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Five-year outcomes of eyes initially enrolled in the 2-year BEVORDEX trial of bevacizumab or dexamethasone implants for diabetic macular oedema.
Cornish, EE, Teo, KY, Gillies, MC, Lim, LL, Nguyen, V, Wickremasinghe, S, Mehta, H, McAllister, IL, Fraser-Bell, S
The British journal of ophthalmology. 2023;(1):79-83
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Abstract
BACKGROUND The BEVORDEX trial compared outcomes of eyes with diabetic macular oedema (DMO) randomised to receive either intravitreal dexamethasone (DEX-) implant or bevacizumab over 2 years. We assessed long-term efficacy and safety outcomes 5 years from enrolment. METHODS Patients received standard clinical care after they finished the study. Their files were reviewed for visual and anatomical outcomes, post-trial treatments and complications. RESULTS Three-year and five-year data were available for 82% and 59% of eyes enrolled in the BEVORDEX study, respectively. Visual acuity gains at end of trial were generally lost by both treatment groups at 5 years but the macular thickness did not change from end of trial to 5 years. A similar proportion of eyes from each treatment group gained ≥10 letters at 5 years from enrolment in the BEVORDEX trial.Eyes that were initially randomised to the DEX-implant group had significantly fewer treatments but were more likely to develop proliferative diabetic retinopathy (PDR) over the 5-year period compared with eyes initially randomised to bevacizumab. The proportion of eyes that had cataract surgery by 5 years was similar between initial treatment groups. CONCLUSIONS Eyes in the BEVORDEX trial had similar 5-year rates of cataract surgery, however, more eyes converted to PDR in the group initially treated with DEX-implant. Eyes that were initially treated for 2 years with either intravitreal DEX-implant of bevacizumab followed by standard of care had similar visual and anatomical outcomes at 5 years.
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COVID-19-Related Retinal Micro-vasculopathy - A Review of Current Evidence.
Teo, KY, Invernizzi, A, Staurenghi, G, Cheung, CMG
American journal of ophthalmology. 2022;:98-110
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Abstract
PURPOSE To evaluate the occurrence of retinal microvasculopathy in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and who developed coronavirus disease (COVID-19). DESIGN Systematic review and meta-analysis. METHODS The Pubmed and Embase databases were comprehensively searched to identify studies that reported retina vascular changes in eyes with COVID-19. Two independent reviewers selected papers and extracted data for analysis. Data of interest were extracted and analyzed in RevMan Web versions 3.3. Quality of evidence was assessed using the National Institute of Health quality assessment tool for a case-control study. RESULTS Thirty-one studies reporting on 1373 subjects (972 COVID-19 and 401 controls) were included. Only case-control studies were included in the pooled analysis. There was a significantly higher likelihood of retinal microvasculopathy in subjects with COVID-19 compared to controls (odds ratio [95% confidence interval], 8.86 [2.54-27.53], P < .01). Optical coherence tomography angiography (OCTA) revealed reduced vessel density and enlarged foveal avascular zone in subjects with COVID-19 compared to controls. CONCLUSIONS The results suggested that COVID-19-related retinal microvasculopathy is a significant ocular manifestation of COVID-19 and may herald future retinal complications. These microvascular impairments might have occurred antecedent to clinically visible changes and could be detected earlier by OCTA. These findings are significant, due to the large numbers with COVID-19, and need to be recognized by ophthalmologists as a potential long-term sequalae of the disease.