AIM： To evaluate the relative efficacy and safety of aflibercept for treatment of diabetic macular oedema （DMO）. METHODS： A comprehensive search in MEDLINE, CENTRAL and EMBASE was undertaken for randomized con...AIM： To evaluate the relative efficacy and safety of aflibercept for treatment of diabetic macular oedema （DMO）. METHODS： A comprehensive search in MEDLINE, CENTRAL and EMBASE was undertaken for randomized controlled trials （RCTs） comparing intravitreal anti-vascular endothelial growth factor （anti-VEGF） versus another treatment. Primary outcome measures were proportion of patients with at least 15 letters of gain or loss on a logMAR visual acuity chart, and change in best corrected visual acuity （BCVA） and central macular thickness （CMT） from baseline. Safety outcomes were rates of death, thromboembolic events and any systemic or ocular serious adverse events. The final search was performed on November 2017. RESULTS： Four RCTs were included. Only one trial compared efficacy and safety of aflibercept with bevacizumab and ranibizumab over 1 or 2y. Three trials were included for Meta-analysis comprising 661 patients （331 in the aflibercept, and 330 in the photocoagulation group）. Aflibercept was more efficacious compared to photocoagulation in the proportion of patients with at least 15 letters of improvement and worsening, and in improvement of BCVA and reduction in CMT at 1 or 2y. The safety estimates at 1 or 2y did not differ statistically. CONCLUSION： Aflibercept offers superior benefits over photocoagulation in improving and preserving vision, with no differences in safety. Further comparative effectiveness trials between aflibercept and other anti-VEGF agents will aid ophthalmologists in treatment decisions.展开更多
Throughout the years,people with diabetic macular oedema(DMO)have seen the number of options for their treatment increasing.Laser photocoagulation was the first of these and great experience is behind it;intraocular s...Throughout the years,people with diabetic macular oedema(DMO)have seen the number of options for their treatment increasing.Laser photocoagulation was the first of these and great experience is behind it;intraocular steroids followed and more recently anti-vascular endothelial growth factor(anti-VEGF)agents came to light.Ophthalmologists face now the dilemma of determining which may be the best therapeutic strategy for each particular patient based on best available evidence.This article summarises data available from randomised clinical trials(RCTs)on treatments for DMO and provides some facts about this condition and its treatments that need to be taken into consideration when treatment decisions are made.展开更多
The macula is an imperative part present in our human visual system which is most responsible for clear and colour vision. For the people suffering from diabetes, the various parts of the body including the retina of ...The macula is an imperative part present in our human visual system which is most responsible for clear and colour vision. For the people suffering from diabetes, the various parts of the body including the retina of the eye are affected. These retinal damages cause swelling and other abnormalities nearby macula. The pathologies in macula due to diabetes are called Diabetic Macular oEdema (DME). It affects patients’ vision that may lead to vision loss. It can be overcome by advance identification of causes for swelling. The major causes for the swelling are neovascularization and other abnormalities occurring in the blood vessels nearby the macula. The aim of this work is to avoid vision loss by detecting the presence of abnormalities in macula in advance. The pathologies present in the abnormal images are detected by image segmentation technique viz. Fuzzy K-means algorithm. The classification is done by two different classifiers namely Cascade Neural Network and Partial Least Square which are employed to identify whether the image is normal or abnormal. The results of both the classifiers are compared with respect to classifier accuracy, sensitivity and specificity. The classifier accuracies of Cascade Neural Network and Partial Least Square are 96.84% and 94.36%, respectively. The information about the severity of the disease and the localization of pathologies are very useful to the ophthalmologist for diagnosing the disease and apply proper treatments to the patients to avoid the formation of any lesion and prevent vision loss.展开更多
This work comprehensively reviews the latest treatment options for diabetic macular edema(DME) used in its management and presents further work on the topic.Diabetic retinopathy is an important and increasingly preval...This work comprehensively reviews the latest treatment options for diabetic macular edema(DME) used in its management and presents further work on the topic.Diabetic retinopathy is an important and increasingly prevalent cause of preventable blindness worldwide. To meet this increasing burden there has recently been a proliferation of pharmacological therapies being used in clinical practice. A variety of medical treatment options now exist for DME. These include non-steroidal antiinflammatory drugs such as nepafenac, as well as intravitreal steroids like triamcinolone(kenalog). Longterm results up to 7 years after commencing treatment are presented for triamcinolone. Studies are reviewed on the use of dexamethasone(ozurdex) and fluocinolone(Retisert and Iluvien implants) including the FAME studies. A variety of anti-vascular endothelial growth factor(anti-VEGF) agents used in DME are considered in detail including ranibizumab(lucentis) and the RESTORE, RIDE, RISE and Diabetic Retinopathy