Intravitreal Aflibercept Injection in Eyes With Substantial Vision Loss After Laser Photocoagulation for Diabetic Macular Edema

Wykoff, Charles C.; Marcus, Dennis M.; Midena, Edoardo; Korobelnik, J.-F.; Saroj, Namrata; Gibson, Andrea; Vitti, Robert; Berliner, Alyson J.; Liu, Zinaria Williams; Zeitz, Oliver; Metzig, Carola; Schmelter, Thomas; Heier, Jeffrey S.

doi:10.1001/jamaophthalmol.2016.4912

Cited by 14 publications

(19 citation statements)

References 16 publications

(61 reference statements)

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“…Our results are also in agreement with those of the subgroup analysis of the VISTA and VIVID studies, though with a smaller effect [17] . The discrepancy might be due to differences in treatment protocols, particularly in regard to the timing of anti-VEGF treatment after laser treatment.…”

Section: Discussionsupporting

confidence: 92%

“…In the subgroup analysis of Protocol I and the RESTORE study, no significant interaction was identified between prior macular laser treatment or pharmacotherapy and the superiority of intravitreal anti-VEGF therapy over additional macular laser photocoagulation for DME [13,14] . Furthermore, a subanalysis of data from the VIS-TA and VIVID studies confirmed the beneficial effect from intravitreal aflibercept on eyes with substantial visual loss after laser photocoagulation for DME [17] .…”

Section: Introductionmentioning

confidence: 72%

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Early Response to Ranibizumab Is Associated with 12-Month Outcome in Diabetic Macular Edema after Prior Macular Laser Therapy

Sheu

Lee²

2017

Ophthalmologica

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Purpose: To evaluate the efficacy of ranibizumab in persistent or recurrent diabetic macular edema (DME) after previous laser therapy. Methods: This prospective, interventional study consisted of a 3-month period of scheduled ranibizumab treatment followed by a 9-month period of pro re nata treatment. Results: A total of 21 eyes (18 patients) were included. Both best corrected visual acuity and central retinal thickness had statistically significantly improved from baseline at month 12 (p < 0.001). The mean number of injections within these 12 months was 7.8 ± 2.6 (range 3-11). The visual change at month 12 did not vary by more than 5 letters from the response observed at week 12. Conclusions: Our study showed a beneficial effect from ranibizumab in DME patients previously treated with macular laser therapy. The response at week 12 was sustained up to 1 year. A suboptimal early visual response may predict a long-term suboptimal response and help identify patients who would benefit from an alternative regimen.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 72%

Early Response to Ranibizumab Is Associated with 12-Month Outcome in Diabetic Macular Edema after Prior Macular Laser Therapy

Sheu

Lee²

2017

Ophthalmologica

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“…exudative conditions such as center-involving DME causing visual loss, earlier intervention can achieve better outcomes at a population level. [62][63][64] 3. Anti-VEGF treatment may be able to slow the development and progression of retinal nonperfusion, the core vascular pathology underlying DR. 65,66 Further studies are required to better understand this possible phenomenon.…”

Section: Numerous Studies Have Demonstrated That For Manymentioning

confidence: 99%

American Society of Retina Specialists Clinical Practice Guidelines: Management of Nonproliferative and Proliferative Diabetic Retinopathy Without Diabetic Macular Edema

