تقاطع شریعتی و بزرگراه همت، خیابان گل نبی غربی، پلاک 3

The Journal of Retina

THE EFFECT OF AGE ON AFLIBERCEPT (EYLEA) RESPONSE IN DIABETIC MACULAR EDEMA

Ozsaygili, Cemal; Duru, Zeynep; Cicek, Ayse ; Ulusoy, Dondu Melek

Purpose: 

To investigate the effect of age on aflibercept (Eylea) response in macular edema secondary to treatment-naive diabetic eyes.

Methods: 

Two hundred seventy-three eyes of 273 treatment-naive patients with macular edema secondary to diabetes mellitus were enrolled in this study. The patients in the study were divided into the following 4 groups according to their ages: Group 1 (40–۵۰ years), Group 2 (51–۶۰ years), Group 3 (61–۷۰ years), and Group 4 (>70 years). Three consecutive injections at intervals of 1 month were applied to all diabetic patients. The efficacy of the aflibercept treatment on macular edema according to age groups was assessed by optical coherence tomography by comparing the central foveal thickness (CFT) values and mean visual acuity changes after initial and three loading dose injections.

Results: 

After three consecutive aflibercept injections, the mean reduction of CFT in Groups 1, 2, 3, and 4 were −۲۵۶.۴ ± ۱۱۰.۹, −۱۹۷.۴ ± ۹۶.۴, −۱۸۹.۴ ± ۱۱۰.۸, and −۱۸۶.۲ ± ۱۱۸.۹ µm, respectively. The changes of CFT was significantly different between age groups (P = ۰.۰۰۳, analysis of covariance). The improvement of visual acuity was significantly different in each group (P < 0.001 in all groups, paired-samples t-test), and changes of visual acuity was significantly different between age groups (P < 0.05, analysis of covariance). In addition, ages of patients were correlated with the mean reduction of CFT and mean improvement of visual acuity for the whole study group (r = −۰.۱۸۳, P = ۰.۰۰۲ for CFT; r = −۰.۶۸۲, P < 0.001 for visual acuity, Pearson correlation).

Conclusion: 

In this study, it was observed that the efficacy of aflibercept treatment was found to be more effective in younger patients in treatment-naive diabetic macular edema patients.

COMPARISON OF INTRAVITREAL DEXAMETHASONE IMPLANT AND AFLIBERCEPT IN PATIENTS WITH TREATMENT-NAIVE DIABETIC MACULAR EDEMA WITH SEROUS RETINAL DETACHMENT

Ozsaygili, Cemal ; Duru, Necati

Purpose: 

To compare the efficacy and safety of intravitreal dexamethasone (DEX) implant versus aflibercept in patients with treatment-naive diabetic macular edema with inflammatory biomarkers.

Methods: 

Ninety-eight eyes of 62 treatment-naive patients with diabetic macular edema with serous retinal detachment and hyperreflective foci were enrolled. Each patient was randomized to receive either aflibercept or DEX implant treatment. The treatment protocol included 3 monthly injections of 2 mg of aflibercept as a loading phase in the anti–vascular endothelial growth factor group and 0.7 mg of DEX implant in the DEX group and then pro re nata treatment. Primary outcome measures were mean changes in visual acuity and central retinal thickness at the end of the 12-month follow-up.

Results: 

Forty-eight eyes of 29 patients were received DEX implant, and 50 eyes of 33 patients received the aflibercept injection. Mean central retinal thickness decreased from 615.2 µm at baseline to 297.7 µm at 12 months in the DEX group (P < 0.001) and from 576.5 µm to 367.4 µm in the aflibercept group (P < 0.001). Except for the first month, mean central retinal thickness reduction was significantly higher in the DEX group (P < 0.05, Mann–Whitney U Test). Visual acuity improved significantly at the end of the follow-ups (46.3–۵۲.۷ Early Treatment Diabetic Retinopathy Study letters in the DEX group and 47.5–۵۶.۸ Early Treatment Diabetic Retinopathy Study letters in the aflibercept group at 12 months, P < 0.001, paired-sample t-test). Adjusting by baseline values, the increase in mean visual acuity during the 12-month follow-ups favored the aflibercept group (P < 0.01), 25% of the DEX-treated eyes and 42% of the aflibercept treated eyes experienced 10 or more Early Treatment Diabetic Retinopathy Study letters visual gain (P: 0.058). The DEX group received significantly fewer (2.6 vs. 7.2) injections (P: 0.001).

Conclusion: 

It was observed that the both of DEX implant and aflibercept were effective and safe in treatment-naive diabetic macular edema patients with inflammatory phenotype. Anatomical results were found to be better in the DEX group, and functional results were found to be better in the aflibercept group. In pseudophakic eyes, the functional superiority of aflibercept ceased to exist, and the low number of injections in the DEX implant group was seen as an advantage.

