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Diabetic macular edema

John J Wroblewski, Allen Y Hu
BACKGROUND AND OBJECTIVE: To evaluate the effects of squalamine (OHR-102; Ohr Pharmaceuticals, New York, NY) and ranibizumab (Lucentis; Genentech, South San Francisco, CA) on macular edema (ME) secondary to retinal vein occlusion (RVO). PATIENTS AND METHODS: Twenty consecutive, treatment-naïve patients with RVO-related ME received topical squalamine and intravitreal ranibizumab 0.5 mg for 10 weeks, followed by randomization to continue or discontinue squalamine...
October 1, 2016: Ophthalmic Surgery, Lasers & Imaging Retina
Yuji Itoh, Daniel Petkovsek, Peter K Kaiser, Rishi P Singh, Justis P Ehlers
BACKGROUND AND OBJECTIVE: To assess the relationship between spectral-domain optical coherence tomography (SD-OCT) features and functional outcomes for diabetic macular edema (DME) undergoing treatment with intravitreal bevacizumab (Avastin; Genentech, South San Francisco, CA). PATIENTS AND METHODS: Institutional review board-approved, retrospective, consecutive case series of eyes receiving intravitreal bevacizumab (1.25 mg) for DME. SD-OCT features were evaluated and correlated with functional response to anti-vascular endothelial growth factor (VEGF) therapy...
October 1, 2016: Ophthalmic Surgery, Lasers & Imaging Retina
Takao Hirano, Yuichi Toriyama, Yasuhiro Iesato, Akira Imai, Kazutaka Hirabayashi, Taiji Nagaoka, Yoshihiro Takamura, Masahiko Sugimoto, Toshinori Murata
PURPOSE: The effect of combination therapy using intravitreal ranibizumab (IVR) injections and short pulse focal/grid laser photocoagulation was evaluated for the treatment of diabetic macular edema (DME). METHODS: The current investigation was a preliminary single-arm, open-label, prospective clinical study conducted on 21 eyes at 4 sites in Japan. Treatment protocol consisted of two phases. The induction IVR phase included two monthly IVRs followed by PRN IVR phase in which additional IVR was administered if the central macular thickness (CMT) exceeded 300 μm...
October 11, 2016: Japanese Journal of Ophthalmology
Jae Hyung Lee, Won Ki Lee, Sung Eun Kim
PURPOSE: To evaluate the efficacy of switching from bevacizumab to ranibizumab in patients with diabetic macular edema (DME). METHODS: Patients with DME who showed persistent fluid after at least 3 monthly bevacizumab injections were administered a single ranibizumab injection and were followed up after 1 month. Anatomic responders to ranibizumab were followed up monthly and administered ranibizumab injections on an as-needed basis for 3 months. RESULTS: At the 1-month follow-up, mean central subfield foveal thickness (CSFT) decreased from 422 to 346 μm (P < 0...
October 11, 2016: Journal of Ocular Pharmacology and Therapeutics
Yuichiro Ogura, Fumio Shiraga, Hiroko Terasaki, Masahito Ohji, Susumu Ishida, Taiji Sakamoto, Akito Hirakata, Tatsuro Ishibashi
PURPOSE: To elucidate the current clinical practice patterns of diabetic macular edema (DME) management by retinal specialists in Japan in the era of anti-vascular endothelial growth factor (VEGF) therapy. METHODS: Forty-six retinal specialists were administered a survey regarding the pathology and clinical practice of DME. RESULTS: Nearly, half of the specialists (45.2 %) think that the main biochemical factor involved in DME development is the vascular permeability-potentiating action of VEGF-A...
October 8, 2016: Japanese Journal of Ophthalmology
Therese Granström, Henrietta Forsman, Anna Lindholm Olinder, Dimitrios Gkretsis, Jan W Eriksson, Elisabet Granstam, Janeth Leksell
AIMS: To examine objective visual acuity measured with ETDRS, retinal thickness (OCT), patient reported outcome and describe levels of glycated hemoglobin and its association with the effects on visual acuity in patients treated with anti-VEGF for visual impairment due to diabetic macular edema (DME) during 12months in a real world setting. METHODS: In this cross-sectional study, 58 patients (29 females and 29 males; mean age, 68years) with type 1 and type 2 diabetes diagnosed with DME were included...
September 21, 2016: Diabetes Research and Clinical Practice
Jie Li, Bifei Lan, Xiaoli Li, Shumao Sun, Ping Lu, Lingyun Cheng
Transscleral drug delivery may become a safe alternative to the intravitreal injection for chronic retinal diseases such as age-related macular degeneration or diabetic macular edema. However, the drug delivered onto the sclera subjects to vigorous clearance by episcleral and choroidal circulation; in addition, the penetration from episclera to retina needs to overcome counter-directional ocular fluid current driven by intraocular pressure (IOP) as well as unfavorable drug disposition exerted by drug transporters before the drug reach retina...
