
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Torfeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereydoun Farrahi
- Department of Ophthalmology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | | | - Mohammad Ali Javadi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Karkhaneh
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Siamak Moradian
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Reza Manaviat
- Department of Ophthalmology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Morsal Mehryar
- Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ramin Nourinia
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Mehdi Parvaresh
- Department of Ophthalmology, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Ramezani
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Torfeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Riazi-Esfahani
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Soheilian
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Shahsavari
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein-Ali Shahriari
- Department of Ophthalmology, Al-Zahra Eye Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Zhale Rajavi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Torfeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sare Safi
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Armin Shirvani
- Standardization and CPG Development Office, Deputy of Curative Affairs, Ministry of Health and Medical Education, Tehran, Iran
| | - Saeed Rahmani
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamideh Sabbaghi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojgan Pakbin
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahareh Kheiri
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Ziaei
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Lin J, Chang JS, Yannuzzi NA, Smiddy WE. Cost Evaluation of Early Vitrectomy versus Panretinal Photocoagulation and Intravitreal Ranibizumab for Proliferative Diabetic Retinopathy. Ophthalmology 2018; 125:1393-1400. [PMID: 29606379 DOI: 10.1016/j.ophtha.2018.02.038] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 02/22/2018] [Accepted: 02/27/2018] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To evaluate costs and cost-utility of early vitrectomy (pars plana vitrectomy [PPV]) compared with panretinal photocoagulation (PRP) and intravitreal ranibizumab (IVR) for proliferative diabetic retinopathy (PDR) without diabetic macular edema. DESIGN A decision analysis model of cost-utility. PARTICIPANTS There were no participants. METHODS A decision analysis was based on results from the Diabetic Retinopathy Clinical Research Network Protocol S comparing treatment of PRP with IVR (0.3 mg) in PDR without incident macular edema to model the total 2-year costs and outcomes for each treatment scenario. These values were compared with the 2-year hypothetical costs of early PPV for PDR. Centers for Medicare and Medicaid Services data were used to calculate associated modeled costs in a hospital/facility-based and nonfacility setting. Cost-utility was calculated on the basis of the preserved visual utility and estimated life years remaining. In addition, costs for lifetime treatment were modeled for all scenarios and used to calculate lifetime quality-adjusted life years (QALY) costs for each scenario. Sensitivity analyses were performed to evaluate the impact of the model's assumptions. MAIN OUTCOME MEASURES Cost of treatment, utility, and cost per QALY. RESULTS The modeled cost per QALY of treatment for PDR for 2 years of utility in the facility (nonfacility) setting was $163 988 ($102 559) in the PRP group, $436 992 ($326 424) in the IVR group, and $181 144 ($107 965) in the PPV group. Sensitivity analysis showed that both IVR and PPV groups would have equivalent costs per QALY over the first 2 years if 78% (facility) and 80% (nonfacility) of patients in the PPV group required additional treatment with IVR (at the dose of 10.1 injections as in Protocol S). Beyond 2 years, the cost per QALY in the facility (nonfacility) setting was calculated as $61 695 ($21 752) in the PRP group, $338 348 ($239 741) in the IVR group, and $63 942 ($22 261) in the PPV group. CONCLUSIONS Early PPV as a strategy for treatment of PDR without macular edema demonstrates cost-utility similar to management with PRP and more favorable cost-utility compared with IVR in the short term. This advantage over IVR continues when lifetime costs are factored.
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Affiliation(s)
- James Lin
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Jonathan S Chang
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Nicolas A Yannuzzi
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - William E Smiddy
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida.
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Modarres M, Nazari H, Ghasemi Falavarjani K, Naseripour M, Hashemi M, Mehdi Parvaresh M. Intravitreal Injection of Bevacizumab before Vitrectomy for Proliferative Diabetic Retinopathy. Eur J Ophthalmol 2018; 19:848-52. [DOI: 10.1177/112067210901900526] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mehdi Modarres
- Department of Ophthalmology, Iran University of Medical Sciences, Tehran - Iran
| | - Hossein Nazari
- Department of Ophthalmology, Iran University of Medical Sciences, Tehran - Iran
| | | | - Masood Naseripour
- Department of Ophthalmology, Iran University of Medical Sciences, Tehran - Iran
| | - Masih Hashemi
- Department of Ophthalmology, Iran University of Medical Sciences, Tehran - Iran
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Zhou YD, Yoshida S, Peng YQ, Kobayashi Y, Zhang LS, Tang LS. Diverse roles of macrophages in intraocular neovascular diseases: a review. Int J Ophthalmol 2017; 10:1902-1908. [PMID: 29259911 PMCID: PMC5733520 DOI: 10.18240/ijo.2017.12.18] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 11/06/2017] [Indexed: 12/21/2022] Open
Abstract
Macrophages are involved in angiogenesis, and might also contribute to the pathogenesis of intraocular neovascular diseases. Recent studies indicated that macrophages exert different functions in the process of intraocular neovascularization, and the polarization of M1 and M2 phenotypes plays extremely essential roles in the diverse functions of macrophages. Moreover, a large number of cytokines released by macrophages not only participate in macrophage polarization, but also associate with retinal and choroidal neovascular diseases. Therefore, macrophage might be considered as a novel therapeutic target to the treatment of pathological neovascularization in the eye. This review mainly summarizes diverse roles of macrophages and discusses the possible mechanisms in retinal and choroidal neovascularization.
