Diabetic retinopathy (DR) is a leading cause of vision loss in the working-age population and is relatedto 1%-5% of cases of blindness worldwide. Diabetic macular edema (DME) is the most frequent cause of DR vision lo...Diabetic retinopathy (DR) is a leading cause of vision loss in the working-age population and is relatedto 1%-5% of cases of blindness worldwide. Diabetic macular edema (DME) is the most frequent cause of DR vision loss and is an important public health problem. Recent studies have implicated vascular endothelial growth factor (VEGF) in DR and DME pathogenesis, as well as provided evidence of the benefits of anti-VEGF agents for the management of such conditions. Despite the benefits of intravitreal ranibizumab injection for the management of DME, the cost-effectiveness of intravitreal bevacizumab therapy has gained increasing interest in the scientific community. This review summarizes the studies examining bevacizumab for the management of DME, focusing on the efficacy and duration of the clinical benefits of decreasing DME and the improvement of best-corrected visual acuity (BCVA). There is strong evidence that intravitreal bevacizumab injection therapy has a good cost-effective profile in the management of DME and may be associated with laser photocoagulation; however, its clinical superiority in terms of the duration of DME regression and the improvement of BCVA compared with intravitreal ranibizumab and other intravitreal anti-VEGF therapies remains unclear and deserves further investigation.展开更多
AIM：To compare the effect of anti-vascular endothelial growth factor（VEGF） monotherapy versus photodynamic therapy（PDT） and anti-VEGF combination treatment in age-related macular degeneration（AMD）.METHODS：A co...AIM：To compare the effect of anti-vascular endothelial growth factor（VEGF） monotherapy versus photodynamic therapy（PDT） and anti-VEGF combination treatment in age-related macular degeneration（AMD）.METHODS：A computerized online search was performed using PubMed,Web of Science and the Cochrane Library.Studies that compared anti-VEGF monotherapy with PDT and anti-VEGF combination treatment of AMD and were designed as randomized controlled trials were included.The means and standard deviations of the best-corrected visual acuity（BCVA）,central retinal thickness（CRT）,number of treatments and proportions of patients who gained BCVA ≥15,10,5,or 0 letters at 12^（th） month were extracted.A systematic review and Meta-analysis of the comparison of the two approaches was conducted using Review Manager 5.2.Subgroup.A sensitivity analysis was also performed.RESULTS：Eight studies were included.When the subgroup and sensitivity analysis was conducted,the results indicated that in the findings that included the monotherapy group and PDT（standard fluence,SF）group of Kaiser＇s study,the patients in the monotherapy group had a better BCVA compared with the combination group at 12^（th） month in the PDT（SF） subgroup[weighted mean difference（WMD）：3.54;95% Cl：0.36 to 6.73;P=0.03],and there were more patients who gained ≥15 letters of BCVA in the monotherapy group compared with the combination group in the total result[odds ratio（OR）：1.41;95% Cl：1.02 to 1.95;P=0.04].The same conclusion was obtained in the total result that included the monotherapy group and PDT（reduced fluence,RF）group of Kaiser＇s study（OR：1.56;95% CI：1.13 to 2.15;P=0.007）.However,there were no significant differences in the other indexes between the two therapies.CONCLUSION：We found that anti-VEGF monotherapy is more effective on the recovery of visual acuity than combination therapy and more researches with lager sample size should be performed to study on the effect of the two therapy approaches on CRT and number of injections.展开更多
AIM： To report the real-life experience and clinical results of intravitreal ranibizumab injections to neovascular agerelated macular degeneration（nAMD） in a single institution in Turkey.METHODS： A total of 101 ey...AIM： To report the real-life experience and clinical results of intravitreal ranibizumab injections to neovascular agerelated macular degeneration（nAMD） in a single institution in Turkey.METHODS： A total of 101 eyes of 89 patients with nAMD treated with intravitreal ranibizumab injection, followed up for at least 24 mo between 2009 and June 2014, which were evaluated retrospectively. A pro re nata（PRN） treatment protocol was performed after the patients had received three, monthly loading injections. Best corrected visual acuity（BCVA） and central macular thickness measurements were evaluated at baseline and 3, 6, 12, 18, and 24 mo. Number of injections and visits were also recorded.RESULTS： Of the 89 patients, 34（38.2%） were male and 55（61.8%） were female and the mean age was 74.0±9.5（52-91）y. The mean follow-up period was 24.82±4.4（24-29）mo. Mean number of visits was 8.4±1.12（7-12） in the first year and 6.6±1.33（4-12） in the second year. The mean number of injections was 5.8±1.6（3-10） and 4.2±2.2（0-9） in the first and second year, respectively. The mean BCVA was 59±15.8 letters at baseline by the Early Treatment Diabetic Retinopathy Study（ETDRS） chart. The mean BCVA at 3, 12, and 24 mo was 70.3±15.9, 67.9±14.3 and 67.3±16.9 letters, respectively. Improvement in visual acuity for each of the visits from baseline was found to be statistically significant（P〈0.01）. Visual acuity in 9 eyes at month 3, 7 eyes at month 12, and 13 eyes at month 24 did not change. The mean central macular thickness（CMT） was 437.99±164.78 μm at baseline. The mean CMT was 348.05±138.47 μm, 349.27±139.79 μm, and 344.13±146.30 μm at months 3, 12, and 24, respectively. The decrease in CMT for each of the visits from baseline was found to be statistically significant（P〈0.01）.CONCLUSION： Anatomical and functional achievement are obtained in our study, but the mean number of injections and visits are found to be lower than the findings reported in randomized controlled clinical trials in the literature. However, the mean number of injections and visits in our study are compatible with the findings reported in real-life experience studies in the literature.展开更多
