Panretinal Photocoagulation Research Articles

Diabetic retinopathy screening and treatment through the Brazilian National Health Insurance

The current study aimed to investigate diabetic retinopathy (DR) screening and treatment coverages among diabetic patients evaluated through the Brazilian National Health Insurance from 2014 to 2019. The Brazilian Public Health System Information Database was used as the primary data source. DR screening coverage was calculated as the rate of procedures of clinical dilated fundus exam and color fundus photograph over the number of diabetic patients. DR treatment coverage was calculated as the rate of procedures of intravitreal injection, photocoagulation, and panretinal photocoagulation over the number of diabetic patients presumably in need of DR treatment. The overall screening coverage increased from 12.1% in 2014 to 21.2% in 2019 (p < 0.001) with substantial regional discrepancies so that North region was the only one with no changes along the period. The overall treatment coverage increased from 27.7% in 2014 to 44.1% in 2019, with Southeast and Midwest absorbing the demand for service from the North, Northeast and South. Despite an improvement along the past years, both screening and treatment coverages for DR in diabetes patients are ineffective in Brazil. Public health policies should address resources disparities throughout the country aiming to offer same healthcare conditions to patients regardless their geographic location.

A systematic review and meta-analysis of randomised controlled trials in the management of neovascular glaucoma: absence of consensus and variability in practice

PurposeNeovascular glaucoma (NVG) is characterised by neovascularisation of the angle and therefore elevated intraocular pressure (IOP). This results in progressive optic neuropathy and loss of visual acuity. Treatment aims to reduce IOP in order to prevent optic nerve damage. A systematic review was completed synthesising results from randomised control trials (RCTs) comparing interventions for the management of NVG and their efficacy and safety.MethodsData was sourced from Web of Science, Embase and Medline after 1st January 2000. The primary outcome measures were mean IOP at follow-up and success rate. The secondary outcomes included mean IOP lowering medications and total complications. A meta-analysis was completed on comparative studies using Revman (version 5.4).ResultsFor the two studies comparing Ahmed glaucoma valve (AGV) + pan-retinal photocoagulation (PRP) vs AGV + PRP + intra-vitreal bevacizumab (IVB), there was no difference in mean IOP or odds of success from the meta-analysis. From the 4 studies examining the utilisation of anti-vascular endothelial growth factor (anti-VEGF), one study showed lower mean IOP at 1 (p = 0.002) and 3 months (p = 0.033) for IVB vs sham injection. In the 2 studies studying transcleral diode laser (TDL), there were no significant findings. From the 4 studies looking at trabeculectomy (trab), lower mean IOP at 6 (p = 0.001), 9 (p = 0.01), 12 (p = 0.02) and 18 months (p = 0.004) was shown for intra-vitreal ranibizumab (IVR) + PRP + visco-trabeculectomy vs IVR + PRP + trab, and a significantly lower mean IOP was present in the Baerveldt group vs trab at 6 months (p = 0.03). In the 2 studies investigating the AGV, there was a lower mean IOP at 1 month (p = 0.01) in the AGV + triamcinolone (TCA) group. The risk of bias was low for 4 studies, high for 4 studies and 6 studies had some concerns.ConclusionThis is the first meta-analysis of RCTs in the management of neovascular glaucoma. The lack of high-quality evidence contributes to the lack of consensus in managing NVG. Our results highlight modern treatment strategies and the need for better powered RCTs with long-term follow-up in order to establish optimal treatment modalities and true patient outcomes.

PREDICTIVE FACTORS ASSOCIATED WITH ANATOMICAL AND FUNCTIONAL OUTCOMES AFTER PANRETINAL PHOTOCOAGULATION IN PEOPLE WITH PROLIFERATIVE DIABETIC RETINOPATHY.

