Treatment Of Nonproliferative Diabetic Retinopathy Research Articles

Evaluation of individualized treatment of nonproliferative diabetic retinopathy: a multicenter, randomized, parallel-controlled study.

To evaluate the differences in the efficacy of stationary treatment and individualized treatment for patients with nonproliferative diabetic retinopathy (NPDR). This study was a randomized, controlled, multicenter clinical trial. Participants with NPDR were randomized into the stationary treatment group or the individualized treatment group. The stationary treatment group was given the basic treatment and Qiming granules, and the individualized treatment group was given the basic treatment, Qiming granules, and individualized Chinese herbal medicines over a 12-week period. The individualized therapeutic formula was also changed over time to adjust to the changes in the clinical presentation of the patient. We conducted observations of fundus retinal exudation and hemorrhage, visual acuity, Traditional Chinese Medicine symptom scores and other indicators. A total of 140 participants with NPDR were randomized into the stationary treatment group or the individualized treatment group, and 132 participants completed this study. Following the 12-week treatment, significant improvements in both primary and secondary outcomes were observed in the stationary and individualized treatment groups. No remarkable difference in the primary outcomes between the two groups was observed. However, there was a significant difference in the Traditional Chinese Medicine symptom scores (18 ± 7 vs 15 ± 6; P < 0.05). There were no severe adverse effects. Compared with stationary treatment, individualized treatment is more effective at relieving the Traditional Chinese Medicine symptoms and improving vision and fundus lesions at 12 weeks post treatment.

Efficacy of addition and subtraction of Buyang Huanwu decoction in the adjuvant treatment of non-proliferative diabetic retinopathy of Qi-Yin deficiency and blood stasis

Efficacy of addition and subtraction of Buyang Huanwu decoction in the adjuvant treatment of non-proliferative diabetic retinopathy of Qi-Yin deficiency and blood stasis

The way it was and the way it should be – the new approach to the treatment of nonproliferative diabetic retinopathy

Diabetes has been declared an epidemic of the XXIst century by the World Health Organisation. Diabetic retinopathy, one of its main complications, is a leading cause of vision impairment among professionally active adults. Diabetic retinopathy is a microangiopathy that affects mainly small vessels, due to their highest vulnerability to hyperglycemia. Preventive measures involve mainly strict diabetic follow-ups, balanced level of glycated hemoglobin, blood pressure values and analysis of lipids. Regular ophthalmological check-ups and imaging tests of the retina are also extremely significant. For many years scientists have searched for a therapy to suppress vascular changes in diabetes. In May 2021 a stance on sulodexide use as a supporting treatment in mild and intermediate diabetic retinopathy was published by the Polish Society of Ophthalmology. Sulodexide protects vascular endothelium, contributes to endothelial cells’ function and has profibrinolytic, anti-inflammatory and vasoregulatory properties. These features make it a promising protective agent in the early stages of diabetic retinopathy.

Evaluation of Intravitreal Aflibercept for the Treatment of Severe Nonproliferative Diabetic Retinopathy

Proactive treatment of nonproliferative diabetic retinopathy (NPDR) reduces the risk of progression to vision-threatening complications. To evaluate vascular endothelial growth factor blockade therapy with intravitreal aflibercept injections in eyes with severe NPDR without diabetic macular edema (DME). The Study of the Efficacy and Safety of Intravitreal Aflibercept for the Improvement of Moderately Severe to Severe Nonproliferative Diabetic Retinopathy (PANORAMA) was a double-masked 100-week randomized clinical trial conducted in multiple centers worldwide. The study included 402 adults with Diabetic Retinopathy Severity Scale (DRSS) level 47 or 53 with no DME and best-corrected visual acuity of 20/40 or better. Intravitreal injections of aflibercept, 2 mg, every 16 weeks after 3 initial monthly doses and one 8-week interval (aflibercept 2q16 group); intravitreal injections of aflibercept, 2 mg, every 8 weeks after 5 initial monthly doses, with pro re nata (PRN) dosing beginning at week 56 (aflibercept 2q8/PRN group); or sham injections (control group). Proportions of eyes with a 2-step or greater improvement in DRSS level, vision-threatening complications, and center-involved DME from baseline to weeks 24, 52, and 100. Among 402 participants (1 eye per participant), the mean (SD) age was 55.7 (10.5) years; 225 (56.0%) were male, and 310 (77.1%) were White. A total of 135 were randomized to the aflibercept 2q16 group, 134 to the aflibercept 2q8/PRN group, and 133 to the control group. At 24 weeks, treatment with aflibercept resulted in a 2-step or greater improvement in DRSS level in 157 of 269 eyes (58.4%) in the combined aflibercept groups vs 8 of 133 eyes (6.0%) in the control group (adjusted difference, 52.3%; 95% CI, 45.2%-59.5%; P < .001). At 52 weeks, 88 of 135 eyes (65.2%) in the aflibercept 2q16 group (adjusted difference, 50.1%; 95% CI, 40.1%-60.1%) and 107 of 134 eyes (79.9%) in the aflibercept 2q8/PRN group (adjusted difference, 64.8%; 95% CI, 55.8%-73.9%) compared with 20 of 133 eyes (15.0%) in the control group (P < .001 for both comparisons) showed a 2-step or greater improvement in DRSS level. Fewer eyes treated with aflibercept vs sham injections developed vision-threatening complications and/or center-involved DME through week 100 (22 of 135 eyes [16.3%] in the 2q16 group [adjusted difference, -34.2%; 95% CI, -44.6 to -23.8] and 25 of 134 eyes [18.7%] in the 2q8/PRN group [adjusted difference, -31.7%; 95% CI, -42.5 to -20.9] compared with 67 of 133 eyes [50.4%] in the control group; P < .001 for both comparisons). No new safety signals were identified. In this study, significantly more eyes with moderately severe to severe NPDR that were treated with aflibercept showed a 2-step or greater improvement in DRSS level at 24, 52, and 100 weeks, and significantly fewer eyes treated with aflibercept vs sham developed vision-threatening complications and center-involved DME. Outcomes on the DRSS between year 1 and 2 emphasize the need for ongoing vascular endothelial growth factor suppression and adherence. ClinicalTrials.gov Identifier: NCT02718326.

