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    Four decades of ocular renin-angiotensin and kallikrein-kinin systems (1977-2017).
    Exp Eye Res 2017 May 23. Epub 2017 May 23.
    Department of Pharmacology, University of Banjaluka, 78000 Banjaluka, and Academy of Arts and Sciences, Republic of Srpska, Bosnia and Herzegovina. Electronic address:
    This review offers a contemporary history of the renin-angiotensin (RAS) and kallikrein-kinin (KKS) systems with emphasis on how these complex systems affect the eye. It describes the types of communication (cross-talk) between the two systems and evaluates their potential role in the development of diabetic retinopathy, diabetic macular edema, age-related macular degeneration, glaucoma, and uveitis. In addition to detailing the important physiological actions of components of the RAS and KKS, possibilities are suggested for new therapeutic avenues in the treatment of common ocular diseases. Read More

    Relationship Between Visual Acuity and Retinal Thickness During Anti-Vascular Endothelial Growth Factor Therapy for Retinal Diseases.
    Am J Ophthalmol 2017 May 23. Epub 2017 May 23.
    Retina Consultants of Houston, 6560 Fannin St., Suite 750, Houston, TX 77030; Blanton Eye Institute, Houston Methodist Hospital & Weill Cornell Medical College, 6565 Fannin St., Houston, TX 77030. Electronic address:
    Purpose: Investigate the relationship between best-corrected visual acuity (BCVA) and central retinal thickness (CRT) in eyes receiving ranibizumab for three common retinal diseases.

    Design: Retrospective analysis of clinical trial data METHODS: Early Treatment Diabetic Retinopathy Study BCVA and spectral-domain optical coherence tomography measured CRT of 387 eyes of 345 patients enrolled in six prospective clinical trials for management of neovascular age-related macular degeneration (AMD), diabetic macular edema (DME), and retinal vein occlusion (RVO) were evaluated by Pearson correlation and linear regression.

    Results: At baseline, there was a small correlation between BCVA and CRT in pooled AMD trial data (r = -0. Read More

    Prognostic factors of short-term outcomes of intravitreal ranibizumab in diabetic macular edema.
    Int J Ophthalmol 2017 18;10(5):765-771. Epub 2017 May 18.
    Department of Ophthalmology, National Taiwan University Hospital, Taipei 10002, Taiwan, China.
    Aim: To evaluate the prognostic factors for short-term visual and anatomical improvement of intravitreal ranibizumab (IVR) for diabetic macular edema (DME).

    Methods: Fifty-one eyes from 35 patients that received three consecutive monthly IVR for DME with moderate visual loss were retrospectively recruited; all cases had their baseline best-corrected visual acuity (BCVA) between 20/400 and 20/40. BCVA and central subfield thickness (CST) at baseline and month 3 were collected. Read More

    Foveal thickness reduction after anti-vascular endothelial growth factor treatment in chronic diabetic macular edema.
    Int J Ophthalmol 2017 18;10(5):760-764. Epub 2017 May 18.
    Department of Ophthalmology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil.
    Aim: To report foveal thickness reduction in eyes with resolution of macular edema and recovery of a foveal depression after one-year of anti-vascular endothelial growth factor (anti-VEGF) therapy for center-involving diabetic macular edema (DME).

    Methods: Foveal thickness was assessed with optical coherence tomography to determine the central subfield foveal thickness (CSFT) and macular volume in 42 eyes with DME (CSFT>275 µm). Evaluations also included measurement of best-corrected visual acuity (BCVA), and were performed at baseline, and upon foveal depression recovery achieved after 12 monthly intravitreal injections of either 1. Read More

    Study of Retinal Neurodegeneration and Maculopathy in Diabetic Meriones shawi: A Particular Animal Model with Human-like Macula.
    J Comp Neurol 2017 May 20. Epub 2017 May 20.
    Laboratory of Physiopthology, Food and Biomolecules (PAB) of the High Institute of Biotechnology, Sidi Thabet (ISBST), Univ Manouba (UMA), BiotechPole Sidi Thabet Tunisia.
    The purpose of this work was to evaluate a potentially useful animal model, Meriones shawi ( - developing metabolic X syndrome, diabetes and possessing a visual streak similar to human macula - in the study of diabetic retinopathy and diabetic macular edema (DME). Type 2 diabetes (T2D) was induced by high fat diet administration in M. Read More

