Topographical Response of Retinal Neovascularization to Aflibercept or Panretinal Photocoagulation in Proliferative Diabetic Retinopathy

Halim, Sandra; Nugawela, Manjula D; Chakravarthy, Usha; Madhusudhan, Savita; Lenfestey, P. M.; Hamill, Barbara; Zheng, Yalin; Parry, D. G.; Nicholson, Luke; Greenwood, John A.; Sivaprasad, Sobha

doi:10.1001/jamaophthalmol.2021.0108

Cited by 6 publications

(5 citation statements)

References 16 publications

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“…Treatment naive patients with NVE demonstrated particularly greater benefit from aflibercept over PRP. The rate of neovascularization regression in these patients was 96% with aflibercept versus 78% with PRP, which was statistically significant [ 51 ].…”

Section: Comparing Anti-vegf Versus Prp As Primary Therapy For Pdrmentioning

confidence: 99%

Update on the Management of Diabetic Retinopathy: Anti-VEGF Agents for the Prevention of Complications and Progression of Nonproliferative and Proliferative Retinopathy

Bahr

Bakri

2023

Life

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Diabetic retinopathy (DR) is a microvascular disease caused by poorly controlled blood glucose, and it is a leading cause of vision loss in people with diabetes. In this review we discuss the current management of DR with particular focus on the use of intraocular anti-vascular endothelial growth factor (anti-VEGF) agents. Intraocular anti-VEGF agents were first studied in the 1990s, and now several of these agents are either FDA approved or used off-label as first-line treatments for DR. Recent evidence shows that anti-VEGF agents can halt the progression of markers of DR severity, reduce the risk of DR worsening, and reduce the onset of new macular edema. These significant benefits have been demonstrated in patients with proliferative DR and the milder nonproliferative DR (NPDR). A wealth of evidence from recent trials and meta-analyses has detailed the intraoperative and postoperative benefits of adjunctive anti-VEGF therapy prior to pars plana vitrectomy (PPV) for proliferative DR with vitreous hemorrhage. In this review, we also discuss literature comparing various anti-VEGF injection regimens including monthly, quarterly, as-needed, and treat and extend protocols. Combination protocols with panretinal photocoagulation (PRP) or PPV are also discussed. Current evidence suggests that anti-VEGF therapies are effective therapy for NPDR and PDR and may also provide significant benefits when used adjunctively with other DR treatment modalities such as PRP or PPV.

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Section: Comparing Anti-vegf Versus Prp As Primary Therapy For Pdrmentioning

confidence: 99%

Update on the Management of Diabetic Retinopathy: Anti-VEGF Agents for the Prevention of Complications and Progression of Nonproliferative and Proliferative Retinopathy

Bahr

Bakri

2023

Life

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“…As recently reviewed [ 48 ], aflibercept is commonly used in the therapy of DME patients, resulting in greater visual acuity improvement and anatomic restoration than traditional laser therapy or monoclonal antibody drugs. The recent CLARITY clinical trial demonstrated that in patients with PDR, the topographical response of retinal neovascularization to aflibercept treatment was superior to panretinal photocoagulation [ 49 ]. Regarding the pharmacokinetics (PK) of anti-VEGF treatments, the intravitreous half-life of aflibercept in humans, as predicted by a mathematical model, is approximately 7 days, which is longer than that of ranibizumab and similar to that of bevacizumab [ 50 ].…”

