Diabetic retinopathy (DR) progressively

Size: px
Start display at page:

Download "Diabetic retinopathy (DR) progressively"

Transcription

1 FOCUS ON DIABETIC MACULAR EDEMA * Frederick L. Ferris III, MD ABSTRACT The current state of treatment for diabetic macular edema (DME) is focused on slowing the rate of vision loss through assessment of retinal function and therapies that prevent DME progression. Recently developed pharmacologic agents have been shown to reduce the risk of vision loss as a result of DME and diabetic retinopathy. In clinical studies, the protein kinase C-β inhibitor ruboxistaurin reduced the risk of DME progression and moderate vision loss, and the vascular endothelial growth factor inhibitor pegaptanib also showed short-term early promise for DME. Bevacizumab is currently under investigation. Early Treatment Diabetic Retinopathy Study-type laser photocoagulation has been shown to improve long-term visual outcomes and is still the mainstay of therapy. Subsequent clinical trials are needed to determine the most effective role of pharmacologic agents and other interventions in preventing vision loss from DME. (Adv Stud Ophthalmol. 6;3(1):18-22) *Based on a presentation given by Dr Ferris at a satellite symposium held in conjunction with the AAO Annual Meeting in Chicago, Illinois, on October 15, 5. Director of Clinical Research and Epidemiology, National Eye Institute, National Institutes of Health, Bethesda, Maryland. Address correspondence to: Frederick L. Ferris III, MD, National Eye Institute, National Institutes of Health, Building 31, Room 6A52, 9 Rockville Pike, Bethesda, MD rickferris@nei.nih.gov. Diabetic retinopathy (DR) progressively damages retinal blood vessels, resulting in the breakdown of the blood-retina barrier and increased vascular permeability. Diabetic macular edema (DME) occurs when fluid and proteins leak from compromised vessels into the surrounding retinal tissue and collect within the macula. 1 In the United States, clinically significant DME develops in 6% of people with type 1 diabetes and 2% to 4% of people with type 2 diabetes. Ten-year incidence rates for clinically significant DME are.1% for people with type 1 diabetes and 13.9% for people with type 2 diabetes. 1 DR, a microvascular complication of diabetes, is the leading cause of blindness among US adults aged to 74 years, resulting in 12 to 24 new cases of blindness each year. 2 In addition to fluorescein angiography and funduscopy, ophthalmologists need reliable and reproducible methods for assessing DME. Although optical coherence tomography (OCT) is very good at measuring retinal thickness, questions remain as to whether it is an effective means of assessing visual function. Further studies on OCT as a tool for assessing DME are needed. When a patient develops DME, ophthalmologists typically intervene with photocoagulation to slow vision loss. New pharmacologic agents, such as protein kinase C-β (PKC-β) inhibitors and vascular endothelial growth factor (VEGF) inhibitors, are currently being studied in clinical trials and have shown evidence of benefit with regards to visual outcomes. These agents may in the future prove to be first-line therapies for the prevention of vision loss as a result of DME. Further study will determine their efficacy as monotherapy and their potential role in combined 18 Vol. 3, No. 1 March 6

2 therapies to prevent or slow vision loss. This article reviews novel therapeutic approaches to DME. ASSESSING DIABETIC MACULAR EDEMA OPTICAL COHERENCE TOMOGRAPHY Optical coherence tomography is a reproducible measurement of retinal thickness and is therefore valuable in the assessment of DME. Despite individual dayto-day and diurnal variations in retinal thickening, and some instrument-dependent variation, OCT is a reliable means of measuring retinal thickness, perhaps even better than photographic assessment. However, it remains unclear if diminished retinal thickness as determined by OCT will equate with functional improvement or improvement in visual acuity. The Diabetic Retinopathy Clinical Research Network (DRCR Network), a collaborative network that facilitates multicenter clinical research on DR, DME, and associated conditions, is conducting a 3-year pilot study which, among other outcomes, will examine the correlation between OCT measurements and visual acuity. 3 This randomized, multicenter clinical trial will compare standard laser photocoagulation therapy to the mild macular grid method for the treatment of DME. Patients enrolled in the study must be at least 18 years old, have clinically significant DME, visual acuity of /4 or better, and no prior laser therapy. Results are expected to be published in 6. TREATING DIABETIC MACULAR EDEMA NOVEL THERAPEUTIC APPROACHES There is a growing body of evidence to support several therapeutic approaches to DME, including PKCβ inhibitors, 4 anti-inflammatory approaches, 5,6 vitrectomy, 7,8 and growth hormone inhibition. 9 The use of these novel medical approaches in combination with standard photocoagulation is also under examination. The use of combination therapies may offer treatment advantages, particularly when the therapies approach the disease through different pathways. The Protein Kinase C-β Inhibitor Diabetic Macular Edema Study (PKC-DMES) demonstrated that ruboxistaurin, a selective PKC-β inhibitor, did not have a significant effect on the progression of DME. However, if patients with very poor glycemic control at baseline were excluded, the risk of DME progression was reduced by 31% (Figure 1). 4 In the Protein Kinase C-β Inhibitor Diabetic Retinopathy Study (PKC-DRS), treatment with ruboxistaurin did not slow the progression of DR, although some loss of treatment effect could be attributed to an abbreviated follow-up period. However, PKC-DRS showed a % or more reduced risk for the development of moderate vision loss in patients treated with ruboxistaurin compared to patients who received placebo (Figure 2). 4,11 The results of these studies suggest that ruboxistaurin Figure 1. Ruboxistaurin Treatment Reduced the Risk of DME Progression PKC-β Inhibitor Trials Ruboxistaurin Development of Central DME 5 4 Placebo 32 mg P =.19 1 DME = diabetic macular edema; PKC = protein kinase C. Reprinted with permission from Aiello et al. Diabetologia. 3;46(suppl 2):A42. 4 Figure 2. Ruboxistaurin Treatment Reduced the Risk of Moderate Vision Loss PKC-β Inhibitor Trials Ruboxistaurin Development of Moderate Vision Loss 5 4 Placebo 32 mg P =.19 1 PKC = protein kinase C. Reprinted with permission from Diabetes. 5;54: Copyright 5 American Diabetes Association. Advanced Studies in Ophthalmology 19

