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      Visual and anatomic outcomes of sustained single agent anti-VEGF treatment versus double anti-VEGF switching in the treatment of persistent diabetic macular edema

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          Abstract

          Background

          To compare the anatomical and visual outcomes in eyes with persistent diabetic macular edema (DME) after initial anti-VEGF therapy that were retreated continuously with the same anti-VEGF drug versus those that underwent two successive cycles of medication change in anti-VEGF drugs (double anti-VEGF switch).

          Methods

          Retrospective review of eyes with persistent DME after 3 initial consecutive monthly anti-VEGF injections. This cohort was divided into two groups: Group 1 continued to receive the same initial anti-VEGF drug for at least 18 months while group 2 eyes were switched to different anti-VEGF medications twice. Group 1 was further subdivided into: Group 1A composed of eyes with less than 20% reduction in central subfield thickness (CRT) at month 3; and group 1B eyes with greater than or equal to 20% reduction in CRT. The percentage of eyes that achieved greater than 10 letters visual acuity (VA) gain or loss was recorded as the primary end point (through month 18 in group 1 and month 6 after 2nd switch in group 2).

          Results

          Group 1A, 1B and group 2 were composed of 24, 18, and 14 eyes respectively. 34.7%, 56.2% and 36.3% of eyes achieved > 10 letters gain, while 4.3%, 6.2% and 27.2% of eyes lost > 10 letters in groups 1A, 1B, and 2, respectively. Analysis of the visual acuity (VA) letter change in this time interval revealed no significant difference between all groups (p = 0.11). Mean VA and CRT measurements at the primary endpoint in all groups were 0.5, 0.39, and 0.47 logMAR (p = 0.44), and 369.7, 279.9, 321 µm, (p = 0.01) respectively.

          Conclusions

          There was no difference in the visual outcomes between the two treatment strategies in eyes with persistent DME after 3 consecutive anti-VEGF injections. This may indicate that anti-VEGF switching—even if it is done twice—may have comparable clinical outcomes to sustained treatment with one agent.

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          Randomized trial evaluating ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema.

          Michael Elman, Lloyd Paul Aiello, Roy Beck … (2010)
          Evaluate intravitreal 0.5 mg ranibizumab or 4 mg triamcinolone combined with focal/grid laser compared with focal/grid laser alone for treatment of diabetic macular edema (DME). Multicenter, randomized clinical trial. A total of 854 study eyes of 691 participants with visual acuity (approximate Snellen equivalent) of 20/32 to 20/320 and DME involving the fovea. Eyes were randomized to sham injection + prompt laser (n=293), 0.5 mg ranibizumab + prompt laser (n=187), 0.5 mg ranibizumab + deferred (> or =24 weeks) laser (n=188), or 4 mg triamcinolone + prompt laser (n=186). Retreatment followed an algorithm facilitated by a web-based, real-time data-entry system. Best-corrected visual acuity and safety at 1 year. The 1-year mean change (+/-standard deviation) in the visual acuity letter score from baseline was significantly greater in the ranibizumab + prompt laser group (+9+/-11, P<0.001) and ranibizumab + deferred laser group (+9+/-12, P<0.001) but not in the triamcinolone + prompt laser group (+4+/-13, P=0.31) compared with the sham + prompt laser group (+3+/-13). Reduction in mean central subfield thickness in the triamcinolone + prompt laser group was similar to both ranibizumab groups and greater than in the sham + prompt laser group. In the subset of pseudophakic eyes at baseline (n=273), visual acuity improvement in the triamcinolone + prompt laser group appeared comparable to that in the ranibizumab groups. No systemic events attributable to study treatment were apparent. Three eyes (0.8%) had injection-related endophthalmitis in the ranibizumab groups, whereas elevated intraocular pressure and cataract surgery were more frequent in the triamcinolone + prompt laser group. Two-year visual acuity outcomes were similar to 1-year outcomes. Intravitreal ranibizumab with prompt or deferred laser is more effective through at least 1 year compared with prompt laser alone for the treatment of DME involving the central macula. Ranibizumab as applied in this study, although uncommonly associated with endophthalmitis, should be considered for patients with DME and characteristics similar to those in this clinical trial. In pseudophakic eyes, intravitreal triamcinolone + prompt laser seems more effective than laser alone but frequently increases the risk of intraocular pressure elevation. Copyright 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
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            Diabetes 2030: Insights from Yesterday, Today, and Future Trends