RAPID MACULAR CAPILLARY LOSS IN PATIENTS WITH UNCONTROLLED TYPE 1 DIABETES

Lavia, Carlo; Feldman-Billard, Sylvie; Erginay, Ali

Purpose: 

To analyze the evolution of macular vessel density (VD) over 1 year, during early worsening of diabetic retinopathy, in patients with uncontrolled Type 1 diabetes (T1D).

Methods: 

Retrospective study of 12 eyes of 9 patients with T1D with early worsening of diabetic retinopathy imaged with optical coherence tomography angiography. The following data were collected at the time of pan retinal photocoagulation initiation and after 6 and 12 months: vessel density within three retinal plexuses—superficial vascular plexus, intermediate capillary plexus, and deep capillary plexus; foveal avascular zone area, acircularity index, and flow density (FD)-300; central macular thickness; and HbA1c levels.

Results: 

A history of rapid reduction in blood glucose was found in seven of nine cases. Vessel density was significantly decreased at 12 months in all plexuses: from 44.68 ± ۴.۷۵ to 40.23 ± ۷.۱۳ in the superficial vascular plexus (P = ۰.۰۰۸), from 42.72 ± ۴.۸۶ to 37.12 ± ۸.۶۴ in the intermediate capillary plexus (P = ۰.۰۳), and from 22.68 ± ۳.۹۳ to 19.66 ± ۴.۹۲ in the deep capillary plexus (P = ۰.۰۰۴). Intermediate capillary plexus and deep capillary plexus changes were strongly correlated (r = 0.86, P < 0.001) and were significant as early as 6 months. The mean foveal avascular zone area increased (P = ۰.۰۵) and the FD-300 decreased (P = ۰.۰۳). No significant change in acircularity index, central macular thickness, and visual acuity were observed over time.

Conclusion: 

Early worsening of diabetic retinopathy induces a rapid macular capillary dropout mainly affecting the intermediate capillary plexus and deep capillary plexus.

PROPHYLACTIC LASER TREATMENT TO DECREASE THE INCIDENCE OF RETINAL DETACHMENT IN FELLOW EYES OF IDIOPATHIC GIANT RETINAL TEARS

Verhoekx, Jennifer S. N; van Etten, Peter G; Wubbels, Rene J

Purpose: 

To evaluate the effectiveness of prophylactic 360° laser treatment in the fellow eye of patients with unilateral idiopathic giant retinal tear (GRT) to prevent the occurrence of a (macula-off) retinal detachment.

Methods: 

We conducted a retrospective, nonrandomized case–control study. Clinical data of consecutive patients, undergoing surgery for idiopathic GRT, between 2003 and 2015 were analyzed. The data collected included GRT, retinal detachment, and RTs in the fellow eye.

Results: 

We included 129 patients who underwent surgery for an idiopathic GRT, with a mean follow-up period of 107 months. In the observation group, a retinal detachment developed in the fellow eye in 22/51 patients (43.1%), leading to a macula-off detachment in 9/51 patients (17.6%). By contrast, in the prophylactic 360° laser group, only 10/78 (12.8%) patients developed a retinal detachment, leading to a macula-off detachment in 1/78 patient (1.3%). This difference was statistically significant.

Conclusion: 

This study suggests that prophylactic 360° laser treatment in the fellow eye of patients with an idiopathic GRT decreased the incidence of retinal detachment, lowering the high risk of visual loss due to a macula-off retinal detachment.

PERIPHERAL ISCHEMIC RETINAL PHOTOCOAGULATION IN ADDITION TO INTRAVITREAL BEVACIZUMAB VERSUS INTRAVITREAL BEVACIZUMAB ALONE FOR THE TREATMENT OF MACULAR EDEMA SECONDARY TO CENTRAL RETINAL VEIN OCCLUSION A Randomized Double-Masked Controlled Clinical Trial

Nourinia, Ramin ; Emamverdi, Mehdi ; Ramezani, Alireza.

Purpose: 

To investigate the effects of peripheral ischemic retinal photocoagulation in addition to intravitreal bevacizumab (IVB) in the treatment of macular edema due to ischemic central retinal vein occlusion.

Methods: 

Forty-eight eyes of 48 treatment-naive patients were randomly selected and divided into 2 groups. Group A comprised 24 eyes that were treated with three consecutive monthly injections of IVB, and Group B comprised 24 eyes that were treated with IVB plus photocoagulation of the peripheral nonperfused retina. Further IVB injections were administered as needed in both groups. Monthly follow-up was conducted for 9 months after the first injection.

Results: 

The data of 46 patients were analyzed. Best-corrected visual acuity changes from the fourth to eighth month follow-up in comparison with the baseline were significantly higher in Group B (P = ۰.۰۰۲–۰.۰۴۴—۰.۰۰۲–۰.۰۰۲—۰.۰۱۲). In addition, significant differences were observed in central macular thickness in Group B throughout the study period (all P < 0.001). Group B required less frequent IVB injections during the 9-month study period.

Conclusion: 

Photocoagulation of the retinal nonperfused area in patients with macular edema because of central retinal vein occlusion might amplify the beneficial effects of IVB on best-corrected visual acuity and central macular thickness and reduce the frequency of IVB injection.