Objective:To evaluate short-term markers of outcome in diabetic macular edema(DME).Methods:Prospective interventional case series included 122 eyes of 122 patients with recently diagnosed DME.Eyes were treated with a ...Objective:To evaluate short-term markers of outcome in diabetic macular edema(DME).Methods:Prospective interventional case series included 122 eyes of 122 patients with recently diagnosed DME.Eyes were treated with a 3-monthly loading dose of ranibizumab or aflibercept and pro re nata thereafter.Serial enhanced deep imaging SD-OCT high resolution scans were used to measure subfoveal choroidal thickness(SFCT)and central retinal thickness(CRT).Anatomic(10%CRT decrease)and functional responses(best corrected visual acuity,BCVA gain≥5 letters)were assessed at 3 months and 6 months using univariate and multivariate analyses.Parameters tested were gender,duration of diabetes,HbA1c,hypertension,CRT,SFCT,BCVA,ellipsoid zone(EZ)status,subfoveal neuroretinal detachment(SND),anti-VEGF used and laser naivety.A logistic regression model was applied to find independent markers outcome.Results:BCVA increased,CRT and SFCT decreased at 3 months and 6 months.Good metabolic control(p=0.003),intact baseline EZ(p=0.030),EZ re-grading at 3 M(p<0.001)and laser naivety(p=0.001)were associated with better functional outcome.The multivariate linear regression model showed that baseline SND and CRT are predictors of anatomic response,while lower baseline BCVA and intact EZ are predictors of functional response.Conclusion:The presence of SND predicts anatomic response only,while an intact EZ is critical to achieve a good functional outcome in DME.展开更多
文摘Diabetic retinopathy (DR) is a leading cause of vision loss in the working-age population and is relatedto 1%-5% of cases of blindness worldwide. Diabetic macular edema (DME) is the most frequent cause of DR vision loss and is an important public health problem. Recent studies have implicated vascular endothelial growth factor (VEGF) in DR and DME pathogenesis, as well as provided evidence of the benefits of anti-VEGF agents for the management of such conditions. Despite the benefits of intravitreal ranibizumab injection for the management of DME, the cost-effectiveness of intravitreal bevacizumab therapy has gained increasing interest in the scientific community. This review summarizes the studies examining bevacizumab for the management of DME, focusing on the efficacy and duration of the clinical benefits of decreasing DME and the improvement of best-corrected visual acuity (BCVA). There is strong evidence that intravitreal bevacizumab injection therapy has a good cost-effective profile in the management of DME and may be associated with laser photocoagulation; however, its clinical superiority in terms of the duration of DME regression and the improvement of BCVA compared with intravitreal ranibizumab and other intravitreal anti-VEGF therapies remains unclear and deserves further investigation.
基金Supported by the National Natural Science Funds of China(No.81371040)Shanghai Pujiang Program(No.15PJD028)
文摘AIM：To compare the effect of anti-vascular endothelial growth factor（VEGF） monotherapy versus photodynamic therapy（PDT） and anti-VEGF combination treatment in age-related macular degeneration（AMD）.METHODS：A computerized online search was performed using PubMed,Web of Science and the Cochrane Library.Studies that compared anti-VEGF monotherapy with PDT and anti-VEGF combination treatment of AMD and were designed as randomized controlled trials were included.The means and standard deviations of the best-corrected visual acuity（BCVA）,central retinal thickness（CRT）,number of treatments and proportions of patients who gained BCVA ≥15,10,5,or 0 letters at 12^（th） month were extracted.A systematic review and Meta-analysis of the comparison of the two approaches was conducted using Review Manager 5.2.Subgroup.A sensitivity analysis was also performed.RESULTS：Eight studies were included.When the subgroup and sensitivity analysis was conducted,the results indicated that in the findings that included the monotherapy group and PDT（standard fluence,SF）group of Kaiser＇s study,the patients in the monotherapy group had a better BCVA compared with the combination group at 12^（th） month in the PDT（SF） subgroup[weighted mean difference（WMD）：3.54;95% Cl：0.36 to 6.73;P=0.03],and there were more patients who gained ≥15 letters of BCVA in the monotherapy group compared with the combination group in the total result[odds ratio（OR）：1.41;95% Cl：1.02 to 1.95;P=0.04].The same conclusion was obtained in the total result that included the monotherapy group and PDT（reduced fluence,RF）group of Kaiser＇s study（OR：1.56;95% CI：1.13 to 2.15;P=0.007）.However,there were no significant differences in the other indexes between the two therapies.CONCLUSION：We found that anti-VEGF monotherapy is more effective on the recovery of visual acuity than combination therapy and more researches with lager sample size should be performed to study on the effect of the two therapy approaches on CRT and number of injections.
