المؤلفون: Lupidi M; Department of Surgical and Biomedical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, 06156, Perugia, Italy. marcomed2@gmail.com.; Fondazione per la Macula Onlus, Di.N.O.G.Mi., University Eye Clinic, Viale Benedetto XV 5, 16132, Genoa, Italy. marcomed2@gmail.com.; Centre de l'Odéon, 113 Boulevard St Germain, 75006, Paris, France. marcomed2@gmail.com., Cerquaglia A; Department of Surgical and Biomedical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, 06156, Perugia, Italy., Gujar R; Department of Surgical and Biomedical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, 06156, Perugia, Italy., Fruttini D; Department of Internal Medicine, University of Perugia, S. Maria della Misericordia Hospital, 06156, Perugia, Italy., Cardillo Piccolino F; Fondazione per la Macula Onlus, Di.N.O.G.Mi., University Eye Clinic, Viale Benedetto XV 5, 16132, Genoa, Italy., Fiore T; Department of Surgical and Biomedical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, 06156, Perugia, Italy., Coscas F; Centre de l'Odéon, 113 Boulevard St Germain, 75006, Paris, France., Coscas G; Centre de l'Odéon, 113 Boulevard St Germain, 75006, Paris, France., Chhablani J; Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA., Cagini C; Department of Surgical and Biomedical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, 06156, Perugia, Italy.

المصدر: Acta diabetologica [Acta Diabetol] 2020 Aug; Vol. 57 (8), pp. 983-990. Date of Electronic Publication: 2020 Mar 23.

نوع المنشور: Journal Article; Observational Study

بيانات الدورية: Publisher: Springer Verlag Country of Publication: Germany NLM ID: 9200299 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-5233 (Electronic) Linking ISSN: 09405429 NLM ISO Abbreviation: Acta Diabetol Subsets: MEDLINE

مواضيع طبية MeSH: Choroid/*blood supply , Diabetic Retinopathy/*pathology , Retinal Vessels/*pathology, Aged ; Case-Control Studies ; Choroid/diagnostic imaging ; Choroid/pathology ; Diabetes Mellitus/diagnosis ; Diabetes Mellitus/pathology ; Diabetes Mellitus/physiopathology ; Diabetic Retinopathy/diagnosis ; Disease Progression ; Female ; Fluorescein Angiography/methods ; Humans ; Male ; Microvessels/diagnostic imaging ; Microvessels/pathology ; Middle Aged ; Retina/diagnostic imaging ; Retina/pathology ; Retinal Vessels/diagnostic imaging ; Retrospective Studies ; Severity of Illness Index ; Tomography, Optical Coherence/methods

مستخلص: Aims: To perform an automated functional assessment of retinal and choroidal microvasculature in eyes with low-grade diabetic retinopathy (DR) using optical coherence tomography angiography (OCT-A) and to identify potential perfusion changes in case of early vascular damage.
Methods: This is an observational, case-control study of consecutive diabetic patients with level 20 DR severity scale score and age-matched healthy subjects. A prototypal OCT-angiography was used to obtain the OCT-angiograms of the superficial capillary plexus (SCP), deep capillary plexus (DCP) and choriocapillaris (CC) layer. A validated automated microstructural analysis provided data on SCP, DCP and CC vascular perfusion density (VPD). A comparative assessment between different vascular layers and different groups was performed.
Results: Twenty-nine diabetic patients (7 females, 24%) and 20 healthy controls were enrolled. VPD values were significantly lower in the DCP (25.1% vs. 26.5%; p = 0.04) and CC (71.2% vs. 86.6%; p = 0.0001) of diabetic patients compared with controls. A statistically significant negative linear correlation was reported between CC VPD and DCP VPD in diabetic patients; at the reverse, a positive linear correlation between the same parameters was noticed in controls.
Conclusion: Retinal and choroidal vascular networks, although distinct entities, seem functionally interconnected: varying the degree of perfusion may be a mutual compensatory mechanism in response to an ischemic injury.