Clinical Research Network(DRCR.net) studies. Bevacizumab(avastin) and pegaptinib(macugen) are also considered. The use of aflibercept(eylea) is reviewed including the significance of the DA VINCI, VISTA-DME, VIVIDDME and the DRCR.net studies which have recently suggested potentially greater efficacy when treating DME for aflibercept in patients with more severely reduced visual acuity at baseline. Evidence for the antiVEGF agent bevasiranib is also considered. Studies of anti-tumour necrosis factor agents like infliximab are reviewed. So are studies of other agents targeting inflammation including minocycline, rapamycin(sirolimus) and protein kinase C inhibitors such as midostaurin and ruboxistaurin. The protein kinase C β inhibitor Diabetic Macular Edema Study is considered. Other agents which have been suggested for DME are discussed including cyclo-oxygenase-2 inhibitors like celecoxib, phospholipase A2 inhibitors, recombinant erythropoietin, and monoclonal anti-interleukin antibodies such as canakinumab. The management of DME in a variety of clinical scenarios is also discussed- in newly diagnosed DME, refractory DME including after macular laser, and postoperatively after intraocular surgery. Results of long-term intravitreal triamcinolone for DME administered up to seven years after commencing treatment are considered in the context of the niche roles available for such agents in modern management of DME. This is alongside more widely used treatments available to the practitioner such as anti-VEGF agents like aflibercept(Eylea) and ranibizumab(Lucentis) which at present are the mainstay of pharmacological treatment of DME.展开更多
· AIM: To evaluate the safety and efficacy of dexamethasone implant in patients with non-infectious posterior uveitis with cystoid macular edema(CME).·METHODS: Retrospective analysis of patients reports with...· AIM: To evaluate the safety and efficacy of dexamethasone implant in patients with non-infectious posterior uveitis with cystoid macular edema(CME).·METHODS: Retrospective analysis of patients reports with CME secondary to non-infectious uveitis treated with dexamethasone implant. Data included type of posterior uveitis, any systemic immunosuppressive therapy, Early Treatment Diabetic Retinopathy Study(ETDRS) best-corrected visual acuity(BCVA), central macular thickness(CMT) on optical coherence tomography(OCT) and signs of intraocular inflammation at baseline and then at 2wk postoperatively and monthly thereafter. Follow-up is up to 10 mo. Any per-operative and post-operative complications were recorded.·RESULTS: Six eyes of 4 patients with CME due to non-infectious posterior uveitis treated with dexamethasone implant. Diagnosis included idiopathic panuveitis, birdshot chorioretinopathy and idiopathic intermediate uveitis. At baseline mean ETDRS BCVA was63 letters and mean CMT 556 μm at 2wk postoperatively mean ETDRS BCVA improved to 70 letters and mean CMT decreased to 329 μm. All eyes showed clinical evidence of decreased inflammation. The duration of effect of the implant was 5 to 6mo and retreatment was required in 2 eyes. Two patients required antiglaucoma therapy for increased intraocular pressures.·CONCLUSION: In patients with non-infectious posterior uveitis dexamethasone implant can be a short-term effective treatment option for controlling intraocular inflammation.展开更多
基金Supported by the University of Sydney,Sydney,Australia
文摘AIM： To evaluate the relative efficacy and safety of aflibercept for treatment of diabetic macular oedema （DMO）. METHODS： A comprehensive search in MEDLINE, CENTRAL and EMBASE was undertaken for randomized controlled trials （RCTs） comparing intravitreal anti-vascular endothelial growth factor （anti-VEGF） versus another treatment. Primary outcome measures were proportion of patients with at least 15 letters of gain or loss on a logMAR visual acuity chart, and change in best corrected visual acuity （BCVA） and central macular thickness （CMT） from baseline. Safety outcomes were rates of death, thromboembolic events and any systemic or ocular serious adverse events. The final search was performed on November 2017. RESULTS： Four RCTs were included. Only one trial compared efficacy and safety of aflibercept with bevacizumab and ranibizumab over 1 or 2y. Three trials were included for Meta-analysis comprising 661 patients （331 in the aflibercept, and 330 in the photocoagulation group）. Aflibercept was more efficacious compared to photocoagulation in the proportion of patients with at least 15 letters of improvement and worsening, and in improvement of BCVA and reduction in CMT at 1 or 2y. The safety estimates at 1 or 2y did not differ statistically. CONCLUSION： Aflibercept offers superior benefits over photocoagulation in improving and preserving vision, with no differences in safety. Further comparative effectiveness trials between aflibercept and other anti-VEGF agents will aid ophthalmologists in treatment decisions.
文摘Throughout the years,people with diabetic macular oedema(DMO)have seen the number of options for their treatment increasing.Laser photocoagulation was the first of these and great experience is behind it;intraocular steroids followed and more recently anti-vascular endothelial growth factor(anti-VEGF)agents came to light.Ophthalmologists face now the dilemma of determining which may be the best therapeutic strategy for each particular patient based on best available evidence.This article summarises data available from randomised clinical trials(RCTs)on treatments for DMO and provides some facts about this condition and its treatments that need to be taken into consideration when treatment decisions are made.
