Subthreshold micropulse laser versus intravitreal anti-VEGF for diabetic macular edema patients with relatively better visual acuity

Akkaya, Sezen; Açıkalın, Banu; Doğan, Yusuf Emre; Çoban, Fatih

doi:10.18240/ijo.2020.10.15

Cited by 13 publications

(11 citation statements)

References 21 publications

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“…In a high blood glucose environment, glycosylation products increase, and active oxygen is at a relatively high level, leading to further diglyceride production. This activates protein kinase C, which mediates the generation of VEGF[ 5 ]. VEGF is the primary regulatory factor for neovascularization and vascular permeability, which characterizes DME.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and mechanism of anti-vascular endothelial growth factor drugs for diabetic macular edema patients

Li¹,

Ren²,

Sun³

et al. 2022

WJD

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BACKGROUND Diabetes is a serious public health concern in China, with 30% of patients developing retinopathy, and diabetic macular edema (DME) having the biggest impact on vision. High blood glucose level can cause retinal cell hypoxia, thus promoting vascular endothelial growth factor (VEGF) formation and increasing vascular permeability, which induces DME. Moreover, cell hypoxia can accelerate the rate of apoptosis, which leads to the aging of patients. In severe cases, optic cell apoptosis or retinal fibrosis and permanent blindness may occur. AIM To investigate and compare the efficacy, mechanism, and differences between two anti-VEGF drugs (Compaq and ranibizumab) in DME patients. METHODS Ninety-six patients with DME who attended our hospital from April 2018 to February 2020 were included and randomly divided into two groups (Compaq group and ranibizumab group). The groups received vitreal cavity injections of 0.5 mg Compaq and 0.5 mg ranibizumab, respectively, once a month. The best corrected visual acuity (BCVA), intraocular pressure (IOP), macular retinal thickness (CMT), macular choroidal thickness (SFCT), foveal no perfusion area (FAZ), superficial capillary density, deep capillary density, treatment effect, and adverse reactions were compared before and after treatment and between the two groups. RESULTS Before treatment and 1-mo post-treatment, there was no statistically significant difference in the estimated BCVA in both groups ( P > 0.05). BCVA decreased in the Compaq group 3 mo after treatment, and the difference was statistically significant ( P < 0.05). Before treatment, and 1 mo and 3 mo post-treatment, there was no statistically significant difference in the estimated IOP in either group ( P > 0.05). Before treatment and 1-mo post-treatment, there was no statistically significant difference in the estimated CMT, SFCT, or FAZ in either group ( P > 0.05). CMT and SFCT values decreased in the Compaq group 3 mo post-treatment, and the difference was statistically significant ( P < 0.05). Before treatment, and 1 mo and 3 mo post-treatment, there were no statistically significant differences in vascular density in the shallow or deep capillary plexi of the fovea, parafovea, or overall macular area between the two groups ( P > 0.05). Marked efficient, effective, and invalid rates were 70.83% and 52.08%, 27.08% and 39.58%, and 2.08% and 8.33% in the Compaq and ranibizumab groups, respectively. The differences between the two groups were statistically significant ( P < 0.05). CONCLUSION Anti-VEGF drugs can effectively improve CMT and SFCT, without affecting microcirculation, thus providing an effective and safe treatment for patients with DME.

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Section: Introductionmentioning

confidence: 99%

Efficacy and mechanism of anti-vascular endothelial growth factor drugs for diabetic macular edema patients

Li¹,

Ren²,

Sun³

et al. 2022

WJD

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“…The disruption of BRB is associated with an increase in the level of vascular endothelial growth factor (VEGF), intercellular adhesion molecule-1 (ICAM-1), interleukin-6 (IL-6), monocyte chemotactic protein-1 (MCP-1), and other in ammatory factors [3]. Therefore, anti-VEGF [4,5] and other antiin ammatory agents [6] become the main treatment way to deal with DME after laser photocoagulation. Although intravitreous a ibercept, bevacizumab, or ranibizumab had been proved to improve vision function in eyes with center-involved DME in a comparative effectiveness randomized clinical trial conducted by Diabetic Retinopathy Clinical Research Network [7], there were still a signi cant number of patients with poor response to anti -VEGF treatment or without sustained improvement in visual acuity.…”

Section: Introductionmentioning

confidence: 99%

Intravitreal ranibizumab alone or in combination with Calcium dobesilate (CaD) for the treatment of diabetic macular edema in non-proliferative diabetic retinopathy patients: a 12-month outcomes of a retrospective study