To determine effects of baseline characteristics and laser type performed on outcomes in people with proliferative diabetic retinopathy (PDR) undergoing panretinal photocoagulation (PRP). Medical records of all consecutive patients with PDR naïve to PRP, identified using an electronic database, evaluated at the Macula Clinic, Belfast Health and Social Care Trust, receiving their first PRP between January 1, 2016, and June 30, 2017, and followed for a minimum of 6 months after stabilization of PDR, were retrospectively reviewed. Outcomes included time to stabilization after PRP, progression of PDR, and mean change in the best-corrected visual acuity from baseline to the last follow-up. Cox regression was used to estimate hazard ratios (HRs) for the effect of baseline characteristics and type of laser on outcomes after treatment. One hundred and fourteen patients (135 eyes) with a mean age of 56.9 (SD: 12.9) years were included, 67% males. People receiving pattern or mixed laser had a statistically significantly delayed stabilization (HR: 0.57, P = 0.020; and HR: 0.44, P ≤ 0.001, respectively) and increased risk of progression (HR: 1.87, P = 0.045; and HR: 1.96, P = 0.028, respectively) when compared with those receiving standard laser. Among other potential predictors in multivariable regression analysis, only vitreous hemorrhage and fibrosis or traction at baseline increased the risk of progression (HR: 1.58, P = 0.047; and HR: 4.29, P ≤ 0.001, respectively). Baseline characteristics and type of laser had no statistically significant effect on vision. These findings should be considered when selecting laser treatment, planning surveillance, and counselling patients with PDR undergoing PRP.

Travel burden in treatment of retinopathy of prematurity

Approximately 10% of infants screened for ROP require treatment. Current treatment options include Panretinal Laser Photocoagulation or Intravitreal antiVEGF. Our institution provides treatment of ROP for a very large geographic region, making the travel burden for some patients a large barrier to care access. Our aim is to compare the follow-up and travel burden between patients with ROP treated with laser and those treated with intravitreal antiVEGF at our institution.

Neovascular Glaucoma from Ocular Ischemic Syndrome Treated with Serial Monthly Intravitreal Bevacizumab and Panretinal Photocoagulation: A Case Report

Purpose To describe a case of open-angle neovascular glaucoma (NVG) secondary to ocular ischemic syndrome (OIS) treated with a planned series of 6 monthly anti-VEGF injections with interspersed panretinal photocoagulation (PRP) sessions. We term this treatment protocol the Salvaging Conventional Outflow Pathway in Neovascular Glaucoma (SCOPING) Protocol, and this is our (MQ and DS) standard of care for all NVG patients presenting with partially or completely open angles. Case A 66-year-old man's right eye had a visual acuity of 20/50, intraocular pressure (IOP) of 42 mmHg on 0 IOP-lowering medications, and neovascularization of the iris and angle with no peripheral anterior synechiae. Fundoscopy revealed midperipheral dot-blot hemorrhages without diabetic retinopathy or vein occlusion. Fluorescein angiography revealed peripheral retinal nonperfusion in both eyes. The patient was diagnosed with open-angle NVG secondary to OIS and treated with 6 serial monthly anti-VEGF injections interspersed with 4 PRP sessions, after which his anterior segment neovascularization regressed and IOP normalized on 0 medications. Ten weeks after the last injection, the anterior segment neovascularization and elevated IOP recurred, so he underwent 4 more monthly anti-VEGF injections and 4 PRP sessions, after which his anterior segment neovascularization regressed and his IOP normalized on 0 medications. However, 6 weeks after the last injection, the anterior segment neovascularization and elevated IOP again recurred, so he was resumed on a third course of lifetime monthly anti-VEGF injections, which may be continued in perpetuity. Conclusion The patient's NVG was quiescent while under the protection of serial anti-VEGF injections with interspersed PRP; however, the disease recurred each time injections were stopped. Therefore, in patients with open-angle NVG secondary to OIS, serial monthly anti-VEGF injections may be necessary combined with PRP to suppress underlying neovascular drive and regress anterior segment neovascularization, maintain physiologic IOP, and prevent synechial angle closure.

Deep Capillary Nonperfusion on OCT Angiography Predicts Complications in Eyes with Referable Nonproliferative Diabetic Retinopathy