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Affiliation(s)
- Ye-Di Zhou
- Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
- Hunan Clinical Research Center of Ophthalmic Disease, Changsha 410011, Hunan Province, China
| | - Shigeo Yoshida
- Department of Ophthalmology, Kyushu University Graduate School of Medical Sciences, Fukuoka 812-8582, Japan
| | - Ying-Qian Peng
- Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
- Hunan Clinical Research Center of Ophthalmic Disease, Changsha 410011, Hunan Province, China
| | - Yoshiyuki Kobayashi
- Department of Ophthalmology, Kyushu University Graduate School of Medical Sciences, Fukuoka 812-8582, Japan
| | - Lu-Si Zhang
- Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
- Hunan Clinical Research Center of Ophthalmic Disease, Changsha 410011, Hunan Province, China
| | - Luo-Sheng Tang
- Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
- Hunan Clinical Research Center of Ophthalmic Disease, Changsha 410011, Hunan Province, China
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Zhao XY, Xia S, Chen YX. Antivascular endothelial growth factor agents pretreatment before vitrectomy for complicated proliferative diabetic retinopathy: a meta-analysis of randomised controlled trials. Br J Ophthalmol 2017; 102:1077-1085. [PMID: 29246890 PMCID: PMC6059039 DOI: 10.1136/bjophthalmol-2017-311344] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/02/2017] [Accepted: 11/21/2017] [Indexed: 12/04/2022]
Abstract
Background/aims To evaluate the efficacy of antivascular endothelial growth factor (anti-VEGF) agents pretreatment before vitrectomy for patients with complicated proliferative diabetic retinopathy (PDR). Methods The PubMed, Embase and the Cochrane Central Register of Controlled Trials were searched up to June 2017 to identify related studies. The Peferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. The StataSE V.12.0 software was used to analyse the relevant data. The weighted mean difference, relative risk and their 95% CIs were used to assess the strength of the association. Results 14 randomised controlled trials involving 613 patients were assessed, the anti-VEGF pretreatment group included 289 patients and the control group included 324 patients. Our analysis indicated that anti-VEGF pretreatment before vitrectomy for complicated PDR could facilitate much easier surgery regarding less intraoperative bleeding, less endodiathermy, shorter duration of surgery, less iatrogenic retinal breaks, less frequency of using silicone oil and relaxing retinotomy (P<0.05). Additionally, anti-VEGF pretreatment could also achieve better postoperative best-corrected visual acuity, less early recurrent vitreous haemorrhage (VH) and quicker absorption of recurrent VH (P<0.05). However, the incidence of late recurrent VH, recurrent retinal detachment or related secondary surgery could not be reduced (P>0.05). Conclusion The pretreatment of anti-VEGF agents before vitrectomy for patients with complicated PDR might facilitate much easier surgery and better visual rehabilitation, reduce the rate of early recurrent VH and accelerate its absorption. Moreover, future better-designed studies with larger sample sizes are required to further evaluate the efficacy of different anti-VEGF agents and reach a firmer conclusion.
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Affiliation(s)
- Xin-Yu Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Song Xia
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - You-Xin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Hooper P, Boucher MC, Cruess A, Dawson KG, Delpero W, Greve M, Kozousek V, Lam WC, Maberley DAL. Excerpt from the Canadian Ophthalmological Society evidence-based clinical practice guidelines for the management of diabetic retinopathy. Can J Ophthalmol 2017; 52 Suppl 1:S45-S74. [PMID: 29074014 DOI: 10.1016/j.jcjo.2017.09.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Philip Hooper
- Philip Hooper, London, ON (Chair) (retina and uveitis); Marie Carole Boucher, Montreal, QC (retina and teleophthalmology); Alan Cruess, Halifax, NS (retina); Keith G. Dawson, Vancouver, BC (endocrinology); Walter Delpero, Ottawa, ON (cataract and strabismus); Mark Greve, Edmonton, AB (retina and teleophthalmology); Vladimir Kozousek, Halifax, NS (medical retina); Wai-Ching Lam, Toronto, ON (retina and research); David A.L. Maberley, Vancouver, BC (retina)..