Efficacy of the ranibizumab combined with panretinal photocoagulation for the treatment of diabetic retinopathy

Objective To evaluate the clinical efficacy of intravitreal injection of ranibizumab combined with panretinal photocoagulation for the treatment of nonproliferative diabetic retinopathy(DR). Methods The data of 104 eyes of 65 cases of nonproliferative DR were retrospectively analyzed.All cases received intravitreal injection of ranibizumab combined with panretinal photocoagulation.The followed-up time was 6 months. Results The visual acuity improved in 42 eyes, no changed in 55 eyes. The efficacy rate was 93.37%.The results of FFA showed markedly effective in 42 cases (40.38%), effective in 34 cases (32.69%) and ineffective in 24 cases (22.93%). The results of OCT showed that, the macular retinal thickness were (367.56±78.34)μm before treatment and(225.12±35.78)μm half a year after treatment. The difference was statistically significant (P<0.05). Conclusion Intravitreal injection of ranibizumab combined with panretinal photocoagulation for the treatment of nonprotiferative DR is effective. Key words: Retinopathy, diabetic, nonproliterative; Ranibizumab, intravitreal injection; Photocoagulation, panretinal

Effect and safety evaluation of Qiming Granule on the treatment of nonproliferative diabetic retinopathy

Effect and safety evaluation of Qiming Granule on the treatment of nonproliferative diabetic retinopathy

Effects of calcium dobesilate in the treatment of non-proliferative diabetic retinopathy after panretinal laser photocoagulation

Effects of calcium dobesilate in the treatment of non-proliferative diabetic retinopathy after panretinal laser photocoagulation

Comparison between multispot laser and conventional laser in the treatment of diabetic clinically significant macular edema

Objectives The purpose of this study was to assess the safety and efficacy of multispot laser and conventional laser in the treatment of nonproliferative diabetic retinopathy with clinically significant macular oedema (CSME) in relation to the visual outcome, central macular thickness (CMT) using optical coherence tomography, and presence of adverse events. Patients and methods This prospective randomized study included a total of 50 eyes from the research institute of ophthalmology in 2015 that were divided into two groups of 25 patients each. Group A patients underwent focal or modified grid macular laser photocoagulation using green laser 532 nm. Group B patients underwent focal or modified grid macular laser photocoagulation using multispot laser photocoagulation Valon TT. Inclusion criteria were as follows: type II diabetes and clinically significant macular edema. Best-corrected visual acuity (BCVA), optical coherence tomography readings, intraocular pressure (IOP), and adverse events were recorded preoperatively and at 1 week, 1 month, and 3 months postoperatively. Results The mean preoperative BCVA in conventional laser was 0.294 ± 0.17 decimal and that in multispot laser was 0.30 ± 0.21. The mean BCVA 3 months after laser in group A was 0.4820 ± 0.244 decimal (P = 0.001) and that in group B was 0.50 ± 0.20 (P = 0.001). The mean preoperative CMT in group A was 375.92 ± 65.69 μm and that in group B was 361.0 ± 50.400 μm. The mean CMT 3 months after laser in group A was 314.44 ± 85.94 μm (P = 0.001) um and that in group B was 0322.67 ± 57.50 μm (P = 0.001). The multispot system parameters used a higher power of 155 ± 90.1 mW (P = 0.001) compared with the conventional laser to produce the same therapeutic visible effect. Conclusion Multispot system was safe, rapid, and effective in the treatment of clinically significant macular edema in short-term follow-up periods and had a short exposure time. Although the short pulse duration of the multispot system necessitated the use of a higher power, it was not associated with adverse effects.