    A Review of Subthreshold Micropulse Laser for Treatment of Macular Disorders.
    Adv Ther 2017 May 24. Epub 2017 May 24.
    Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany.
    Micropulse laser treatment is an alternative to the conventional continuous-wave laser for the treatment of retinal or macular diseases. In contrast to the conventional laser, the therapeutic effect of the subthreshold micropulse laser is not accompanied by thermal retinal damage. This fact is of particular importance when a treatment near the fovea is required. Read More

    Diabetic choroidopathy.
    Vision Res 2017 May 20. Epub 2017 May 20.
    Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, MD. Electronic address:
    Early histopathological studies of diabetic choroids demonstrated loss of choriocapillaris (CC), tortuous blood vessels, microaneurysms, drusenoid deposits on Bruchs membrane, and choroidal neovascularization. The preponderance of histopathological changes were at and beyond equator. Studies from my lab suggest that diabetic choroidopathy is an inflammatory disease in that leukocyte adhesion molecules are elevated in the choroidal vasculature and polymorphonuclear neutrophils are often associated with sites of vascular loss. Read More

    Conceptual analysis of diabetic retinopathy in Ayurveda.
    J Ayurveda Integr Med 2017 May 16. Epub 2017 May 16.
    P.G. Dept. of Shalakya Tantra, National Institute of Ayurveda, Jaipur, India. Electronic address:
    Inclusion of Prameha among the eight major disorders in Charaka Samhita shows the significance of the disease given by ancient seers. The risk of development of blindness in diabetics increases by 20-25 times as compared to the normal population. High prevalence rate of Diabetic Retinopathy (34. Read More

    Impact of estimated glomerular filtration rate on diabetic macular edema.
    Int Ophthalmol 2017 May 18. Epub 2017 May 18.
    Retina and Uvea Services, Dr R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, 110029, India.
    Purpose: Diabetic macular edema (DME) is a major cause of visual impairment in patients with diabetes and is influenced by various systemic factors. This study evaluates the effect of renal status on DME using estimated glomerular filtration rate (eGFR) as a study marker.

    Methods: This was a prospective observational cross-sectional study. Read More

    Retina 2017 May 16. Epub 2017 May 16.
    Department of Ophthalmology, Okmeydani Training and Research Hospital, Istanbul, Turkey.
    Purpose: The goal of this study was to assess the effects of a single injection of intravitreal ranibizumab (RAN) or bevacizumab (BEV) on the retinal vessel size in eyes with diabetic macular edema.

    Materials And Methods: In total, 32 patients were enrolled in the RAN group, and 30 patients were included in BEV group. Each of these groups was also subdivided into two others groups: a study group and a control group. Read More

    Local and Systemic Inflammatory Biomarkers of Diabetic Retinopathy: An Integrative Approach.
    Invest Ophthalmol Vis Sci 2017 May;58(6):BIO68-BIO75
    Diabetes and Metabolism Research Unit, Institut de Recerca Hospital, Universitari Vall d'Hebron (VHIR), Barcelona, Spain 4CIBERDEM (Instituto de Salud Carlos III), Madrid, Spain.
    Purpose: To review the usefulness of local and systemic inflammatory biomarkers of diabetic retinopathy (DR) to implement a more personalized treatment.

    Methods: An integrated research (from ophthalmologist and diabetologist point of view) of most significant literature on serum, vitreous, and aqueous humor (AH) biochemical biomarkers related to inflammation at early and advanced stages of DR (including diabetic macular edema [DME] and proliferative DR) was performed. Moreover, novel imaging retinal biomarkers of local "inflammatory condition" were described. Read More

    The Diabetic Retinopathy Barometer Study: Global perspectives on access to and experiences of diabetic retinopathy screening and treatment.
    Diabetes Res Clin Pract 2017 Apr 4;129:16-24. Epub 2017 Apr 4.
    International Federation on Ageing, 351 Christie Street, Toronto, Ontario, Canada. Electronic address:
    Aim: To assess the level of awareness, prevention and treatment of Diabetic Eye Disease (DED) comprising Diabetic Retinopathy (DR) and Diabetic Macula Edema (DME) retinopathy among adults with diabetes and health professionals.