| | - Marie Carole Boucher
- Philip Hooper, London, ON (Chair) (retina and uveitis); Marie Carole Boucher, Montreal, QC (retina and teleophthalmology); Alan Cruess, Halifax, NS (retina); Keith G. Dawson, Vancouver, BC (endocrinology); Walter Delpero, Ottawa, ON (cataract and strabismus); Mark Greve, Edmonton, AB (retina and teleophthalmology); Vladimir Kozousek, Halifax, NS (medical retina); Wai-Ching Lam, Toronto, ON (retina and research); David A.L. Maberley, Vancouver, BC (retina)
| | - Alan Cruess
- Philip Hooper, London, ON (Chair) (retina and uveitis); Marie Carole Boucher, Montreal, QC (retina and teleophthalmology); Alan Cruess, Halifax, NS (retina); Keith G. Dawson, Vancouver, BC (endocrinology); Walter Delpero, Ottawa, ON (cataract and strabismus); Mark Greve, Edmonton, AB (retina and teleophthalmology); Vladimir Kozousek, Halifax, NS (medical retina); Wai-Ching Lam, Toronto, ON (retina and research); David A.L. Maberley, Vancouver, BC (retina)
| | - Keith G Dawson
- Philip Hooper, London, ON (Chair) (retina and uveitis); Marie Carole Boucher, Montreal, QC (retina and teleophthalmology); Alan Cruess, Halifax, NS (retina); Keith G. Dawson, Vancouver, BC (endocrinology); Walter Delpero, Ottawa, ON (cataract and strabismus); Mark Greve, Edmonton, AB (retina and teleophthalmology); Vladimir Kozousek, Halifax, NS (medical retina); Wai-Ching Lam, Toronto, ON (retina and research); David A.L. Maberley, Vancouver, BC (retina)
| | - Walter Delpero
- Philip Hooper, London, ON (Chair) (retina and uveitis); Marie Carole Boucher, Montreal, QC (retina and teleophthalmology); Alan Cruess, Halifax, NS (retina); Keith G. Dawson, Vancouver, BC (endocrinology); Walter Delpero, Ottawa, ON (cataract and strabismus); Mark Greve, Edmonton, AB (retina and teleophthalmology); Vladimir Kozousek, Halifax, NS (medical retina); Wai-Ching Lam, Toronto, ON (retina and research); David A.L. Maberley, Vancouver, BC (retina)
| | - Mark Greve
- Philip Hooper, London, ON (Chair) (retina and uveitis); Marie Carole Boucher, Montreal, QC (retina and teleophthalmology); Alan Cruess, Halifax, NS (retina); Keith G. Dawson, Vancouver, BC (endocrinology); Walter Delpero, Ottawa, ON (cataract and strabismus); Mark Greve, Edmonton, AB (retina and teleophthalmology); Vladimir Kozousek, Halifax, NS (medical retina); Wai-Ching Lam, Toronto, ON (retina and research); David A.L. Maberley, Vancouver, BC (retina)
| | - Vladimir Kozousek
- Philip Hooper, London, ON (Chair) (retina and uveitis); Marie Carole Boucher, Montreal, QC (retina and teleophthalmology); Alan Cruess, Halifax, NS (retina); Keith G. Dawson, Vancouver, BC (endocrinology); Walter Delpero, Ottawa, ON (cataract and strabismus); Mark Greve, Edmonton, AB (retina and teleophthalmology); Vladimir Kozousek, Halifax, NS (medical retina); Wai-Ching Lam, Toronto, ON (retina and research); David A.L. Maberley, Vancouver, BC (retina)
| | - Wai-Ching Lam
- Philip Hooper, London, ON (Chair) (retina and uveitis); Marie Carole Boucher, Montreal, QC (retina and teleophthalmology); Alan Cruess, Halifax, NS (retina); Keith G. Dawson, Vancouver, BC (endocrinology); Walter Delpero, Ottawa, ON (cataract and strabismus); Mark Greve, Edmonton, AB (retina and teleophthalmology); Vladimir Kozousek, Halifax, NS (medical retina); Wai-Ching Lam, Toronto, ON (retina and research); David A.L. Maberley, Vancouver, BC (retina)
| | - David A L Maberley
- Philip Hooper, London, ON (Chair) (retina and uveitis); Marie Carole Boucher, Montreal, QC (retina and teleophthalmology); Alan Cruess, Halifax, NS (retina); Keith G. Dawson, Vancouver, BC (endocrinology); Walter Delpero, Ottawa, ON (cataract and strabismus); Mark Greve, Edmonton, AB (retina and teleophthalmology); Vladimir Kozousek, Halifax, NS (medical retina); Wai-Ching Lam, Toronto, ON (retina and research); David A.L. Maberley, Vancouver, BC (retina)
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Cruz-Iñigo YJ, Berrocal MH. Twenty-seven-gauge vitrectomy for combined tractional and rhegmatogenous retinal detachment involving the macula associated with proliferative diabetic retinopathy. Int J Retina Vitreous 2017; 3:38. [PMID: 29043092 PMCID: PMC5632824 DOI: 10.1186/s40942-017-0091-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/20/2017] [Indexed: 11/10/2022] Open