3 is an effective therapy for the prevention of vision loss in DME and DR. Intravitreal VEGF inhibitors are another novel therapeutic approach to DME. A recently published phase II study showed that patients treated with pegaptanib had better visual acuity, were more likely to show a reduction in central retinal thickness, and were less likely to need photocoagulation at follow-up compared to patients receiving placebo. 9 In another small unpublished series, patients injected with bevacizumab experienced decreased neovascularization of the iris, of the disc, and elsewhere, in addition to decreased DME. 12 Studies of ranibizumab for DME are ongoing. Although these preliminary results are promising, the long-term outcomes from treatment with these agents remain unknown. For instance, data have shown that neovascularization appears to recur when pegaptanib is no longer present in the eye, suggesting that there may be a role for concomitant therapy with other modalities. Early phase studies of novel pharmacologic agents for the treatment of DR and DME show that these therapies are effective. Ruboxistaurin has been shown to substantially reduce the risk of DME progression and moderate vision loss. Pegaptanib treatment has been associated with improved visual acuity, lower rates of retinal thickening, and reduced need for further treatment at followup. Bevacizumab and ranibizumab injections also have shown promising early results. Further study will determine the long-term effects of pharmacologic therapies for DME and their potential utility as preventive treatments for this condition. STEROIDS Intravitreal steroid use is widely gaining acceptance as a treatment for DME. In animal studies, corticosteroids have been shown to reduce the breakdown of the blood-retinal barrier that occurs as a result of retinal photocoagulation. 13 Corticosteroids also downregulate the production of VEGF. 14 Case series of intravitreal triamcinolone acetonide use in patients with DME by Martidis et al, Jonas et al, and Massin et al (4 mg, 25 mg, and 4 mg, respectively) each reported improvement in mean visual acuity at endpoint The safety and efficacy of intravitreal triamcinolone acetonide in the treatment of diffuse DME has been retrospectively studied in a clinical case series by Chieh et al. 18 The study involved 2 eyes of 174 patients who received an intravitreal injection of 1 mg or 4 mg of triamcinolone acetonide, and found a significant improvement in visual acuity (P <.1) in the study group at 6 months. Cardillo et al compared the safety and efficacy of intravitreal versus posterior sub-tenon s capsule injection of triamcinolone acetonide for diffuse DME in a prospective, double-masked, randomized controlled trial involving 12 patients (24 eyes). 19 This study randomized 1 eye of each patient to receive 4-mg triamcinolone acetonide intravitreal injection and the fellow eye to receive a 4-mg triamcinolone acetonide posterior sub-tenon s capsule injection. Both intravitreal and sub-tenon s capsule injections resulted in significant but transient improvements in central macular thickness, with the intravitreal injection demonstrating significantly thinner central macular thickness than that obtained with the sub-tenon s capsule injection. The mean visual acuity was significantly better than in the sub-tenon s capsule-injected eyes at 3 months after injection. Studies delineating the possible role of steroids in DR are ongoing. A DRCR Network randomized multicenter trial that began enrolling patients in 5 seeks to compare intravitreal triamcinolone acetonide injections at doses of 1 mg or 4 mg to macular laser photocoagulation for DME. Another DRCR Network-sponsored phase II randomized clinical trial of peribulbar triamcinolone acetonide to treat DME is currently recruiting patients. 21 PHOTOCOAGULATION TREATMENT Studies published before the development of photocoagulation showed that approximately 5% of patients with proliferative diabetic retinopathy (PDR) were blind within 5 years of onset. 22,23 With intensive treatment and careful follow-up, as demonstrated by the Early Treatment Diabetic Retinopathy Study (ETDRS) Report 9, only 4% of patients with PDR who received active treatment progressed to severe vision loss within 5 years. 24 The long-term effectiveness of pan-retinal photocoagulation in DR also has been demonstrated. In one series, 15-year repeat procedure rates for argon laser and xenon photocoagulation were not significantly higher than 5-year rates. Of the patients randomized to photocoagulation, 5% of the argon-treated patients and 3% of the xenon-treated patients had received additional laser treatment, 58% of the argon-treated patients and 41% of the xenontreated patients had /4 or better visual acuity, and 95% of argon-treated patients and 82% of xenontreated patients had / or better visual acuity. 25 Photocoagulation also remains the principal treatment for DME. ETDRS Report 1 showed that focal Vol. 3, No. 1 March 6

4 photocoagulation for clinically significant DME substantially reduced the risk of vision loss, increased the chance of visual improvement, and decreased the frequency of persistent macular edema. However, approximately 12% of eyes lost lines of vision even with treatment (Figure 3). 26,27 Findings from the ETDRS Report 19 support photocoagulation for patients with clinically significant DME, particularly when the center of the macula is involved. 28 The group of ETDRS patients at the highest risk for vision loss from DME had definite involvement of the macula center at baseline. Nevertheless, patients receiving immediate focal photocoagulation had improved visual outcomes compared to patients who were assigned to deferred photocoagulation treatment. These studies suggest that focal photocoagulation was effective in slowing the vision loss associated with DME. The results from scatter photocoagulation studies suggest that more intense scatter photocoagulation may have detrimental effects on the macula. The ETDRS Report 3 showed that full scatter treatment increased the risk of losing 3 full lines of vision compared to no treatment, and the incidence of vision loss was twice as high within the first 4 months of treatment. Patients in the mild scatter group had a high initial event rate that decreased over time (Figure 4). The high initial rates could be partially attributed to the mild scatter photocoagulation being administered in 2 treatments (6 8 burns at baseline followed by another 6 8 burns). The difference between full scatter and mild scatter was highly statistically significant, whereas there was no difference between vision loss rates for patients receiving full scatter photocoagulation compared to those not receiving treatment. 29 Focal photocoagulation also has been shown to be effective treatment for PDR and DME, although further studies are needed to determine optimal photocoagulation strategies and the role of photocoagulation in combination therapy. CONCLUSIONS Diabetic retinopathy is a common microvascular complication, which is a factor in the development of DME, that contributes to blindness in patients with DR. Photocoagulation is currently the primary intervention to slow vision loss in DME. Clinical trials of pharmacologic agents also have shown benefit for visual outcomes. Patients treated with ruboxistaurin had reduced risk for DME progression and reduced risk for moderate vision loss, and preliminary studies and case reports of pegaptanib, ranibizumab, and bevacizumab treatment have shown improved visual outcomes. Areas of current and future investigation include photocoagulation, intravitreal steroid injection, vitrectomy, peribulbar and retrobulbar steroids, combination therapies, and medical and surgical procedures. Further study will determine the role of structural assessments, photocoagulation techniques, and pharmacologic agents in an optimized treatment strategy for patients with DME. Figure 3. Focal Photocoagulation Treatment Reduced the Risk of Moderate Vision Loss Early Treatment Diabetic Retinopathy Study Development of Moderate Vision Loss Control group Focal argon P <.1 1 Data from Arch Ophthalmol. 1985;3: ; and Early Treatment Diabetic Retinopathy Study Group. 27 Figure 4. Mild Scatter Photocoagulation Treatment Reduced the Long-Term Risk of Moderate Vision Loss 4 Scatter Treatment and Macular Edema Moderate Visual Acuity Loss Eyes with Central Macular Edema at Baseline* Control group Full scatter delayed focal Mild scatter delayed focal P < *Mild to moderate nonproliferative DR. DR = diabetic retinopathy. Reprinted with permission from Int Ophthalmol Clin. 1987;27: Advanced Studies in Ophthalmology 21

