Diabetic Macular Edema Treatment with Bevacizumab Does Not Depend on the Retinal Nonperfusion Presence

Sędziak-Marcinek, Bogumiła; Teper, Sławomir; Chełmecka, Elżbieta; Wylęgała, Adam; Marcinek, Mateusz; Bas, Mateusz; Wylęgała, Edward

doi:10.1155/2021/6620122

Cited by 10 publications

(15 citation statements)

References 41 publications

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“…Here we present the prospective observational study of 98 eyes of 98 consecutive patients diagnosed with diabetic retinopathy and diabetic macular edema (DME), who underwent bevacizumab treatment and were monitored using ultra-wide-field fluorescein angiography (UWFFA). The study presented here is an extension of the work by Sędziak-Marcinek et al [10], where we described in detail both the diagnostic methodology and the general characteristics of patients enrolled in the study.…”

Section: Methodsmentioning

confidence: 99%

“…The patients' recruitment, diagnostics and intravitreal treatment were carried out in the outpatient clinic of the Clinical Department of Ophthalmology, Faculty of Medical Science, Medical University of Silesia throughout 2018-2020. The including and excluding criteria applied in the study were described in detail in the previous work by Sędziak-Marcinek et al [10].…”

Section: Methodsmentioning

confidence: 99%

“…Ultra-wide-field fluorescein angiography (UWFFA) images were taken with the scanning laser ophthalmoscope Optos California P200DTx (Optos, Dunfermline, Scotland, UK) and processed using the OptosAdvance Software v4.2.31 that allows for accurate measurements of the visible retinal area in square millimeters (mm 2 ) and adjusts for peripheral distortion. The preparation and image analysis were carried out according to the methodology by Fan et al [5] and Fang et al [17] exactly as described in the previous work [10]. The assessment of diabetic retinopathy parameters (non-perfusion areas, contrast leakage areas and microaneurysms count) and diabetic retinopathy severity were also carried out as described in the previous work [10].…”

Section: Ultra-wide-field Fluorescein Angiography (Uwffa)mentioning

confidence: 99%

“…Since diabetes in adults is estimated to affect 10.4% of the global population in 2040, the improvement of DME treatment becomes increasingly important [9]. Our previous study showed that the strict regimen of bevacizumab (IVB) intravitreal injections-9 injections over 12 months-decreased DME and DR severity in patients with and without retinal non-perfusion [10]. The study also showed that UWFFA allowed determining a satisfactory prognosis for patients with retinal non-perfusion and confirmed that patients with DME could be successfully treated with bevacizumab regardless of their non-perfusion status [10].…”

Section: Introductionmentioning

confidence: 99%

“…Our previous study showed that the strict regimen of bevacizumab (IVB) intravitreal injections-9 injections over 12 months-decreased DME and DR severity in patients with and without retinal non-perfusion [10]. The study also showed that UWFFA allowed determining a satisfactory prognosis for patients with retinal non-perfusion and confirmed that patients with DME could be successfully treated with bevacizumab regardless of their non-perfusion status [10]. Nevertheless, the major factors helping achieve normal visual acuity in patients with DME after IVB treatment were not profoundly studied.…”

Section: Introductionmentioning

confidence: 99%

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How to Achieve Near-Normal Visual Acuity with Bevacizumab in Diabetic Macular Edema Patients

Sędziak-Marcinek

Wylęgała

Chełmecka

et al. 2021

JCM

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Patients suffering from diabetic retinopathy (DR) and diabetic macular edema (DME) are inherently interested in achieving normal or near-normal visual acuity. The study aimed to investigate factors influencing the visual acuity achieved by DME patients after bevacizumab (IVB) treatment. 98 patients (98 eyes) diagnosed with DR and DME underwent IVB treatment (9 injections/12 months). Patients were diagnosed and monitored using swept-source optical coherence tomography (SS-OCT), ultra-wide-field fluorescein angiography (UWFFA) and Early Treatment Diabetic Retinopathy Study (ETDRS) chart testing. We assessed macular central subfield thickness (CST), non-proliferative diabetic retinopathy (NPDR) indicators and best-corrected visual acuity (BCVA). After the treatment, patients were divided into BCVA£75 and BCVA>75 groups. The IVB therapy increased the number of ETDRS letters read by about 9 and 8 in the BCVA£75 and the BCVA>75 group, respectively. Before and after treatment, the BCVA>75 group had lower CST than the BCVA£75 group. The treatment reduced macular CST by 177 μm in the BCVA£75 group and only by 93 μm in the BCVA>75 group. Total non-perfusion area (NPA) decreased in both BCVA score groups after IVB therapy. Normal or near-normal vision can be achieved with IVB treatment, provided it starts when visual acuity is not significantly reduced yet. The ophthalmic screening of DR patients should also target those with relatively high visual acuity.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Ultra-wide-field Fluorescein Angiography (Uwffa)mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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How to Achieve Near-Normal Visual Acuity with Bevacizumab in Diabetic Macular Edema Patients

