Aflibercept for diabetic macular oedema： a Meta-analysis of randomized controlled trials

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.

Treatment for diabetic macular oedema:looking further into the evidence

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.

Assessment of Severity Level for Diabetic Macular Oedema Using Machine Learning Algorithms

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.