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Diabetic macular edema

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https://www.readbyqxmd.com/read/28430872/optimal-screening-schedules-for-disease-progression-with-application-to-diabetic-retinopathy
#1
Ionut Bebu, John M Lachin
Clinical management of chronic diseases requires periodic evaluations. Subjects transition between various levels of severity of a disease over time, one of which may trigger an intervention that requires treatment. For example, in diabetic retinopathy, patients with type 1 diabetes are evaluated yearly for either the onset of proliferative diabetic retinopathy (PDR) or clinically significant macular edema (CSME) that would require immediate treatment to preserve vision. Herein, we investigate methods for the selection of personalized cost-effective screening schedules and compare them with a fixed visit schedule (e...
April 20, 2017: Biostatistics
https://www.readbyqxmd.com/read/28430331/factors-influencing-intravitreal-bevacizumab-and-triamcinolone-treatment-in-patients-with-diabetic-macular-edema
#2
Tai K Kim, Hye Y Shin, Su Y Kim, Young C Lee, Mee Y Lee
PURPOSE: To evaluate factors associated with response to intravitreal bevacizumab (IVB) and intravitreal triamcinolone acetonide (IVTA) in diabetic macular edema (DME). METHODS: Ninety-one eyes of 88 patients diagnosed with DME were enrolled in this retrospective chart review. Group 1 included eyes that showed good response to IVB. Group 2 included eyes that did not respond to IVB but responded to IVTA. Group 3 included eyes that responded to neither. Clinical factors, HbA1c, and optical coherence tomography (OCT) findings including patterns of macular edema were compared among the 3 groups...
April 11, 2017: European Journal of Ophthalmology
https://www.readbyqxmd.com/read/28430181/supervised-learning-and-dimension-reduction-techniques-for-quantification-of-retinal-fluid-in-optical-coherence-tomography-images
#3
A Breger, M Ehler, H Bogunovic, S M Waldstein, A-M Philip, U Schmidt-Erfurth, B S Gerendas
PurposeThe purpose of the present study is to develop fast automated quantification of retinal fluid in optical coherence tomography (OCT) image sets.MethodsWe developed an image analysis pipeline tailored towards OCT images that consists of five steps for binary retinal fluid segmentation. The method is based on feature extraction, pre-segmention, dimension reduction procedures, and supervised learning tools.ResultsFluid identification using our pipeline was tested on two separate patient groups: one associated to neovascular age-related macular degeneration, the other showing diabetic macular edema...
April 21, 2017: Eye
https://www.readbyqxmd.com/read/28427075/diabetic-macular-edema-emerging-strategies-and-treatment-algorithms
#4
Elad Moisseiev, Anat Loewenstein
Diabetic macular edema (DME) is the most common cause of vision loss in diabetic patients, and its management is often a long process requiring frequent monitoring and therapeutic interventions. During the past several decades, numerous treatments have been developed for the treatment of DME. Although many of them have been found to be effective and safe, there is relatively little comparative data, and no established guidelines for the optimal treatment approach exist. In this chapter, the evolution of DME therapies is reviewed, and the current common practice patterns are discussed...
2017: Developments in Ophthalmology
https://www.readbyqxmd.com/read/28427074/enzymatic-vitreolysis-for-vitreomacular-traction-in-diabetic-retinopathy
#5
Stanislao Rizzo, Daniela Bacherini
Vitreomacular traction (VMT) is one of many possible factors involved in the etiology of diabetic macular edema (DME). Pharmacologic vitreoretinal separation is a potential alternative to vitrectomy for VMT in diabetic retinopathy. Small case series have been published on the use of enzymatic vitreolysis in tractional DME, and demonstrate that the enzymatic release of the posterior vitreous cortex is more likely following the injection of plasmin enzyme. Further prospective and randomized clinical trials are necessary to evaluate the clinical relevance of ocriplasmin for vitreomacular traction in diabetic retinopathy, and additional studies are needed to determine more accurately which patients might benefit most from this treatment and how often and at what concentration ocriplasmin should be administered...