المؤلفون: Busch C; Department of Ophthalmology, University Hospital Leipzig, Liebigstr. 10-14, 04103, Leipzig, Germany. busch.catharina@gmail.com., Fraser-Bell S; Department of Ophthalmology, Sydney University, Sydney, Australia., Iglicki M; Private Retina Service, University of Buenos Aires, Buenos Aires, Argentina., Lupidi M; Department of Biomedical and Surgical Sciences, Section of Ophthalmology, University of Perugia, Perugia, Italy., Couturier A; Department of Ophthalmology, Hôpital Lariboisière, AP-HP, Université Paris, 7 - Sorbonne Paris Cité, Paris, France., Chaikitmongkol V; Retina Division, Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand., Giancipoli E; Department of Surgical, Microsurgical and Medical Sciences, Eye Clinic, University of Sassari, Sassari, Italy.; Department of Biomedical Sciences, University of Sassari, Sassari, Italy., Rodríguez-Valdés PJ; Instituto de Oftalmología y Ciencias Visuales, Escuela de Medicina, Tecnológico de Monterrey, Monterrey, Mexico., Gabrielle PH; Department of Ophthalmology, Dijon University Hospital, Dijon, France.; UMR1324, INRA, Center for Taste and Feeding Behaviour, Dijon, France., Laíns I; Faculty of Medicine, University of Coimbra, Coimbra, Portugal.; Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal.; Massachusetts Eye and Ear, Harvard Medical School, Boston, USA., Santos AR; Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal.; School of Allied Health Technologies, Polytechnic Institute of Porto, Porto, Portugal., Cebeci Z; Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey., Amphornphruet A; Department of Ophthalmology, Faculty of Medicine, Rajavithi Hospital, Rangsit University, Bangkok, Thailand., Degenhardt V; Department of Ophthalmology, University Hospital Leipzig, Liebigstr. 10-14, 04103, Leipzig, Germany.; Department of Ophthalmology, University Hospital Heidelberg, Heidelberg, Germany., Unterlauft JD; Department of Ophthalmology, University Hospital Leipzig, Liebigstr. 10-14, 04103, Leipzig, Germany., Cagini C; Department of Biomedical and Surgical Sciences, Section of Ophthalmology, University of Perugia, Perugia, Italy., Mané-Tauty V; Department of Ophthalmology, Hôpital Lariboisière, AP-HP, Université Paris, 7 - Sorbonne Paris Cité, Paris, France., D'Amico Ricci G; Department of Surgical, Microsurgical and Medical Sciences, Eye Clinic, University of Sassari, Sassari, Italy.; Department of Biomedical Sciences, University of Sassari, Sassari, Italy., Hindi I; Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel., Agrawal K; Jupiter Hospital, Thane, India., Chhablani J; UPMC Eye Center, University of Pittsburgh, Pittsburgh, USA.; L.V. Prasad Eye Institute, Banjara Hills, Hyderabad, India., Loewenstein A; Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.; Incumbent, Sydney A. Fox Chair in Ophthalmology, Tel Aviv University, Tel Aviv, Israel., Zur D; Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel., Rehak M; Department of Ophthalmology, University Hospital Leipzig, Liebigstr. 10-14, 04103, Leipzig, Germany.

مؤلفون مشاركون: International Retina Group

المصدر: Acta diabetologica [Acta Diabetol] 2019 Dec; Vol. 56 (12), pp. 1341-1350. Date of Electronic Publication: 2019 Sep 21.

نوع المنشور: Journal Article; Multicenter Study

بيانات الدورية: Publisher: Springer Verlag Country of Publication: Germany NLM ID: 9200299 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-5233 (Electronic) Linking ISSN: 09405429 NLM ISO Abbreviation: Acta Diabetol Subsets: MEDLINE