            William Rowley, Clement Bezold, Yasemin Arikan … (2017)
            Abstract To forecast future trends in diabetes prevalence, morbidity, and costs in the United States, the Institute for Alternative Futures has updated its diabetes forecasting model and extended its projections to 2030 for the nation, all states, and several metropolitan areas. This paper describes the methodology and data sources for these diabetes forecasts and discusses key implications. In short, diabetes will remain a major health crisis in America, in spite of medical advances and prevention efforts. The prevalence of diabetes (type 2 diabetes and type 1 diabetes) will increase by 54% to more than 54.9 million Americans between 2015 and 2030; annual deaths attributed to diabetes will climb by 38% to 385,800; and total annual medical and societal costs related to diabetes will increase 53% to more than $622 billion by 2030. Improvements in management reducing the annual incidence of morbidities and premature deaths related to diabetes over this time period will result in diabetes patients living longer, but requiring many years of comprehensive management of multiple chronic diseases, resulting in dramatically increased costs. Aggressive population health measures, including increased availability of diabetes prevention programs, could help millions of adults prevent or delay the progression to type 2 diabetes, thereby helping turn around these dire projections.
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              Effects of Crocin on Diabetic Maculopathy: A Placebo-Controlled Randomized Clinical Trial

              Sayyed Tabassi, Nasser Shoeibi, Samaneh Sepahi … (2018)
              Article 0 comments Cited 45 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Nadia K. Waheed:
                ORCID: http://orcid.org/0000-0002-8229-7519
                nwaheed@tuftsmedicalcenter.org
                Journal
                Journal ID (nlm-ta): Int J Retina Vitreous
                Journal ID (iso-abbrev): Int J Retina Vitreous
                Title: International Journal of Retina and Vitreous
                Publisher: BioMed Central (London )
                ISSN (Electronic): 2056-9920
                Publication date (Electronic): 8 June 2020
                Publication date PMC-release: 8 June 2020
                Publication date Collection: 2020
                Volume: 6
                Electronic Location Identifier: 17
                Affiliations
                [1 ]GRID grid.429997.8, ISNI 0000 0004 1936 7531, New England Eye Center, Tufts Medical Center, , Tufts University, ; Boston, MA USA
                [2 ]GRID grid.412258.8, ISNI 0000 0000 9477 7793, Department of Ophthalmology, , Tanta University, ; Tanta, Egypt
                [3 ]GRID grid.410445.0, ISNI 0000 0001 2188 0957, University of Hawai’i John A. Burns School of Medicine, ; Honolulu, HI USA
                [4 ]GRID grid.40263.33, ISNI 0000 0004 1936 9094, The Warren Alpert Medical School of Brown University, ; Providence, RI USA
                [5 ]GRID grid.47100.32, ISNI 0000000419368710, Yale School of Medicine, , Yale University, ; New Haven, CT USA
                [6 ]GRID grid.429997.8, ISNI 0000 0004 1936 7531, Tufts University School of Medicine, Tufts University, ; Boston, MA USA
                [7 ]GRID grid.67033.31, ISNI 0000 0000 8934 4045, Department of Ophthalmology, , Tufts Medical Center, ; 800 Washington Street, Box 450, Boston, MA 02111 USA
                Author information
                http://orcid.org/0000-0002-8229-7519
                Article
                Publisher ID: 220
                DOI: 10.1186/s40942-020-00220-5
                PMC ID: 7278067
                PubMed ID: 32523776
                SO-VID: ca68b16b-ed55-45da-a50f-72d6921ed273
                Copyright © © The Author(s) 2020
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 28 February 2020
                Date accepted : 25 April 2020
                Categories
                Subject: Original Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2020

                Keywords: diabetic macular edema,anti-vegf,oct,diabetic retinopathy,intravitreal
                Data availability:
                Keywords: diabetic macular edema, anti-vegf, oct, diabetic retinopathy, intravitreal

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