2017: Developments in Ophthalmology
https://www.readbyqxmd.com/read/28427073/surgical-management-and-techniques
#6
Marco Codenotti, Lorenzo Iuliano, Gisella Maestranzi
Technical advancements have substantially extended the indications for surgery in diabetic retinopathy (DR) during the last 40 years, from the traditional indications including non-clearing vitreous hemorrhage, traction retinal detachment (RD), and traction-rhegmatogenous RD, to epiretinal membrane (ERM), vitreomacular traction, diffuse macular edema, neovascular glaucoma, and anterior hyaloid fibrovascular proliferation. The goals of vitreoretinal surgery in DR are multiple: clearing media opacities, release of traction (anteroposterior and/or tangential), segmentation and/or removal of traction bands, peeling of ERMs, hemostasis, laser photocoagulation, and tamponade of retinal breaks with gas or silicone oil...
2017: Developments in Ophthalmology
https://www.readbyqxmd.com/read/28427072/anti-vascular-endothelial-growth-factor-injections-the-new-standard-of-care-in-proliferative-diabetic-retinopathy
#7
Xintong Li, Marco A Zarbin, Neelakshi Bhagat
For decades, panretinal photocoagulation (PRP) has been the standard of care for the treatment of proliferative diabetic retinopathy (PDR). The relatively recent advent of anti-vascular endothelial growth factor (VEGF) formulations for intravitreal injection has provided a fresh perspective on PDR treatment, especially in eyes with concurrent diabetic macular edema (DME). The anti-VEGF agent ranibizumab has demonstrated a potentially protective effect on eyes with DME in terms of progression to PDR in the RIDE/RISE trials, as has aflibercept in the VIVID/VISTA trials...
2017: Developments in Ophthalmology
https://www.readbyqxmd.com/read/28427071/is-laser-still-important-in-diabetic-macular-edema-as-primary-or-deferral-therapy
#8
Maurizio Battaglia Parodi, Francesco Bandello
Laser treatment was used in the past to reduce the visual loss due to diabetic macular edema. The recent advent of anti-vascular endothelial growth factor (anti-VEGF) has completely revolutionized the management of diabetic retinopathy, with a significant improvement in the overall prognosis. Nevertheless, macular laser can still be applied in selected cases characterized by retinal thickness ≤400 microns, high visual acuity, extrafoveal location, and contraindications to the intravitreal approach with anti-VEGF and steroids...
2017: Developments in Ophthalmology
https://www.readbyqxmd.com/read/28427070/practical-lessons-from-protocol-t-for-the-management-of-diabetic-macular-edema
#9
Lekha Mukkamala, Neelakshi Bhagat, Marco Zarbin
PURPOSE: To review the results of Diabetic Retinopathy Clinical Research Network Protocol T, as applied to clinical practice. METHODS: Review of major publications reporting the results of Protocol T, a randomized single-masked (in year-1 only), multicenter clinical trial comparing aflibercept, bevacizumab, and ranibizumab as treatment option for center-involving diabetic macular edema (DME). The main outcome measures were change in visual acuity (VA), central subfield thickness (CST) on optical coherence tomography, cost effectiveness, burden of care, and safety...
2017: Developments in Ophthalmology
https://www.readbyqxmd.com/read/28427069/practical-lessons-from-protocol-i-for-the-management-of-diabetic-macular-edema
#10
Lekha Mukkamala, Neelakshi Bhagat, Marco A Zarbin
Protocol I, a multicenter randomized clinical trial, compared the visual outcomes of patients treated with 0.5 mg intravitreal ranibizumab with either prompt or deferred (by 24 weeks laser), 4 mg intravitreal triamcinolone with prompt laser, or sham injection with prompt laser for the treatment of center-involving diabetic macular edema (DME). A total of 854 adult patients with type I or II diabetes and any level of non-proliferative diabetic retinopathy or proliferative retinopathy with adequate panretinal photocoagulation, with best-corrected visual acuity (BCVA) of 78 to 24 ETDRS letters (Snellen equivalent of 20/32 to 20/320) and visual loss attributed to macular edema, or retinal thickening with central subfield thickness of at least 250 µm by OCT were enrolled...