مواضيع طبية MeSH: Angiogenesis Inhibitors/*administration & dosage , Dexamethasone/*administration & dosage , Diabetic Retinopathy/*drug therapy , Macular Edema/*drug therapy , Vascular Endothelial Growth Factor A/*antagonists & inhibitors, Aged ; Bevacizumab/administration & dosage ; Diabetic Retinopathy/epidemiology ; Drug Administration Schedule ; Drug Implants ; Drug Resistance/drug effects ; Drug Substitution ; Female ; Humans ; Intravitreal Injections ; Macular Edema/epidemiology ; Male ; Middle Aged ; Retrospective Studies ; Time Factors ; Treatment Outcome ; Vascular Endothelial Growth Factor A/immunology ; Visual Acuity/drug effects

مستخلص: Aims: To provide 2-year follow-up data on eyes with diabetic macular edema (DME) that were non-responsive after three initial anti-vascular endothelial growth factor (VEGF) injections, comparing functional and anatomical outcomes under continued anti-VEGF therapy versus dexamethasone (DEX) implant.
Methods: Multicenter, retrospective chart review comparing eyes with treatment-naïve DME and a suboptimal response to a loading phase of anti-VEGF therapy (3 injections given monthly) which were then treated with (a) further anti-VEGF (n = 72) or (b) initially switched to DEX implant (n = 38). Main outcome measures were change in visual acuity (VA) and central subfield thickness (CST) from the end of the loading phase to 24 months.
Results: In 79% of the 12-month study population (87/110 eyes), 24-month data were available. One quarter of eyes in each group switched treatments during the second year. Eyes that were switched early to DEX implant maintained the functional and anatomical improvements at 24 months which were seen in the first year (from month 3: + 8.9 letters, - 214 µm). Eyes that were switched from anti-VEGF therapy to steroids in the second year improved VA and reduced CST at 24 months (from month 12: + 6.8 letters, p = 0.023; - 226 µm, p = 0.004). In eyes continued on anti-VEGF therapy, VA and CST were stable at 24 months (from month 3: + 2.8 letters, p = 0.254; - 24 µm, p = 0.243). Eyes that were non-responsive to anti-VEGF therapy for 12 months had similar chances to experience a VA gain from further therapy as eyes that were non-responsive for 3 months only (23.8 vs. 31.0%, p = 0.344).
Conclusions: The beneficial effect of an early switch to DEX implant in DME non-responders seen at month 12 was maintained during the second year. A later switch from anti-VEGF to steroids still provided significant improvement. Eyes continued on anti-VEGF over a period of 24 months maintained vision. A quarter of eyes, which had not improved vision at 12 months, exhibited a delayed response to treatment.

المؤلفون: Busch C; Department of Ophthalmology, University Hospital Leipzig, Liebigstr. 10-14, 04103, Leipzig, Germany. busch.catharina@gmail.com., Zur D; Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel., Fraser-Bell S; Department of Ophthalmology, Sydney University, Sydney, Australia., Laíns I; Faculty of Medicine, University of Coimbra, Coimbra, Portugal.; Association for Innovation and Biomedical Research on Light, Coimbra, Portugal.; Massachusetts Eye and Ear, Harvard Medical School, Boston, USA., Santos AR; Association for Innovation and Biomedical Research on Light, Coimbra, Portugal.; School of Allied Health Technologies, Polytechnic Institute of Porto, Porto, Portugal., Lupidi M; Section of Ophthalmology, Department of Biomedical and Surgical Sciences, University of Perugia, Perugia, Italy., Cagini C; Section of Ophthalmology, Department of Biomedical and Surgical Sciences, University of Perugia, Perugia, Italy., Gabrielle PH; Ophthalmology Department, Dijon University Hospital, Dijon, France.; Center for Taste and Feeding Behaviour, INRA, UMR1324, Dijon, France., Couturier A; Department of Ophthalmology, Hôpital Lariboisière, AP-HP, Université Paris 7, Sorbonne Paris Cité, Paris, France., Mané-Tauty V; Department of Ophthalmology, Hôpital Lariboisière, AP-HP, Université Paris 7, Sorbonne Paris Cité, Paris, France., Giancipoli E; Department of Surgical, Microsurgical and Medical Sciences, Eye Clinic, University of Sassari, Sassari, Italy.; Department of Biomedical Sciences, University of Sassari, Sassari, Italy., Ricci GD; Department of Surgical, Microsurgical and Medical Sciences, Eye Clinic, University of Sassari, Sassari, Italy.; Department of Biomedical Sciences, University of Sassari, Sassari, Italy., Cebeci Z; Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey., Rodríguez-Valdés PJ; Instituto de Oftalmología y Ciencias Visuales, Escuela de Medicina, Tecnológico de Monterrey, Monterrey, Mexico., Chaikitmongkol V; Retina Division, Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand., Amphornphruet A; Department of Ophthalmology, Faculty of Medicine, Rajavithi Hospital, Rangsit University, Bangkok, Thailand., Hindi I; Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel., Agrawal K; L.V. Prasad Eye Institute, Banjara Hills, Hyderabad, India., Chhablani J; L.V. Prasad Eye Institute, Banjara Hills, Hyderabad, India., Loewenstein A; Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.; Incumbent, Sydney A. Fox Chair in Ophthalmology, Tel Aviv University, Tel Aviv, Israel., Iglicki M; Private Retina Service, University of Buenos Aires, Buenos Aires, Argentina., Rehak M; Department of Ophthalmology, University Hospital Leipzig, Liebigstr. 10-14, 04103, Leipzig, Germany.