To evaluate the ability of capillary nonperfusion parameters on OCT angiography (OCTA) to predict the development of clinically significant outcomes in eyes with referable nonproliferative diabetic retinopathy (NPDR). Prospective longitudinal observational study. In total, 59 patients (74 eyes) with treatment-naive moderate and severe (referable) NPDR. Patients were imaged with OCTA at baseline and then followed-up for 1 year. We evaluated 2 OCTA capillary nonperfusion metrics, vessel density (VD) and geometric perfusion deficits (GPDs), in the superficialcapillary plexus, middle capillary plexus (MCP), and deep capillary plexus (DCP). We compared thepredictive accuracy of baseline OCTA metrics for clinically significant diabetic retinopathy (DR) outcomes at1year. Significant clinical outcomes at 1 year, defined as 1 or more of the following-vitreous hemorrhage, center-involving diabetic macular edema, and initiation of treatment with pan-retinal photocoagulation or anti-VEGF injections. Overall, 49 patients (61 eyes) returned for the 1-year follow-up. Geometric perfusion deficits and VD in the MCP and DCP correlated with clinically significant outcomes at 1 year (P < 0.001). Eyes with these outcomes had lower VD and higher GPD, indicating worse nonperfusion of the deeper retinal layers than those that remained free from complication. These differences remained significant (P= 0.046 to < 0.001) when OCTA parameters were incorporated into models that also considered sex, baseline corrected visual acuity, and baseline DR severity. Adjusted receiver operating characteristic curve for DCP GPD achieved an area under the curve (AUC) of 0.929, with sensitivity of 89% and specificity of 98%. In a separate analysis focusing on high-risk proliferative diabetic retinopathy outcomes, MCP and DCP GPD and VD remained significantly predictive with comparable AUC and sensitivities to the pooled analysis. Evidence of deep capillary nonperfusion at baseline in eyes with clinically referable NPDR can predict short-term DR complications with high accuracy, suggesting that deep retinal ischemia has an important pathophysiologic role in DR progression. Our results suggest that OCTA may provide additional prognostic benefit to clinical DR staging in eyes with high risk.

Diabetic retinopathy with extensively large area of capillary non-perfusion: characteristics and treatment outcomes

BackgroundCapillary non-perfusion is an important characteristic for diabetic retinopathy (DR) indicating microvascular damage and ischemia. Data on the description and treatment outcomes of DR with large area of non-perfusion are lacking to date. We aim to describe the characteristics and treatment outcomes in a series of patients with DR who presented extensively large area of capillary non-perfusion (LACNP).MethodsFundus fluorescein angiograms from medical charts in patients diagnosed with DR between Jan 2017 and Dec 2019 were retrospectively reviewed. Clinical data in eyes with LACNP including imaging and laboratory findings at the first presentation were analyzed. The LACNP was defined as over 70% area of capillary non-perfusion throughout the whole image retina. The mean follow-up duration was 12.4 ± 16.7 months. Follow-up data including extensive pan-retinal photocoagulation and surgical intervention and treatment outcomes were evaluated.ResultsA total of 43 eyes in 24 patients with LACNP were included, accounting for 3.3% of DR populations in the same period. The overall percentage of non-perfusion area was 79.1 ± 8.1%. All patients received proper control of diabetes and hypertension, and extensive pan-retinal laser photocoagulation. During the follow-up periods, 20 eyes (46.5%) developed severe neovascular complications, of which 15 eyes (34.9%) underwent vitrectomy and/or anti-glaucoma surgeries. Conservative therapies including glycemic control and supplemental laser photocoagulation were conducted in 23 eyes (53.5%) without neovascular complications. In the final follow-up, best corrected visual acuity improved or maintained stable in 19 eyes (44.2%) while deteriorated in 24 eyes (55.8%).ConclusionsThe presence of LACNP is the hallmark of advanced DR and often indicates a poor visual outcome, although aggressive treatments may slow DR progression and maintain central vision for some time.

Single-Session Prophylactic Pan-Retinal Photocoagulation in Moderate Nonproliferative Diabetic Retinopathy in Low-Resource Settings

Purpose: To study patient's acceptability and safety of offering a prophylactic early single session of pan-retinal photocoagulation (PRP) for moderate nonproliferative diabetic retinopathy (NPDR) in selected patients. Settings and Design: Mixed observational and interventional study. Patients and Methods: The observational study included 82 eyes of 68 patients presenting with proliferative diabetic retinopathy (PDR) or its complications and the interventional study included 48 eyes of 48 patients with moderate NPDR who were offered a single session PRP because they were unlikely to comply with the follow-up protocol and were at higher risk of diabetic retinopathy (DR) progression. Results: The observational study showed that nearly 51% of patients had no idea about the DR screening protocols, 47.5% of included eyes presented with vitreous hemorrhage, 30.5% with tractional retinal detachment, and 22% with retinal neovascularization. The interventional study showed that minor patients' complaints were reported such as night vision problems, flashes, and peripheral field defects. There was no significant change in the mean preoperative logarithm of the minimum angle of resolution (logMAR) corrected distance visual acuity (CDVA) over time throughout the study (P = 0.951). At the end of follow-up, 89.5% of included eyes showed no loss of any lines of their preoperative logMAR CDVA and 10.5% lost only one line. All eyes remained in the same stage of moderate NPDR with no signs of progression to severe or very severe NPDR or proliferative DR. Conclusion: Prophylactic early PRP is an acceptable, safe, and satisfactory procedure for patients with moderate NPDR in low-resource settings.