2017: Developments in Ophthalmology
https://www.readbyqxmd.com/read/28427068/intravitreal-steroids-in-diabetic-macular-edema
#11
Rosangela Lattanzio, Maria Vittoria Cicinelli, Francesco Bandello
Over the past decade, great strides have been made in the management of diabetic macular edema (DME). Therapeutic alternatives now include focal/grid laser photocoagulation, vitreo-retinal surgery, and intraocular injection of anti-angiogenic and steroid molecules. Intravitreal administration of steroids represents a fundamental alternative for recalcitrant and naive eyes with DME, especially in those cases when anti-vascular endothelial growth factor (VEGF) agents are contraindicated or a treatment regimen with fewer intravitreal injections is required...
2017: Developments in Ophthalmology
https://www.readbyqxmd.com/read/28427067/intravitreal-aflibercept-in-diabetic-macular-edema-long-term-outcomes
#12
Ugo Introini, Giuseppe Casalino
For decades, macular laser photocoagulation has been the standard of care in the treatment of diabetic macular edema (DME). With the relatively recent advent of anti-vascular endothelial growth factor (VEGF) agents, DME treatment has entered a new era. VEGF is a well-known pro-angiogenic and pro-permeability factor involved in the pathogenesis of DME. VEGF blockade has proven remarkably effective at reducing DME and improving visual acuity (VA) in eyes with center involved DME causing VA loss in several randomized controlled trials (RCTs)...
2017: Developments in Ophthalmology
https://www.readbyqxmd.com/read/28427066/intravitreal-ranibizumab-in-diabetic-macular-edema-long-term-outcomes
#13
Ilaria Zucchiatti, Francesco Bandello
Intravitreal ranibizumab (RBZ) has been shown in multiple randomized clinical trials to be a valuable treatment for diabetic macular edema (DME), promoting a significant improvement in best-corrected visual acuity (BCVA) and in anatomic outcomes. Compared to sham (RISE and RIDE studies), RBZ rapidly and sustainably improved BCVA and decreased macular edema at 2 years, reducing the risk of further vision loss, with low rates of local or systemic side effects. Compared to macular laser photocoagulation (READ-2 study), RBZ provided a greater improvement in BCVA and regression in foveal thickness, but required a higher number of injections compared to patients treated with both RBZ and laser...
2017: Developments in Ophthalmology
https://www.readbyqxmd.com/read/28427063/optical-coherence-tomography-angiography-in-diabetic-maculopathy
#14
Gabriel Coscas, Marco Lupidi, Florence Coscas
Fluorescein angiography (FA) and indocyanine green angiography have provided information about the normal retinal and choroidal anatomy, nearly comparable to histological findings. These tests have been fundamental in the evaluation of all retinal and choroidal vascular diseases and have allowed clinicians to define and diagnose several pathological conditions. FA became the "gold standard" in retinal imaging due to the capacity to visualize the retinal capillary bed and its changes, both in the macular area and in the periphery...
2017: Developments in Ophthalmology
https://www.readbyqxmd.com/read/28427062/emerging-issues-for-optical-coherence-tomography
#15
Luisa Pierro, Alessandro Rabiolo
Almost 25 years after its introduction, optical coherence tomography (OCT) is still a crucial test in the evaluation of patients affected by diabetic retinopathy. In this chapter, the authors provide an extensive overview of the posterior segment pathological changes induced by diabetes, characterized using OCT. OCT plays a key role in diabetic macular edema (DME) as it assesses related retinal changes both in a qualitative (i.e., DME pattern, presence and aspects of cysts, fluid localization, integrity, and reflectivity of retinal layers) and quantitative (i...