    Methods: The Diabetic Retinopathy Barometer Study consisted of a qualitative study, which consisted of semi-structured interviews, and a quantitative study using online surveys for adults with diabetes and for health professionals.

    Results: A total of 4340 adults with diabetes and 2329 health professionals participated in the surveys. Read More

    Safety and Efficacy of Ziv-Aflibercept in the Treatment of Refractory Diabetic Macular Edema.
    Ophthalmic Surg Lasers Imaging Retina 2017 May;48(5):399-405
    Background And Objective: To evaluate the safety and efficacy of ziv-aflibercept (Zaltrap; Sanofi-Aventis, Bridgewater, NJ/Regeneron Pharmaceuticals, Tarrytown, NY) in the treatment of refractory diabetic macular edema (DME).

    Patients And Methods: Retrospective case series looking at the safety of ziv-aflibercept in patients with DME refractory to previous anti-vascular endothelial growth factor (VEGF) therapy. Detailed ophthalmologic examination, best-corrected visual acuity, and optical coherence tomography measurements were performed pre-switch, as well as at each monthly follow-up visit. Read More

    Cost-effectiveness of Intravitreous Ranibizumab Compared With Panretinal Photocoagulation for Proliferative Diabetic Retinopathy: Secondary Analysis From a Diabetic Retinopathy Clinical Research Network Randomized Clinical Trial.
    JAMA Ophthalmol 2017 May 8. Epub 2017 May 8.
    Jaeb Center for Health Research, Tampa, Florida.
    Importance: The Diabetic Retinopathy Clinical Research Network Protocol S randomized clinical trial results suggest that ranibizumab is a reasonable treatment alternative to panretinal photocoagulation (PRP) when managing proliferative diabetic retinopathy (PDR), with or without concomitant baseline diabetic macular edema (DME). However, ranibizumab injections are costly. Thus, it would be useful to examine the relative cost-effectiveness of these 2 treatment modalities. Read More

    Effect of Bevacizumab vs Aflibercept on Visual Acuity Among Patients With Macular Edema Due to Central Retinal Vein Occlusion: The SCORE2 Randomized Clinical Trial.
    JAMA 2017 May;317(20):2072-2087
    The Emmes Corporation, Rockville, Maryland.
    Importance: Studies have established the efficacy and safety of aflibercept for the treatment of macular edema due to central retinal vein occlusion. Bevacizumab is used off-label to treat this condition despite the absence of supporting data.

    Objective: To investigate whether bevacizumab is noninferior to aflibercept for the treatment of macular edema secondary to central retinal or hemiretinal vein occlusion. Read More

    Retina 2017 May 10. Epub 2017 May 10.
    *St. Petersburg Branch, S. Fyodorov Eye Microsurgery Federal State Institution, St. Petersburg, Russia; †Department of Ophthalmology, Military Medical Academy, St. Petersburg, Russia; and ‡Department of Ophthalmology, Mechnikov North-West State Medical University, St. Petersburg, Russia.
    Purpose: To investigate the relationship of the pre-anti-vascular endothelial growth factor (VEGF) retinal tissue area (RTA) and optical density (ODRT) of the retinal optical slice portion located in the central subfield, and their ratio (RTA/ODRT), in the presence of diabetic macular edema or of inraretinal cystic fluid in neovascular age-related macular degeneration, to central retinal thickness and best-corrected visual acuity after anti-VEGF treatment with ME resolution.