Abstract
Background To report our experience using 27-gauge pars plana vitrectomy (PPV) system for treating patients with combined tractional and rhegmatogenous retinal detachments (CTRRD) involving the macula associated with proliferative diabetic retinopathy (PDR). Methods Retrospective noncomparative interventional cases series of 12 patients with CTRRD associated with PDR who underwent 3-port, transconjunctival 27-gauge PPV by a single surgeon. Main outcome measures were change in Snellen best corrected visual acuity (BCVA) and occurrence of intra- and post-operative complications. Results Twelve eyes from 12 patients (9 men and 3 women) underwent 27-gauge PPV. Mean follow-up was 17 months (range 8–26 months). Preoperatively, BCVA of 20/400 or better was recorded in only 2 of 12 (16.7%) eyes. Postoperatively, BCVA improved to 20/400 or better in 11 of 12 (91.7%) eyes at 6 months (P = 0.001). At last follow-up, BCVA of 20/400 or better was recorded in 10 of 12 (83.3%), in comparison to 2 (16.7%) eyes at baseline (P = 0.004). The only intraoperative complication was an iatrogenic break in 1 eye (8.3%). Postoperative complications included vitreous hemorrhage in 4 eyes (33.3%) and transient ocular hypertension in 3 eyes (25.0%). At final follow-up anatomic success was confirmed in all eyes. Conclusion The current study findings suggest that 27-gauge PPV is a safe and promising surgical technology for treating patients with CTRRD involving the macula associated with PDR. Smaller gauge instruments and higher cutting rates may facilitate the dissection and shaving of fibrovascular membranes, while minimizing intra- and post-operative complications. Electronic supplementary material The online version of this article (doi:10.1186/s40942-017-0091-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yousef J Cruz-Iñigo
- Department of Ophthalmology, Río Piedras Medical Center, University of Puerto Rico, San Juan, 00909 Puerto Rico
| | - María H Berrocal
- Department of Ophthalmology, Río Piedras Medical Center, University of Puerto Rico, San Juan, 00909 Puerto Rico.,Berrocal & Associates, San Juan, Puerto Rico
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INTRAVITREAL BEVACIZUMAB FOR PROLIFERATIVE DIABETIC RETINOPATHY: Results From the Pan-American Collaborative Retina Study Group (PACORES) at 24 Months of Follow-up. Retina 2017; 37:334-343. [PMID: 27429384 DOI: 10.1097/iae.0000000000001181] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the effects of intravitreal bevacizumab (IVB) on retinal neovascularization in patients with proliferative diabetic retinopathy (PDR). METHODS Retrospective multicenter interventional case series. A chart review was performed of 81 consecutive patients (97 eyes) with retinal neovascularization due to PDR, who received at least 1 IVB injection. RESULTS The mean age of the patients was 55.6 ± 11.6 years. The mean number of IVB injections was 4 ± 2.5 injections (range, 1-8 injections) per eye. The mean interval between IVB applications was 3 ± 7 months. The mean duration of follow-up was 29.6 ± 2 months (range, 24-30 months). Best-corrected visual acuity and optical coherence tomography improved statistically significantly (P < 0.0001, both comparisons). Three eyes without previous panretinal photocoagulation ("naive" eyes) and with vitreous hemorrhage did not require vitreoretinal surgery. Five (5.2%) eyes with PDR progressed to tractional retinal detachment requiring vitrectomy. No systemic adverse events were noted. CONCLUSION Intravitreal bevacizumab resulted in marked regression of retinal neovascularization in patients with PDR and previous panretinal photocoagulation. Intravitreal bevacizumab in naive eyes resulted in control or regression of 42.1% of eyes without adjunctive laser or vitrectomy during 24 months of follow-up. There were no safety concerns during the 2 years of follow-up of IVB for PDR.