October 4, 2016: Journal of Controlled Release: Official Journal of the Controlled Release Society
Dordi Austeng, Tora Sund Morken, Stine Bolme, Turid Follestad, Vidar Halsteinli
BACKGROUND: Intravitreal injections (IVI) of anti-vascular endothelial growth factor (anti-VEGF) now improve or stabilize visual acuity in a number of previously untreatable eye diseases, of which the main are age-related macular degeneration, retinal vein occlusion and diabetic macular edema. Most patients require multiple injections over lengthy periods of time and the prevalence of treatable conditions is increasing. Anti-VEGF IVI normally administered by physicians, therefore represent a considerable workload on ophthalmologic clinics and will continue to do so in the near future...
October 1, 2016: BMC Ophthalmology
Andreas Ebneter, Dominik Waldmeier, Denise C Zysset-Burri, Sebastian Wolf, Martin Sebastian Zinkernagel
PURPOSE: To compare outcomes between an as-needed and a treat-and-extend regimen in managing diabetic macular edema with intravitreal ranibizumab. METHODS: This was a retrospective, single-centre, comparative case series on 46 treatment naive patients with diabetic macular edema. Twenty-two patients were treated following an optical coherence tomography guided treat-and-extend protocol (OCTER), and 24 patients were treated according to a visual acuity guided pro re nata regimen (VAPRN) at a tertiarry referral centre...
October 7, 2016: Graefe's Archive for Clinical and Experimental Ophthalmology
Lee M Jampol, Adam R Glassman, Neil M Bressler, John A Wells, Allison R Ayala
Importance: Post hoc analyses from the Diabetic Retinopathy Clinical Research Network randomized clinical trial comparing aflibercept, bevacizumab, and ranibizumab for diabetic macular edema (DME) might influence interpretation of study results. Objective: To provide additional outcomes comparing 3 anti-vascular endothelial growth factor (VEGF) agents for DME. Design, Setting, and Participants: Post hoc analyses performed from May 3, 2016, to June 21, 2016, of a randomized clinical trial performed from August 22, 2012, to September 23, 2015, of 660 participants comparing 3 anti-VEGF treatments in eyes with center-involved DME causing vision impairment...
October 6, 2016: JAMA Ophthalmology
Yasir J Sepah, Mohammad Ali Sadiq, David Boyer, David Callanan, Ron Gallemore, Michael Bennett, Dennis Marcus, Lawrence Halperin, Muhammad Hassan, Peter A Campochiaro, Quan Dong Nguyen, Diana V Do
PURPOSE: To compare 2.0 mg ranibizumab (RBZ) injections with 0.5 mg RBZ for eyes with center-involved diabetic macular edema (DME). DESIGN: Randomized, controlled, double-masked (to the dose), interventional, multicenter clinical trial. PARTICIPANTS: A total of 152 patients (152 eyes) with DME. METHODS: Eligible eyes were randomized in a 1:1 ratio to 0.5 mg (n = 77) or 2.0 mg (n = 75) RBZ. Study eyes received 6 monthly mandatory injections followed by as-needed injections until month 24...
October 1, 2016: Ophthalmology
Charles C Wykoff, Ryan T Le, Rahul N Khurana, David M Brown, William C Ou, Rui Wang, W Lloyd Clark, David S Boyer
PURPOSE: To determine whether the efficacy and safety achieved with 2.0mg intravitreal aflibercept injections (IAI) for diabetic macular edema (DME) during the phase III VISTA DME trial were maintained with individualized, as-needed treatment. DESIGN: Phase IV, multicenter, open-label extension study. METHODS: Sixty patients completing VISTA DME elected to enter the ENDURANCE extension study. All patients received IAI in the presence of clinically relevant DME...
October 1, 2016: American Journal of Ophthalmology
Michael David Abràmoff, Yiyue Lou, Ali Erginay, Warren Clarida, Ryan Amelon, James C Folk, Meindert Niemeijer
Purpose: To compare performance of a deep-learning enhanced algorithm for automated detection of diabetic retinopathy (DR), to the previously published performance of that algorithm, the Iowa Detection Program (IDP)-without deep learning components-on the same publicly available set of fundus images and previously reported consensus reference standard set, by three US Board certified retinal specialists. Methods: We used the previously reported consensus reference standard of referable DR (rDR), defined as International Clinical Classification of Diabetic Retinopathy moderate, severe nonproliferative (NPDR), proliferative DR, and/or macular edema (ME)...