Wang

et al. 2022

Preprint

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Purpose To investigate the effect of calcium dobesilate (CaD) in the treatment of diabetic macular edema (DME) in patients with non-proliferative diabetic retinopathy (NPDR).Methods This retrospective, observational, consecutive case control study enrolled patients newly diagnosed with DME who received intravitreal ranibizumab (IVR) administration with 3-monthly loading dose injection followed by pro re nata (3+PRN) regimen with or without CaD orally daily for at least 12-month follow-up. Medical records and optical coherence tomography (OCT) results were reviewed and compared.Results A total of 102 eyes from 102 patients were enrolled in this study. Fifty-four patients received IVR combined with CaD orally (IVR+CaD group), while forty-eight patients received IVR solely (IVR group). At every follow-up, 3, 6 and 12 months after injection, the best corrected visual acuity (BCVA) improved and the central macular thickness (CMT) decreased in both groups when compared with those at baseline (P < 0.05), while there were no significant differences in BCVA improvement and CMT reduction between the two groups (P > 0.05). The mean number of ranibizumab injections in R+C group was significantly lower than that in R group (5.4 ± 1.1 injections versus 6.7 ± 1.6 injections, P<0.05) within 1-year treatment. No adverse events were found in neither groups.Conclusions Adding orally CaD to intravitreal ranibizumab was demonstrated to have similar effectiveness and safety for improving visual function and restoring the anatomy of the retina in macular with fewer injections in DME patients.

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“…BRB disruption is associated with increased production of the vascular endothelial growth factor (VEGF), intercellular adhesion molecule-1, interleukin-6, monocyte chemotactic protein-1, and other inflammatory factors [ 3 ]. Therefore, anti-VEGF [ 4 , 5 ] and anti-inflammatory agents [ 6 ] are the main treatment methods for DME after laser photocoagulation. Although the Diabetic Retinopathy Clinical Research Network randomized clinical trial [ 7 ] reported that intravitreal aflibercept, bevacizumab, and ranibizumab injections improved vision in eyes with center-involved DME (CIDME), a significant number of patients have a poor or short-duration response to anti-VEGF treatment.…”

Section: Introductionmentioning

confidence: 99%

Intravitreal Ranibizumab Alone or in Combination with Calcium Dobesilate for the Treatment of Diabetic Macular Edema in Nonproliferative Diabetic Retinopathy Patients: 12-Month Outcomes of a Retrospective Study

Wang

et al. 2022

International Journal of Clinical Practice

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Objective. This study investigates the efficacy of CaD combined with intravitreal ranibizumab for the treatment of diabetic macular edema (DME) in patients with nonproliferative DR. Methods. This retrospective, observational, case-control study enrolled consecutive patients newly diagnosed with DME. The patients were treated with 3-monthly loading dose injections of intravitreal ranibizumab (IVR) followed by pro re nata injections (3 + PRN), with or without daily oral CaD. The patients were treated and followed up for 12 months. We reviewed their medical records to determine the optical coherence tomography (OCT) findings, number of injections, best-corrected visual acuity (BCVA), and central macular thickness (CMT) at 3, 6, and 12 months after the first injection. Results. We reviewed 102 eyes of 102 patients; 54 patients received IVR combined with oral CaD (IVR + CaD group) and 48 received only IVR (IVR group). In both groups, BCVA was higher, and CMT was lower, at 3, 6, and 12 months after the injection compared to those at the baseline ( p < 0.05 for all), while there were no significant differences in BCVA improvement or CMT reduction between the two groups ( p > 0.05 ). The mean number of IVR injections was significantly lower in the IVR + CaD group than the IVR group (5.4 ± 1.1 vs. 6.7 ± 1.6 injections, p < 0.05 ) during 1 year of treatment. No adverse events were noted in either group. Conclusions. Compared to IVR alone, the addition of oral CaD to IVR in DME patients was safe and effective for improving visual function and restoring the retinal anatomy and was associated with the need for fewer injections.

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Subthreshold micropulse laser versus intravitreal anti-VEGF for diabetic macular edema patients with relatively better visual acuity

Cited by 13 publications

References 21 publications

Efficacy and mechanism of anti-vascular endothelial growth factor drugs for diabetic macular edema patients

Efficacy and mechanism of anti-vascular endothelial growth factor drugs for diabetic macular edema patients

Intravitreal ranibizumab alone or in combination with Calcium dobesilate (CaD) for the treatment of diabetic macular edema in non-proliferative diabetic retinopathy patients: a 12-month outcomes of a retrospective study

Intravitreal Ranibizumab Alone or in Combination with Calcium Dobesilate for the Treatment of Diabetic Macular Edema in Nonproliferative Diabetic Retinopathy Patients: 12-Month Outcomes of a Retrospective Study

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