Monitoring the Patient with Retinal Angiopathy Associated with Hereditary Transthyretin Amyloidosis: Current Perspectives.

Retinal angiopathy associated with hereditary transthyretin amyloidosis (ATTRv), if untreated, may lead to irreversible vision loss. Our purpose was to systematically review the clinical and imaging features of retinal angiopathy associated with ATTRv and assemble a monitoring approach for these patients. All types of original research studies reporting clinical and imaging findings on retinal angiopathy associated with ATTRv were included. The most common clinical findings were tortuous retinal vessels, microaneurysms, retinal hemorrhages, sheathing of retinal vessels, whitish amyloid deposits along retinal arteries, obliteration of retinal vessels, vitreous hemorrhage, retinal and iris neovascularization. The most relevant imaging findings were hyperautofluorescence of perivessel amyloid deposits; delayed arterial filling, vascular leakage, and retinal ischemia on fluorescein angiography; late hypercyanescence along the choroidal arteries on indocyanine green angiography; perivascular hyperreflective material, needle-shaped deposits on the retinal surface and macular edema on optical coherence tomography (OCT) and attenuated retinal vascular network on OCT-angiography. ATTRv patients should be strictly followed to detect and treat retinal angiopathy, avoiding complications. Both panretinal photocoagulation and intravitreal anti-vascular endothelial growth factor have been used to treat retinal angiopathy in ATTRv. In an individual that presents with retinal angiopathy of unknown etiology, ATTRv should be considered as in the differential diagnosis, even out of the initial core countries. The prognostic value of subclinical findings, namely in OCT-A, is not yet established.

Change in Central Macular Thickness on OCT after Pan Retinal Photocoagulation

Background: Proliferative diabetic retinopathy is the proliferation of retinal neo vessels due to uncontrolled diabetes mellitus and long duration of this disease that leads to advance diabetic eye disease . proliferative diabetic retinopathy is treated by pan retinal photocoagulation which reduces retinal oxygen demand by retinal photocoagulation. Retinal photocoagulation leads to the laser tissue interaction called thermal damage leading to coagulative necrosis of the retinal pigment epithelial cells as these cells contain melanin a dark pigment that has the ability to absorb light energy in argon laser spectrum. Objective: To determine the mean change in central macular thickness after pan retinal photocoagulation on optical coherence tomography of the macula in patients with proliferative diabetic retinopathy . Material &amp; Methods: Our study was a Quasi experimental study conducted at Department of Ophthalmology, Services Hospital Lahore for duration of six months from April 2021 to September 2021. In this study 40 eyes from 40 patients with proliferative diabetic retinopathy were selected who underwent pan retinal photocoagulation in one sessions with 1500 burn marks. Patients in the age group of 15 to 70 years, male and female, with proliferative diabetic retinopathy in at least one eye with no history of ocular surgery or ocular trauma in last one year were included in this study . Optical coherence tomography of macula was performed before and four weeks after the session of pan retinal photocoagulation. CMT (central macular thickness) was measured for mean change in central macular thickness. Results: In this study , the mean age of patients was 48.68±1.52 years, and gender ratio of female to male patients was 1:0.77,The mean CMT before start of treatment that was considered as baseline was 230.55±5.0 and the mean CMT value after four weeks of pan retinal photocoagulation was 238.50±6.43. (p-value=0.001) Conclusion: No significant change in CMT was found from baseline CMT to four weeks after pan retinal photocoagulation. Keywords: Optical coherence tomography, pan retinal photocoagulation, Central Macular Thickness, proliferative diabetic retinopathy

Transnasal sphenopalatine ganglion block for pain relief during panretinal photocoagulation laser for diabetic retinopathy: a pre and post interventional study