5 REFERENCES 1. Williams R, Airey M, Baxter H, et al. Epidemiology of diabetic retinopathy and macular edema: a systematic review. Eye. 4;18: National Diabetes Statistics Fact Sheet: General Information and National Estimates on Diabetes in the United States, 3. Bethesda, Md: National Institute of Diabetes and Digestive and Kidney Diseases; US Department of Health and Human Services, National Institute of Health. 3. A pilot study of laser photocoagulation for diabetic macular edema. Diabetic Retinopathy Clinical Research Network. Available at: ProtocolA_laser/ProtAInfo.html. Accessed November 15, Aiello LP, Davis M, Milton R, et al. Initial results of the protein kinase C β inhibitor diabetic macular edema study (PKC-DMES) [abstract]. Diabetologia. 3;46(suppl 2):A Jonas JB, Kreissig I, Sofker A, Degenring RF. Intravitreal injection of triamcinolone for diffuse diabetic macular edema. Arch Ophthalmol. 3;121: Spandau UH, Derse M, Schmitz-Valckenberg P, et al. Dosage dependency of intravitreal triamcinolone acetonide as treatment for diabetic macular edema. Br J Ophthalmol. 5;89: Stolba U, Binder S, Gruber D, et al. Vitrectomy for persistent diffuse diabetic macular edema. Am J Ophthalmol. 5;14: Patel JI, Hykin PG, Schadt M, et al. Pars plana vitrectomy for diabetic macular edema: OCT and functional correlations. Eye. Oct 21, 5 [Epub ahead of print]. 9. Cunningham ET Jr., Adamis AP, Altaweel M, et al. A phase II randomized double-masked trial of pegaptanib, an antivascular endothelial growth factor aptamer, for diabetic macular edema. Ophthalmology. 5;112: Zacks DN, Johnson MW. Combined intravitreal injection of triamcinolone acetonide and pan-retinal photocoagulation for concomitant diabetic macular edema and proliferative diabetic retinopathy. Retina. 5;25: The effect of ruboxistaurin on visual loss in patients with moderately severe to very severe nonproliferative diabetic retinopathy: initial results of the Protein Kinase C beta Inhibitor Diabetic Retinopathy Study (PKC-DRS) multicenter randomized clinical trial. Diabetes. 5;54: Avery R. Intravitreal bevacizumab (Avastin) for retinal vascular diseases. Presented at: the American Academy of Ophthalmology 9th Annual Meeting; October 15-18, 5; Chicago, Illinois. 13. Wilson CA, Berkowitz BA, Sato Y, et al. Treatment with intravitreal steroid reduces blood-retinal barrier breakdown due to retinal photocoagulation. Arch Ophthalmol. 1992;1: Osaki NK, Behany KD, Nishihara KC, et al. Regulation of retinal vascular endothelial growth factor and receptors in rabbits exposed to hyperoxia. Invest Ophthalmol Vis Sci. 2;43: Martidis A, Duker J, Greenberg P, et al. Intravitreal triamcinolone for refractory diabetic macular edema. Ophthalmology. 2;9: Jonas J, Kreissig I, Sofker A, Degenring R. Intravitreal injection of triamcinolone for diffuse diabetic macular edema. Arch Ophthalmol. 3;121: Massin P, Audren F, Haouchine B, et al. Intravitreal triamcinolone acetonide for diabetic diffuse macular edema. Ophthalmology. 4;111: Chieh JJ, Roth DB, Liu M, et al. Intravitreal triamcinolone acetonide for diabetic macular edema. Retina. 5; 25: Cardillo JA, Melo LA Jr, Costa RA. Comparison of intravitreal versus posterior sub-tenon s capsule injection of triamcinolone acetonide for diffuse diabetic macular edema. Ophthalmology. 5;112: Diabetic Retinopathy Clinical Research Network Web site. A randomized trial comparing intravitreal triamcinolone acetonide and laser photocoagulation for diabetic macular edema. Available at: ProtocolB_steroid/ProtBInfo.html. Accessed January 31, Diabetic Retinopathy Clinical Research Network Web site. Triamcinolone acetonide injections to treat diabetic macular edema. Available at: gov/ct/gui/show/nct2323. Accessed January 31, Caird FI, Burditt AF, Draper GJ. Diabetic retinopathy. A further study of prognosis for vision. Diabetes. 1968;17: Deckert T, Simonsen SE, Poulsen JE. Prognosis of proliferative retinopathy in juvenile diabetics. Diabetes. 1967;16: Early photocoagulation for diabetic retinopathy. ETDRS report number 9. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology. 1991;98(5, suppl): Blankenship GW. Fifteen-year argon laser and xenon photocoagulation results of Bascom Palmer Eye Institute s patients participating in the diabetic retinopathy study. Ophthalmology. 1991;98: Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1. Early Treatment Diabetic Retinopathy Study Research Group. Arch Ophthalmol. 1985;3: Early Treatment Diabetic Retinopathy Study Group. Treatment technique and clinical guidelines for photocoagulation of diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 2. Ophthalmology. 1987;94: Focal photocoagulation treatment of diabetic macular edema. Relationship of treatment effect to fluorescein angiographic and other retinal characteristics at baseline: ETDRS report no. 19. Early Treatment Diabetic Retinopathy Study Research Group. Arch Ophthalmol. 1995;113: Techniques for scatter and local photocoagulation treatment of diabetic retinopathy: Early Treatment Diabetic Retinopathy Study Report no. 3. The Early Treatment Diabetic Retinopathy Study Research Group. Int Ophthalmol Clin. 1987;27: Vol. 3, No. 1 March 6

Diabetic retinopathy (DR) represents a

Diabetic retinopathy (DR) represents a THE MOLECULAR BIOLOGY OF DIABETIC RETINOPATHY: OPPORTUNITIES FOR THERAPEUTIC INTERVENTION Lloyd P. Aiello, MD, PhD ABSTRACT Hyperglycemia is the principal underlying cause of diabetic microvascular complications,

More information

A retrospective nonrandomized study was conducted at 3

A retrospective nonrandomized study was conducted at 3 Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine 1, Seoul, Korea Hangil Eye Hospital 2, Incheon, Korea Seoul National University Bundang Hospital 3, Seongnam,

More information

Diabetic retinopathy (DR) is the leading PROCEEDINGS EVIDENCE-BASED DATA IN THE TREATMENT OF DIABETIC RETINOPATHY*

Diabetic retinopathy (DR) is the leading PROCEEDINGS EVIDENCE-BASED DATA IN THE TREATMENT OF DIABETIC RETINOPATHY* EVIDENCE-BASED DATA IN THE TREATMENT OF DIABETIC RETINOPATHY* Lloyd Paul Aiello, MD, PhD, and Jennifer K. Sun, MD, MPH ABSTRACT There is a wide array of research into the pathophysiology and treatment

More information

Diagnosis and treatment of diabetic retinopathy. Blake Cooper MD Ophthalmologist Vitreoretinal Surgeon Retina Associates Kansas City

Diagnosis and treatment of diabetic retinopathy. Blake Cooper MD Ophthalmologist Vitreoretinal Surgeon Retina Associates Kansas City Diagnosis and treatment of diabetic retinopathy Blake Cooper MD Ophthalmologist Vitreoretinal Surgeon Retina Associates Kansas City Disclosures Consulted for Novo Nordisk 2017,2018. Will be discussing

More information

Intravitreal versus Posterior Subtenon Injection of Triamcinolone Acetonide for Diabetic Macular Edema

Intravitreal versus Posterior Subtenon Injection of Triamcinolone Acetonide for Diabetic Macular Edema Intravitreal versus Posterior Subtenon Injection of Triamcinolone Acetonide for Diabetic Macular Edema Young Jae Choi, MD, In Kyung Oh, MD, Jae Ryung Oh, MD, PhD, Kuhl Huh, MD, PhD Department of Ophthalmology,

More information

New Developments in the treatment of Diabetic Retinopathy

New Developments in the treatment of Diabetic Retinopathy New Developments in the treatment of Diabetic Retinopathy B. Jeroen Klevering University Medical Centre Nijmegen - The Netherlands Topics Management of diabetic retinopathy Interventions a. primary (prevention)

More information

ROLE OF LASER PHOTOCOAGULATION VERSUS INTRAVITREAL TRIAMCINOLONE ACETONIDE IN ANGIOGRAPHIC MACULAR EDEMA IN DIABETES MELLITUS

ROLE OF LASER PHOTOCOAGULATION VERSUS INTRAVITREAL TRIAMCINOLONE ACETONIDE IN ANGIOGRAPHIC MACULAR EDEMA IN DIABETES MELLITUS ORIGINAL ARTICLE ROLE OF LASER PHOTOCOAGULATION VERSUS INTRAVITREAL TRIAMCINOLONE ACETONIDE IN ANGIOGRAPHIC MACULAR EDEMA IN DIABETES MELLITUS Aggarwal Somesh VP 1, Shah Sonali N 2, Bharwada Rekha M 3,

More information

Diabetic Retinopathy: Managing the Extremes. J. Michael Jumper, MD West Coast Retina

Diabetic Retinopathy: Managing the Extremes. J. Michael Jumper, MD West Coast Retina Diabetic Retinopathy: Managing the Extremes J. Michael Jumper, MD West Coast Retina Case 1: EC 65 y.o. HM No vision complaints Meds: Glyburide Metformin Pioglitazone Va: 20/20 OU 20/20 Case 2: HS 68 y.o.

More information

EFFICACY OF INTRAVITREAL TRIAMCINOLONE ACETONIDE FOR THE TREATMENT OF DIABETIC MACULAR EDEMA

EFFICACY OF INTRAVITREAL TRIAMCINOLONE ACETONIDE FOR THE TREATMENT OF DIABETIC MACULAR EDEMA Basrah Journal Of Surgery EFFICACY OF INTRAVITREAL TRIAMCINOLONE ACETONIDE FOR THE TREATMENT OF DIABETIC MACULAR EDEMA Salah Zuhair Abed Al-Asadi MB,ChB, FICMS, Lecturer, Department of Surgery, College

More information

Clinical Trials in Diabetic Retinopathy. Harry W. Flynn Jr., M.D. Nidhi Relhan Batra, M.D.

