Pars Plana Vitrectomy in the Early Treatment Diabetic Retinopathy Study

Flynn, Harry W.; Chew, Emily Y.; Simons, Brad D.; Barton, Franca B.; Remaley, Nancy A.; Ferris, Frederick L.

doi:10.1016/s0161-6420(92)31779-8

Cited by 167 publications

(72 citation statements)

References 19 publications

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“…15 Many diabetic patients need additional laser therapy and 4.5% of them eventually require vitrectomy surgery despite laser PRP. 17 Moreover, NV regression may take several weeks after completion of PRP, and NV continues to grow despite the first session of PRP in one-third of patients. 18 Therefore, VH may lead to visual loss and preclude complete laser PRP in these patients.…”

Section: Figmentioning

confidence: 99%

Intravitreal Bevacizumab (Avastin) and Panretinal Photocoagulation in the Treatment of High-Risk Proliferative Diabetic Retinopathy

Yang

Hung

Huang

et al. 2013

Journal of Ocular Pharmacology and Therapeutics

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Purpose: To report the short-term efficacy and safety of intravitreal bevacizumab (Avastin) injection with panretinal laser photocoagulation (PRP) in patients with high-risk proliferative diabetic retinopathy (PDR) according to the Early Treatment Diabetic Retinopathy Study criteria. Methods: A prospective, interventional case series study was conducted in 17 patients (20 eyes) with high-risk PDR, who were treated with intravitreal bevacizumab (2.5 mg) followed by PRP when the peripheral vitreous became clear or 2 weeks after injection. Patients underwent complete ophthalmic evaluation, including Snellen visual acuity and fluorescein angiography at baseline, 1, 3, and 6 months after bevacizumab injection. Main outcome measures included the serial changes in visual acuity, vitreous clear-up time, and neovascularization on the disc (NVD) regression time. Results: All patients had obvious reduction in angiographic leakage and involution of retinal neovascularization (NV) at the 1-and 3-month follow-up. The mean follow-up time was 7.5 months. The vitreous hemorrhage (VH) showed a partial resolution as early as 1 week, and complete regression at 3 months. The mean vitreous clear-up time after intravitreal Avastin was 8.5 -2.2 weeks. The mean time interval from intravitreal Avastin to NVD regression was 10.8 -3.4 weeks. Mean logarithm of the minimum angle resolution visual acuity improved from 1.03 at baseline to 0.36 at 1-month, 0.38 at 3-month, and 0.48 at the 6-month follow-up (P < 0.01). Three eyes (18%) required vitrectomy surgery during follow-up. The indication for vitrectomy was dense, persistent VH in 2 eyes, and focal tractional retinal detachment (TRD) in 1 eye. Recurrent retinal NV with minor preretinal hemorrhage was observed in 6 eyes (30%) 3 months after the first injection, and resolved after repeated bevacizumab injections. Patients received an average of 1.4 injections (range: 1-2). Seven eyes (35%) underwent 2 injections. One eye (5%) had ocular complication of PDR progression to TRD. No systemic adverse events were observed following injections. Conclusions: Short-term results suggest combined intravitreal bevacizumab and PRP achieved rapid clearance of VH, regression of retinal NV, and visual improvement in the treatment of high-risk PDR. Long-term study is warranted to assess the long-term efficacy and safety.

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Section: Figmentioning

confidence: 99%

Intravitreal Bevacizumab (Avastin) and Panretinal Photocoagulation in the Treatment of High-Risk Proliferative Diabetic Retinopathy

Yang

Hung

Huang

et al. 2013

Journal of Ocular Pharmacology and Therapeutics

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“…In the EDTRS studies, significant vision loss only occurred in 5% of patients [100]. However, there are several limitations to laser therapy.…”

Section: Laser Therapymentioning

confidence: 99%

“…One of the goals of vitreous surgery in diabetic retinopathy is the removal of as much vitreous as possible including the posterior hyaloid, the bridge for the fibrovascular growth. It is also possible to use delamination and segmentation techniques to remove fibrovascular membranes that lie on the internal limiting membrane and cause retinal distortion [8,100,122,123]. The removal of these tractional elements may improve the retinal architecture and provide benefits for vision.…”

Section: Vitreo-retinal Surgerymentioning

confidence: 99%

Diabetic Retinopathy: Understanding Pathologic Angiogenesis and Exploring its Treatment Options

Falcão¹

2012

TOCVJ

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Diabetic retinopathy is the major cause of blindness at working age. The pathogenesis behind visual loss is related with retinal angiogenesis and increased retinal vascular permeability. These changes seem to be the result of chronic hyperglycemia and hypoxia. Several mechanisms have been proposed to cause the retinal and vasculature cellular damage. They include the formation of advanced end glycation products, aldose reductase activity and reactive oxygen species. Ultimately, they lead to the expression of VEGF-A. This growth factor seems to play the pivotal role in the development of the complications associated with the disease including break down of the inner blood retinal barrier, macular edema and vasoproliferation. Other mechanisms like inflammation, protein kinase C activity and erythropoietin have been strongly associated with the pathogenesis.Laser therapy is still the standard of care for diabetic retinopathy and prevents severe vision loss in 95% of patients if timely treatment is performed. The better understanding of the disease has led to the production of new management options that may become important adjuvants for the disease. They include intravitreal anti-VEGF therapy, intravitreal steroid therapy and systemic protein kinase C inhibitors. Vitrectomy is an important option for advanced cases of the disease such as tractional retinal detachment or non-absorbing vitreous hemorrhages.

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“…Once PDR develops, panretinal photocoagulation (PRP) remains the standard of care established by the Diabetic Retinopathy Study (DRS) [18]. While efficacious, PRP has a number of potential adverse effects, including exacerbation of macular edema, peripheral visual-field defects, and nyctalopia [19], and its administration can be difficult in the presence of vitreous hemorrhage (VH), a complication of retinal neovascularization [20,21]. Other sight-threatening complications of PDR are tractional retinal detachment (TRD), which, along with non-clearing VH, can be managed by vitrectomy, and neovascular glaucoma [22].…”

Section: Introductionmentioning

confidence: 99%

Pharmacotherapy for Treatment and Prevention of Proliferative Diabetic Retinopathy

Flamendorf

Fine

2014

Curr Ophthalmol Rep

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Pars Plana Vitrectomy in the Early Treatment Diabetic Retinopathy Study

Cited by 167 publications

References 19 publications

Intravitreal Bevacizumab (Avastin) and Panretinal Photocoagulation in the Treatment of High-Risk Proliferative Diabetic Retinopathy

Intravitreal Bevacizumab (Avastin) and Panretinal Photocoagulation in the Treatment of High-Risk Proliferative Diabetic Retinopathy

Diabetic Retinopathy: Understanding Pathologic Angiogenesis and Exploring its Treatment Options

Pharmacotherapy for Treatment and Prevention of Proliferative Diabetic Retinopathy

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