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Ranibizumab pretreatment in diabetic vitrectomy: a pilot randomised controlled trial (the RaDiVit study). Eye (Lond) 2017; 31:1253-1258. [PMID: 28498374 DOI: 10.1038/eye.2017.75] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 04/02/2017] [Indexed: 12/17/2022] Open
Abstract
PurposeOur aim was to evaluate the impact of intravitreal ranibizumab pretreatment on the outcome of vitrectomy surgery for advanced proliferative diabetic retinopathy. The objective was to determine the feasibility of a subsequent definitive trial and estimate the effect size and variability of the outcome measure.Patients and methodsWe performed a pilot randomised double-masked single-centre clinical trial in 30 participants with tractional retinal detachment associated with proliferative diabetic retinopathy. Seven days prior to vitrectomy surgery, participants were randomly allocated to receive either intravitreal ranibizumab (Lucentis, Novartis Pharmaceuticals UK Ltd, Frimley, UK) or subconjunctival saline (control). The primary outcome was best-corrected visual acuity 12 weeks following surgery.ResultsAt 12 weeks, the mean (SD) visual acuity was 46.7 (25) ETDRS letters in the control group and 52.6 (21) letters in the ranibizumab group. Mean visual acuity improved by 14 (31) letters in the control group and by 24 (27) letters in the ranibizumab group. We found no difference in the progression of tractional retinal detachment prior to surgery, the duration of surgery, or its technical difficulty. Vitreous cavity haemorrhage persisted at 12 weeks in two of the control group but none of the ranibizumab group.ConclusionRanibizumab pretreatment may improve the outcome of vitrectomy surgery for advanced proliferative diabetic retinopathy by reducing the extent of post-operative vitreous cavity haemorrhage. However, the effect size appears to be modest; we calculate that a definitive study to establish a minimally important difference of 5.9 letters at a significance level of P<0.05 would require 348 subjects in each arm.
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Sultan Z, Rizvi SF, Qureshi FM, Mahmood SA. Role of bevacizumab in the prevention of early postoperative haemorrhage after 25-gauge microincision vitrectomy surgery. Pak J Med Sci 2016; 32:1184-1187. [PMID: 27882018 PMCID: PMC5103130 DOI: 10.12669/pjms.325.10362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To evaluate the effect of preoperative intravitreal bevacizumab injection on the incidence of postoperative haemorrhage and visual prognosis, in patients undergoing 25-gauge micro incision vitrectomy surgery (MIVS) for diabetic vitreous haemorrhage. Methods: One hundred and twenty two eyes of 122 patients of diabetic retinopathy of both genders and aged over 18 years, who presented with non-resolving vitreous haemorrhage were enrolled for this study. All patients received an intravitreal injection of 1.25 mg/0.05 mL bevacizumab (Avastin) which was followed one week later by 25-gauge sutureless micro incision vitrectomy surgery. Main outcomes measured were best corrected visual acuity (BCVA) assessed with logMAR and post-operative vitreous haemorrhage. Follow ups were up to six months post-operatively. IBM SPSS 21 was used for data analysis. Result: A total of 122 patients were included; 78 (63.9%) males and 44 (36.1%) females. Mean age at the time of surgery was 51.4 ± 13.66 years. The mean preoperative BCVA was 1.64 ± 0.427 logMAR which improved to 0.57 ± 0.253 logMAR at 12 months post-operatively (p-value < 0.001). Recurrent vitreous haemorrhage was seen in four patients (3.28%). one1 week before 25-gauge vitrectomy helps to reduce the incidence of early post-vitrectomy haemorrhage in diabetic patients.
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Affiliation(s)
- Zaheer Sultan
- Dr. Zaheer Sultan, FCPS. LRBT Free Base Eye Hospital, Korangi 2 ½, Karachi, Pakistan
| | - Syed Fawad Rizvi
- Dr. Syed Fawad Rizvi, FCPS. LRBT Free Base Eye Hospital, Korangi 2 ½, Karachi, Pakistan
| | - Faisal Murtaza Qureshi
- Dr. Faisal Murtaza Qureshi, FRCS. LRBT Free Base Eye Hospital, Korangi 2 ½, Karachi, Pakistan
| | - Syed Asaad Mahmood
- Dr. Syed Asaad Mahmood, MBBS. LRBT Free Base Eye Hospital, Korangi 2 ½, Karachi, Pakistan
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Abstract
New modalities for the treatment of diabetic eye complications have emerged in the past decade. Nevertheless, many severe diabetic retinopathy complications can only be treated with vitreoretinal surgery. Technological advances in pars plana vitrectomy have expanded the gamut of pathologies that can be successfully treated with surgery. The most common pathologies managed surgically include vitreous opacities and traction retinal detachment. The indications, surgical objectives, adjunctive pharmacotherapy, microincisional surgical techniques, and outcomes of diabetic vitrectomy for proliferative diabetic retinopathy and diabetic tractional retinal detachment will be discussed. With the availability of new microincisional vitrectomy technology, wide angle microscope viewing systems, and pharmacologic agents, vitrectomy can improve visual acuity and achieve long-term anatomic stability in eyes with severe complications from proliferative diabetic retinopathy.
