Profile of non-responder and late responder patients treated for diabetic macular edema: systemic and ocular factors

Parravano, Mariacristina; Costanzo, Eliana; Querques, Giuseppe

doi:10.1007/s00592-020-01496-7

Cited by 21 publications

(31 citation statements)

References 56 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Treatment response is a matter of controversy between studies since there is no univocal definition of responsiveness to treatment and there are different criteria of “successful” treatment response or “nonresponse,” while the time to assess treatment response varies among studies [27]. Although anti-VEGF agents were found to be effective in DME treatment, reducing retinal thickness as a whole and in all separate retinal layers and improving visual acuity in the 12-month follow-up, the definition of factors affecting visual outcome is significant to determine treatment response and consider early switch in treatment in cases of “nonresponders.” Although it has been supported that there may be a delayed treatment response and that patients with DME may benefit from sustained anti-VEGF treatment [28], a recent study by Ruiz-Medrano et al [29] has shown that in eyes with insufficient response to anti-VEGF agents, switching to dexamethasone implant after 3 intravitreal anti-VEGF injections provided better functional results than receiving >3 injections and then switching, supporting early switch in “nonresponders.”…”

Section: Discussionmentioning

confidence: 99%

Retinal Layers Changes in Patients with Diabetic Macular Edema Treated with Intravitreal Anti-VEGF Agents: Long-Term Outcomes of a Spectral-Domain OCT Study

Chatziralli¹,

Kazantzis²,

Theodossiadis³

et al. 2020

Ophthalmic Res

View full text Add to dashboard Cite

Purpose: The purpose of this study was to investigate retinal layers’ changes in patients with diabetic macular edema (DME) treated with anti-vascular endothelial growth factor (anti-VEGF) agents and to evaluate if these changes may affect treatment response. Methods: Participants in this prospective study were 110 treatment-naïve patients with center involved DME, who were treated with anti-VEGF agents and followed up for at least 12 months. A qualitative and quantitative analysis of retinal layers that can affect visual acuity was performed. Patients with persistent DME were defined, and factors which could affect this outcome were determined. Results: Visual acuity was significantly improved, while there was also a statistically significant reduction in central retinal thickness and in all separate retinal layers’ thickness at month 12 compared to baseline (p < 0.001). Visual acuity was associated with central retinal thickness and outer retinal layers’ thickness;51.8% of the patients presented with persistent DME at month 12, which was found to be significantly associated with baseline visual acuity and HbA1C levels. Conclusions: Anti-VEGF treatment is effective in reducing retinal thickness as a whole and in all separate retinal layers at 12-month follow-up in patients with DME. Changes in central retinal thickness and in outer retinal layers were found to affect visual acuity. HbA1c was the most significant factor to determine persistence of DME at month 12.

show abstract

Section: Discussionmentioning

confidence: 99%

Retinal Layers Changes in Patients with Diabetic Macular Edema Treated with Intravitreal Anti-VEGF Agents: Long-Term Outcomes of a Spectral-Domain OCT Study

Chatziralli¹,

Kazantzis²,

Theodossiadis³

et al. 2020

Ophthalmic Res

View full text Add to dashboard Cite

show abstract

“…Anti-VEGF agents have demonstrated remarkable efficacy in several pivotal clinical trials for control of CI-DME and have become the gold standard primary treatment, replacing laser photocoagulation [4]. Differences between anti-VEGF drugs have been explored in Protocol T, a comparative effectiveness trial conducted by the Diabetic Retinopathy Clinical Research Network (DRCR.net) that compared 3 commonly used anti-VEGF agents (bevacizumab, ranibizumab, and aflibercept) for eyes with CI-DME [15]. On average, each drug was found to improve vision and reduce central retinal thickness (CRT) [15].…”