Yonekawa

Modi

Kim

et al. 2020

Journal of VitreoRetinal Diseases

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Diabetic retinopathy (DR) is common, preventable, and treatable, with blinding consequences that affect working-aged adults, making it a major focus of public health internationally. 1,2 More than 30 million people live with diabetes in the United States, according to the 2017 National Diabetes Statistics Report. 3 The National Eye Institute estimates that 7.7 million also have DR based on 2010 census data, and projects the prevalence to double by 2050. 4 DR affects more people in the United States than age-related macular degeneration and glaucoma combined. Although the prevalence of DR has been surging, 4 the severity of encountered disease overall may have decreased, 5 owing to significant strides in the past several decades in screening, diagnostic imaging, and medical management. This underscores the importance of continued implementation of up-todate management for patients with diabetes. This clinical practice guidelines from the American Society of Retina Specialists (ASRS) summarize major clinical studies with discussion that may help guide retina specialists in tailoring the treatment of patients with DR. The topic of DR is extensive. Therefore, we focus on the treatment of nonproliferative (NPDR) and proliferative diabetic retinopathy (PDR) without diabetic macular edema (DME) in this article. DME is the most common cause of visual impairment in patients with DR, and separate ASRS clinical practice guidelines have been previously published on the topic. 6 Screening, imaging, and vitreoretinal surgery are also notable clinical themes within DR that will not be detailed in this article. Systemic Optimization DR is a microvascular end-organ complication of diabetes mellitus. The evidence for optimizing systemic glycemic and cardiovascular factors is well established for decreasing mortality and morbidity, and should be reinforced with visits with the retina specialist. 7,8 The American Diabetes Association (ADA) recommends glycemic, blood pressure, and serum lipid optimization to reduce the risk or slow the progression of DR. 9 Glycemic Goals The Diabetic Control and Complications Trial (DCCT) definitively established the relationship between hyperglycemia and DR in patients with type 1 diabetes. 10 Intensive glycemic

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“…Nevertheless, supporting earlier pharmaceutical intervention, better baseline VA at the time of initiation of intravitreal pharmaceutical therapy for DME is associated with better outcomes, 15 a correlation that has demonstrated remarkable consistency across many exudative retinal diseases. [16][17][18] In eyes with CIDME and VA loss, intravitreal pharmaceutical delivery is generally first-line therapy. Numerous well-designed, randomized, phase 3 clinical trials have demonstrated significant benefit compared to observation or macular laser, 6,7,9,13 and anti-VEGF therapies are the current mainstay of therapy.…”

Section: Management Consideration For 3 Clinically Relevant Dme Subcamentioning

confidence: 99%

Section: Management Consideration For 3 Clinically Relevant Dme Subcamentioning

confidence: 99%

Evidence-Based Guidelines for Management of Diabetic Macular Edema

Bakri

Wolfe

Regillo

et al. 2019

Journal of VitreoRetinal Diseases

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The purpose of this article is to provide a data-driven set of best practices to consider in the management of diabetic macular edema (DME). Methods: The current discussion and recommendations represent the authors' interpretations of data from selected references based on perceived relevance and study design. Results: DME is a common cause of visual impairment globally. The underlying progressive retinal microvascular damage is associated with upregulation of VEGF and a multitude of other inflammatory pathways. Three clinically relevant subcategories of DME can be identified: central-involved DME (CIDME) with preserved visual acuity, CIDME with associated visual loss, and non-CIDME. Management approaches may include observation, laser photocoagulation, intravitreal pharmacotherapy with anti-VEGF agents or corticosteroids, or a combination of these, and may vary depending on the specific type of DME and associated severity of diabetic retinopathy. Additional factors to consider in the management of patients with DME include the appropriate use of imaging and recognition of the chronic nature of the underlying disease process in many eyes. Conclusions: DME management is complex. Intravitreal pharmacotherapies are the current cornerstone of treatment for CIDME and appear poised to remain so for the foreseeable future.

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Intravitreal Aflibercept Injection in Eyes With Substantial Vision Loss After Laser Photocoagulation for Diabetic Macular Edema

Cited by 14 publications

References 16 publications

Early Response to Ranibizumab Is Associated with 12-Month Outcome in Diabetic Macular Edema after Prior Macular Laser Therapy

Early Response to Ranibizumab Is Associated with 12-Month Outcome in Diabetic Macular Edema after Prior Macular Laser Therapy

American Society of Retina Specialists Clinical Practice Guidelines: Management of Nonproliferative and Proliferative Diabetic Retinopathy Without Diabetic Macular Edema

Evidence-Based Guidelines for Management of Diabetic Macular Edema

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