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Posterior segment drug delivery for the treatment of exudative age-related macular degeneration and diabetic macular oedema.
Wong, CW, Wong, TT
The British journal of ophthalmology. 2019;(10):1356-1360
Abstract
Inhibitors of vascular endothelial growth factors are used to treat a myriad of retinal conditions, including exudative age-related macular degeneration (AMD), diabetic macular oedema (DME) and diabetic retinopathy. Although effective, long-term efficacy is limited by the need for frequent and invasive intravitreal injections. The quest for sustained action therapeutics that can be delivered to target tissue in the least invasive manner is an arduous endeavour that has ended in premature failure for several technologies in Phase II or III trials. Nevertheless, there have been promising preclinical studies, and more are on the horizon: port delivery systems for the treatment of exudative AMD have entered Phase III trials and a wide array of preclinical studies have demonstrated the potential for nanoparticles, such as liposomes, dendrimers and cell penetrating peptides to deliver therapeutics into the posterior segment via minimally invasive routes. In this review, we discuss the challenges posed by ocular barriers for drug penetration and present the recent advancements of the most pertinent drug delivery platforms with a focus on the treatment of exudative AMD and DME.
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ETDRS Grading of Diabetic Retinopathy: Still the Gold Standard?
Solomon, SD, Goldberg, MF
Ophthalmic research. 2019;(4):190-195
Abstract
This article aims to provide a narrative history of the evolution, modification, and legacy of the Early Treatment Diabetic Retinopathy Study classification system.
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Scaling Up Teleophthalmology for Diabetic Eye Screening: Opportunities for Widespread Implementation in the USA.
Liu, Y, Torres Diaz, A, Benkert, R
Current diabetes reports. 2019;(9):74
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Abstract
PURPOSE OF REVIEW We discuss opportunities to address key barriers to widespread implementation of teleophthalmology programs for diabetic eye screening in the United States (U.S.). RECENT FINDINGS Teleophthalmology is an evidence-based form of diabetic eye screening. This technology has been proven to substantially increase diabetic eye screening rates and decrease blindness. However, teleophthalmology implementation remains limited among U.S. health systems. Major barriers include financial concerns as well as limited utilization by providers, clinical staff, and patients. Possible interventions include increasingly affordable camera technology, demonstration of financially sustainable billing models, and engaging key stakeholders. Significant opportunities exist to overcome barriers to scale up and promote widespread implementation of teleophthalmology in the USA. Further development of methods to sustain effective increases in diabetic eye screening rates using this technology is needed. In addition, the demonstration of cost-effectiveness in a variety of billing models should be investigated to facilitate widespread implementation of teleophthalmology in U.S. health systems.
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Interventions to increase attendance for diabetic retinopathy screening: A cochrane review summary.
Whitehead, L
International journal of nursing studies. 2019;:103229
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Nephrotoxicity induced by intravitreal vascular endothelial growth factor inhibitors: emerging evidence.
Hanna, RM, Barsoum, M, Arman, F, Selamet, U, Hasnain, H, Kurtz, I
Kidney international. 2019;(3):572-580
Abstract
Vascular endothelial growth factor (VEGF) inhibitors have emerged as powerful tools to treat malignant neoplasms and ocular diseases by virtue of their ability to inhibit angiogenesis. Recent data indicate that intravitreal injections of VEGF inhibitors can lead to significant systemic absorption as well as a measurable reduction of plasma VEGF activity. There is increasing evidence showing that vitreal absorption of these drugs is associated with cases of accelerated hypertension, worsening proteinuria, glomerular disease, thrombotic microangiopathy, and possible chronic renal function decline. In this review, the 3 most commonly used anti-VEGF agents-bevacizumab, ranibizumab, and aflibercept-are discussed, highlighting their intravitreal absorption and associated effects on the kidney as a target organ system. We provide clinical suggestions for clinicians to both better manage patients receiving anti-VEGF agents intravitreally and detect any putative systemic renal effects of these agents. While acknowledging the risks of aberrant retinal angiogenesis, it is important for clinicians to be aware of the potential for adverse renal risks with use of these agents.
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Genetics of Diabetic Retinopathy.
Han, J, Lando, L, Skowronska-Krawczyk, D, Chao, DL
Current diabetes reports. 2019;(9):67
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PURPOSE OF REVIEW The goal of this paper is to review the latest findings in understanding the genetics of diabetic retinopathy. We highlight recent literature using a variety of molecular genetic techniques to identify variants which contribute to genetic susceptibility for diabetic retinopathy. RECENT FINDINGS New genome-wide association study (GWAS) and whole-exome sequencing approaches have been utilized to identify both common and rare variants associated with diabetic retinopathy. While variants have been identified in isolated studies, no variants have been replicated across multiple studies. The identification of genetic factors associated with diabetic retinopathy remains elusive. This is due to the multifactorial nature of the disease, small sample sizes for GWAS, and difficulty in controlling covariates of the disease. Larger populations as well as utilization of new sequencing and data analysis techniques may lead to new insights into genetic factors associated with diabetic retinopathy in the future.
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The prevalence of retinopathy among type 2 diabetic patients in Iran: A systematic review and meta-analysis.