Clinical Trials in Diabetic Retinopathy. Harry W. Flynn Jr., M.D. Nidhi Relhan Batra, M.D. 1 Clinical Trials in Diabetic Retinopathy 2018 Harry W. Flynn Jr., M.D. Nidhi Relhan Batra, M.D. Bascom Palmer Eye Institute 900 N.W. 17th Street Miami, FL 33136 Phone: (305) 326-6118 Fax: (305) 326-6417

More information

COMPARISON OF INTRAVITREAL TRIAMCINOLONE INJECTION VS LASER PHOTOCOAGULATION IN ANGIOGRAPHIC MACULAR EDEMA IN DIABETIC RETINOPATHY

COMPARISON OF INTRAVITREAL TRIAMCINOLONE INJECTION VS LASER PHOTOCOAGULATION IN ANGIOGRAPHIC MACULAR EDEMA IN DIABETIC RETINOPATHY Original Article COMPARISON OF INTRAVITREAL TRIAMCINOLONE INJECTION VS LASER PHOTOCOAGULATION IN ANGIOGRAPHIC MACULAR EDEMA IN DIABETIC RETINOPATHY Aggarwal Somesh V 1, Shah Sonali N 2, Bharwada Rekha

More information

Clinically Significant Macular Edema (CSME)

Clinically Significant Macular Edema (CSME) Clinically Significant Macular Edema (CSME) 1 Clinically Significant Macular Edema (CSME) Sadrina T. Shaw OMT I Student July 26, 2014 Advisor: Dr. Uwaydat Clinically Significant Macular Edema (CSME) 2

More information

Molecular Biology of Diabetic Retinopathy

Molecular Biology of Diabetic Retinopathy Opportunities for Therapeutic Intervention: Molecular Biology of Diabetic Retinopathy Jointly sponsored by The Dulaney Foundation and DIABETIC MICROVASCULAR COMPLICATIONS TODAY. Release Date: January 2006.

More information

Although photocoagulation and photodynamic PROCEEDINGS PEGAPTANIB SODIUM FOR THE TREATMENT OF AGE-RELATED MACULAR DEGENERATION *

Although photocoagulation and photodynamic PROCEEDINGS PEGAPTANIB SODIUM FOR THE TREATMENT OF AGE-RELATED MACULAR DEGENERATION * PEGAPTANIB SODIUM FOR THE TREATMENT OF AGE-RELATED MACULAR DEGENERATION Evangelos S. Gragoudas, MD ABSTRACT In December 24, the US Food and Drug Administration (FDA) approved pegaptanib sodium. Pegaptanib

More information

Paradigm Shift in the treatment of Diabetic Retinopathy. Haytham I. S. Salti, MD Associate Professor

Paradigm Shift in the treatment of Diabetic Retinopathy. Haytham I. S. Salti, MD Associate Professor Paradigm Shift in the treatment of Diabetic Retinopathy Haytham I. S. Salti, MD Associate Professor Disclosure No financial interests related to the subject matter of this talk This presentation includes

More information

Diabetic Retinopathy WHAT IS DIABETIC RETINOPATHY? WHAT CAUSES DIABETIC RETINOPATHY? WHAT ARE THE STAGES OF DIABETIC RETINOPATHY?

Diabetic Retinopathy WHAT IS DIABETIC RETINOPATHY? WHAT CAUSES DIABETIC RETINOPATHY? WHAT ARE THE STAGES OF DIABETIC RETINOPATHY? Diabetic Retinopathy WHAT IS DIABETIC RETINOPATHY? Diabetic retinopathy affects 8 million Americans with diabetes. A leading cause of blindness in American adults, it is caused by damage to the small blood

More information

Diabetic Macular Edema Treatment in the 21st Century

Diabetic Macular Edema Treatment in the 21st Century Transcript Details This is a transcript of a continuing medical education (CME) activity accessible on the ReachMD network. Additional media formats for the activity and full activity details (including

More information

Diabetic Retinopathy A Presentation for the Public

Diabetic Retinopathy A Presentation for the Public Diabetic Retinopathy A Presentation for the Public Ray M. Balyeat, MD The Eye Institute Tulsa, Oklahoma The Healthy Eye Light rays enter the eye through the cornea, pupil and lens. These light rays are

More information

Comparison of the Short-Term Effects of Intravitreal Triamcinolone Acetonide and Bevacizumab Injection for Diabetic Macular Edema

Comparison of the Short-Term Effects of Intravitreal Triamcinolone Acetonide and Bevacizumab Injection for Diabetic Macular Edema pissn: 1011-8942 eissn: 2092-9382 Korean J Ophthalmol 2011;25(3):156-160 DOI: 10.3341/kjo.2011.25.3.156 Original Article Comparison of the Short-Term Effects of Intravitreal Triamcinolone Acetonide and

More information

The Diabetic Retinopathy Clinical Research Network. Management of DME in Eyes with PDR

The Diabetic Retinopathy Clinical Research Network. Management of DME in Eyes with PDR The Diabetic Retinopathy Clinical Research Network Management of DME in Eyes with PDR 1 What Has Been Learned? Diabetic Retinopathy Treatment Protocol F: Results suggest that clinically meaningful differences

More information

Long-Term Visual Outcome in Proliferative Diabetic Retinopathy Patients After Panretinal Photocoagulation

Long-Term Visual Outcome in Proliferative Diabetic Retinopathy Patients After Panretinal Photocoagulation Long-Term Visual Outcome in Proliferative Diabetic Retinopathy Patients After Panretinal Photocoagulation Murat Dogru, Makoto Nakamura, Masanori Inoue and Misao Yamamoto Department of Ophthalmology, Kobe

More information

International Journal of Health Sciences and Research ISSN:

International Journal of Health Sciences and Research   ISSN: International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Original Research Article A Multivariate Analysis of Intravitreal Injection of Anti-VEGF Bevacizumab in the Treatment

More information

Diabetic Retinopathy: Recent Advances in Treatment and Treatment Approaches

Diabetic Retinopathy: Recent Advances in Treatment and Treatment Approaches Diabetic Retinopathy: Recent Advances in Treatment and Treatment Approaches Dr. David Wong Associate Professor Retina Specialist, Department of Ophthalmology & Vision Sciences, University of Toronto, Canada

More information

Study of clinical significance of optical coherence tomography in diagnosis & management of diabetic macular edema

Study of clinical significance of optical coherence tomography in diagnosis & management of diabetic macular edema Original Research Article Study of clinical significance of optical coherence tomography in diagnosis & management of diabetic macular edema Neha Kantilal Desai 1,*, Somesh Vedprakash Aggarwal 2, Sonali

More information

Facts About Diabetic Eye Disease

Facts About Diabetic Eye Disease Facts About Diabetic Eye Disease Points to Remember 1. Diabetic eye disease comprises a group of eye conditions that affect people with diabetes. These conditions include diabetic retinopathy, diabetic

More information

Macular edema (ME) is the most common

Macular edema (ME) is the most common MANAGEMENT OF RETINAL VEIN OCCLUSIONS * Peter A. Campochiaro, MD ABSTRACT Macular edema (ME) is the most common cause of reduced vision in patients with retinal vein occlusions (RVOs). The primary cause

More information

Diabetic maculopathy 11/ An update on. Miss Vasuki Sivagnanavel

Diabetic maculopathy 11/ An update on. Miss Vasuki Sivagnanavel Miss Vasuki Sivagnanavel Consultant Ophthalmologist An update on Diabetic maculopathy Despite advances in the management of diabetes, diabetic retinopathy is already the commonest cause of blindness among

More information

Scott M. Pfahler D.O. Dayton Vitreo-Retinal Associates AOCOO-HNS Palm Springs, CA 2012