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Affiliation(s)
| | - Luis A Acaba
- Thomas Jefferson University, Philadelphia, PA, USA
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Rajavi Z, Safi S, Javadi MA, Azarmina M, Moradian S, Entezari M, Nourinia R, Ahmadieh H, Shirvani A, Shahraz S, Ramezani A, Dehghan MH, Shahsavari M, Soheilian M, Nikkhah H, Ziaei H, Behboudi H, Farrahi F, Falavarjani KG, Parvaresh MM, Fesharaki H, Abrishami M, Shoeibi N, Rahimi M, Javadzadeh A, Karkhaneh R, Riazi-Esfahani M, Manaviat MR, Maleki A, Kheiri B, Golbafian F. Diabetic Retinopathy Clinical Practice Guidelines: Customized for Iranian Population. J Ophthalmic Vis Res 2016; 11:394-414. [PMID: 27994809 PMCID: PMC5139552 DOI: 10.4103/2008-322x.194131] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 09/24/2016] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To customize clinical practice guidelines (CPGs) for management of diabetic retinopathy (DR) in the Iranian population. METHODS Three DR CPGs (The Royal College of Ophthalmologists 2013, American Academy of Ophthalmology [Preferred Practice Pattern 2012], and Australian Diabetes Society 2008) were selected from the literature using the AGREE tool. Clinical questions were designed and summarized into four tables by the customization team. The components of the clinical questions along with pertinent recommendations extracted from the above-mentioned CPGs; details of the supporting articles and their levels of evidence; clinical recommendations considering clinical benefits, cost and side effects; and revised recommendations based on customization capability (applicability, acceptability, external validity) were recorded in 4 tables, respectively. Customized recommendations were sent to the faculty members of all universities across the country to score the recommendations from 1 to 9. RESULTS Agreed recommendations were accepted as the final recommendations while the non-agreed ones were approved after revision. Eventually, 29 customized recommendations under three major categories consisting of screening, diagnosis and treatment of DR were developed along with their sources and levels of evidence. CONCLUSION This customized CPGs for management of DR can be used to standardize the referral pathway, diagnosis and treatment of patients with diabetic retinopathy.
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Affiliation(s)
- Zhale Rajavi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sare Safi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Javadi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Azarmina
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Siamak Moradian
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Entezari
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ramin Nourinia
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Ahmadieh
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Armin Shirvani
- Standardization and CPG Development Office, Deputy of Curative Affairs, Ministry of Health and Medical Education, Tehran, Iran
| | | | - Alireza Ramezani
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Dehghan
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Shahsavari
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Soheilian
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Homayoun Nikkhah
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Torfeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Ziaei
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hasan Behboudi
- Department of Ophthalmology, Gilan University of Medical Sciences, Rasht, Iran
| | - Fereydoun Farrahi
- Department of Ophthalmology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Mohammad Mehdi Parvaresh
- Department of Ophthalmology, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Fesharaki
- Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Abrishami
- Department of Ophthalmology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nasser Shoeibi
- Department of Ophthalmology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mansour Rahimi
- Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Javadzadeh
- Department of Ophthalmology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Karkhaneh
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Riazi-Esfahani
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Alireza Maleki
- Department of Ophthalmology, Al Zahra Eye Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Bahareh Kheiri
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Al-Kharashi A, Galbinur T, Mandelcorn ED, Muni RH, Nabavi M, Kertes PJ. The adjunctive use of pre-operative intravitreal bevacizumab in the setting of proliferative diabetic retinopathy. Saudi J Ophthalmol 2016; 30:217-220. [PMID: 28003778 PMCID: PMC5161812 DOI: 10.1016/j.sjopt.2016.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 01/27/2016] [Accepted: 10/03/2016] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To evaluate the efficacy of pre-operative intravitreal bevacizumab injection on the rate of postoperative vitreous hemorrhage in patients undergoing vitrectomy for complications of proliferative diabetic retinopathy. METHODS Consecutive retrospective comparative cohort study. Forty eyes of 37 patients who received pre-operative intravitreal bevacizumab 1.25 mg were compared to a similar group of 44 eyes of 44 patients who had undergone vitrectomy surgery prior to the availability and widespread use of pre-operative intravitreal bevacizumab. The primary outcome measure was the incidence of post-vitrectomy hemorrhage at one week after surgery. Secondary outcome measures included are postoperative vitreous hemorrhage at one month and changes in the best-corrected visual acuity (BCVA). For statistical analysis, the paired Student's t-test and Fisher's exact test were used. RESULTS Four out of 40 eyes (10%) pretreated with intravitreal bevacizumab vs. 12 of 44 eyes (27%) not pretreated with intravitreal bevacizumab had a clinically significant postoperative vitreous hemorrhage at one week. The mean best-corrected visual acuity (BCVA) in bevacizumab group improved from a mean of hand motions to a mean of 20/300 at 1 month (range: 20/25-light perception; p < .001) and mean BCVA in the non-injected group improved from preoperative mean of hand motion to 20/200 at one month follow-up (range: 20/25-no light perception; p < .001). In both groups, 4 patients (12%) needed repeat vitrectomy. CONCLUSION There is a trend to reduced incidence of early post-vitrectomy hemorrhage in patients undergoing vitrectomy for complications of proliferative diabetic retinopathy that have been pre-treated with intravitreal bevacizumab 1 week prior to surgery.