Statins and fibrates as the treatment of nonproliferative diabetic retinopathy in type 2 diabetes mellitus

Background Diabetic retinopathy is the result of microvascular retinal changes. Hyperglycemia-induced intramural pericyte death and thickening of the basement membrane lead to incompetence of the vascular walls. The purpose was to improve medication for nonproliferative diabetic retinopathy in patients with type 2 diabetes mellitus using statins and fibrates.

A clinical research on the effect of retinal photocoagulation combined with Tangwangkang for the treatment of nonproliferative diabetic retinopathy

Objective To evaluate the effect of retinal laser photocoagulation combined with traditional Chinese medicine Tangwangkang capsule for the treatment of nonproliferative diabetic retinopathy (NPDR). Methods In a parallel randomized trial, 84 patients of NPDR were randomly divided into the treatment group and the control group with 56 eyes of 42 cases in each group. In the treatment group, the patients were treated with retinal photocoagulation combined with oral traditional Chinese medicine TangWangKang capsule. In the control group, the patients were treated with retinal photocoagulation combined with oral Difrarel. After 3 months of medicine treatment, the vision, electro-physiological test, fluorescence fundus angiography, OCT and hemorheological changes were observed to evaluate the treatment effect. Results The curative effect of the treatment group was better than that of the control group. The postoperative visual acuity of treatment group was better than that of control group and the difference between the two groups was statistically significant (χ2=5.6, P=0.036). The peak value and latency period of electro-physiological oscillatory potentials (OPs) in treatment group were better than those of control group and the differences were statistically significant between the two groups. (F=6.80, P=0.042). Hemorheological changes were improved in both two groups. Blood viscosity, eruthrocutes sedimentation rate and whole blood viscosity significantly declined after the treatment in both groups (HSV F=15.2, P=0.008; ESR F=12.1, P=0.0088; HRV F=12.1, P=0.009), and the red blood cell deformed exponent increased significantly (F=15.2, P=0.0076). The differences in all parameters of hemorheological changes between before and after the treatment in both two groups were statistically significant (P=0.04). There was no statistically significant difference in macula thickness by OCT examination between the two groups (F=2.35, P=0.324). Conclusion Retinal photocoagulation combined with traditional Chinese medicine TangWangKang capsule is effective for NPDR. Key words: Diabetic retinopathy, nonproliferative; Retinal photocoagulation; Chinese medicine Tangwangkang

Probucol for non-proliferative diabetic retinopathy with hyperlipidemia

Objective To observe the effectiveness of probucol for non-proliferative diabetic retinopathy (NPDR) with hyperlipidemia.Methods Fifty-two patients (104 eyes) of NPDR with hyperlipidemia were enrolled in this study.The patients were randomly divided into treatment group and control group,26 patients (52 eyes) in each group.Both groups received diet and exercise guidance,oral hypoglycemic agents and (or) intensive insulin therapy.After blood sugar and blood pressure were controlled,the treatment group received probucol 0.5 g,two times per day; and the control group received atorvastatin of 10 mg,one time per day.The total course was 12 months.Before and after one,three,six and 12 months,all patients underwent vision,ophthalmoscope,fundus fluorescein angiography,blood and urine tested.Variations of visual acuity,fundus condition,macular edema,triglyceride (TG),total cholesterol (TC),low-density lipoprotein cholesterol (LDLC),high-density lipoprotein cholesterol (HDLC) and 8-0HdG were observed before and after treatment.Results The total effective rate of visual prognosis were 44.23％ and 40.38％ in the treatment group and the control group,the difference had no statistical significacy (Z＝-0.335,P＞0.05).Retinal hemorrhages and microaneurysms alleviated after treatment in both groups.The total efficiency of fundus prognosis was 65.38％ in the treatment group and 36.54％ in the control group,and the difference was statistically significant (Z=-2.973,P＜0.05).Macular edema was in six and five eyes in the treatment group and the control group respectively,which were lower than before treatment,the difference was statisticaly significant (x2=4.833,4.300; P＜0.05).Between the two groups,the difference was not statistically significant (x2 =0.102,P＞ 0.05).Twelve months after treatment,TG,TC and LDLC were decreased in the treatment group (t=15.653,7.634,14.871) and control group (t=13.275,7.415,13.632),and the difference was statistically significant (P＜0.05).HDLC showed no significant difference than before in the two groups (t=0.584,0.275; P＞0.05).TG,TC,LDLC and HDLC showed no difference between the two groups (t＝1.857,0.133,1.671,0.875; P＞0.05).8-0HdG decreased gradually during the one,three,six and 12 months in the treatment group (t=7.352,15.581,27.324,28.143) and control group (t =6.877,8.672,14.671,14.855) after treatment,and the difference was statistically significant (P＜0.05).In the first month aftertreatment,8 0HdG showed no difference between the two groups (t=0.513,P＞0.05).In the 3,6,and 12 months after treatment,the 8 0HdG was lower in the treatment group than that in the control group,and the difference was statistically significant (t =3.434,5.917,5.226; P＜0.05).Conclusion In the treatment of NPDR with hyperlipidemia,probucol can reduce blood lipid,stable visual function and relieve macular edema. Key words: Diabetic retinopathy/drug therapy; Hyperlipidemias/drug therapy; Probucol/therapeutic use