Mohammadi, M, Raiegani, AAV, Jalali, R, Ghobadi, A, Salari, N
Reviews in endocrine & metabolic disorders. 2019;(1):79-88
Abstract
Diabetic retinopathy is one of the most major causes of blindness and disability in diabetic patients and imposes very high cost on Health Care System. Studies conducted in the country showed different and inconsistent prevalence of the disease. The study aims to determine the overall prevalence of retinopathy in patients with type 2 diabetes in Iran through a systematic review and meta-analysis. The present study was conducted via meta-analysis method during March, 2000 to October, 2018. The articles related to the subject under study were obtained from Magiran, SID, Medline (PubMed), Science Direct, Scopus and Google Scholar databases. I2 index was used to examine the heterogeneity of articles studied; and the data was analyzed by Comprehensive Meta-Analysis Software. Through the study of 34 articles and 17,079 individuals with age range of 5-83, the overall prevalence of retinopathy for type 2 diabetic patients in Iran and on the basis of meta-analysis, was obtained that was 37.8% (32.84-43%, 95% confidence interval); the highest prevalence of retinopathy for type 2 diabetic patients was in Tehran province with 78% (68.8-85.1%, 95% confidence interval) in 2006 and the lowest prevalence of retinopathy for type 2 diabetic patients was in Isfahan province with 9% (7.1-11.4, 95% confidence interval) in 2006; furthermore, the prevalence of retinopathy for type 2 diabetic patients in Iran increases with increased sample size that it was statistically significant (P < 0.05). Regarding the high prevalence of retinopathy for type 2 diabetic patients in the country, it is essential that health policy makers take effective measures to reduce the disease incidence in diabetic patients.
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Preoperative intravitreal bevacizumab for proliferative diabetic retinopathy patients undergoing vitrectomy - First update.
Pérez-Argandoña, E, Verdaguer, J, Zacharías, S, González, R
Medwave. 2019;(1):e7512
Abstract
UPDATE This Living FRISBEE (Living FRIendly Summary of the Body of Evidence using Epistemonikos) is an update of the summary published in December 2014. INTRODUCTION Proliferative diabetic retinopathy can cause severe vision loss and even blindness if left untreated. Vitrectomy is often required in the treatment of more severe cases. Preoperative administration of bevacizumab, a humanized anti-vascular endothelial growth factor would improve intraoperative variables that facilitate surgery and improve postoperative course. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified five systematic reviews including 16 studies overall, of which 14 were randomized trials. We concluded the preoperative use of intravitreal bevacizumab reduces the rate of vitreous hemorrhage in the early postoperative period, and probably also in the late postoperative period, but its effect on visual acuity is not clear. Furthermore, it probably decreases the surgical time and may decrease the incidence of iatrogenic retinal breaks. Although we are uncertain whether preoperative bevacizumab decreases intraoperative bleeding, it may reduce the need for endodiathermy.
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Implication of Deep-Vascular-Layer Alteration Detected by Optical Coherence Tomography Angiography for the Pathogenesis of Diabetic Retinopathy.
Dimitrova, G, Chihara, E
Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde. 2019;(4):179-182
Abstract
The aim of this narrative mini review is to analyze optical coherence tomography angiography (OCTA) parameters from reports that involved both superficial and deep vascular layers in patients with diabetes and to assess their relevance for the pathogenesis of diabetic retinopathy (DR). Papers published from January 2015 to August 2018 describing the use of OCTA in diabetes were identified and reviewed through a Medline/PubMed search. OCTA studies suggest that parameters are altered in patients with diabetes in all retinal vascular layers. From all included studies that evaluated both the superficial and the deep vascular layer, a number of studies suggested that the deep vascular layer was affected at an earlier stage of DR. OCTA parameter alterations were more prominent in the deep vascular layer than in the superficial vascular layer in patients with DR, and deep-vascular-layer alterations were most evident in patients with diabetic macular edema. Regarding that retinal venules originate from the deep vascular layer of the retina, alteration of OCTA parameters at the deep vascular layer in diabetic patients may imply a predominant affection of the venous side of the retinal vascular system in the pathogenesis of DR.
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An evidence-based approach to the routine use of optical coherence tomography.
Ly, A, Phu, J, Katalinic, P, Kalloniatis, M
Clinical & experimental optometry. 2019;(3):242-259
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Optical coherence tomography is an imaging technology that has revolutionised the detection, assessment and management of ocular disease. It is now a mainstream technology in clinical practice and is performed by non-specialised personnel in some settings. This article provides a clinical perspective on the implications of that movement and describes best practice using multimodal imaging and an evidence-based approach. Practical, illustrative guides on the interpretation of optical coherence tomography are provided for three major diseases of the ocular fundus, in which optical coherence tomography is often crucial to management: age-related macular degeneration, diabetic retinopathy and glaucoma. Topics discussed include: cross-sectional and longitudinal signs in ocular disease, so-called 'red-green' disease whereby clinicians rely on machine/statistical comparisons for diagnosis in managing treatment-naïve patients, and the utility of optical coherence tomography angiography and machine learning.