This study was performed to utilize transnasal Sphenopalatine Ganglion (SPG) block for pain reliving during panretinal photocoagulation (PRP) in diabetic patients with diabetic retinopathy. This pre and post interventional study was performed on 20 patients with proliferative diabetic retinopathy. The first PRP treatment session of all the patients is performed with no transnasal SPG block, but before holding the second session, all the patients underwent transnasal SPG block and pain levels during and after PRP were compared to each other. Before the transnasal SPG block, each nostril of all the cases was inspected for finding any obstruction in each PRP session. Transnasal SPG block was also performed in with 2% lidocaine. The mean age of the included cases was 52.84 ± 8.62 years old (from 36 to 72 years old). All the cases underwent two PRP lasers treatment sessions with the same characteristic (spot size, power and duration) for each patient. In the first and second PRP treatment sessions, the mean NRS scores were obtained immediately after the PRP laser (8.4 vs. 4.2), 15 min (8.2 vs. 4.2), 1 h (8.0 vs. 4.1), and 24 h (5.4 vs. 3.6) after the PRP respectively. The mean NRS scores significantly reduced during the second PRP treatment session compared to the first session (p < 0.001). Transnasal SPG block is a safe and effective strategy used for relieving pain caused by the PRP laser treatment in patients with diabetic retinopathy.

Aqueous Humor Analyses in Patients with Diabetic Retinopathy Who Had Undergone Panretinal Photocoagulation

Purpose To determine the associations between aqueous humor cytokine levels and the severity of diabetic retinopathy and the prior panretinal photocoagulation (PRP) status of patients with diabetic macular edema (DME). Methods We divided 98 DME patients into those with nonproliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR), and PRP patients. We compared the concentrations of interleukin- (IL-) 1β, IL-6, IL-8, IL-10, and IL-17; placental growth factor (PlGF); and vascular endothelial growth factor (VEGF) in the aqueous humors. We subclassified PRP patients by the interval between PRP and aqueous sampling and analyzed the associations between aqueous cytokine levels and this interval. Results The aqueous humor levels of IL-6, IL-8, VEGF, and PlGF were significantly higher in the PDR group than in the NPDR group. The PlGF and VEGF levels in the PDR group were significantly higher than those in the PRP group. On PRP subgroup analyses, patients who had undergone PRP within 6 months prior exhibited higher levels of VEGF, PlGF, and TNF-α than did those who had undergone PRP more than 12 months prior. The TNF-α level of the PRP subgroup treated within 6 months prior was significantly higher than that of the PDR group. Regression analyses showed that the levels of VEGF, PlGF, and TNF-α decreased significantly as the interval between PRP and aqueous sampling became longer. Conclusions PDR patients exhibited higher concentrations of VEGF and certain inflammatory cytokines than did NPDR and PRP patients. In the latter patients, the intraocular VEGF and inflammatory cytokine levels fell gradually over time.

Pain control during panretinal photocoagulation for diabetic retinopathy

Objectives This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects (benefits and harms) of different interventions aimed at controlling pain associated with panretinal photocoagulation, in people with severe non‐proliferative diabetic retinopathy and proliferative diabetic retinopathy, according to the classification of ETDRS 1991.

PANRETINAL PHOTOCOAGULATION VERSUS INTRAVITREAL BEVACIZUMAB VERSUS A PROPOSED MODIFIED COMBINATION THERAPY FOR TREATMENT OF PROLIFERATIVE DIABETIC RETINOPATHY: A Randomized Three-Arm Clinical Trial (CTPDR Study).

To compare safety and therapeutic effect of three treatment protocols on patients with naive proliferative diabetic retinopathy. A total of 207 eyes with proliferative diabetic retinopathy were randomly divided into three groups: full panretinal photocoagulation group; intravitreal bevacizumab (IVB) group with four monthly IVB injections; and modified combination group with two bimonthly IVB injections and a modified laser therapy. The best-corrected visual acuity and area of neovascularization leakage were compared at 1-year follow-up. The difference in final best-corrected visual acuity was not significant between the groups (P = 0.77). The modified combination group had the lowest final leakage area (P = 0.006). The difference in final mean deviation of visual field was not significant between IVB and modified combination groups (mean difference = 0.25, P = 0.23, 95% confidence interval, 0.12-1.38). There was no difference in rate of new-onset diabetic macular edema between IVB and modified combination groups (mean difference = 1.5%, P = 0.31, 95% confidence interval, 1.1-1.88). Mean of total IVB injections were 3.5, 7.4, and 6.2 for panretinal photocoagulation, IVB, and modified combination groups, respectively (P = 0.002). Patients in the IVB group underwent more visits (P = 0.001). In subgroup analysis, the difference in the final leakage area was significant for the eyes with diabetic macular edema (P = 0.005). A combination protocol of photocoagulation and IVB can be recommended for proliferative diabetic retinopathy, especially with baseline diabetic macular edema.