ACUTE RETINAL ISCHEMIA IN CENTRAL VERSUS BRANCH RETINAL ARTERY OCCLUSION Changes in Retinal Layers’ Thickness on Spectral-Domain Optical Coherence Tomography in Different Grades of Retinal Ischemia

Matthé, Egbert ; Eulitz, Peggy ; Furashova, Olga

Purpose: 

To compare changes in thickness of separate retinal layers between acute central and branch retinal artery occlusion (RAO) regarding the severity grade of retinal ischemia using spectral-domain optical coherence tomography.

Methods: 

Design: retrospective, observational case–control series. Setting: institutional. Patients: ۱۱۴ patients with acute RAO. Examinations were conducted with spectral-domain optical coherence tomography at the first visit (baseline). Observations: RAO was categorized as branch (43 patients) or central RAO (71 patients) clinically. Retinal artery occlusion was categorized into the 3 grades “incomplete,” “subtotal,” and “total,” based on optical coherence tomography findings. Thickness of several retinal layers was evaluated on spectral-domain optical coherence tomography images. Obtained data were compared between the 3 grades and between central and branch RAO. The contralateral eyes were used as controls. Main outcome measures: thickness of selected retinal layers.

Results: 

Thickness of selected inner retinal layers and central foveal thickness increased statistically significant according to the severity grade (healthy = incomplete < subtotal < total). In each severity grade, there was no significant difference in retinal layers’ thickness between branch and central RAO, except for central foveal thickness.

Conclusion: 

Thickness increase of selected retinal layers follows—except for central foveal thickness—the same pattern in central and branch RAO. Retinal layers’ thickness increases significantly with the higher ischemia grade in both central and branch RAO.

EARLY VITAMIN A SUPPLEMENTATION IMPROVES THE OUTCOME OF RETINOPATHY OF PREMATURITY IN EXTREMELY PRETERM INFANTS

Sun, Huiqing ; Cheng, Rui ; Wang, Zhansheng

Purpose: 

This study assessed the efficacy and safety of early vitamin A (VA) supplementation to improve outcomes of retinopathy of prematurity in extremely preterm infants.

Methods: 

A total of 262 eligible extremely preterm infants underwent randomization; of these, 132 were assigned to the VA group and 130 to the control group. The infants were administered a solution of VA (1,500 IU/day), added to their enteral feeds as soon as minimal feeding was introduced and continued for 28 days or until discharge.

Results: 

With no adverse effects occurring, serum VA of the VA-supplemented infants on Days 14, 28, and postmenstrual 36 weeks was higher than that of the placebo group (P < 0.001). No signs of VA toxicity or increased intracranial pressure were reported. The VA group had lower unadjusted rates of Type 1 retinopathy of prematurity (۱.۶ vs. 6.9%, P = ۰.۰۳۰) and bronchopulmonary dysplasia (18.9 vs. 33.8%, P = ۰.۰۰۸) than the control group. Regression analysis revealed an association between serum VA levels and risk of Type 1 retinopathy of prematurity (beta = −۲.۳۷).

Conclusion: 

Vitamin A supplementation reduced VA deficiency in extremely preterm infants; it was associated with a decreased incidence of Type 1 retinopathy of prematurity and may also have a positive impact on reducing bronchopulmonary dysplasia.

TAMOXIFEN-INDUCED CHORIORETINAL CHANGES an Optical Coherence Tomography and Optical Coherence Tomography Angiography Study

Crisóstomo, Sara ; Vieira, Luísa ; Cardigos, Joana

Purpose: 

To study structural chorioretinal changes in tamoxifen-treated patients.

Methods: 

Cross-sectional case–control study comparing structural chorioretinal aspects in tamoxifen-treated patients and healthy controls. Enhanced depth spectral domain optic coherence tomography with choroidal binarization and optic coherence tomography angiography were performed. Individual retinal layer thickness and chorioretinal vascular components were compared. Subgroup analysis regarding history of chemotherapy was performed.

Results: 

Two hundred eyes of 100 TAM-treated patients (Group 1) and 80 eyes of 40 healthy controls (Group 2) were included. Of the 200 spectral domain optic coherence tomography scans from patients, 2 showed structural changes attributable to tamoxifen. Group 1 showed significantly lower values in choroidal parameters and in total retinal, ganglion cell layer, inner plexiform layer, outer nuclear layer, and retinal pigment epithelial thicknesses as well as an increased thickness in the outer plexiform layer. The subgroup not submitted to chemotherapy maintained significant reductions in total retinal thickness, ganglion cell layer, retinal pigment epithelium, outer nuclear layer, outer retinal layer, choroidal parameters, as well as an increased thickness in the outer plexiform layer, in comparison with Group 2.

Conclusion: 

Subclinical structural retinal changes could indicate early retinal pigment epithelial and photoreceptor damage. The new finding of choroidal thinning could point toward another important pathophysiologic process in tamoxifen-induced toxicity