The Impact of Laboratory Findings and Optical Coherence Tomography Biomarkers on Response to Intravitreal Anti-VEGF Treatment in Patients with Diabetic Macular Edema

Chatziralli, Irini; Dimitriou, Eleni; Lambadiari, Vaia; Kazantzis, Dimitrios; Kapsis, Petros; Theodossiadis, George; Theodossiadis, Panagiotis; Sergentanis, Theodoros N.

doi:10.1080/08820538.2022.2069470

Cited by 7 publications

(3 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Concerning the time of switching, a general consensus is still lacking. However, most clinical studies recommend waiting at least until the end of the three anti-VEGF loading doses before making the switch or carefully evaluating the OCT parameters and biomarkers to identify inflammatory components that could favor better clinical results with a DEX implant [ 87 , 88 ]. Regarding the safety profile, the systemic and local adverse effects of intravitreal DEX are somewhat reduced compared to those of other steroids (triamcinolone, fluocinolone).…”

Section: Discussionmentioning

confidence: 99%

Switching to an Intravitreal Dexamethasone Implant after Intravitreal Anti-VEGF Therapy for Diabetic Macular Edema: A Review

Vitiello,

Salerno,

Coppola

et al. 2024

Life

View full text Add to dashboard Cite

Among working-age people, diabetic retinopathy and diabetic macular edema are currently considered the main causes of blindness. Nowadays, intravitreal injections are widely acknowledged as a significant milestone in ophthalmology, especially for the treatment of several retinal diseases, including diabetic macular edema. In particular, anti-vascular endothelial growth factor (VEGF) agents are typically the first line of treatment; however, monthly injections are required, at least, during the loading dosage. Notably, an intravitreal 0.7 mg dexamethasone (DEX) implant (Ozurdex®, AbbVie Inc., North Chicago, IL, USA) is considered a legitimate substitute treatment for diabetic eyes that have not responded to anti-VEGF treatment. In fact, clinical trials and real-life studies have demonstrated the effectiveness and safety of an intravitreal DEX implant in treating such conditions over a period of three to six months. For this reason, wisely selecting diabetic patients might be crucial to decreasing the load of injections in clinics and hospitals. The purpose of this review is to analyze the available scientific literature to highlight the benefits, efficacy, and clinical criteria for choosing whether to switch from intravitreal anti-VEGF therapy to an intravitreal DEX implant in diabetic macular edema.

show abstract

Section: Discussionmentioning

confidence: 99%

Switching to an Intravitreal Dexamethasone Implant after Intravitreal Anti-VEGF Therapy for Diabetic Macular Edema: A Review

Vitiello,

Salerno,

Coppola

et al. 2024

Life

View full text Add to dashboard Cite

show abstract

“…2,18 Further, other studies have shown that targeting pathways other than VEGF, can be beneficial to anti-VEGF nonresponders. [2][3][4][18][19][20][21][22] Current alternatives to anti-VEGF treatment include the use of corticosteroids, which act by targeting anti-inflammatory pathway along with decreasing VEGF synthesis, focal laser, subthreshold laser therapies, and vitrectomy. 5 Finally, emerging pharmacotherapeutics targeting other mediators such as cytokines/chemokines, adhesion molecules, and multiple growth factors also show promise to anti-VEGF nonresponders.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and Treatment Patterns of Patients with Diabetic Macular Edema Non-Responsive to Anti-Vascular Endothelial Growth Factor Treatment in Ontario, Canada