43-OR: Aqueous Retinol Binding Protein 3 Is Reduced in Patients with Advanced Diabetic Retinopathy in Type 1 and Type 2 Diabetes

The Joslin Medalist Study identified Retinol-binding protein 3 (RBP3) as a potential protective factor against diabetic retinopathy (DR) in the vitreous and retina of individuals with type 1 diabetes for 50 years or longer. This study evaluated the association of aqueous RBP3 concentration to vitreous RBP3 concentrations and DR severity. We measured 131 aqueous samples from patients with type 1 and 2 diabetes undergoing cataract surgery at the Joslin Beetham Eye Institute (BEI) and postmortem samples of Medalists. Aqueous RBP3 concentrations in BEI and Medalists samples were similar for eyes with proliferative DR (PDR, P=0.11) and were well correlated between fellow eyes (r=0.65, P&amp;lt;0.0001) . With an average 12-fold decreased concentration compared to vitreous samples, RBP3 concentrations in aqueous and vitreous samples were correlated within the same individual (r=0.32, P=0.003, N=89) . Aqueous RBP3 was not associated with A1c (P=0.60) , however, RBP3 concentration was inversely associated with the presence of pan-retinal laser photocoagulation scars (β estimate −22.0, 95% CI −31.9;−12.0, P&amp;lt;0.0001) . With increasing DR severity, aqueous RBP3 levels decreased from mild DR (median 0.7nM ± 0.2) , moderate-severe (0.65nM ± 0.3, P=0.0092 vs. PDR) , to PDR (0.5nM ± 0.2, P=0.0vs. mild DR) . Individual retinal layer thicknesses measured by optical coherence tomography (Heidelberg v6.0c, Germany, N=45) showed that higher aqueous concentrations were associated with increased thickness of the ganglion cell layer (β estimate 0.002, 95% CI 0.0019;0.0023, P&amp;lt;0.0001) and inner nuclear layer (0.0026, 0.0025;0.0028, P&amp;lt;0.0001) . The retinal pigment epithelium was inversely associated with aqueous RBP3 levels (−0.001, −0.0017;0.0003, P=0.004) . These findings indicate that aqueous RBP3 concentrations are correlated to vitreous fluids and reduced in people with advanced DR, supporting its potential use as a biomarker for DR severity in people with type 1 and 2 diabetes. Disclosure T.Chokshi: None. J.Sun: Consultant; American Diabetes Association, American Medical Association, Research Support; Adaptive Sensory Technology, Boehringer Ingelheim International GmbH, Genentech, Inc., Jaeb Center for Health Research, Janssen Pharmaceuticals, Inc., Novartis Pharmaceuticals Corporation, Novo Nordisk, Optovue, Incorporated, Physical Sciences, Inc, Roche Pharmaceuticals. G.L.King: Advisory Panel; Medtronic, Research Support; Janssen Pharmaceuticals, Inc. W.Fickweiler: None. M.G.Mitzner: None. I.Wu: None. T.Boumenna: None. D.B.Robinson: None. H.Park: None. K.Park: None. L.P.Aiello: Consultant; KalVista Pharmaceuticals, Inc., Novo Nordisk, Stock/Shareholder; KalVista Pharmaceuticals, Inc. Funding American Diabetes Association (7-21-PDF-022) ; National Eye Institute (R01EYE26080-01) , the National Institute of Diabetes and Digestive and Kidney Diseases and National Institutes of Health (DP3-DK-094333-01) ; JDRF (17-2013-310) ; the Dianne Nunnally Hoppes Fund; the Beatson Pledge Fund

A Long-term Clinical Study to Evaluate AGV with Concurrent Intravitreal Ranibizumab vs Primary AGV Implantation in Cases of Refractory Neovascular Glaucoma.