Section: Management Of Neovascular Retinal Diseasesmentioning

confidence: 99%

Pharmacotherapy and Nutritional Supplements for Neovascular Eye Diseases

Rusciano

Bagnoli

2023

Medicina

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In this review, we aim to provide an overview of the recent findings about the treatment of neovascular retinal diseases. The use of conventional drugs and nutraceuticals endowed with antioxidant and anti-inflammatory properties that may support conventional therapies will be considered, with the final aim of achieving risk reduction (prevention) and outcome improvement (cooperation between treatments) of such sight-threatening proliferative retinopathies. For this purpose, we consider a medicinal product one that contains well-defined compound(s) with proven pharmacological and therapeutic effects, usually given for the treatment of full-blown diseases. Rarely are prescription drugs given for preventive purposes. A dietary supplement refers to a compound (often an extract or a mixture) used in the prevention or co-adjuvant treatment of a given pathology. However, it must be kept in mind that drug–supplement interactions may exist and might affect the efficacy of certain drug treatments. Moreover, the distinction between medicinal products and dietary supplements is not always straightforward. For instance, melatonin is formulated as a medicinal product for the treatment of sleep and behavioral problems; at low doses (usually below 1 mg), it is considered a nutraceutical, while at higher doses, it is sold as a psychotropic drug. Despite their lower status with respect to drugs, increasing evidence supports the notion of the beneficial effects of dietary supplements on proliferative retinopathies, a major cause of vision loss in the elderly. Therefore, we believe that, on a patient-by-patient basis, the administration of nutraceuticals, either alone or in association, could benefit many patients, delaying the progression of their disease and likely improving the efficacy of pharmaceutical drugs.

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“… 84 , 89 The CLARITY study was the first randomised clinical trial of intravitreal aflibercept for PDR and its use over PRP in PDR management. 90 , 91 In the post hoc analysis of the CLARITY study, 120 treatment-naïve patients with PDR were randomly assigned to intravitreal aflibercept (2 mg/0.05 mL at baseline, 4 weeks, 8 weeks, and as needed from 12 weeks onwards) or PRP (conducted in initial fractionated sessions and reviewed every 8 weeks followed by PRP again if required). The investigation was undertaken to establish the outcome of aflibercept and PRP on NV in PDR by examining the topological response.…”

Section: Pivotal Trials Related To Use Of Anti-vegf Therapy In Pdrmentioning

confidence: 99%

“…However, it was observed that NVD was rare, although more resistant to available treatment regimens. 84 , 90 …”

Section: Pivotal Trials Related To Use Of Anti-vegf Therapy In Pdrmentioning

confidence: 99%

A Paradigm Shift in the Management Approaches of Proliferative Diabetic Retinopathy: Role of Anti-VEGF Therapy

Raman

Ramasamy²,

Shah³

2022

OPTH

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Diabetic retinopathy (DR) is considered one of the leading causes of vision loss globally. It principally causes upregulation of pro-angiogenic, proinflammatory, and vascular permeability factors such as vascular endothelial growth factor (VEGF), leading to neovascularisation. The advanced stage of DR or proliferative diabetic retinopathy (PDR) is of more concern, as it leads to vitreous haemorrhage and traction retinal detachment. Various risk factors associated with PDR include hyperglycemia, hypertension, neuropathy, dyslipidemia, anaemia, nephropathy, and retinal complications of drugs used for diabetes. Current management approaches for PDR have been stratified and involve pan-retinal photocoagulation, vitrectomy, and anti-VEGF agents. Given the emerging role of anti-VEGF agents as a favourable adjunct or alternative therapy, they have a critical role in the management of PDR. The review emphasises current management approaches for PDR focusing on anti-VEGF therapy. The review also highlights the risk/benefit evaluation of the various approaches employed for PDR management in various clinical scenarios.

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Topographical Response of Retinal Neovascularization to Aflibercept or Panretinal Photocoagulation in Proliferative Diabetic Retinopathy

Cited by 6 publications

References 16 publications

Update on the Management of Diabetic Retinopathy: Anti-VEGF Agents for the Prevention of Complications and Progression of Nonproliferative and Proliferative Retinopathy

Update on the Management of Diabetic Retinopathy: Anti-VEGF Agents for the Prevention of Complications and Progression of Nonproliferative and Proliferative Retinopathy

Pharmacotherapy and Nutritional Supplements for Neovascular Eye Diseases

A Paradigm Shift in the Management Approaches of Proliferative Diabetic Retinopathy: Role of Anti-VEGF Therapy

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