Scott M. Pfahler D.O. Dayton Vitreo-Retinal Associates AOCOO-HNS Palm Springs, CA 2012 Scott M. Pfahler D.O. Dayton Vitreo-Retinal Associates AOCOO-HNS Palm Springs, CA 2012 Proliferative Diabetic Retinopathy Laser Treatments Medical Treatment Surgical Treatment Diabetic Macular Edema Laser

More information

VISUAL OUTCOME IN DIABETIC MACULAR EDEMA AFTER GRID LASER TREATMENT

VISUAL OUTCOME IN DIABETIC MACULAR EDEMA AFTER GRID LASER TREATMENT The Professional Medical Journal DOI: 10.17957/TPMJ/16.2856 ORIGINAL PROF-2856 VISUAL OUTCOME IN DIABETIC MACULAR EDEMA AFTER GRID LASER TREATMENT 1. MBBS.FCPS Assistant Professor Ophthalmology Independent

More information

Diabetic Retinopathy

Diabetic Retinopathy Diabetic Retinopathy Diabetes can be classified into type 1 diabetes mellitus and type 2 diabetes mellitus, formerly known as insulin-dependent diabetes mellitus, and non-insulin diabetes mellitus, respectively.

More information

Preliminary Assessment of Celecoxib and Microdiode Pulse Laser Treatment of Diabetic Macular Edema

Preliminary Assessment of Celecoxib and Microdiode Pulse Laser Treatment of Diabetic Macular Edema Preliminary Assessment of Celecoxib and Microdiode Pulse Laser Treatment of Diabetic Macular Edema The Harvard community has made this article openly available. Please share how this access benefits you.

More information

measure of your overall performance. An isolated glucose test is helpful to let you know what your sugar level is at one moment, but it doesn t tell you whether or not your diabetes is under adequate control

More information

Jay M. Haynie, O.D.; F.A.A.O. Olympia Tacoma Renton Kennewick Washington

Jay M. Haynie, O.D.; F.A.A.O. Olympia Tacoma Renton Kennewick Washington Jay M. Haynie, O.D.; F.A.A.O. Olympia Tacoma Renton Kennewick Washington I Jay M. Haynie, OD, FAAO have received honoraria from the following companies: Reichert Technologies Notal Vision Carl Zeiss Meditec

More information

THE ROLE OF anti-vegf IN DIABETIC RETINOPATHY AND AGE RELATED MACULAR DEGENERATION

THE ROLE OF anti-vegf IN DIABETIC RETINOPATHY AND AGE RELATED MACULAR DEGENERATION THE ROLE OF anti-vegf IN DIABETIC RETINOPATHY AND AGE RELATED MACULAR DEGENERATION MOESTIDJAB DEPARTMENT OF OPHTHALMOLOGY SCHOOL OF MEDICINE AIRLANGGA UNIVERSITY DR SOETOMO HOSPITAL SURABAYA INTRODUCTION

More information

Persistent Macular Thickening After Ranibizumab Treatment for Diabetic Macular Edema With Vision Impairment

Persistent Macular Thickening After Ranibizumab Treatment for Diabetic Macular Edema With Vision Impairment 9:30 AM Persistent Macular Thickening After Ranibizumab Treatment for Diabetic Macular Edema With Vision Impairment Lee Jampol, MD OBJECTIVE To assess subsequent visual and anatomic outcomes of eyes with

More information

Recalcitrant Diabetic Macular Oedema: Therapeutic Options

Recalcitrant Diabetic Macular Oedema: Therapeutic Options December 2007 A. Giridhar et al. - Recalcitrant DME 451 CONSULTATION S E C T I O N Recalcitrant Diabetic Macular Oedema: Therapeutic Options Dr. Cyrus M Shroff 1, Dr. N S Muralidhar 2, Dr. R Narayanan

More information

The Human Eye. Cornea Iris. Pupil. Lens. Retina

The Human Eye. Cornea Iris. Pupil. Lens. Retina The Retina Thin layer of light-sensitive tissue at the back of the eye (the film of the camera). Light rays are focused on the retina then transmitted to the brain. The macula is the very small area in

More information

Eyes on Diabetics: How to Avoid Blindness in Diabetic Patient

Eyes on Diabetics: How to Avoid Blindness in Diabetic Patient Eyes on Diabetics: How to Avoid Blindness in Diabetic Patient Rova Virgana FK Unpad Pusat Mata Nasional RS Mata Cicendo Bandung Eye Center (Hospital and Clinic) PIT IDI Jabar 2018 Keys Facts from WHO

More information

Brampton Hurontario Street Brampton, ON L6Y 0P6

Brampton Hurontario Street Brampton, ON L6Y 0P6 Diabetic Retinopathy What is Diabetic Retinopathy Diabetic retinopathy is one of the leading causes of blindness world-wide. Diabetes damages blood vessels in many organs of the body including the eyes.

More information

Diabetic eye disease. Diabetic retinopathy. Sam S. Dahr, M.D. Retina Center of Oklahoma.

Diabetic eye disease. Diabetic retinopathy. Sam S. Dahr, M.D. Retina Center of Oklahoma. Diabetic eye disease Sam S. Dahr, M.D. Retina Center of Oklahoma www.rcoklahoma.com Downloaded from: The Retina (on 28 May 2007 12:48 AM) 2007 Elsevier Diabetic retinopathy Downloaded from: The Retina

More information

Diabetic Retinopatathy

Diabetic Retinopatathy Diabetic Retinopatathy Jay M. Haynie, OD, FAAO Financial Disclosure I have received honoraria or am on the advisory board for the following companies: Carl Zeiss Meditec Arctic DX Macula Risk Advanced

More information

In its initial report, the Early Treatment Diabetic Retinopathy. A Severity Scale for Diabetic Macular Edema Developed from ETDRS Data

In its initial report, the Early Treatment Diabetic Retinopathy. A Severity Scale for Diabetic Macular Edema Developed from ETDRS Data A Severity Scale for Diabetic Macular Edema Developed from ETDRS Data Ronald E. Gangnon, 1,2 Matthew D. Davis, 3 Larry D. Hubbard, 3 Lloyd M. Aiello, 4 Emily Y. Chew, 5 Frederick L. Ferris III, 5 Marian

More information

Case Report Inherent Challenges in Managing Long Standing Refractory Diabetic Macular Edema

Case Report Inherent Challenges in Managing Long Standing Refractory Diabetic Macular Edema Cronicon OPEN ACCESS EC OPHTHALMOLOGY Case Report Inherent Challenges in Managing Long Standing Refractory Diabetic Macular Edema V Swetha E Jeganathan 1,2 * and Karen Madill 3 1 Department of Ophthalmology,

More information

A Patient s Guide to Diabetic Retinopathy

A Patient s Guide to Diabetic Retinopathy Diabetic Retinopathy A Patient s Guide to Diabetic Retinopathy 840 Walnut Street, Philadelphia PA 19107 www.willseye.org Diabetic Retinopathy 1. Definition Diabetic retinopathy is a complication of diabetes

More information

NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE. Health Technology Appraisal. Aflibercept for treating diabetic macular oedema.

NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE. Health Technology Appraisal. Aflibercept for treating diabetic macular oedema. NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Health Technology Appraisal Aflibercept for treating diabetic macular oedema Final scope Final remit/appraisal objective To appraise the clinical and cost

More information

Original Article. Authors

Original Article. Authors Original Article APMC-303 Efficacy of Intra-Vitreal Bevacizumab Combined with Phaco- Emulsification in the Prophylaxis of Macular Edema in Patients with Non-Proliferative Diabetic Retinopathy Muhammad

More information

Randomized Trial Evaluating Short- Term Effects of Intravitreal Ranibizumab or Triamcinolone Acetonide on Macular

Randomized Trial Evaluating Short- Term Effects of Intravitreal Ranibizumab or Triamcinolone Acetonide on Macular Randomized Trial Evaluating Short- Term Effects of Intravitreal Ranibizumab or Triamcinolone Acetonide on Macular Edema After Focal/grid Laser for Diabetic Macular Edema in Eyes Also Receiving Panretinal

More information

PROCEEDINGS NEW TRENDS IN THE MANAGEMENT OF DIABETIC RETINOPATHY* Paul M. Dodson, MD, FRCP, FRCOphth ABSTRACT

PROCEEDINGS NEW TRENDS IN THE MANAGEMENT OF DIABETIC RETINOPATHY* Paul M. Dodson, MD, FRCP, FRCOphth ABSTRACT NEW TRENDS IN THE MANAGEMENT OF DIABETIC RETINOPATHY Paul M. Dodson, MD, FRCP, FRCOphth ABSTRACT Based on a presentation given by Dr Dodson at a symposium held in conjunction with the 12th International

More information

SUMMARY. Heather Casparis, MD,* and Neil M. Bressler, MD MARINA AND ANCHOR

SUMMARY. Heather Casparis, MD,* and Neil M. Bressler, MD MARINA AND ANCHOR The following are summaries of selected presentations and posters from the American Society of Retina Specialists and European VitreoRetinal Society Annual Meeting held September 9 13, 2006, in Cannes,

More information

PART 1: GENERAL RETINAL ANATOMY

PART 1: GENERAL RETINAL ANATOMY PART 1: GENERAL RETINAL ANATOMY General Anatomy At Ora Serrata At Optic Nerve Head Fundoscopic View Of Normal Retina What Is So Special About Diabetic Retinopathy? The WHO definition of blindness is

More information

Diabetic ocular complications are a leading PROCEEDINGS MOLECULAR BIOLOGY AND NATURAL HISTORY OF DIABETIC RETINOPATHY * Lloyd P.

Diabetic ocular complications are a leading PROCEEDINGS MOLECULAR BIOLOGY AND NATURAL HISTORY OF DIABETIC RETINOPATHY * Lloyd P. MOLECULAR BIOLOGY AND NATURAL HISTORY OF DIABETIC RETINOPATHY * Lloyd P. Aiello, MD, PhD ABSTRACT Diabetic retinopathy is the most common diabetic microvascular complication, affecting approximately 50%

More information

Dr Dianne Sharp Ophthalmologist Retina Specialists, Parnell Greenlane Clinical Centre

Dr Dianne Sharp Ophthalmologist Retina Specialists, Parnell Greenlane Clinical Centre Dr Dianne Sharp Ophthalmologist Retina Specialists, Parnell Greenlane Clinical Centre 11:00-11:55 WS #115: The Revolution in Macular Degeneration Management 12:05-13:00 WS #127: The Revolution in Macular

More information

Diabetic Retinopathy What You Should Know. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Eye Institute

Diabetic Retinopathy What You Should Know. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Eye Institute Diabetic Retinopathy What You Should Know U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Eye Institute The National Eye Institute (NEI) conducts and supports research

More information

POSTERIOR SUBTENON INJECTION OF TRIAMCINALONE ACETONIDE FOR CYSTOID DIABETIC MACULAR EDEMA

POSTERIOR SUBTENON INJECTION OF TRIAMCINALONE ACETONIDE FOR CYSTOID DIABETIC MACULAR EDEMA POSTERIOR SUBTENON INJECTION OF TRIAMCINALONE ACETONIDE FOR CYSTOID DIABETIC MACULAR EDEMA Basel T. Ba arah MD, PhD*, Farid H. Al-Zawaideh MD*, Issam M. Al-Bataineh MD* ABSTRACT Objectives: To assess the

More information

Intravitreal Ranibizumab or Triamcinolone Acetonide in Combination with Laser Photocoagulation for Diabetic Macular Edema

Intravitreal Ranibizumab or Triamcinolone Acetonide in Combination with Laser Photocoagulation for Diabetic Macular Edema Diabetic Retinopathy Clinical Research Network Intravitreal Ranibizumab or Triamcinolone Acetonide in Combination with Laser Photocoagulation for Diabetic Macular Edema Version 6.0 May 21, 2010 Note: See

More information

Vitrectomy Combined with Intravitreal Triamcinolone Acetonide Injection and Macular Laser Photocoagulation for Nontractional Diabetic Macular Edema

Vitrectomy Combined with Intravitreal Triamcinolone Acetonide Injection and Macular Laser Photocoagulation for Nontractional Diabetic Macular Edema pissn: 1011-8942 eissn: 2092-9382 Korean J Ophthalmol 2013;27(3):186-193 http://dx.doi.org/10.3341/kjo.2013.27.3.186 Original Article Vitrectomy Combined with Intravitreal Triamcinolone Acetonide Injection

More information

New Insights on Treating Diabetic Retinopathy & Diabetic Macular Edema from the 2018 AAO Meeting

New Insights on Treating Diabetic Retinopathy & Diabetic Macular Edema from the 2018 AAO Meeting Transcript Details This is a transcript of a continuing medical education (CME) activity accessible on the ReachMD network. Additional media formats for the activity and full activity details (including

More information

Intravitreal Monotherapy with Bevacizumab and Triamcinolone Versus Combination Therapy in Recalcitiant Diabetic Macular Edema

Intravitreal Monotherapy with Bevacizumab and Triamcinolone Versus Combination Therapy in Recalcitiant Diabetic Macular Edema Intravitreal Monotherapy with Bevacizumab and Triamcinolone Versus Combination Therapy in Recalcitiant Diabetic Macular Edema Meena Chakrabarti MS, DO, DNB Meena Chakrabarti MS, DO, DNB, Sonia Rani John

More information

The limited number of currently approved

The limited number of currently approved CLINICAL TRIALS OF VERTEPORFIN AND PEGAPTANIB: WHAT ARE THE RESULTS? * William F. Mieler, MD ABSTRACT Currently available treatment options for the management of choroidal neovascularization (CNV) in age-related

More information

CSME BCVA. OCT Bevacizumab CMT CMT BCVA. BCVA LogMAR. p CMT NPDR PDR PDR. Bevacizumab PDR FDA. Ranibizumab. Bevacizumab.

CSME BCVA. OCT Bevacizumab CMT CMT BCVA. BCVA LogMAR. p CMT NPDR PDR PDR. Bevacizumab PDR FDA. Ranibizumab. Bevacizumab. email: rezaj76@yahoo.com Bevacizumab FDA mg Ranibizumab - Bevacizumab NPDR PDR PDR PDR CSME FAZFA BCVA CMT OCT Bevacizumab BCVA CMT BCVA LogMAR p CMT p CSME CRVO CSME BRVO CRVOBRVO (fovea avascular zone)

More information

CENTENE PHARMACY AND THERAPEUTICS NEW DRUG REVIEW 2Q17 April May

CENTENE PHARMACY AND THERAPEUTICS NEW DRUG REVIEW 2Q17 April May BRAND NAME Lucentis GENERIC NAME ranibizumab MANUFACTURER Genentech, Inc. DATE OF APPROVAL June 30, 2006 PRODUCT LAUNCH DATE July 13, 2006 REVIEW TYPE Review type 1 (RT1): New Drug Review Full review of

More information

Diabetic Retinopathy Clinical Research Network

Diabetic Retinopathy Clinical Research Network Diabetic Retinopathy Clinical Research Network Intravitreal Ranibizumab or Triamcinolone Acetonide as Adjunctive Treatment to Panretinal Photocoagulation for Proliferative Diabetic Retinopathy Version

More information

Diabetes & Your Eyes

Diabetes & Your Eyes Diabetes & Your Eyes Diabetes is a disease that occurs when the pancreas does not secrete enough insulin or the body is unable to process it properly. Insulin is the hormone that regulates the level of

More information

Visual prognosis after panretinal photocoagulation for. Proliferative diabetic retinopathy (PDR)