PurposeThis study was aimed to gauge the efficacy of primary AGV implantation with concurrent intraoperative intravitreal ranibizumab vs primary AGV implantation alone in the management of neovascular glaucoma (NVG).MethodsThis retrospective comparative study was carried out based on the data collected in patients of neovascular glaucoma who underwent Ahmed Glaucoma Valve implantation with or without concurrent intravitreal ranibizumab between the period from Feb 2009 to Feb 2015 involving two groups of 40 patients each, having the clinical diagnosis of neovascular glaucoma, having undergone pan-retinal photocoagulation with minimum 03 intravitreal injections of ranibizumab not less than 4 weeks prior to undergoing primary Ahmed glaucoma valve implantation and allotted randomly to either group to receive concurrent administration of intravitreal ranibizumab with Ahmed glaucoma valve (AGV) implant surgery or AGV implant surgery alone. The minimum qualifying follow-up was 3-years. The functional outcome measures included intraoperative and postoperative complications, intraocular pressure (IOP), and the need for antiglaucoma medication, if any, as well as best corrected visual acuity.ResultsBoth the groups showed a significant decrease in IOP (p < 0.05). Sight and IOP threatening postoperative complications were significantly low in the study group. NVI regression was higher in the study group and re-emergence was significantly lesser in the study group (p = 0.002). Mean postop IOP had shown an excellent reduction in IOP up to 14.25 ± 2.05 mm Hg with 1.5 ± 1 antiglaucoma drugs in ranibizumab group and 15.25 ± 2.95 mm Hg with 1.7 ± 0.87 antiglaucoma drugs in the control group at the 3-years follow-up period. Surgical success rates were comparable between the two groups at 1 and 3-year.ConclusionConcurrent intravitreal ranibizumab along with primary AGV implantation minimizes postoperative complications, regresses NVI while accelerating stabilization of IOP and visual functions.How to cite this articleKaushik J, Parihar JKS, Shetty R, et al. A Long-term Clinical Study to Evaluate AGV with Concurrent Intravitreal Ranibizumab vs Primary AGV Implantation in Cases of Refractory Neovascular Glaucoma. J Curr Glaucoma Pract 2022;16(1):41–46.

Optical Coherence Tomography Combined with Fluorescein Fundus Angiography under Intelligent Algorithm to Evaluate the Clinical Efficacy of Ranibizumab Combined with Panretinal Photocoagulation in the Treatment of Macular Edema of Diabetic Retinopathy Patients.

This study aimed at investigating the clinical effect of ranibizumab combined with panretinal photocoagulation in the treatment of macular edema in diabetic retinopathy (DR) patients. A parametric deformation model was constructed, and based on this, it was evaluated using optical coherence tomography (OCT) combined with fluorescein fundus angiography (FFA). 56 DR patients (80 eyes) who needed surgery were selected for OCT and FFA scanning, and 0.5 mg ranibizumab was administered intravitreal injection before surgery. It should observe the OCT and FFA image characteristics of patients. In addition, the vision correction status before the surgery, 1 month, 3 months, and 6 months after the surgery, the thickness of the macular retina, operation time, the number of intraoperative electrocoagulation, and complications of patients were recorded. It was found that 82.85% of patients had improved visual acuity after surgery. Compared with preoperative, the average logarithm of the minimum angle of resolution (logMAR) of patients at 6 months after surgery increased significantly (P < 0.01). With the increase of the grade of fibrosis and the grade of hemorrhage, the logMAR visual acuity recovery at 6 months after the surgery became worse; the macular retinal thickness at 6 months after the surgery decreased significantly (P < 0.01). With the increase of the grade of fibrous proliferation and the grade of bleeding, the operation time, the number of electrocoagulation, and the possibility of iatrogenic holes of patient would increase. It can be known that ranibizumab combined with panretinal photocoagulation surgery could not only reduce the macular edema but also effectively reduce the intraoperative bleeding, simplify the removal of proliferative membranes, decrease the number of electrocoagulation, and shorten the operation time, enhancing the visual function of patients.