文摘AIM： To report the real-life experience and clinical results of intravitreal ranibizumab injections to neovascular agerelated macular degeneration（nAMD） in a single institution in Turkey.METHODS： A total of 101 eyes of 89 patients with nAMD treated with intravitreal ranibizumab injection, followed up for at least 24 mo between 2009 and June 2014, which were evaluated retrospectively. A pro re nata（PRN） treatment protocol was performed after the patients had received three, monthly loading injections. Best corrected visual acuity（BCVA） and central macular thickness measurements were evaluated at baseline and 3, 6, 12, 18, and 24 mo. Number of injections and visits were also recorded.RESULTS： Of the 89 patients, 34（38.2%） were male and 55（61.8%） were female and the mean age was 74.0±9.5（52-91）y. The mean follow-up period was 24.82±4.4（24-29）mo. Mean number of visits was 8.4±1.12（7-12） in the first year and 6.6±1.33（4-12） in the second year. The mean number of injections was 5.8±1.6（3-10） and 4.2±2.2（0-9） in the first and second year, respectively. The mean BCVA was 59±15.8 letters at baseline by the Early Treatment Diabetic Retinopathy Study（ETDRS） chart. The mean BCVA at 3, 12, and 24 mo was 70.3±15.9, 67.9±14.3 and 67.3±16.9 letters, respectively. Improvement in visual acuity for each of the visits from baseline was found to be statistically significant（P〈0.01）. Visual acuity in 9 eyes at month 3, 7 eyes at month 12, and 13 eyes at month 24 did not change. The mean central macular thickness（CMT） was 437.99±164.78 μm at baseline. The mean CMT was 348.05±138.47 μm, 349.27±139.79 μm, and 344.13±146.30 μm at months 3, 12, and 24, respectively. The decrease in CMT for each of the visits from baseline was found to be statistically significant（P〈0.01）.CONCLUSION： Anatomical and functional achievement are obtained in our study, but the mean number of injections and visits are found to be lower than the findings reported in randomized controlled clinical trials in the literature. However, the mean number of injections and visits in our study are compatible with the findings reported in real-life experience studies in the literature.
基金Grant by the Portuguese Foundation for Science and Technology, StrategicProject (UID/NEU/04539/2013) and COMPETE-FEDER (POCI-01-0145-FEDER007440)EJC was financially supported by the FCT Postdoctoral FellowshipSFRH/BPD/93672/2013, through European Union and National funds and cofunded by Human Capital Operating Program (Programa Operacional do Capital Humano, POCH)JM was financially supported by an unrestricted grantfrom Novartis.
文摘Objective:To evaluate short-term markers of outcome in diabetic macular edema(DME).Methods:Prospective interventional case series included 122 eyes of 122 patients with recently diagnosed DME.Eyes were treated with a 3-monthly loading dose of ranibizumab or aflibercept and pro re nata thereafter.Serial enhanced deep imaging SD-OCT high resolution scans were used to measure subfoveal choroidal thickness(SFCT)and central retinal thickness(CRT).Anatomic(10%CRT decrease)and functional responses(best corrected visual acuity,BCVA gain≥5 letters)were assessed at 3 months and 6 months using univariate and multivariate analyses.Parameters tested were gender,duration of diabetes,HbA1c,hypertension,CRT,SFCT,BCVA,ellipsoid zone(EZ)status,subfoveal neuroretinal detachment(SND),anti-VEGF used and laser naivety.A logistic regression model was applied to find independent markers outcome.Results:BCVA increased,CRT and SFCT decreased at 3 months and 6 months.Good metabolic control(p=0.003),intact baseline EZ(p=0.030),EZ re-grading at 3 M(p<0.001)and laser naivety(p=0.001)were associated with better functional outcome.The multivariate linear regression model showed that baseline SND and CRT are predictors of anatomic response,while lower baseline BCVA and intact EZ are predictors of functional response.Conclusion:The presence of SND predicts anatomic response only,while an intact EZ is critical to achieve a good functional outcome in DME.