    Methods: The optical coherence tomography images and medical records of 33 patients (41 eyes) with neovascular age-related macular degeneration, 15 (21 eyes) with diabetic macular edema and 9 healthy individuals (15 eyes) were retrospectively analyzed. RTA, ODRT, and RTA/ODRT were calculated on pre-anti-VEGF B-scan images. Read More

    Noninvasive Retinal Markers in Diabetic Retinopathy: Advancing from Bench towards Bedside.
    J Diabetes Res 2017 13;2017:2562759. Epub 2017 Apr 13.
    Department of Ophthalmology, Odense University Hospital, Odense, Denmark.
    The retinal vascular system is the only part of the human body available for direct, in vivo inspection. Noninvasive retinal markers are important to identity patients in risk of sight-threatening diabetic retinopathy. Studies have correlated structural features like retinal vascular caliber and fractals with micro- and macrovascular dysfunction in diabetes. Read More

    Ultra-wide-field fluorescein angiography in diabetic retinopathy: a narrative review.
    Clin Ophthalmol 2017 27;11:803-807. Epub 2017 Apr 27.
    Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan.
    Fluorescein angiography (FA) is a useful examination in patients suffering from diabetic retinopathy (DR). Traditional angiograms explore 30°-50° of the retina at once; however, visualization of peripheral retina is fundamental in order to assess nonperfused areas, vascular leakage, microvascular abnormalities, and neovascularizations. In order to expand the field of view, wide-field and ultra-wide-field imaging has been developed allowing to image up to 200° of retinal surface in one single shot. Read More

    Ranibizumab in the Treatment of Diabetic Macular Edema: A Review of the Current Status, Unmet Needs, and Emerging Challenges.
    Adv Ther 2017 May 8. Epub 2017 May 8.
    Aristotle University of Thessaloniki, Thessaloniki, Greece.
    Diabetic retinopathy (more specifically diabetic macular edema, DME) is the most common cause of loss of vision in the working population in developed countries. Anti-vascular endothelial growth factor (anti-VEGF) agents considerably changed the treatment algorithms and improved prognosis of center-involving DME. Ranibizumab was the first approved anti-VEGF agent that revolutionized DME treatment. Read More

    Patient Preferences with Regard to Laser versus Intravitreal Injections in the Treatment of Diabetic Macular Edema.
    J Ophthalmol 2017 4;2017:7398470. Epub 2017 Apr 4.
    Retina Consultants of Alabama, University of Alabama at Birmingham School of Medicine, Callahan Eye Hospital, 700 18th St. South, Suite 707, Birmingham, AL 35233, USA.
    Purpose. To identify treatment preferences of patients with diabetic macular edema (DME) having undergone laser and intravitreal injections. Methods. Read More

    Relationship between internal reflectivity of diabetic microaneurysms on SD-OCT and detection on OCT Angiography.
    Am J Ophthalmol 2017 May 5. Epub 2017 May 5.
    Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele, Milan, Italy. Electronic address:
    Purpose: To correlate the appearance of Microaneurysms (MAs) on structural spectral-domain optical coherence tomography (SD-OCT) with their detection on OCT angiography (OCTA) in patients with non-proliferative diabetic retinopathy (NPDR).

    Design: Inter-instrument reliability study.

    Methods: Sixteen patients with NPDR without macular edema underwent SD-OCT and OCTA. Read More

    Association of Diabetic Macular Edema and Proliferative Diabetic Retinopathy With Cardiovascular Disease: A Systematic Review and Meta-analysis.
    JAMA Ophthalmol 2017 May 4. Epub 2017 May 4.
    Singapore Eye Research Institute, Singapore National Eye Centre, National University of Singapore, Singapore3Duke-NUS Medical School, National University of Singapore, Singapore.
    Importance: Previous studies on the relationship between diabetic retinopathy (DR) and cardiovascular disease (CVD) focused on the early stages of DR. Understanding whether patients with type 2 diabetes and severe stages of DR (diabetic macular edema [DME] and proliferative diabetic retinopathy [PDR]) have a higher risk of CVD will allow physicians to more effectively counsel patients.