Section: Response To Treatmentmentioning

confidence: 99%

New Insights in Resistant Diabetic Macular Edema

Kuroiwa

Malerbi

Regatieri³

2021

Ophthalmologica

View full text Add to dashboard Cite

Diabetic macular edema (DME) is the most common cause of vision loss in diabetic eyes, and due to the rapid rise in the number of diabetic patients, the treatment burden has increased exponentially. The introduction of antivascular endothelial growth factor (anti-VEGF) therapy has been a major breakthrough in the management of center-involving DME, replacing laser photocoagulation as the first-line treatment. Despite the improvement in DME treatment with anti-VEGF therapy, persistent DME remains a challenge due to the extremely complex pathogenesis and the involvement of several different biochemical pathways. This review focuses on therapeutic options for persistent DME, which include corticosteroids, laser, and surgery. Novel agents for DME control such as new anti-VEGF, interleukin inhibitor, Rho-kinase inhibitor, and neuroprotective agents that are being investigated are reviewed as well. Future treatment perspectives include an individualized DME management.

show abstract

“…Increased CMT after treatment also considered predictor of poor response to treatment. (19,20) The limitation of this study were short follow up and the diagnostic criteria for macular edema were only based on the CMT despite the presence of hard exudate and macular ischemia, both of which could affect the results of this study.…”

Section: Discussionmentioning

confidence: 98%

Central Macular Thickness After Combined Therapy of Bevacizumab Intravitreal Injection and Topical Diclofenac Compared With Bevacizumab Intravitreal Injection Alone in Diabetic Macular Edema

Sandra¹,

Shabrina²,

Widayanti³

et al. 2021

IJRetina

View full text Add to dashboard Cite

Introduction: To evaluate whether the combination of diclofenac eye drops and bevacizumab intravitreal injection would provide additional benefits over bevacizumab alone in the treatment of naïve diabetic macular edema (DME). Methods: A total of 43 patients were enrolled consecutively and randomized into two groups to receive combination treatment with intravitreal bevacizumab and topical diclofenac (group 1) or bevacizumab alone (group 2). Group 1 patients received single bevacizumab intravitreal injection and got self-administered diclofenac eye drop four times daily for one month. Group 2 patients received single bevacizumab intravitreal injection alone. Outcome data were obtained from patient visits at baseline and at 1 month after bevacizumab intravitreal injection. All patients underwent measurement of best corrected visual acuity (BCVA), a complete eye examination, and measurement of central macular thickness (CMT). Result: The mean reduction in CMT in the combination group was 130.42±32.57 µm (p<0.01), while in the bevacizumab alone group the reduction was 141.38±45.27 µm (p<0.01), there is no significant difference between the two groups (p=0.866). The mean improvement of BCVA was 0.32±0.10 log Mar in the combination group and 0.26±0.12 in group 2, there is no significant difference between the two groups (p=0.691). There was no adverse ocular event in the two groups. Conclusion: In patients with naïve DME, adding diclofenac eye drop as adjuvant of bevacizumab intravitreal injection are less likely to have a meaningful effect on reducing the central macular thickness. Keywords: Diabetic macular edema, NSAID, diclofenac, anti-VEGF, bevacizumab, central macular thickness

show abstract

Profile of non-responder and late responder patients treated for diabetic macular edema: systemic and ocular factors

Cited by 21 publications

References 56 publications

Retinal Layers Changes in Patients with Diabetic Macular Edema Treated with Intravitreal Anti-VEGF Agents: Long-Term Outcomes of a Spectral-Domain OCT Study

Retinal Layers Changes in Patients with Diabetic Macular Edema Treated with Intravitreal Anti-VEGF Agents: Long-Term Outcomes of a Spectral-Domain OCT Study

New Insights in Resistant Diabetic Macular Edema

Central Macular Thickness After Combined Therapy of Bevacizumab Intravitreal Injection and Topical Diclofenac Compared With Bevacizumab Intravitreal Injection Alone in Diabetic Macular Edema

Contact Info

Product

Resources

About