Comparison of serum and vitreous TGF-β1 levels in proliferative diabetic retinopathy with and without panretinal photocoagulation laser therapy

Introduction: A long-term diabetic retinopathy will cause an increase in several growth factors expression like Transforming Growth Factor β (TGF-β). This multipotent cytokine is involved in the process of endothelial cell proliferation. Therefore, this study aims to observe the relationship between TGF-β1 levels in serum and vitreous fluid of Proliferative Diabetic Retinopathy (PDR) patients given Pan Retinal Photocoagulation (PRP) laser therapy. Method: This was a cross-sectional study involving 14 patients with PDR. TGF-β1 levels of vitreous and peripheral blood were measured using Enzyme-linked Immunosorbent Assay (ELISA) method. The data were statistically analyzed using SPSS software for Windows ver. 23.0 for Mann-Whitney and the Spearman correlation test. Results: Our subjects consisted of 57.1% males with a mean age of 51.8 years, where dyslipidemia was the most common comorbid disease. Mean serum TGF-β1 level was 12,821.43 ± 5,253.16 pg/ml, while the mean value in vitreous was 3,692.86 ± 333.89 pg/ml. Meanwhile, there was no significant difference in serum and vitreous TGF-β1 levels between subjects with and without PRP laser therapy (p&gt;0.05). Conclusion: There was no significant correlation between TGF-β1 levels in proliferative diabetic retinopathy patients with and without panretinal photocoagulation laser therapy. However, there was a decreasing trend in TGF-β1 levels in the vitreous fluid, indicating that PRP laser therapy has a positive effect on preventing the formation of neovascularization in the eye.

Correlation of Optical Coherence Tomography Angiography Characteristics with Visual Function to Define Vision-Threatening Diabetic Macular Ischemia.

The thresholds of macular microvasculature parameters associated with mild visual impairment in diabetic macular ischemia (DMI) patients are unclear. Therefore, this prospective observational study is aimed at demonstrating the optical coherence tomography angiography parameters that best correlate with mild visual impairment (<70 Early Treatment Diabetic Retinopathy Study (ETDRS) letters, Snellen equivalent 20/40) in DMI. The study was completed at the Moorfields Eye Hospital from December 2019 to August 2021. A total of 123 eyes of 87 patients with stable-treated proliferative diabetic retinopathy following panretinal photocoagulation were recruited. DMI was defined as an irregular foveal avascular zone (FAZ) area ≥ 0.5 mm2 or a smaller FAZ area with parafoveal capillary dropout in at least one quadrant. The analysis showed that the whole image deep vascular complex vessel density (DVC VD) in the 3 × 3 mm area had the best discriminatory ability to identify participants with mild visual impairment at 41.9% (area under the curve = 0.77, sensitivity 94%, specificity 54%, likelihood ratio [LR] = 2.04), and the FAZ area had the greatest post-test LR = 4.21 at 0.64 mm2. The 3 × 3 mm whole image DVC VD and FAZ area cutoffs are useful for screening vision-threatening DMI, but DVC VD has low specificity.

Efficacy of intravitreal conbercept combined with panretinal photocoagulation for severe nonproliferative diabetic retinopathy without macular edema.

To assess efficacy of intravitreal conbercept (IVC) injection in combination with panretinal photocoagulation (PRP) vs PRP alone in patients with severe nonproliferative diabetic retinopathy (SNPDR) without macular edema (ME). Forty-eight patients with SNPDR without ME (56 eyes) were divided into the PRP group and IVC+PRP group (the pulse group) in this retrospective clinical study. Conbercept was intravitreally administered to patients in the pulse group 1wk before treatment with PRP and followed up for 1, 3, and 6mo. The best-corrected visual acuity (BCVA, logMAR), center foveal thickness (CFT), visual acuity (VA) improvement, and adverse reactions were compared between groups. In the PRP group, the BCVA reduced at 1 and 3mo before improving at 6mo. In the pulse group, baseline BCVA decreased continuously at 1mo, increased at 3 and 6mo. BCVA in the pulse group was better than that in the PRP group at 1, 3, and 6mo. There was an increase in CFT in the PRP group during follow-up compared with baseline. In the pulse group, CFT was increased at 1mo relative to baseline, steadily decreased to the baseline level at 3 and 6mo. There was a more significant reduction in CFT in the pulse group during follow-up compared with the PRP group. The effective rates of VA in the PRP and the pulse groups were 81.48% and 100%, respectively. As PRP pretreatment, a single dose of IVC administration has beneficial effects for preventing PRP-induced foveal thickening and increasing VA in patients with SNPDR without ME.