October 1, 2016: Investigative Ophthalmology & Visual Science
Undurti N Das
Diabetic macular edema (DME) and diabetic retinopathy (DR) are complications affecting about 25% of all patients with long-standing type 1 and type 2 diabetes mellitus and are a major cause of significant decrease in vision and quality of life. Age-related macular degeneration (AMD) is not uncommon, and diabetes mellitus affects the incidence and progression of AMD through altering hemodynamics, increasing oxidative stress, accumulating advanced glycation end products, etc. Recent studies suggest that DME, DR and AMD are inflammatory conditions characterized by a breakdown of the blood-retinal barrier, inflammatory processes and an increase in vascular permeability...
October 1, 2016: Archives of Medical Science: AMS
Stela Vujosevic, Silvia Bini, Tommaso Torresin, Marianna Berton, Giulia Midena, Raffaele Parrozzani, Ferdinando Martini, Porzia Pucci, Anna R Daniele, Fabiano Cavarzeran, Edoardo Midena
PURPOSE: To evaluate hyperreflective retinal spots (HRS), in normal subjects and diabetic patients without and with macular edema (diabetic macular edema, DME), on linear B-scans and corresponding en face image of spectral-domain optical coherence tomography. METHODS: Retrospective evaluation of images of 54 eyes/subjects (16 normal subjects, 19 diabetic patients without DME, and 19 with DME). On horizontal B-scan spectral-domain optical coherence tomography, passing through the center of the fovea, the following characteristics of HRS were evaluated: location (inner retina or outer retina), size (≤30 or >30 μm), reflectivity (similar to nerve fiber layer or to retinal pigment epithelium-Bruch complex), and presence or absence of back shadowing...
September 23, 2016: Retina
Ivan J Suñer, Neil M Bressler, Rohit Varma, Chantal M Dolan, James Ward, Adam Turpcu
PURPOSE: To evaluate the responsiveness of the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) in patients with diabetic macular edema using data from the RIDE and RISE trials. METHODS: Patients were randomized to monthly intravitreal ranibizumab 0.3 mg, 0.5 mg, or sham injections for 2 years. The NEI VFQ-25 was administered at baseline and at Months 6, 12, 18, and 24. The least-squares mean change in NEI VFQ-25 for ≥15 letters gained or lost was derived from analysis of covariance models...
September 23, 2016: Retina
Nancy M Holekamp
Diabetic retinopathy (DR) is both the leading cause of blindness among adults aged 20 to 74 in the United States, and the leading ocular complication associated with diabetes mellitus (DM). An estimated 4.4% of adults with DM over 40 years of age have the more advanced form of DR: diabetic macular edema (DME), which significantly increases the risk of blindness. Medical costs for Medicare patients with DME are a third higher than for patients without DME. The majority of these costs stem from other DM-related complications, as DME is a marker for poorly controlled DM overall...
July 2016: American Journal of Managed Care
Seenu M Hariprasad
Three modalities have a role in the primary management of diabetic macular edema (DME): laser photocoagulation, intravitreal vascular endothelial growth factor (VEGF) inhibitors, and intravitreal corticosteroid implants. Intravitreal VEGF inhibitors are most commonly used for center-involved DME, but laser photocoagulation and intravitreal corticosteroids also have an important role in DME management. Until recently, the selection of a VEGF inhibitor for a patient was complicated by a lack of comparative data and a much lower cost for bevacizumab compared with other agents...
July 2016: American Journal of Managed Care
Nancy M Holekamp
Diabetes mellitus (DM) is a rapidly growing epidemic in the United States, and it is expected to affect 592 million individuals within the next 20 years. Diabetic retinopathy (DR) and diabetic macular edema (DME) are the 2 most common ophthalmic complications of DM. DR is the leading cause of blindness among working-age adults around the world, and development of DR is tied to DM disease duration. With the only identifier of early markers of DR being a complete ophthalmic exam, early signs of the disease are asymptomatic...
July 2016: American Journal of Managed Care
Peter A Campochiaro, Lloyd Paul Aiello, Philip J Rosenfeld
The association of retinal hypoxia with retinal neovascularization has been recognized for decades, causing Michaelson to postulate in 1948 that a factor secreted by hypoxic retina was involved. The isolation of vascular endothelial growth factor (VEGF), characterization of its angiogenic activity, and demonstration that its expression was increased in hypoxic tissue made it a prime candidate. Intraocular levels of VEGF are elevated in patients with retinal or iris neovascularization, and VEGF-specific antagonists markedly suppress retinal neovascularization in mice and primates with ischemic retinopathy...
October 2016: Ophthalmology
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