    Objective: To examine the association of severe stages of DR (DME and PDR) with incident CVD in patients with type 2 diabetes. Read More

    Designed Ankyrin Repeat Proteins: A look at their evolving use in medicine with a focus on the treatment of chorioretinal vascular disorders.
    Antiinflamm Antiallergy Agents Med Chem 2017 May 1. Epub 2017 May 1.
    Duke University, Durham, NC; b Mayo Clinic, Jacksonville, FL. United States.
    Background: Antibodies constitute an important drug development platform for drugs to treat several ophthalmic, oncologic, and immunologic conditions, but due to limitations inherent in antibody production and structure, a wide range of other protein binding scaffolds are being investigated. Designed ankyrin repeat proteins (DARPins) are simple to produce and offer a range of advantages over antibodies because of their stability, high binding affinity, and rigid structure.

    Objective: DARPins are being developed for a wide variety of medical applications, and the most studied molecule, abicipar pegol, is used to treat chorioretinal vascular diseases. Read More

    Impact of Diabetic Retinopathy on Health-related Quality of Life in Iranian Diabetics.
    Iran J Public Health 2017 Jan;46(1):55-65
    Dept. of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
    Background: To extract utility values of diabetic retinopathy on a perfect health and perfect vision scales for Iranians with both types diabetes.

    Methods: In this investigation, 150 untreated patients with diabetic retinopathy consecutively were examined and interviewed in Farabi Eye Hospital, Tehran, Iran, a tertiary referral center in the Iranian health care system. Utility values based on patients-reported outcome measures, standard gamble, time trade off and visual analogue scale approaches, were estimated. Read More

    Change in Diabetic Retinopathy Through 2 Years: Secondary Analysis of a Randomized Clinical Trial Comparing Aflibercept, Bevacizumab, and Ranibizumab.
    JAMA Ophthalmol 2017 Apr 27. Epub 2017 Apr 27.
    Palmetto Retina Center, Columbia, South Carolina.
    Importance: Anti-vascular endothelial growth factor (anti-VEGF) therapy for diabetic macular edema (DME) favorably affects diabetic retinopathy (DR) improvement and worsening. It is unknown whether these effects differ across anti-VEGF agents.

    Objective: To compare changes in DR severity during aflibercept, bevacizumab, or ranibizumab treatment for DME. Read More

    Teleophthalmology image-based navigated retinal laser therapy for diabetic macular edema: a concept of retinal telephotocoagulation.
    Graefes Arch Clin Exp Ophthalmol 2017 Apr 26. Epub 2017 Apr 26.
    OD-OS, GmbH, Teltow, Germany.
    Background: To determine the feasibility and efficacy of a retinal telephotocoagulation treatment plan for diabetic macular edema.

    Methods: Prospective, interventional cohort study at two clinical sites. Sixteen eyes of ten subjects with diabetic macular edema underwent navigated focal laser photocoagulation using a novel teleretinal treatment plan. Read More

    Immortal Ozurdex: A 10-month follow-up of an intralenticular implant.
    Indian J Ophthalmol 2017 Mar;65(3):255-257
    Department of Vitreo-retina, Narayana Nethralaya Eye Institute, Bengaluru, Karnataka, India.
    A 78-year-old male who had received a dexamethasone implant (Ozurdex, Allergan, Inc., Irvine, CA, USA) 15 days back for recalcitrant diabetic macular edema in the left eye came to us for a second opinion. On examination, his corrected distance visual acuity was 20/20 in the right eye and 20/40 in the left eye. Read More

    Intravitreal Aflibercept for Patients With Diabetic Macular Edema Refractory to Bevacizumab or Ranibizumab: Analysis of Response to Aflibercept.
    Asia Pac J Ophthalmol (Phila) 2017 Apr 10. Epub 2017 Apr 10.
    Department of Ophthalmology, Far Eastern Memorial Hospital, Taipei, Taiwan.
    Purpose: To investigate the short-term efficacy and safety of intravitreal aflibercept in a case series of patients with diabetic macular edema (DME) refractory to ranibizumab or bevacizumab.

    Design: A retrospective chart review.

