Proliferative Diabetic Retinopathy

Silva, Paolo A.S.; Cavallerano, Jerry D.; Sun, Jennifer K.; Blodi, Bárbara A.; Davis, Matthew D.; Aiello, Lloyd M.; Aiello, Lloyd Paul

doi:10.1016/b978-1-4557-0737-9.00048-5

Cited by 16 publications

(13 citation statements)

References 176 publications

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“…Proliferative diabetic retinopathy (PDR) is characterized by the presence of neovascularization, which can lead to severe visual loss resulting from hemorrhagic and/or tractional complications. [1][2][3] There are several established imaging techniques to evaluate PDR, with fluorescein angiography (FA) and optical coherence tomography (OCT) being the most relevant. While FA is considered the gold standard, it is an invasive technique.…”

Section: Introductionmentioning

confidence: 99%

<p>Optical Coherence Tomography Angiography Features of Neovascularization in Proliferative Diabetic Retinopathy</p>

Vaz-Pereira¹,

Silva²,

Freund³

et al. 2020

OPTH

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To describe features of neovascularization in proliferative diabetic retinopathy (PDR) using optical coherence tomography angiography (OCTA). Methods: A retrospective case series was performed in 23 eyes from 21 patients who underwent OCTA of neovascular complexes (NVCs) due to PDR. Eyes were imaged with the DRI Triton swept-source OCTA, Avanti RTVue XR or Cirrus HD-OCT 5000 as part of routine clinical examination. Segmentation was adjusted to include vasculature between the vitreous cavity and the internal limiting membrane (ILM). The presence of NVCs was confirmed by clinical examination and multimodal imaging such as color or red-free fundus photography, fluorescein angiography, multicolor imaging or near-infrared reflectance. Results: Thirty-five NVCs were imaged, of which, 34% were neovascularization of the disc (NVD) and 66% were neovascularization elsewhere (NVE). On structural OCT B-scans, NVE appeared as medium to highly reflective tissue that breached the ILM, while NVD showed highly reflective tissue protruding from the disc in a sea fan configuration. Flow signal was seen on OCTA in all cases of NVE and in 67% of NVD lesions. Areas with minimal or absent retinal flow signal identified retinal nonperfusion areas and were found adjacent to 87% of NVE. Intraretinal microvascular abnormalities (IRMAs) were noted next to 70% of NVE. Absent flow signal was seen in 4 NVD cases showing posterior shadowing and were considered inactive. Conclusion: OCTA appears useful for imaging NVCs, IRMAs, and retinal nonperfusion areas in eyes with diabetic retinopathy. This imaging modality enables noninvasive screening and monitoring of PDR and can obviate the need for additional testing in certain clinical settings.

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Section: Introductionmentioning

confidence: 99%

<p>Optical Coherence Tomography Angiography Features of Neovascularization in Proliferative Diabetic Retinopathy</p>

Vaz-Pereira¹,

Silva²,

Freund³

et al. 2020

OPTH

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“…This is even more critical when assuming the necessity for life-long treatment [6]. Another concern is the questionable long-term efficacy of pharmacologic treatment compared with the well-known long-term efficacy of laser treatment [7, 8]. …”

Section: Introductionmentioning

confidence: 99%

“…Conventional PRP has a wide array of undesirable side effects, i.e., early ones, such as patient pain/discomfort, worsening of macular edema, progression to vitreous hemorrhage, and vitrectomy; and late ones, such as confluent retinal scarring, visual field constriction, and optic disc atrophy [8]. These side effects can be minimized using less invasive treatment strategies such as short-pulse (10–20 ms) laser burns delivered through a pattern scanning method, i.e., multispot.…”

Section: Introductionmentioning

confidence: 99%

Comparison of 577-nm Multispot and Standard Single-Spot Photocoagulation for Diabetic Retinopathy

et al. 2018

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Objective: To compare two different laser strategies of panretinal photocoagulation for diabetic retinopathy. Methods: Single-center, randomized study including 41 eyes treated with 577-nm multispot laser with a 20-ms pulse duration (group 1) or a 532-nm single-spot laser with a 100-ms pulse duration (group 2). The outcomes included best-corrected visual acuity (BCVA) and imaging changes at baseline, 6 and 12 months, laser parameters, and results of subjective pain analysis. Results: At 12 months, the treatments did not differ significantly in BCVA, central retinal thicknesses (CRTs), improved macular edema, vitreomacular interface changes, patient-reported pain scores, or angiographic responses. Group 1 had significantly fewer treatment sessions but used more laser spots (p < 0.001). Conclusion: The multispot laser required fewer applications with more spots delivered to compensate for lower fluency, showing similar patient tolerance to single-spot laser. Both groups maintained the initial visual acuities and CRTs; about 50% of cases had vitreomacular interface changes and improved macular edema, with similar angiographic improvements after 12 months.

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“…This was evidenced in DR eyes treated with anti-VEGF for DME [34][35][36]. It has been reported that panretinal photocoagulation (PRP) reduces VEGF and leads to NV regression [37]. This might be the result of a decrease in the NP area following PRP.…”

Section: Discussionmentioning

confidence: 95%

Relationships among Retinal Nonperfusion, Neovascularization, and Vascular Endothelial Growth Factor Levels in Quiescent Proliferative Diabetic Retinopathy

Park

Baek

et al. 2020

JCM

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Purpose: To investigate the relationships among the retinal nonperfusion (NP) area, neovascularization (NV) area, and aqueous humor vascular endothelial growth factor (VEGF) levels in quiescent proliferative diabetic retinopathy (PDR). Methods: Forty-seven eyes from 47 patients with treatment-naïve PDR that did not show macular edema or vitreous hemorrhage were enrolled. NP area, NV number, and NV area were quantitatively measured using ultra-widefield fluorescein angiography in an automated manner. Aqueous humor VEGF level was measured using a bead assay. Results: The NP areas of the total, posterior pole, peripheral retinae, and NV area positively correlated with each other (all p < 0.034). NV number correlated with total NP area, peripheral NP area, and NV area (all p ≤ 0.001). VEGF levels were significantly positively correlated with total, posterior polar, and peripheral NP areas and NV area (r = 0.575, 0.422, 0.558, and 0.362, respectively; all p ≤ 0.012). In eyes with NV in the disc area, the VEGF level was higher compare to eyes without NV in the disc area (208.89 ± 192.77 pg/mL vs. 103.34 ± 132.66, p = 0.010). A multiple linear regression model using NP area, NV area, and NVD demonstrated good prediction for VEGF level (R2 = 0.417, p < 0.001) and revealed a significant contribution of the peripheral NP area in predicting the VEGF level (β = 0.497, p = 0.002). Conclusions: Aqueous humor VEGF levels in quiescent PDR eyes were associated with NP and NV areas, which had positive correlations with each other. In addition, the NP area of the peripheral retina was the most important predictor of VEGF level.

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Proliferative Diabetic Retinopathy

Cited by 16 publications

References 176 publications

<p>Optical Coherence Tomography Angiography Features of Neovascularization in Proliferative Diabetic Retinopathy</p>

<p>Optical Coherence Tomography Angiography Features of Neovascularization in Proliferative Diabetic Retinopathy</p>

Comparison of 577-nm Multispot and Standard Single-Spot Photocoagulation for Diabetic Retinopathy

Relationships among Retinal Nonperfusion, Neovascularization, and Vascular Endothelial Growth Factor Levels in Quiescent Proliferative Diabetic Retinopathy

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