Efficacy of Ranibizumab in Eyes with Diabetic Macular Edema and Macular Nonperfusion in RIDE and RISE

Reddy, Rahul; Pieramici, Dante J.; Gune, Shamika; Ghanekar, Avanti; Lu, Na; Ruiz, Carlos Quezada; Baumal, Caroline R.

doi:10.1016/j.ophtha.2018.04.002

Cited by 42 publications

(41 citation statements)

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“…These advantages may allow OCTA to be more suited for the analysis of changes in macular perfusion following DME treatment. 24 In a study investigating the effect of aflibercept injections for treatment naïve wet age-related macular degeneration on the macular vascular density using OCTA, there was a statistically significant decrease in the superficial foveal and parafoveal vascular density after 1, 2, and 3 injections compared to baseline (approximately 31% reduction in foveal vascular density and 6.6% reduction in parafoveal vascular density after 3 injections). 25 This is interesting since patients with a history of retinal vascular disease were excluded from the study which suggests that anti-VEGF injections may affect the vascular density of normal retinal vessels.…”

Section: Discussionmentioning

confidence: 99%

Changes in Macular Perfusion Detected by Optical Coherence Tomography Angiography Following 3 Intravitreal Monthly Bevacizumab Injections for Diabetic Macular Edema in the IMPACT Study

Elnahry

Abdelkader

Raafat

et al. 2019

Preprint

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Background This study was done to evaluate macular perfusion changes following intravitreal bevacizumab injections for diabetic macular edema (DME) using spectral domain optical coherence tomography angiography (SD-OCTA). Methods This study was a prospective noncomparative interventional case series. Treatment naïve patients with DME were recruited at Cairo University retina clinic and underwent full ophthalmological examination and SD-OCTA scanning at baseline and after 3 intravitreal bevacizumab injections. Both the 6X6 and 3X3-mm macular scan protocols were used. Pre and post-treatment OCTA images were automatically aligned using a commercially available retina alignment software (i2k Align Retina software) then the fractal dimension (FD), vascular density (VD), and skeleton VD changes were obtained at the full retinal thickness (Full) and superficial (SCP) and deep (DCP) capillary plexuses after processing images using a semi-automated program. The foveal avascular zone (FAZ) was manually measured and FD was calculated using the FracLac plugin of ImageJ. Results Forty eyes of 26 patients were included. Following injections, there was an 8.1% increase in FAZ, 1.3% decrease in FD-Full and FD-SCP, 1.9% decrease in FD-DCP, 8% decrease in VD-Full, 9.1% decrease in VD-SCP, 10.6% decrease in VD-DCP, 13.3% decrease in skeleton VD-Full, 12.5% decrease in skeleton VD-SCP, and 16.3% decrease in skeleton VD-DCP in the 6X6 mm macular area, and a 2.6% decrease in FD-Full, 3.4% decrease in FD-SCP, 11.5% decrease in VD-Full, 14.3% decrease in VD-SCP, and 25.1% decrease in skeleton VD-SCP in the 3X3 mm macular area which were all statistically significant (p<0.05). There was also an 8.3% increase in the FAZ, 18.5% decrease in skeleton VD-Full, 2.6% decrease in FD-DCP, 8.8% decrease in VD-DCP, and 19.7% decrease in skeleton VD-DCP in the 3X3 mm macular area but these were not statistically significant (p>0.05). Using univariate and multivariate analysis, the pre-treatment FD, VD, and skeleton VD at each capillary layer significantly negatively correlated with the change in FD, VD, and skeleton VD at the corresponding capillary layer respectively (p>0.05). Conclusion OCTA is a useful non-invasive tool for quantitative evaluation of macular perfusion changes following DME treatment. Trial Registration Trial registered at ClinicalTrials.gov on August 11, 2017 (Study ID: NCT03246152).

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Section: Discussionmentioning

confidence: 99%

Changes in Macular Perfusion Detected by Optical Coherence Tomography Angiography Following 3 Intravitreal Monthly Bevacizumab Injections for Diabetic Macular Edema in the IMPACT Study

Elnahry

Abdelkader

Raafat

et al. 2019

Preprint

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“…Meaningful treatment of diabetic retinopathy has been limited by failure to recognize the neurovascular condition which precedes and then continues in parallel with the progressive microangiopathy (18)(19)(20)(21)(22)(23). For example, although anti-VEFG therapies are initiated for treating all manner of retinopathy with observed retinal central thickening, they only result in modest, and very often transient, improvement of visual acuity (10)(11)(12).…”

Section: Implications For Diabetic Retinopathy Diagnostic Screening Amentioning

confidence: 99%

“…Of note, diabetic retinopathy is the leading cause of blindness in the adult working population (7,9). Although retinopathy is common, poor patient compliance with yearly ocular screening (only 35-55% compliance) and techniques which rely on physician examination of the retina or retinal photography focused on vascular changes, detection is often delayed until after severe damage has occurred and treatments are unable to substantively restore vision (only 25-28% demonstrating improvement of ≥3 ETDRS lines) (10)(11)(12)(13)(14)(15). Indeed, visual examination by optometrists or ophthalmologists detect only very poorly vascular changes (most often when they occur with intra-retinal hemorrhages) and physician examinations cannot easily or precisely define progressive changes over time.…”

Section: Introductionmentioning

confidence: 99%

Diabetic Retinopathy–An Underdiagnosed and Undertreated Inflammatory, Neuro-Vascular Complication of Diabetes

Sinclair

Schwartz

2019

Front. Endocrinol.

