Diagnostic and Therapeutic Challenges

Bianchi, Juan I.; Graue, Emiliano Fulda; Lopez-Rubio, Salvador; Bellerive, Claudine; Biscotti, Charles V.; Singh, Arun D.

doi:10.1097/00006982-900000000-96460

Cited by 3 publications

(3 citation statements)

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“…While the beneficial effects of combined treatment of anti-VEGF plus PRP has not been fully clarified in clinical trials, this approach appears to be a preferred practice pattern in the clinical practice setting. Yet, recent reporting from the American Society of Retina Specialists Preferences and Trends surveys revealed some clinician preference for anti-VEGF monotherapy in a select group of patients . However, limitations of anti-VEGF therapy have been reported, and ultimately, the treatment choice for PDR must be considered carefully based on the risks and benefits of each individual therapy and the patient’s values and compliance …”

Section: Discussionmentioning

confidence: 99%

Progression to Pars Plana Vitrectomy in Patients With Proliferative Diabetic Retinopathy

Alsoudi,

Wai,

Koo

et al. 2024

JAMA Ophthalmol

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ImportanceThe Diabetic Retinopathy Clinical Research Network Protocol S suggested that vitrectomy for vitreous hemorrhage (VH) or tractional retinal detachment (TRD) was more common among eyes assigned initially to panretinal photocoagulation (PRP) vs anti–vascular endothelial growth factor (anti-VEGF) for proliferative diabetic retinopathy (PDR). These clinical implications warrant further evaluation in the clinical practice setting.ObjectiveTo explore outcomes of PDR treated with PRP monotherapy compared with matched patients treated with anti-VEGF monotherapy.Design, Setting, and ParticipantsRetrospective cohort study using an aggregated electronic health records research network. Patients with PDR who received PRP or anti-VEGF monotherapy between January and September 2023 were included before propensity score matching. Patients were excluded with 6 or fewer months’ follow-up after monotherapy or with a combination of PRP and anti-VEGF. Data were analyzed in September 2023.ExposuresPatients with new PDR diagnoses stratified by monotherapy with PRP or anti-VEGF agents using Current Procedural Terminology code.Main Outcome MeasuresIncidence of pars plana vitrectomy (PPV), VH, or TRD.ResultsAmong 6020 patients (PRP cohort: mean [SD] age, 64.8 [13.4]; 6424 [50.88%] female; 3562 [28.21%] Black, 6180 [48.95%] White, and 2716 [21.51%] unknown race; anti-VEGF cohort: mean [SD] age, 66.1 [13.2]; 5399 [50.52%] male; 2859 [26.75%] Black, 5377 [50.31%] White, and 2382 [22.29%] unknown race) who received treatment, PRP monotherapy was associated with higher rates of PPV when compared with patients treated with anti-VEGF monotherapy at 5 years (RR, 1.18; 95% CI, 1.05-1.36; RD, 1.37%; 95% CI, 0.39%-2.37%; P &lt; .001), with similar associations at 1 and 3 years. PRP monotherapy was associated with higher rates of VH at 5 years (relative risk [RR], 1.72; 95% CI, 1.52-1.95; risk difference [RD], 7.05; 95% CI, 5.41%-8.69%; P &lt; .001) and higher rates of TRD at 5 years (RR, 2.76; 95% CI, 2.26-3.37; RD, 4.25%; 95% CI, 3.45%-5.05%; P &lt; .001), with similar magnitudes of associations at 6 months, 1 year, and 3 years, when compared with patients treated with anti-VEGF monotherapy.Conclusions and RelevanceThese findings support the hypothesis that patients with PDR treated with PRP monotherapy are more likely to develop VH, TRD, and undergo PPV when compared with matched patients treated with anti-VEGF monotherapy. However, given the wide range in relative risk, confounding factors may account for some of the association between PRP vs anti-VEGF monotherapy and outcomes evaluated.

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Section: Discussionmentioning

confidence: 99%

Progression to Pars Plana Vitrectomy in Patients With Proliferative Diabetic Retinopathy

Alsoudi,

Wai,

Koo

et al. 2024

JAMA Ophthalmol

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“…Spontaneous resolution can be expected if the choroidal mass is secondary to localized hemorrhage [2]. Only a few cases of choroidal inflammation that have undergone spontaneous resolution have been reported [17, 18].…”

Section: Discussionmentioning

confidence: 99%

“…FNAB is a relatively safe and effective diagnostic procedure, especially when a definitive diagnosis cannot be achieved despite ancillary studies and systemic investigations [6, 20]. Cytologic evaluation of the FNAB sample in 1 published case had revealed nonspecific inflammation, excluding a neoplastic process [18]. The immediate onset in our case 1 after an intraocular surgery, and the presence of hyperreflective dots in the retina, subretinal space, and choroid on OCT in case 2, suggest a probable inflammatory etiology for both.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Resolution of a Choroidal Mass: A Case Series

et al. 2020

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• Choroidal masses can be of varied etiology. • Multimodal imaging techniques including standardized A-scan and B-scan ultrasonography, fluorescein angiography, indocyanine green angiography, and optical coherence tomography are essential. • In appropriate cases, systemic investigations may also be required. Novel Insights • Choroidal masses (non-neoplastic) can resolve spontaneously. • Despite the use of multimodal imaging techniques, the etiology of choroidal masses may remain elusive. • Extensive systemic investigations may have to be repeated to identify their underlying etiology.

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