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Affiliation(s)
- Abdullah Al-Kharashi
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Tural Galbinur
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
- Department of Ophthalmology, Azerbaijan Medical University, Baku, Azerbaijan
| | - Efrem D. Mandelcorn
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
- Donald K. Johnson Eye Centre Toronto Western Hospital, University Health Network, 399 Bathurst St., Toronto, ON M5T 2S8, Canada
| | - Rajeev H. Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
- Department of Ophthalmology, St. Michael’s Hospital, 801-61 Queen St E, Toronto, ON M5C 2T2, Canada
| | - Mir Nabavi
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Peter J. Kertes
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
- The John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room M1-202a, Toronto, ON M4N 3M5, Canada
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Fassbender JM, Ozkok A, Canter H, Schaal S. A Comparison of Immediate and Delayed Vitrectomy for the Management of Vitreous Hemorrhage due to Proliferative Diabetic Retinopathy. Ophthalmic Surg Lasers Imaging Retina 2016; 47:35-41. [PMID: 26731207 DOI: 10.3928/23258160-20151214-05] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 10/28/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To compare immediate and delayed vitrectomy for the management of vitreous hemorrhage (VH) due to proliferative diabetic retinopathy (PDR). PATIENTS AND METHODS Retrospective review of 134 eyes receiving vitrectomy for non-clearing, PDR-associated VH. Primary outcome was area under the vision curve (AUC) in patients receiving immediate (< 30 days) versus delayed (> 30 days) vitrectomy with endolaser. RESULTS Forty-six eyes were included, with 17 undergoing immediate (< 30 days) vitrectomy with endolaser and 29 undergoing delayed (> 30 days) vitrectomy with endolaser. Time to vitrectomy was 14.8 days ± 8.26 days compared to 629.6 days ± 894.9 days in the immediate and delayed groups, respectively. AUC was significantly greater for patients undergoing delayed versus immediate vitrectomy (276.1 ± 0.601 logMAR*time versus 165.7 ± 0.761 logMAR*time; P < .0001). There was no difference in AUC postoperatively for delayed versus immediate surgery. Both groups required significantly less postoperative panretinal photocoagulation (P < .05). Preoperative and final visual acuities were equivalent (immediate: 1.86 ± 0.99 and 0.35 ± 0.25; P = .002; delayed: 1.71 ± 1.05 and 0.31 ± 0.34; P < .0001). CONCLUSIONS Immediate vitrectomy with endolaser for PDR-associated VH (< 30 days) decreases time spent with vision loss and the need for adjunctive PRP. Modern vitrectomy is safe and may be considered earlier in VH management.
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Khatib N, Carvounis PE. Surgical Management of Tractional Retinal Detachments in Proliferative Diabetic Retinopathy. CURRENT OPHTHALMOLOGY REPORTS 2016. [DOI: 10.1007/s40135-016-0096-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Celik E, Sever O, Horozoglu F, Yanyalı A. Segmentation and removal of fibrovascular membranes with high-speed 23 G transconjunctival sutureless vitrectomy, in severe proliferative diabetic retinopathy. Clin Ophthalmol 2016; 10:903-10. [PMID: 27274192 PMCID: PMC4876088 DOI: 10.2147/opth.s95145] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim To evaluate the effectiveness and safety of high-speed (5,000 cuts per minute) 23 G transconjunctival sutureless vitrectomy (TSV) in severe diabetic fibrovascular proliferation (DFVP). Patients and methods In this retrospective consecutive case series, patients who underwent 23 G TSV for severe DFVP between October 2011 and March 2014 at our institution were evaluated. 23 G TSV was performed with a high-speed (5,000 cuts per minute) cutter without a chandelier light. Results The mean follow-up period was 8 months (range: 4–23 months). Of the 27 eyes of 27 patients, 14 eyes (52%) underwent concomitant phacoemulsification with posterior chamber intraocular lens implantation, nine eyes (33%) were pseudophakic, and four eyes were phakic (15%). DFVP was removed with ease in all, and visual acuity was improved in 18 (67%) eyes. Iatrogenic retinal tear was observed in four eyes (15%) and treated successfully during surgery. Suture placement to a single sclerotomy was performed in eight eyes (30%). Postoperative intraocular hemorrhage was observed in five eyes (18%). Cataract formation was observed in two of the four phakic eyes. Three (11%) patients had postoperative intraocular pressure rise. Postoperative hypotony (≤6 mmHg) and endophthalmitis were not observed in any eye. Conclusion The segmentation and removal of fibrovascular membranes with high-speed 23 G TSV seems to be a safe and easy method in severe diabetic eye disease.