Visual prognosis after panretinal photocoagulation for. Proliferative diabetic retinopathy (PDR) Visual prognosis after panretinal photocoagulation for proliferative diabetic retinopathy Toke Bek 1 and Mogens Erlandsen 2 1 Department of Ophthalmology, A rhus University Hospital, A rhus, Denmark 2

More information

INTRAVITREAL TRIAMCINOLONE

INTRAVITREAL TRIAMCINOLONE CLINICAL SCIENCES Predictive Factors for Visual Acuity After Intravitreal Triamcinolone Treatment for Diabetic Macular Edema Jost B. Jonas, MD; Peter Martus, PhD; Robert F. Degenring, MD; Ingrid Kreissig,

More information

Opthea Initiates OPT-302 Diabetic Macular Edema Clinical Trial

Opthea Initiates OPT-302 Diabetic Macular Edema Clinical Trial ASX and Media Release 3 January 2018 Opthea Initiates OPT-302 Diabetic Macular Edema Clinical Trial Melbourne, Australia; January 3 2018 Opthea Limited (ASX:OPT), a late stage biopharmaceutical company

More information

ILUVIEN IN DIABETIC MACULAR ODEMA

ILUVIEN IN DIABETIC MACULAR ODEMA 1 ILUVIEN IN DIABETIC MACULAR ODEMA Marie Tsaloumas Consultant Ophthalmic Surgeon Queen Elizabeth Hospital, Birmingham bars conference 2104 1 2 Declaration of interest I have sat on Advisory boards for

More information

Diabetic Retinopathy Clinical Research Network

Diabetic Retinopathy Clinical Research Network Diabetic Retinopathy Clinical Research Network An Observational Study of the Development of Diabetic Macular Edema Following Scatter Laser Photocoagulation Version 1.4 June 24, 2005 PRP Obs Study Protocol

More information

Diabetic retinopathy damage to the blood vessels in the retina. Cataract clouding of the eye s lens. Cataracts develop at an earlier age in people

Diabetic retinopathy damage to the blood vessels in the retina. Cataract clouding of the eye s lens. Cataracts develop at an earlier age in people Diabetic Retinopathy What is diabetic eye disease? Diabetic eye disease refers to a group of eye problems that people with diabetes may face as a complication of diabetes. All can cause severe vision loss

More information

Review Article Combination Therapy for Diabetic Macular Edema

Review Article Combination Therapy for Diabetic Macular Edema Ophthalmology Volume 2012, Article ID 484612, 6 pages doi:10.1155/2012/484612 Review Article Combination Therapy for Diabetic Macular Edema Dinah Zur and Anat Loewenstein Department of Ophthalmology, Tel

More information

A Phase 2 Evaluation of Anti-VEGF Therapy for Diabetic Macular Edema: Bevacizumab (Avastin)

A Phase 2 Evaluation of Anti-VEGF Therapy for Diabetic Macular Edema: Bevacizumab (Avastin) Diabetic Retinopathy Clinical Research Network A Phase 2 Evaluation of Anti-VEGF Therapy for Diabetic Macular Edema: Bevacizumab (Avastin) Version1.2 April 27, 2006 Avastin Protocol 4-27-06 V1.2.doc Contact

More information

EU Regulatory workshop Ophthalmology clinical development and scientific advice. Industry view on DME and macular edema secondary to RVO

EU Regulatory workshop Ophthalmology clinical development and scientific advice. Industry view on DME and macular edema secondary to RVO EU Regulatory workshop Ophthalmology clinical development and scientific advice. Industry view on DME and macular edema secondary to RVO Yehia Hashad, M.D. Vice President and Global Therapeutic Area Head

More information

Anti Vascular Endothelial Growth Factor Pharmacotherapy for Diabetic Macular Edema

Anti Vascular Endothelial Growth Factor Pharmacotherapy for Diabetic Macular Edema Ophthalmic Technology Assessment Anti Vascular Endothelial Growth Factor Pharmacotherapy for Diabetic Macular Edema A Report by the American Academy of Ophthalmology Allen C. Ho, MD, Ingrid U. Scott, MD,

More information

Optical Coherence Tomography Fast versus Regular Macular Thickness Mapping in Diabetic Retinopathy

Optical Coherence Tomography Fast versus Regular Macular Thickness Mapping in Diabetic Retinopathy Original Paper DOI: 10.1159/000127830 Received: March 18, 2007 Accepted after revision: July 9, 2007 Published online: April 25, 2008 Optical Coherence Tomography Fast versus Regular Macular Thickness

More information

ORIGINAL ARTICLE. Introduction. June 2009 Kerala Journal of Ophthalmology 139

ORIGINAL ARTICLE. Introduction. June 2009 Kerala Journal of Ophthalmology 139 June 2009 Kerala Journal of Ophthalmology 139 ORIGINAL ARTICLE Intravitreal Monotherapy With Bevacizumab (IVB) and Triamcinolone Acetonide (IVTA) Versus Combination Therapy (IVB and IVTA) for Recalcitiant

More information

DIABETIC RETINOPATHY (DR) PREFERRED PRACTICE PATTERNS (PPP) Philippines 2016

DIABETIC RETINOPATHY (DR) PREFERRED PRACTICE PATTERNS (PPP) Philippines 2016 DIABETIC RETINOPATHY (DR) PREFERRED PRACTICE PATTERNS (PPP) Philippines 2016 The Diabetic Retinopathy (DR) Preferred Practice Patterns (PPP) Philippines: 2016 was prepared by the VitreoRetina Society of

More information

Andrew J. Barkmeier, MD; Benjamin P. Nicholson, MA; Levent Akduman, MD

Andrew J. Barkmeier, MD; Benjamin P. Nicholson, MA; Levent Akduman, MD c l i n i c a l s c i e n c e Effectiveness of Laser Photocoagulation in Clinically Significant Macular Edema With Focal Versus Diffuse Parafoveal Thickening on Optical Coherence Tomography Andrew J. Barkmeier,

More information

mg

mg 24 11 2 40 mg 23 12 19 24 10 26 4 24 10 16 40 mg 23 12 19 1 40 mg 4 6 24 10 16 40 mg 23 12 19 1 4 ml 10 mg/ml 0.5 4 mg 0.05 0.4 ml 40 mg/ml 1 1mL 4mg 40 mg/ml 0.1 ml 2 . 1 40 mg 24 9 6 23 12 19 1 40 mg

More information

Serious Eye diseases, New treatments. Mr. M. Usman Saeed MBBS, FRCS, FRCOphth Consultant Ophthalmologist

Serious Eye diseases, New treatments. Mr. M. Usman Saeed MBBS, FRCS, FRCOphth Consultant Ophthalmologist Serious Eye diseases, New treatments Mr. M. Usman Saeed MBBS, FRCS, FRCOphth Consultant Ophthalmologist 5 major causes of loss of vision Cataracts Glaucoma Macular degeneration Retinal Vein occlusions

More information

Past ocular history. DME Case 1. Patient presents blurred VA. Hemoglobin A1c 11.5% -- patient states sugars have not been in good control

Past ocular history. DME Case 1. Patient presents blurred VA. Hemoglobin A1c 11.5% -- patient states sugars have not been in good control Past ocular history Patient presents blurred VA DME Case 1 Hemoglobin A1c 11.5% -- patient states sugars have not been in good control PDR with macular edema OU Rishi Singh MD Cleveland Clinic OD OS 1

More information

Diabetic Retinopathy Clinical Research Network

Diabetic Retinopathy Clinical Research Network Diabetic Retinopathy Clinical Research Network A Randomized Trial Comparing Intravitreal Triamcinolone Acetonide and Laser Photocoagulation for Diabetic Macular Edema Version 6.0 July 20, 2007 Triamcinolone

More information

Treatment for Central-Involved Diabetic Macular Edema in Eyes with Very Good Visual Acuity

Treatment for Central-Involved Diabetic Macular Edema in Eyes with Very Good Visual Acuity Diabetic Retinopathy Clinical Research Network Treatment for Central-Involved Diabetic Macular Edema in Eyes with Very Good Visual Acuity Version 3.0 April 18, 2014 Treatment of CIDME in Eyes with Good

More information

Clinical Outcomes After Intravitreal Bevacizumab Injection for Diabetic Macular Edema

Clinical Outcomes After Intravitreal Bevacizumab Injection for Diabetic Macular Edema Original Article Clinical Outcomes After Intravitreal Bevacizumab Injection for Diabetic Macular Edema Karen Joyce G. Castro, MD, Marie Joan V. Loy, MD International Eye Institute St. Luke s Medical Center

More information

Measures have been taken, by the Utah Department of Health, Bureau of Health Promotions, to ensure no conflict of interest in this activity.

