Incidence and Risk Factors for Tractional Macular Detachment after Anti-Vascular Endothelial Growth Factor Agent Pretreatment before Vitrectomy for Complicated Proliferative Diabetic Retinopathy

Russo, Andrea; Longo, Antonio; Avitabile, Teresio; Bonfiglio, Vincenza; Fallico, Matteo; Boscia, Francesco; Furino, Claudio; Cillino, Salvatore; Toro, Mario Damiano; Ręjdak, Robert; Nowomiejska, Katarzyna; Reibaldi, Michele

doi:10.3390/jcm8111960

Cited by 13 publications

(9 citation statements)

References 38 publications

(56 reference statements)

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“…Therefore, it could be hypothesized that anti-VEGF agents might facilitate much easier surgery and better visual rehabilitation, help in neovascularization regression, reduce the rate of early recurrent VH and accelerate its absorption, especially in cases of recurrent VH or residual VH post-PPV [ 65 , 66 , 67 , 68 ]. However, one should take into account that TRD may occur in 10% of eyes after anti-VEGF injection with the main risk factors to be the days between anti-VEGF injection and vitrectomy, VH, and age [ 69 ].…”

Section: Resultsmentioning

confidence: 99%

Intravitreal Anti-Vascular Endothelial Growth Factor Agents for the Treatment of Diabetic Retinopathy: A Review of the Literature

Chatziralli

Loewenstein

2021

Pharmaceutics

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Background: Diabetic retinopathy (DR) is the leading cause of blindness in the working-age population. The purpose of this review is to gather the existing literature regarding the use of the approved anti-vascular endothelial growth (anti-VEGF) agents in the treatment of DR. Methods: A comprehensive literature review in PubMed engine search was performed for articles written in English language up to 1 July 2021, using the keywords “diabetic retinopathy”, “ranibizumab”, “aflibercept”, and “anti-VEGF”. Emphasis was given on pivotal trials and recent robust studies. Results: Intravitreal anti-VEGF agents have been found to significantly improve visual acuity and reduce retinal thickness in patients with diabetic macular edema (DME) in a long-term follow-up ranging from 1 to 5 years and are considered the standard-of-care in such patients. Regarding DR, intravitreal anti-VEGF agents provided ≥2-step improvement in DR severity on color fundus photography in about 30–35% of patients with NPDR at baseline, in the majority of clinical trials originally designed to evaluate the efficacy of intravitreal anti-VEGF agents in patients with DME. Protocol S and CLARITY study have firstly reported that intravitreal anti-VEGF agents are non-inferior to panretinal photocoagulation (PRP) in patients with proliferative DR (PDR). However, the use of new imaging modalities, such as optical coherence tomography-angiography and wide-field fluorescein angiography, reveals conflicting results about the impact of anti-VEGF agents on the regression of retinal non-perfusion in patients with DR. Furthermore, one should consider the high “loss to follow-up” rate and its devastating consequences especially in patients with PDR, when deciding to treat the latter with intravitreal anti-VEGF agents alone compared to PRP. In patients with PDR, combination of treatment of intravitreal anti-VEGF agents and PRP has been also supported. Moreover, in the specific case of vitreous hemorrhage or tractional retinal detachment as complications of PDR, intravitreal anti-VEGF agents have been found to be beneficial as an adjunct to pars plana vitrectomy (PPV), most commonly given 3–7 days before PPV, offering reduction in the recurrence of vitreous hemorrhage. Conclusions: There is no general consensus regarding the use of intravitreal anti-VEGF agents in patients with DR. Although anti-VEGF agents are the gold standard in the treatment of DME and seem to improve DR severity, challenges in their use exist and should be taken into account in the decision of treatment, based on an individualized approach.