    Methods: From September 2013 to March 2016, we identified patients with DME who developed resistance to bevacizumab or ranibizumab. Read More

    Nap Counteracts Hyperglycemia/Hypoxia Induced Retinal Pigment Epithelial Barrier Breakdown Through Modulation Of HIFs and VEGF Expression.
    J Cell Physiol 2017 Apr 24. Epub 2017 Apr 24.
    Section of Human Anatomy and Histology, Department of Biomedical and Biotechnological Sciences, University of Catania, Italy.
    Diabetic macular edema (DME) is a common complication leading to a central vision loss in patients with diabetes. In this eye pathology, the hyperglycaemic/hypoxic microenvironment of pigmented epithelium is responsible for outer blood retinal barrier integrity changes. More recently, we have shown that a small peptide derived from the activity-dependent neuroprotective protein (ADNP), known as NAP, counteracts damages occurring during progression of diabetic retinopathy by modulating HIFs/VEGF pathway. Read More

    Computational image analysis for prognosis determination in DME.
    Vision Res 2017 May 9. Epub 2017 May 9.
    Christian Doppler Laboratory for Ophthalmic Image Analysis, Vienna Reading Center, Department of Ophthalmology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria. Electronic address:
    In this pilot study, we evaluated the potential of computational image analysis of optical coherence tomography (OCT) data to determine the prognosis of patients with diabetic macular edema (DME). Spectral-domain OCT scans with fully automated retinal layer segmentation and segmentation of intraretinal cystoid fluid (IRC) and subretinal fluid of 629 patients receiving anti-vascular endothelial growth factor therapy for DME in a randomized prospective clinical trial were analyzed. The results were used to define 312 potentially predictive features at three timepoints (baseline, weeks 12 and 24) for best-corrected visual acuity (BCVA) at baseline and after one year used in a random forest prediction path. Read More

    Early response to ranibizumab predictive of functional outcome after dexamethasone for unresponsive diabetic macular oedema.
    Br J Ophthalmol 2017 Apr 21. Epub 2017 Apr 21.
    Department of Ophthalmology, University Vita-Salute, San Raffaele Hospital, Milan, Italy.
    Purpose: To analyse the effects of intravitreal dexamethasone implant in patients suffering from diabetic macular oedema (DME) on the basis of their visual and functional response to antivascular endothelial growth factor (VEGF) loading dose, in order to early shift to corticosteroids in poorly responding patients.

    Design: Retrospective monocentric study.

    Methods: Data of patients with diabetes shifted to 0. Read More

    Optimal screening schedules for disease progression with application to diabetic retinopathy.
    Biostatistics 2017 Apr 20. Epub 2017 Apr 20.
    The Biostatistics Center, Department of Epidemiology and Biostatistics, The George Washington University, 6110 Executive Blvd., Rockville MD 20852,
    Clinical management of chronic diseases requires periodic evaluations. Subjects transition between various levels of severity of a disease over time, one of which may trigger an intervention that requires treatment. For example, in diabetic retinopathy, patients with type 1 diabetes are evaluated yearly for either the onset of proliferative diabetic retinopathy (PDR) or clinically significant macular edema (CSME) that would require immediate treatment to preserve vision. Read More

    Factors influencing intravitreal bevacizumab and triamcinolone treatment in patients with diabetic macular edema.
    Eur J Ophthalmol 2017 Apr 11. Epub 2017 Apr 11.
    Department of Ophthalmology and Visual Science, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu-si, Gyeonggi-do - Korea.
    Purpose: To evaluate factors associated with response to intravitreal bevacizumab (IVB) and intravitreal triamcinolone acetonide (IVTA) in diabetic macular edema (DME).

    Methods: Ninety-one eyes of 88 patients diagnosed with DME were enrolled in this retrospective chart review. Group 1 included eyes that showed good response to IVB. Read More

    Supervised learning and dimension reduction techniques for quantification of retinal fluid in optical coherence tomography images.
    Eye (Lond) 2017 Apr 21. Epub 2017 Apr 21.
    Vienna Reading Center and Christian Doppler Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
    PurposeThe purpose of the present study is to develop fast automated quantification of retinal fluid in optical coherence tomography (OCT) image sets.MethodsWe developed an image analysis pipeline tailored towards OCT images that consists of five steps for binary retinal fluid segmentation. The method is based on feature extraction, pre-segmention, dimension reduction procedures, and supervised learning tools. Read More