Sędziak-Marcinek

Wylęgała

Chełmecka

et al. 2021

JCM

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Retinal non-perfusion in diabetic retinopathy

Wykoff

Avery

et al. 2022

Eye

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Diabetic retinopathy is a major cause of vision loss worldwide and areas of retinal non-perfusion (RNP) are a key pathologic feature of the vascular component of diabetic retinopathy. While there is a need for a more complete understanding of the natural history of RNP development and progression, overall, increasing RNP has been closely linked with worsening DR severity. Both traditional and novel approaches to quantitative image assessment are being explored to advance our understanding of the vascular, physiologic and functional changes associated with progressive RNP. Retinal ischemia secondary to RNP leads to tissue hypoxia and changes in the expression of a host of signalling molecules. Current anti-vascular endothelial growth factor and steroid pharmaceutical agents appear to be unable to reperuse areas of RNP, but may be able to slow the progressive longitudinal accumulation of RNP with regular retreatments. There remains a tremendous unmet need for pharmacotherapies that can slow RNP progression and ultimately reperfuse areas of the non-perfused retina. Towards this end, novel targets including the semaphorin family are being investigated.

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Response to 1-Year Fixed-Regimen Bevacizumab Therapy in Treatment-Naïve DME Patients: Assessment by OCT Angiography

Hunt

Teper

Wylęgała

et al. 2022

Journal of Diabetes Research

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Purpose. To evaluate the effectiveness of intravitreal bevacizumab treatment in patients with diabetic macular edema (DME) by assessing retinal changes using optical coherence tomography angiography (OCT-A). Methods. This prospective study was performed in patients with treatment-naïve DME. The eyes of patients were imaged using a swept-source OCT system with a scan area of 6 × 6 mm. The DME patients with a central macular thickness (CMT) of ≥300 μm received nine bevacizumab injections within 12 months. The demographic, systemic, and ocular parameters, including the best-corrected visual acuity (BCVA), CMT, microaneurysm (MA) count, and foveal avascular zone (FAZ) area in both superficial capillary plexus (SCP) and deep capillary plexus (DCP), as well as vessel density in SCP, were assessed in the patients. In addition, the response (good or poor) of the DME eyes to bevacizumab treatment and the final visual acuity (BCVA of 75 letters) were analyzed. Results. Seventy-seven eyes of DME patients were subjected to the final analysis. Bevacizumab treatment reduced CMT from 425.06 μm (±77.15) to 350.25 μm (±82.04) and improved BCVA by about 8.61 letters (from 64.73 to 73.34) in the patients. The mean number of MAs in SCP decreased from 3.51 ± 2.07 to 2.31 ± 1.15 ( p < 0.001 ) and in DCP from 17.12 ± 11.56 to 12.21 ± 6.99 ( p < 0.001 ), whereas the area of FAZ increased in SCP from 328.22 ± 131.38 to 399.70 ± 156.98 ( p < 0.001 ) and in DCP from 571.13 ± 396.01 to 665.89 ± 412.77 ( p = 0.001 ). The final BCVA letter score and CMT were statistically significant in both poor and good responders, as well as in BCVA < 75 and BCVA ≥ 75 groups. Conclusion. The fixed-regimen intravitreal bevacizumab therapy was effective in treating DME. Apart from noninvasive visualization of microvascular damage, OCT-A showed limited usefulness in predicting treatment response. Although the study showed that the number of MAs was significantly reduced during treatment, which is an OCT-A predictor of a good response to bevacizumab treatment at a 12-month visit, commonly observed artifacts may reduce the usefulness of OCT-A.

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Diabetic Macular Edema Treatment with Bevacizumab Does Not Depend on the Retinal Nonperfusion Presence

Cited by 10 publications

References 41 publications

How to Achieve Near-Normal Visual Acuity with Bevacizumab in Diabetic Macular Edema Patients

How to Achieve Near-Normal Visual Acuity with Bevacizumab in Diabetic Macular Edema Patients

Retinal non-perfusion in diabetic retinopathy

Response to 1-Year Fixed-Regimen Bevacizumab Therapy in Treatment-Naïve DME Patients: Assessment by OCT Angiography

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