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Section: Resultsmentioning

confidence: 99%

Intravitreal Anti-Vascular Endothelial Growth Factor Agents for the Treatment of Diabetic Retinopathy: A Review of the Literature

Chatziralli

Loewenstein

2021

Pharmaceutics

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“…The main risk factors are days between anti-VEGF injection and vitrectomy, vitreous hemorrhage, and age. [ 35 ] However, preoperative intravitreal injections of anti-VEGF agents are effective and safe for complicated PDR. [ 36 , 37 ]…”

Section: Discussionmentioning

confidence: 99%

Mapping research trends in diabetic retinopathy from 2010 to 2019

et al. 2021

Medicine

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Background: Although many publications in diabetic retinopathy (DR) have been reported, there is no bibliometric analysis. Purpose: To perform a bibliometric analysis in the field of diabetic retinopathy (DR) research, to characterize the current international status of DR research, to identify the most effective factors involved in this field, and to explore research hotspots in DR research. Methods: Based on the Web of Science Core Collection (WoSCC), a bibliometric analysis was conducted to investigate the publication trends in research related to DR. Knowledge maps were constructed by VOSviewer v.1.6.10 to visualize the publications, the distribution of countries, international collaborations, author productivity, source journals, cited references and keywords, and research hotspots in this field. Results: In total, 11,839 peer-reviewed papers were retrieved on DR from 2010 to 2019, and the annual research output increased with time. The United States ranks highest among countries with the most publications. The most active institution is the University of Melbourne. Wong, TY contributed the largest number of publications in this field. Investigative Ophthalmology & Visual Science was the most prolific journal in DR research. The top-cited references mainly investigated the use of anti-vascular endothelial growth factor (VEGF) medications in the management of DR, and the keywords formed 6 clusters: Discussion: With the improvement of living standard, DR has gradually become one of the important causes of blindness, and has become a hot spot of public health research in many countries. The application of deep learning and artificial intelligence in diabetes screening and anti-VEGF medications in the management of DR have been the research hotspots in recent 10 years. Conclusions: Based on data extracted from the WoSCC, this study provides a broad view of the current status and trends in DR research and may provide clinicians and researchers with insight into DR research and valuable information to identify potential collaborators and partner institutions and better predict their dynamic directions.

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“…A concern when administering anti-VEGF to patients with advanced PDR is the risk of tractional detachment. Although there is strong evidence for anti-VEGF's role in the management of PDR, it can facilitate brosis and subsequent traction through upregulation of the brin-bronectin complex 19 . Of 608 eyes that received anti-VEGF prior to vitrectomy for active PDR and non-macular involving traction, the incidence of tractional macula detachment was 10% at the time of surgery.…”

Section: Discussionmentioning

confidence: 99%

Management of Acute Proliferative Diabetic Retinopathy Related Complications During the First COVID-19 Wave

Dhillon

Santiago

2021

Preprint

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Background. Routine hospital eye services (HES) and diabetic retinal screening were paused during COVID lockdown in March 2020. Alternate pathways for managing acute ophthalmic pathology were devised in NHS Grampian: Emergency eye treatment centres (EETC) manned by community optometrists were set up to treat and triage referrals to HES. Methods. Retrospective study analysing patients referred to HES with proliferative diabetic retinopathy (PDR) related complications between March and August 2020. Results. 52 eyes of 46 patients with PDR related complications were identified. HES appointment had been delayed or cancelled in 43% due to COVID. Mean age was 54.5 years (± 15.1), 46% were female, 46% had type 1 diabetes; mean HbA1c was 78 mmol/l (± 18.7). Vision ranged from 6/6 to perception of light. 36 patients had unilateral vitreous haemorrhage (VH), 6 bilateral, 2 tractional retinal detachments and 3 had neovascular glaucoma. Following assessment, 23 eyes received anti-VEGF injection within 3 days, two had PRP on the same day, 16 were rebooked for urgent PRP, 13 referred for urgent surgical review and 17 advised observation. After a mean follow-up of 6 months, 12 eyes (23%) of 11 patients progressed to have vitrectomy. Conclusion. Despite lockdown, hospital appointment cancellations and recommended footfall reduction limiting capacity due to COVID19, patients reaching out with PDR complications were promptly referred to HES and appropriate treatments carried out with COVID precautions as recommended.

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Incidence and Risk Factors for Tractional Macular Detachment after Anti-Vascular Endothelial Growth Factor Agent Pretreatment before Vitrectomy for Complicated Proliferative Diabetic Retinopathy

Cited by 13 publications

References 38 publications

Intravitreal Anti-Vascular Endothelial Growth Factor Agents for the Treatment of Diabetic Retinopathy: A Review of the Literature

Intravitreal Anti-Vascular Endothelial Growth Factor Agents for the Treatment of Diabetic Retinopathy: A Review of the Literature

Mapping research trends in diabetic retinopathy from 2010 to 2019

Management of Acute Proliferative Diabetic Retinopathy Related Complications During the First COVID-19 Wave

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