Somani,

Koushan,

Shah-Manek

et al. 2023

OPTH

View full text Add to dashboard Cite

To understand the demographics, clinical characteristics, treatment patterns, visual and anatomic responses of patients with diabetic macular edema (DME) initially treated with anti-vascular endothelial growth factor (anti-VEGF) agents in the real-world clinical setting. Patients and Methods: This retrospective cohort study used electronic health records to identify consecutively presenting patients with DME who received their first documented anti-VEGF injection (index injection) on or after 1 October 2015 and before 30 September 2016 (index period) at 4 clinical sites in Ontario, Canada. Patients receiving anti-VEGF injections in the study eye were followed for ≥18 months. After the first 3 monthly injections, patients were classified as "responder" (≥20% reduction in central retinal thickness [CRT] from index date) or "nonresponder" (<20% reduction in CRT) to anti-VEGF treatment. Results: At 12 months, change from baseline (CFB) in best visual acuity (BVA) of responders (n = 30) was mean (SD) 12.8 (13.00) letters; CFB in nonresponders (n = 56) was 3.2 (16.3) letters. Sensitivity analyses stratified by initial BVA were supportive. Mean (SD) change in CRT (μm) was −160.4 (111.4) in responders and −62.2 (98.6) in nonresponders. While changes in anti-VEGF therapy were lower in responders versus nonresponders (10.0% vs 23.2%), mean number of injections was similar (8.3 in each cohort). Conclusion: Despite receiving a substantial number of injections and requiring changes in therapy more frequently, nonresponders showed a lack of clinically meaningful change in BVA and CRT. Nonresponders could be identified after 3 anti-VEGF injections. There remains an unmet need for treatment options in patients with DME who show a nonresponse after 3 months of anti-VEGF treatment.

show abstract

“…Although some markers and measurements have been shown to carry clinical significance, there has been a lack of consensus and guidelines on which parameters can be used to predict treatment outcomes reliably. In fact, despite the advancement of OCT technology and anti-VEGF therapy, at least 40% of patients with DME showed suboptimal response to treatment 4 . With the financial burden and treatment complication related to anti-VEGF therapy, it is important to identify OCT markers and measurements that carry prognostic implications, which can guide patient selection to enhance DME management.…”

mentioning

confidence: 99%

Optical Coherence Tomography Classification Systems for Diabetic Macular Edema and Their Associations With Visual Outcome and Treatment Responses – An Updated Review

Hui

Szeto

Tang

et al. 2022

Asia-Pacific Journal of Ophthalmology

View full text Add to dashboard Cite

Optical coherence tomography (OCT) is an invaluable imaging tool in detecting and assessing diabetic macular edema (DME). Over the past decade, there have been different proposed OCT-based classification systems for DME. In this review, we present an update of spectraldomain OCT (SDOCT)-based DME classifications over the past 5 years. In addition, we attempt to summarize the proposed OCT qualitative and quantitative parameters from different classification systems in relation to disease severity, risk of progression, and treatment outcome. Although some OCT-based measurements were found to have prognostic value on visual outcome, there has been a lack of consensus or guidelines on which parameters can be reliably used to predict treatment outcomes. We also summarize recent literatures on the prognostic value of these parameters including quantitative measures such as macular thickness or volume, central subfield thickness or foveal thickness, and qualitative features such as the morphology of the vitreoretinal interface, disorganization of retinal inner layers, ellipsoid zone disruption integrity, and hyperreflective foci. In addition, we discuss that a framework to assess the validity of biomarkers for treatment outcome is essentially important in assessing the prognosis before deciding on treatment in DME. Finally, we echo with other experts on the demand for updating the current diabetic retinal disease classification.

show abstract

The Impact of Laboratory Findings and Optical Coherence Tomography Biomarkers on Response to Intravitreal Anti-VEGF Treatment in Patients with Diabetic Macular Edema

Cited by 7 publications

References 47 publications

Switching to an Intravitreal Dexamethasone Implant after Intravitreal Anti-VEGF Therapy for Diabetic Macular Edema: A Review

Switching to an Intravitreal Dexamethasone Implant after Intravitreal Anti-VEGF Therapy for Diabetic Macular Edema: A Review

Characteristics and Treatment Patterns of Patients with Diabetic Macular Edema Non-Responsive to Anti-Vascular Endothelial Growth Factor Treatment in Ontario, Canada

Optical Coherence Tomography Classification Systems for Diabetic Macular Edema and Their Associations With Visual Outcome and Treatment Responses – An Updated Review

Contact Info

Product

Resources

About