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Diabetes mellitus is a world-wide epidemic and diabetic retinopathy, a devastating, vision-threatening condition, is one of the most common diabetes-specific complications. Diabetic retinopathy is now recognized to be an inflammatory, neuro-vascular complication with neuronal injury/dysfunction preceding clinical microvascular damage. Importantly, the same pathophysiologic mechanisms that damage the pancreatic β-cell (e.g., inflammation, epigenetic changes, insulin resistance, fuel excess, and abnormal metabolic environment), also lead to cell and tissue damage causing organ dysfunction, elevating the risk of all complications, including diabetic retinopathy. Viewing diabetic retinopathy within the context whereby diabetes and all its complications arise from common pathophysiologic factors allows for the consideration of a wider array of potential ocular as well as systemic treatments for this common and devastating complication. Moreover, it also raises the importance of the need for methods that will provide more timely detection and prediction of the course in order to address early damage to the neurovascular unit prior to the clinical observation of microangiopathy. Currently, treatment success is limited as it is often initiated far too late and after significant neurodegeneration has occurred. This forward-thinking approach of earlier detection and treatment with a wider array of possible therapies broadens the physician's armamentarium and increases the opportunity for prevention and early treatment of diabetic retinopathy with preservation of good vision, as well the prevention of similar destructive processes occurring among other organs.

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“…is allows OCTA to be repeated frequently with no risks or discomfort to the patient. ese advantages may allow OCTA to be more suited for the analysis of changes in macular perfusion following DME treatment [28].…”

mentioning

confidence: 99%

Evaluation of Changes in Macular Perfusion Detected by Optical Coherence Tomography Angiography following 3 Intravitreal Monthly Bevacizumab Injections for Diabetic Macular Edema in the IMPACT Study

Elnahry

Abdelkader

Raafat

et al. 2020

Journal of Ophthalmology

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Objective. To evaluate macular perfusion changes following intravitreal bevacizumab injections for diabetic macular edema (DME) using spectral domain optical coherence tomography angiography (SD-OCTA). Methods. This study was a prospective noncomparative interventional case series. Treatment naïve patients with DME underwent full ophthalmological examination and SD-OCTA scanning at baseline and after 3 intravitreal bevacizumab injections. Both the 6 × 6 and 3 × 3 mm macular scan protocols were used. Pretreatment and posttreatment OCTA images were automatically aligned using a commercially available retina alignment software (i2k Align Retina software); then the fractal dimension (FD), vascular density (VD), and skeleton VD changes were obtained at the full retinal thickness (Full) and superficial (SCP) and deep (DCP) capillary plexuses after processing images using a semiautomated program. The foveal avascular zone (FAZ) was manually measured and FD was calculated using the FracLac plugin of ImageJ. Results. Forty eyes of 26 patients were included. Following injections, there were an 8.1% increase in FAZ, 1.3% decrease in FD-Full and FD-SCP, 1.9% decrease in FD-DCP, 8% decrease in VD-Full, 9.1% decrease in VD-SCP, 10.6% decrease in VD-DCP, 13.3% decrease in skeleton VD-Full, 12.5% decrease in skeleton VD-SCP, and 16.3% decrease in skeleton VD-DCP in the 6 × 6 mm macular area and a 2.6% decrease in FD-Full, 3.4% decrease in FD-SCP, 11.5% decrease in VD-Full, 14.3% decrease in VD-SCP, and 25.1% decrease in skeleton VD-SCP in the 3 × 3 mm macular area which were all statistically significant p<0.05. Using univariate and multivariate analysis, the pretreatment FD, VD, and skeleton VD at each capillary layer significantly negatively correlated with the change in FD, VD, and skeleton VD at the corresponding capillary layer, respectively p<0.05. Conclusion. OCTA is a useful noninvasive tool for quantitative evaluation of macular perfusion changes following DME treatment. This trial is registered with NCT03246152.

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Efficacy of Ranibizumab in Eyes with Diabetic Macular Edema and Macular Nonperfusion in RIDE and RISE

Abstract: Despite having worse vision/increased CST versus those without baseline MNP, eyes with concurrent DME and baseline MNP entering RIDE/RISE experienced robust VA and anatomic improvement with ranibizumab and therefore should not be excluded from therapy.

Cited by 42 publications

References 13 publications

Changes in Macular Perfusion Detected by Optical Coherence Tomography Angiography Following 3 Intravitreal Monthly Bevacizumab Injections for Diabetic Macular Edema in the IMPACT Study

Changes in Macular Perfusion Detected by Optical Coherence Tomography Angiography Following 3 Intravitreal Monthly Bevacizumab Injections for Diabetic Macular Edema in the IMPACT Study

Diabetic Retinopathy–An Underdiagnosed and Undertreated Inflammatory, Neuro-Vascular Complication of Diabetes

Evaluation of Changes in Macular Perfusion Detected by Optical Coherence Tomography Angiography following 3 Intravitreal Monthly Bevacizumab Injections for Diabetic Macular Edema in the IMPACT Study

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