2017: Developments in Ophthalmology
https://www.readbyqxmd.com/read/28427061/emerging-insights-into-pathogenesis
#16
Edoardo Midena, Elisabetta Pilotto
Diabetic retinopathy (DR) is a frequent complication of diabetes mellitus (DM). Persistent hyperglycemia leads to the activation of multiple cellular pathways involved in the pathogenesis of DR, resulting in increased inflammation, oxidative stress, and vascular dysfunction. DR has been considered a "chronic, low-grade inflammatory disease of the retina". However, an increasing body of evidence suggests that inflammation and neurodegeneration both occur in human diabetes even before the development of clinical signs of DR...
2017: Developments in Ophthalmology
https://www.readbyqxmd.com/read/28426623/intravitreal-dexamethasone-implantation-in-patients-with-different-morphological-diabetic-macular-edema-having-insufficient-response-to-ranibizumab
#17
Havva Kaldırım, Serpil Yazgan, Kursat Atalay, Ceren Gurez, Fatma Savur
PURPOSE: To evaluate the effectiveness of a single intravitreal injection of dexamethasone implant in resistant diabetic macular edema that have different morphological types. METHODS: In this retrospective study, 31 patients (35 eyes) with persistent diabetic macular edema, who underwent a single injection of dexamethasone implant, were evaluated. Diabetic macular edema was classified into three types: diffuse retinal thickening (n = 10), cystoid macular edema (n = 13), and serous retinal detachment (n = 12)...
April 19, 2017: Retina
https://www.readbyqxmd.com/read/28426622/changes-in-central-choroidal-thickness-after-treatment-of-diabetic-macular-edema-with-intravitreal-bevacizumab-correlation-with-central-macular-thickness-and-best-corrected-visual-acuity
#18
Ramin Nourinia, Hamid Ahmadieh, Elnaz Nekoei, Parviz Malekifar, Zahra Tofighi
PURPOSE: To assess the effect of intravitreal injection of bevacizumab on central choroidal thickness (CCT) and its relationship with central macular thickness (CMT) and best-corrected visual acuity (BCVA) changes in eyes with center-involving diabetic macular edema. METHODS: This prospective interventional case series included 20 eyes of 20 patients with center-involving diabetic macular edema naive to treatment. The BCVA assessment, complete eye examination, enhanced depth optical coherence tomography, and fluorescein angiography were performed at baseline followed by 3 monthly intravitreal injection of bevacizumab...
April 19, 2017: Retina
https://www.readbyqxmd.com/read/28423385/guidelines-for-the-management-of-diabetic-macular-edema-by-the-european-society-of-retina-specialists-euretina
#19
Ursula Schmidt-Erfurth, Jose Garcia-Arumi, Francesco Bandello, Karina Berg, Usha Chakravarthy, Bianca S Gerendas, Jost Jonas, Michael Larsen, Ramin Tadayoni, Anat Loewenstein
Diabetic retinal disease is envisioned to become the plague of the coming decades with a steep increase of worldwide diabetes incidence followed by a substantial rise in retinal disease. Improvements in diagnostic and therapeutic care have to cope with this dilemma in a clinically and socioeconomically efficient manner. Laser treatment has found a less destructive competitor in pharmacological treatments. As a consequence of recent rigorous clinical trials, laser photocoagulation is no longer recommended for the treatment of diabetic macular edema (DME), and anti-vascular endothelial growth factor therapy has emerged as first-line therapy...
April 20, 2017: Ophthalmologica. Journal International D'ophtalmologie
https://www.readbyqxmd.com/read/28423305/frequency-of-evidence-based-screening-for-retinopathy-in-type-1-diabetes
#20
(no author information available yet)
Background In patients who have had type 1 diabetes for 5 years, current recommendations regarding screening for diabetic retinopathy include annual dilated retinal examinations to detect proliferative retinopathy or clinically significant macular edema, both of which require timely intervention to preserve vision. During 30 years of the Diabetes Control and Complications Trial (DCCT) and its longitudinal follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study, retinal photography was performed at intervals of 6 months to 4 years...
April 20, 2017: New England Journal of Medicine
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