Changes of serum VEGF concentration after intravitreal injection of Avastin in treatment of diabetic retinopathy

Avastin (bevacizumab) intravitreal injections are widely used for treatment of diabetic retinopathy. The aim of our study was to analyze effect of 1.25 mg of intravitreal Avastin on serum concentration of vascular endothelial growth factor (VEGF) in diabetic patients. Participants were 10 diabetic patients on insulin therapy, without any other eye or systemic disease, and no kidney disfunction. Both eyes of diabetic patients were injected simultaneously with 1.25 mg of intravitreal Avastin, as a first step in treatment of nonproliferative diabetic retinopathy with clinically significant macular edema (4 patients), and of proliferative diabetic retinopathy (6 patients). Fluorescein angiography was performed prior to and laser therapy followed 1 month after Avastin treatment. VEGF concentration in patients serum was measured by ELISA technique: on the day of the Avastin administration, and 1, 7, and 28 days after intravitreal injection. In all analyzed participants, 24 hours after Avastin treatment, serum levels of VEGF were lower then basal (preinjection value). Maximal reduction of serum VEGF was noted on the 7th postoperative day. Twenty-eight days after, VEGF level in serum was raised, without completely reaching basal preoperative concentrations in most patients. Intravitreal injections of anti-VEGF drugs have an effect on decreasing systemic VEGF values. Rhythm of changes in serum VEGF concentrations and lowest detected concentration on the seventh postinjection day are according to pharmacokinetics of Avastin in serum and vitreous, reported by similar studies. The small number of patients involved in this pilot study implicates the need for further studies.

Anterior chamber depth and intraocular pressure following panretinal argon laser photocoagulation for diabetic retinopathy

Anterior chamber depth and intraocular pressure following panretinal argon laser photocoagulation for diabetic retinopathy

Treatment of Nonproliferative Diabetic Retinopathy with a Peptide Fraction from Bovine Factor VIII

28 patients with diabetic retinopathy randomly received oral treatment with a bovine factor VIII peptide fraction (Vueffe®) 0.5mg twice daily or calcium-dobesilate (Doxium®) 500mg twice daily for 4 months. Changes in the activity of plasma factor VIII fractions [von Willebrand factor (vWf); factor VIII-related antigen (FVIII:Ag); and factor VIII procoagulant activity (FVIII:C)] were determined during treatment, and compared at baseline with a control group of 10 diabetic patients without retinopathy. Bovine factor VIII peptide fraction reduced the high levels of vWf and FVII:Ag to values found in control patients without retinopathy, while no effect on FVIII:C was detected. Bovine factor VIII peptide fraction produced a statistically significantly greater reduction in vWf and FVIII:Ag than calcium-dobesilate: the percentage reduction of vWf was 33 vs 11 (p < 0.01), that of FVIII:Ag was 25 vs 7 (p < 0.01). In addition, the retinopathy improvement rate was 47% for bovine factor VIII peptide fraction and 8% for calcium-dobesilate (p = 0.037). It is concluded that bovine factor VIII peptide fraction improves diabetic retinopathy by lessening endothelial damage to retinal microvessels by reducing plasma vWf and FVIII:Ag activity.

The Effect of Calcium Dobesilate on Nonproliferative Diabetic Retinopathy: A Controlled Study

Two independent, double-masked, controlled studies were made to evaluate the efficacy of calcium dobesilate for the treatment of nonproliferative diabetic retinopathy. Forty-two patients underwent a six-month crossover evaluation while receiving calcium dobesilate (750 mg per day) and placebo in random order. Thirty-six patients received calcium dobesilate (1,000 mg per day) or placebo for one year. Evaluation by clinical examination, fluorescein angiography, angiography, and fundus photography failed to demonstrate any beneficial effect of calcium dobesilate.