Measures have been taken, by the Utah Department of Health, Bureau of Health Promotions, to ensure no conflict of interest in this activity. Measures have been taken, by the Utah Department of Health, Bureau of Health Promotions, to ensure no conflict of interest in this activity. CNE/CPE/CEU s are available for this live webinar. You must

More information

Anti VEGF Agents in Retinal Disorders Current Scenario

Anti VEGF Agents in Retinal Disorders Current Scenario Retina Anti VEGF Agents in Retinal Disorders Current Scenario Charu Gupta MS Charu Gupta MS, Cyrus M. Shroff MD Shroff Eye Centre, New Delhi T is a group of proteins involved in the regulation of angiogenesis,

More information

DIABETIC MACULAR edema

DIABETIC MACULAR edema CLINICAL SCIENCES Intravitreal Injection of Triamcinolone for Diffuse Diabetic Macular Edema Jost B. Jonas, MD; Ingrid Kreissig, MD; Antje Söfker, MD; Robert F. Degenring, MD Objective: To evaluate the

More information

Retinal Complications of Obstructive Sleep Apnea A Growing Concern!

Retinal Complications of Obstructive Sleep Apnea A Growing Concern! Retinal Complications of Obstructive Sleep Apnea A Growing Concern! Jay M. Haynie, OD, FAAO Financial Disclosure I have received honoraria or am on the advisory board for the following companies: Carl

More information

Clinical Trials Related to Age Related Macular Degeneration

Clinical Trials Related to Age Related Macular Degeneration Clinical Trials Related to Age Related Macular Degeneration Kirti Singh MD, DNB, FRCS Kirti Singh MD, DNB, FRCS, Pooja Jain MBBS, Nitasha Ahir MBBS, Divya Jain MD, DNB Guru Nanak Eye Centre, Maulana Azad

More information

INTRODUCTION. Trans Am Ophthalmol Soc 2010;108:62-76

INTRODUCTION. Trans Am Ophthalmol Soc 2010;108:62-76 INTERPRETING THICKNESS CHANGES IN THE DIABETIC MACULA: THE PROBLEM OF SHORT- TERM VARIATION IN OPTICAL COHERENCE TOMOGRAPHY MEASURED MACULAR THICKENING (AN AMERICAN OPHTHALMOLOGICAL SOCIETY THESIS) BY

More information

The Natural History of Diabetic Retinopathy and How Primary Care Makes A Difference

The Natural History of Diabetic Retinopathy and How Primary Care Makes A Difference The Natural History of Diabetic Retinopathy and How Primary Care Makes A Difference We will discuss - How exactly does blood sugar control affect retinopathy? - What are other factors that we measure in

More information

Marcus Gonzales, OD, FAAO Cedar Springs Eye Clinic

Marcus Gonzales, OD, FAAO Cedar Springs Eye Clinic Marcus Gonzales, OD, FAAO Cedar Springs Eye Clinic 25.6 million adults 11.3% of the adult population 10.9 million adults 65 years and older 26.9% of this age population 79 million people are Pre-diabetic!!

More information

Vascular Disease Ocular Manifestations of Systemic Hypertension

Vascular Disease Ocular Manifestations of Systemic Hypertension Vascular Disease Ocular Manifestations of Systemic Hypertension Maynard L. Pohl, OD, FAAO Pacific Cataract & Laser Institute 10500 NE 8 th Street, Suite 1650 Bellevue, WA 98004 USA 425-462-7664 Cerebrovascular

More information

Efficacy of intravitreal bevacizumab (Avastin TM ) for shortterm treatment of diabetic macular edema

Efficacy of intravitreal bevacizumab (Avastin TM ) for shortterm treatment of diabetic macular edema 111 ORIGINAL Efficacy of intravitreal bevacizumab (Avastin TM ) for shortterm treatment of diabetic macular edema Toshihiko Nagasawa, Takeshi Naito, Shingo Matsushita, Hiroyuki Sato, Takashi Katome, and

More information

Clinical Case Presentation. Branch Retinal Vein Occlusion. Sarita M. Registered Nurse Whangarei Base Hospital

Clinical Case Presentation. Branch Retinal Vein Occlusion. Sarita M. Registered Nurse Whangarei Base Hospital Clinical Case Presentation on Branch Retinal Vein Occlusion Sarita M. Registered Nurse Whangarei Base Hospital Introduction Case Study Pathogenesis Clinical Features Investigations Treatment Follow-up

More information

Supplement to March Ranibizumab for Visual Impairment in DME: An Overview of The Evidence SPONSORED BY NOVARTIS PHARMA AG

Supplement to March Ranibizumab for Visual Impairment in DME: An Overview of The Evidence SPONSORED BY NOVARTIS PHARMA AG Supplement to March 2018 Ranibizumab for Visual Impairment in DME: An Overview of The Evidence SPONSORED BY NOVARTIS PHARMA AG Ranibizumab for Visual Impairment in DME: An Overview of The Evidence BY PROF.

More information

ANTIVASCULAR ENDOTHELIAL GROWTH FACTOR

ANTIVASCULAR ENDOTHELIAL GROWTH FACTOR THE ROLE OF RANIBIZUMAB * Michael L. Klein, MD ABSTRACT The positive 1-year results of ranibizumab trials reported at the 23rd Annual Meeting of the American Society of Retina Specialists have generated

More information

Evaluation of Changes of Macular Thickness in Diabetic Retinopathy after Cataract Surgery

Evaluation of Changes of Macular Thickness in Diabetic Retinopathy after Cataract Surgery pissn: 1011-8942 eissn: 2092-9382 Korean J Ophthalmol 2011;25(4):238-242 DOI: 10.3341/kjo.2011.25.4.238 Evaluation of Changes of Macular Thickness in Diabetic Retinopathy after Cataract Surgery Original

More information

INTRAVITREAL BEVACIZUMAB (AVASTIN) FOR PERSISTENT NEW VESSELS IN DIABETIC RETINOPATHY (IBEPE STUDY )

INTRAVITREAL BEVACIZUMAB (AVASTIN) FOR PERSISTENT NEW VESSELS IN DIABETIC RETINOPATHY (IBEPE STUDY ) INTRAVITREAL BEVACIZUMAB (AVASTIN) FOR PERSISTENT NEW VESSELS IN DIABETIC RETINOPATHY (IBEPE STUDY ) 1-Year Results LÉSSIA P. CINTRA, MD,* ROGÉRIO A. COSTA, MD, PHD,* JEFFERSON A. S. RIBEIRO, MD,* DANIELA

More information

Multiple Laser Photocoagulation Treatments for the Management of Diabetic Macular Edema

Multiple Laser Photocoagulation Treatments for the Management of Diabetic Macular Edema Yale University EliScholar A Digital Platform for Scholarly Publishing at Yale Yale Medicine Thesis Digital Library School of Medicine 11-15-2006 Multiple Laser Photocoagulation Treatments for the Management

More information

Subclinical Diabetic Macular Edema Study

Subclinical Diabetic Macular Edema Study Diabetic Retinopathy Clinical Research Network Subclinical Diabetic Macular Edema Study Version 2.0 March 21, 2006 Subclinical DME Protocol v2 0 3-21-06.doc Table of Contents Chapter 1. Background Information

More information