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Affiliation(s)
- Erkan Celik
- Sakarya University Medical Education and Research Hospital, Sakarya, Turkey
| | - Ozkan Sever
- Namik Kemal University, School of Medicine, Tekirdag, Turkey
| | - Fatih Horozoglu
- Namik Kemal University, School of Medicine, Tekirdag, Turkey
| | - Ates Yanyalı
- Haydarpasa Numune Medical Education and Research Hospital, Istanbul, Turkey
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ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY FOR PROLIFERATIVE DIABETIC RETINOPATHY: A Systematic Review and Meta-Analysis. Retina 2016; 35:1931-42. [PMID: 26398553 DOI: 10.1097/iae.0000000000000723] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To systematically review and perform meta-analysis on the available randomized controlled trial data for anti-vascular endothelial growth factor (anti-VEGF) agents in the management of proliferative diabetic retinopathy and its complications. METHODS The authors identified randomized controlled trials using anti-VEGF agents, either as stand-alone therapy or combined with other interventions, in the management of proliferative diabetic retinopathy. The primary outcome measures were change in best-corrected visual acuity and (in the context of vitrectomy) duration of surgery and postoperative vitreous hemorrhage. Secondary outcomes were change in central retinal thickness and (in the context of vitrectomy) intraoperative variables suggestive of complex surgery (retinal breaks, intraoperative bleeding, and endodiathermy applications). The quality of evidence for all outcomes was appraised using the GRADE criteria. RESULTS Twenty-two studies involving 1,397 subjects met the criteria for inclusion in this study. One study compared intravitreal ranibizumab with saline, one compared intravitreal pegaptanib to pan-retinal photocoagulation (PRP), one compared intravitreal bevacizumab to PRP, 3 compared combined intravitreal ranibizumab/PRP to PRP, 5 compared combined intravitreal bevacizumab/PRP to PRP alone, and 11 compared combined intravitreal bevacizumab/PPV to PPV alone. When used in conjunction with PRP, there is a high-quality evidence to suggest that intravitreal ranibizumab is associated with superior visual acuity and central retinal thickness outcomes at 3 months to 4 months. In the context of PPV, there is moderate quality evidence to suggest that preoperative intravitreal bevacizumab results in a significant reduction in the duration of surgery, fewer retinal breaks, less intraoperative bleeding, and fewer endodiathermy applications. Although there is evidence to suggest occurrence of early postoperative vitreous hemorrhage is reduced, the quality of evidence in support of this finding is low. CONCLUSION The use of anti-VEGF agents before PRP results in superior functional and structural outcomes at 3 months to 4 months. The use of anti-VEGF agents before PPV results in decreased duration of surgery, fewer breaks, and less intra-operative bleeding. Although there is evidence for a decreased incidence of early postoperative vitreous hemorrhage, the quality of evidence is low. The available data therefore support the use of anti-VEGF agents as adjuncts to PRP and PPV in patients with complicated proliferative diabetic retinopathy primarily as a means of facilitating, and potentially minimizing the iatrogenic damage resulting from, these procedures.
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50
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Sharma T, Fong A, Lai TY, Lee V, Das S, Lam D. Surgical treatment for diabetic vitreoretinal diseases: a review. Clin Exp Ophthalmol 2016; 44:340-54. [PMID: 27027299 DOI: 10.1111/ceo.12752] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 03/08/2016] [Accepted: 03/11/2016] [Indexed: 01/26/2023]
Abstract
Over the past four decades, advancements in surgical instrumentations and techniques have significantly improved the postoperative anatomical and visual outcomes of patients with various diabetic vitreoretinal diseases. In particular, surgical interventions for previously serious and untreatable blinding proliferative diabetic retinopathy can now be performed, with much better results. The advents of micro incisional vitrectomy system with better visualization system like binocular indirect ophthalmomicroscope and state-of-the-art instrumentation revolutionized the era of diabetic vitrectomy. High-speed vitrectors, finer instruments, chromo-assisted vitrectomy and use of anti-vascular endothelial growth factors not only change the paradigm but also help achieve much better outcome after diabetic vitrectomies. In this review, we will discuss and summarize the indications, surgical considerations, surgical techniques, potential complications and outcomes of vitreoretinal surgery for diabetic eye diseases.
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Affiliation(s)
- Tarun Sharma
- Sankara Nethralaya (Main Campus), Chennai, Tamil Nadu, India
| | - Angie Fong
- Hong Kong Eye Hospital, Kowloon, Hong Kong
| | - Timothy Y Lai
- 2010 Eye & Cataract Centre, TsimShaTsui, Kowloon, Hong Kong
| | - Vincent Lee
- Dennis Lam & Partners Eye Center, Central, Hong Kong
| | - Sudipta Das
- C-MER (Shenzhen) Dennis Lam Eye Hospital, Shenzhen, Guangdong, China
| | - Dennis Lam
- Dennis Lam & Partners Eye Center, Central, Hong Kong.,C-MER (Shenzhen) Dennis Lam Eye Hospital, Shenzhen, Guangdong, China
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