An updated review of long-term outcomes from randomized controlled trials in approved pharmaceuticals for diabetic macular edema

Wang, Jia-Kang; Huang, Tzu-Lun; Su, Pei–Yuan; Chang, Po‐Yuan

doi:10.21037/jes.2016.04.12

Cited by 8 publications

(8 citation statements)

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“…2–5 Moreover, if clinically significant macular edema or vision-threatening proliferative diabetic retinopathy develops, timely intervention with laser photocoagulation or with intraocular glucocorticoids or anti–vascular endothelial growth factor (VEGF) agents can substantially reduce loss of vision. 6–9 Thus, the goal of retinopathy screening is the timely detection of retinopathy that would, without intervention, cause vision loss.…”

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confidence: 99%

Frequency of Evidence-Based Screening for Retinopathy in Type 1 Diabetes

Dcct¹,

et al. 2017

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BACKGROUND In patients who have had type 1 diabetes for 5 years, current recommendations regarding screening for diabetic retinopathy include annual dilated retinal examinations to detect proliferative retinopathy or clinically significant macular edema, both of which require timely intervention to preserve vision. During 30 years of the Diabetes Control and Complications Trial (DCCT) and its longitudinal follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study, retinal photography was performed at intervals of 6 months to 4 years. METHODS We used retinal photographs from the DCCT/EDIC study to develop a rational screening frequency for retinopathy. Markov modeling was used to determine the likelihood of progression to proliferative diabetic retinopathy or clinically significant macular edema in patients with various initial retinopathy levels (no retinopathy or mild, moderate, or severe nonproliferative diabetic retinopathy). The models included recognized risk factors for progression of retinopathy. RESULTS Overall, the probability of progression to proliferative diabetic retinopathy or clinically significant macular edema was limited to approximately 5% between retinal screening examinations at 4 years among patients who had no retinopathy, 3 years among those with mild retinopathy, 6 months among those with moderate retinopathy, and 3 months among those with severe nonproliferative diabetic retinopathy. The risk of progression was also closely related to mean glycated hemoglobin levels. The risk of progression from no retinopathy to proliferative diabetic retinopathy or clinically significant macular edema was 1.0% over 5 years among patients with a glycated hemoglobin level of 6%, as compared with 4.3% over 3 years among patients with a glycated hemoglobin level of 10%. Over a 20-year period, the frequency of eye examinations was 58% lower with our practical, evidence-based schedule than with routine annual examinations, which resulted in substantial cost savings. CONCLUSIONS Our model for establishing an individualized schedule for retinopathy screening on the basis of the patient’s current state of retinopathy and glycated hemoglobin level reduced the frequency of eye examinations without delaying the diagnosis of clinically significant disease.

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confidence: 99%

Frequency of Evidence-Based Screening for Retinopathy in Type 1 Diabetes

Dcct¹,

et al. 2017

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“…8,[10][11][12] For diabetic retinopathy, current accepted therapies include laser photocoagulation, intravitreal injections of corticosteroids, anti-VEGF antibodies, and vitreoretinal sur-gery. [11][12][13][14][15][16] All these approaches are effective but are invasive, costly, and are not novel mechanisms. No new drugs targeting novel targets or disease mechanisms have been approved in over 10 years.…”

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confidence: 99%

Subconjunctival Delivery of p75^NTR Antagonists Reduces the Inflammatory, Vascular, and Neurodegenerative Pathologies of Diabetic Retinopathy

Galán

Barcelona

Nedev

et al. 2017

Invest. Ophthalmol. Vis. Sci.

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“…Norrin/Frizzled4 signaling is perturbed in Norrie disease, leading to abnormal vasculatures and BRB/BBB leakage in the brain and the retina [26,88]. Glucocorticoids and various anti-VEGF agents, such as Avastin, Lucentis, and Aflibercept, have been exploited to treat patients with leaky retinal blood vessels and pathological angiogenesis concerning diabetic macular edema and proliferative diabetic retinopathy [2,89,90]. Cell-based therapies, such as ESCs, iPSCs, and progenitor cells, hold the promise for replacing degenerative vascular cells [91].…”

Section: Pericyte-ec Communication Impairments In the Retinal Vasculamentioning

confidence: 99%

Pericyte-Endothelial Interactions in the Retinal Microvasculature

2020

IJMS

114

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Retinal microvasculature is crucial for the visual function of the neural retina. Pericytes and endothelial cells (ECs) are the two main cellular constituents in the retinal microvessels. Formation, maturation, and stabilization of the micro-vasculatures require pericyte-endothelial interactions, which are perturbed in many retinal vascular disorders, such as retinopathy of prematurity, retinal vein occlusion, and diabetic retinopathy. Understanding the cellular and molecular mechanisms of pericyte-endothelial interaction and perturbation can facilitate the design of therapeutic intervention for the prevention and treatment of retinal vascular disorders. Pericyte-endothelial interactions are indispensable for the integrity and functionality of retinal neurovascular unit (NVU), including vascular cells, retinal neurons, and glial cells. The essential autocrine and paracrine signaling pathways, such as Vascular endothelial growth factor (VEGF), Platelet-derived growth factor subunit B (PDGFB), Notch, Angipointein, Norrin, and Transforming growth factor-beta (TGF-β), have been well characterized for the regulation of pericyte-endothelial interactions in the neo-vessel formation processes (vasculogenesis and angiogenesis) during embryonic development. They also play a vital role in stabilizing and remodeling mature vasculature under pathological conditions. Awry signals, aberrant metabolisms, and pathological conditions, such as oxidative stress and inflammation, can disrupt the communication between pericytes and endothelial cells, thereby resulting in the breakdown of the blood-retinal barrier (BRB) and other microangiopathies. The emerging evidence supports extracellular exosomes’ roles in the (mis)communications between the two cell types. This review summarizes the essential knowledge and updates about new advancements in pericyte-EC interaction and communication, emphasizing the retinal microvasculature.

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An updated review of long-term outcomes from randomized controlled trials in approved pharmaceuticals for diabetic macular edema

Cited by 8 publications

References 0 publications

Frequency of Evidence-Based Screening for Retinopathy in Type 1 Diabetes

Frequency of Evidence-Based Screening for Retinopathy in Type 1 Diabetes

Subconjunctival Delivery of p75^NTR Antagonists Reduces the Inflammatory, Vascular, and Neurodegenerative Pathologies of Diabetic Retinopathy

Pericyte-Endothelial Interactions in the Retinal Microvasculature

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An updated review of long-term outcomes from randomized controlled trials in approved pharmaceuticals for diabetic macular edema

Cited by 8 publications

References 0 publications

Frequency of Evidence-Based Screening for Retinopathy in Type 1 Diabetes

Frequency of Evidence-Based Screening for Retinopathy in Type 1 Diabetes

Subconjunctival Delivery of p75NTR Antagonists Reduces the Inflammatory, Vascular, and Neurodegenerative Pathologies of Diabetic Retinopathy

Pericyte-Endothelial Interactions in the Retinal Microvasculature

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Product

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Subconjunctival Delivery of p75^NTR Antagonists Reduces the Inflammatory, Vascular, and Neurodegenerative Pathologies of Diabetic Retinopathy