文摘The macula is an imperative part present in our human visual system which is most responsible for clear and colour vision. For the people suffering from diabetes, the various parts of the body including the retina of the eye are affected. These retinal damages cause swelling and other abnormalities nearby macula. The pathologies in macula due to diabetes are called Diabetic Macular oEdema (DME). It affects patients’ vision that may lead to vision loss. It can be overcome by advance identification of causes for swelling. The major causes for the swelling are neovascularization and other abnormalities occurring in the blood vessels nearby the macula. The aim of this work is to avoid vision loss by detecting the presence of abnormalities in macula in advance. The pathologies present in the abnormal images are detected by image segmentation technique viz. Fuzzy K-means algorithm. The classification is done by two different classifiers namely Cascade Neural Network and Partial Least Square which are employed to identify whether the image is normal or abnormal. The results of both the classifiers are compared with respect to classifier accuracy, sensitivity and specificity. The classifier accuracies of Cascade Neural Network and Partial Least Square are 96.84% and 94.36%, respectively. The information about the severity of the disease and the localization of pathologies are very useful to the ophthalmologist for diagnosing the disease and apply proper treatments to the patients to avoid the formation of any lesion and prevent vision loss.
文摘This work comprehensively reviews the latest treatment options for diabetic macular edema(DME) used in its management and presents further work on the topic.Diabetic retinopathy is an important and increasingly prevalent cause of preventable blindness worldwide. To meet this increasing burden there has recently been a proliferation of pharmacological therapies being used in clinical practice. A variety of medical treatment options now exist for DME. These include non-steroidal antiinflammatory drugs such as nepafenac, as well as intravitreal steroids like triamcinolone(kenalog). Longterm results up to 7 years after commencing treatment are presented for triamcinolone. Studies are reviewed on the use of dexamethasone(ozurdex) and fluocinolone(Retisert and Iluvien implants) including the FAME studies. A variety of anti-vascular endothelial growth factor(anti-VEGF) agents used in DME are considered in detail including ranibizumab(lucentis) and the RESTORE, RIDE, RISE and Diabetic Retinopathy Clinical Research Network(DRCR.net) studies. Bevacizumab(avastin) and pegaptinib(macugen) are also considered. The use of aflibercept(eylea) is reviewed including the significance of the DA VINCI, VISTA-DME, VIVIDDME and the DRCR.net studies which have recently suggested potentially greater efficacy when treating DME for aflibercept in patients with more severely reduced visual acuity at baseline. Evidence for the antiVEGF agent bevasiranib is also considered. Studies of anti-tumour necrosis factor agents like infliximab are reviewed. So are studies of other agents targeting inflammation including minocycline, rapamycin(sirolimus) and protein kinase C inhibitors such as midostaurin and ruboxistaurin. The protein kinase C β inhibitor Diabetic Macular Edema Study is considered. Other agents which have been suggested for DME are discussed including cyclo-oxygenase-2 inhibitors like celecoxib, phospholipase A2 inhibitors, recombinant erythropoietin, and monoclonal anti-interleukin antibodies such as canakinumab. The management of DME in a variety of clinical scenarios is also discussed- in newly diagnosed DME, refractory DME including after macular laser, and postoperatively after intraocular surgery. Results of long-term intravitreal triamcinolone for DME administered up to seven years after commencing treatment are considered in the context of the niche roles available for such agents in modern management of DME. This is alongside more widely used treatments available to the practitioner such as anti-VEGF agents like aflibercept(Eylea) and ranibizumab(Lucentis) which at present are the mainstay of pharmacological treatment of DME.
文摘· AIM: To evaluate the safety and efficacy of dexamethasone implant in patients with non-infectious posterior uveitis with cystoid macular edema(CME).·METHODS: Retrospective analysis of patients reports with CME secondary to non-infectious uveitis treated with dexamethasone implant. Data included type of posterior uveitis, any systemic immunosuppressive therapy, Early Treatment Diabetic Retinopathy Study(ETDRS) best-corrected visual acuity(BCVA), central macular thickness(CMT) on optical coherence tomography(OCT) and signs of intraocular inflammation at baseline and then at 2wk postoperatively and monthly thereafter. Follow-up is up to 10 mo. Any per-operative and post-operative complications were recorded.·RESULTS: Six eyes of 4 patients with CME due to non-infectious posterior uveitis treated with dexamethasone implant. Diagnosis included idiopathic panuveitis, birdshot chorioretinopathy and idiopathic intermediate uveitis. At baseline mean ETDRS BCVA was63 letters and mean CMT 556 μm at 2wk postoperatively mean ETDRS BCVA improved to 70 letters and mean CMT decreased to 329 μm. All eyes showed clinical evidence of decreased inflammation. The duration of effect of the implant was 5 to 6mo and retreatment was required in 2 eyes. Two patients required antiglaucoma therapy for increased intraocular pressures.·CONCLUSION: In patients with non-infectious posterior uveitis dexamethasone implant can be a short-term effective treatment option for controlling intraocular inflammation.