مؤلفون مشاركون: International Retina Group

المصدر: Acta diabetologica [Acta Diabetol] 2018 Aug; Vol. 55 (8), pp. 789-796. Date of Electronic Publication: 2018 May 05.

نوع المنشور: Journal Article; Multicenter Study

بيانات الدورية: Publisher: Springer Verlag Country of Publication: Germany NLM ID: 9200299 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-5233 (Electronic) Linking ISSN: 09405429 NLM ISO Abbreviation: Acta Diabetol Subsets: MEDLINE

مواضيع طبية MeSH: Drug Substitution*, Angiogenesis Inhibitors/*administration & dosage , Dexamethasone/*administration & dosage , Diabetic Retinopathy/*drug therapy , Macular Edema/*drug therapy , Vascular Endothelial Growth Factor A/*antagonists & inhibitors, Aged ; Case-Control Studies ; Drug Administration Schedule ; Drug Implants ; Drug Resistance/drug effects ; Female ; Glucocorticoids ; Humans ; Intravitreal Injections ; Male ; Middle Aged ; Retrospective Studies ; Treatment Failure ; Visual Acuity/drug effects

مستخلص: Aims: To compare functional and anatomical outcomes of continued anti-vascular endothelial growth factor (VEGF) therapy versus dexamethasone (DEX) implant in eyes with refractory diabetic macular edema (DME) after three initial anti-VEGF injections in a real-world setting.
Methods: To be included in this retrospective multicenter, case-control study, eyes were required: (1) to present with early refractory DME, as defined by visual acuity (VA) gain ≤ 5 letters or reduction in central subfield thickness (CST) ≤ 20%, after a loading phase of anti-VEGF therapy (three monthly injections) and (2) to treat further with (a) anti-VEGF therapy or (b) DEX implant. Main outcome measures were change in visual acuity (VA) and central subfield thickness (CST) at 12 months. Due to imbalanced baseline characteristics, a matched anti-VEGF group was formed by only keeping eyes with similar baseline characteristics as those in the DEX group.
Results: A total of 110 eyes from 105 patients were included (anti-VEGF group: 72 eyes, DEX group: 38 eyes). Mean change in VA at 12 months was - 0.4 ± 10.8 letters (anti-VEGF group), and + 6.1 ± 10.6 letters (DEX group) (P = 0.004). Over the same period, mean change in CST was + 18.3 ± 145.9 µm (anti-VEGF group) and - 92.8 ± 173.6 µm (DEX group) (P < 0.001). Eyes in the DEX group were more likely to gain ≥ 10 letters (OR 3.71, 95% CI 1.19-11.61, P = 0.024) at month 12.
Conclusions: In a real-world setting, eyes with DME considered refractory to anti-VEGF therapy after three monthly injections which were switched to DEX implant and had better visual and anatomical outcomes at 12 months than those that continued treatment with anti-VEGF therapy.