    Diabetic Macular Edema: Emerging Strategies and Treatment Algorithms.
    Dev Ophthalmol 2017 20;60:165-174. Epub 2017 Apr 20.
    Diabetic macular edema (DME) is the most common cause of vision loss in diabetic patients, and its management is often a long process requiring frequent monitoring and therapeutic interventions. During the past several decades, numerous treatments have been developed for the treatment of DME. Although many of them have been found to be effective and safe, there is relatively little comparative data, and no established guidelines for the optimal treatment approach exist. Read More

    Enzymatic Vitreolysis for Vitreomacular Traction in Diabetic Retinopathy.
    Dev Ophthalmol 2017 20;60:160-164. Epub 2017 Apr 20.
    Vitreomacular traction (VMT) is one of many possible factors involved in the etiology of diabetic macular edema (DME). Pharmacologic vitreoretinal separation is a potential alternative to vitrectomy for VMT in diabetic retinopathy. Small case series have been published on the use of enzymatic vitreolysis in tractional DME, and demonstrate that the enzymatic release of the posterior vitreous cortex is more likely following the injection of plasmin enzyme. Read More

    Surgical Management and Techniques.
    Dev Ophthalmol 2017 20;60:143-159. Epub 2017 Apr 20.
    Technical advancements have substantially extended the indications for surgery in diabetic retinopathy (DR) during the last 40 years, from the traditional indications including non-clearing vitreous hemorrhage, traction retinal detachment (RD), and traction-rhegmatogenous RD, to epiretinal membrane (ERM), vitreomacular traction, diffuse macular edema, neovascular glaucoma, and anterior hyaloid fibrovascular proliferation. The goals of vitreoretinal surgery in DR are multiple: clearing media opacities, release of traction (anteroposterior and/or tangential), segmentation and/or removal of traction bands, peeling of ERMs, hemostasis, laser photocoagulation, and tamponade of retinal breaks with gas or silicone oil. The best management is achieved with integrated care provided by physicians with expertise in medical management of diabetes and surgical care of DR. Read More

    Anti-Vascular Endothelial Growth Factor Injections: The New Standard of Care in Proliferative Diabetic Retinopathy?
    Dev Ophthalmol 2017 20;60:131-142. Epub 2017 Apr 20.
    For decades, panretinal photocoagulation (PRP) has been the standard of care for the treatment of proliferative diabetic retinopathy (PDR). The relatively recent advent of anti-vascular endothelial growth factor (VEGF) formulations for intravitreal injection has provided a fresh perspective on PDR treatment, especially in eyes with concurrent diabetic macular edema (DME). The anti-VEGF agent ranibizumab has demonstrated a potentially protective effect on eyes with DME in terms of progression to PDR in the RIDE/RISE trials, as has aflibercept in the VIVID/VISTA trials. Read More

    Is Laser Still Important in Diabetic Macular Edema as Primary or Deferral Therapy?
    Dev Ophthalmol 2017 20;60:125-130. Epub 2017 Apr 20.
    Laser treatment was used in the past to reduce the visual loss due to diabetic macular edema. The recent advent of anti-vascular endothelial growth factor (anti-VEGF) has completely revolutionized the management of diabetic retinopathy, with a significant improvement in the overall prognosis. Nevertheless, macular laser can still be applied in selected cases characterized by retinal thickness ≤400 microns, high visual acuity, extrafoveal location, and contraindications to the intravitreal approach with anti-VEGF and steroids. Read More

    Practical Lessons from Protocol T for the Management of Diabetic Macular Edema.
    Dev Ophthalmol 2017 20;60:109-124. Epub 2017 Apr 20.
    Purpose: To review the results of Diabetic Retinopathy Clinical Research Network Protocol T, as applied to clinical practice.

    Methods: Review of major publications reporting the results of Protocol T, a randomized single-masked (in year-1 only), multicenter clinical trial comparing aflibercept, bevacizumab, and ranibizumab as treatment option for center-involving diabetic macular edema (DME). The main outcome measures were change in visual acuity (VA), central subfield thickness (CST) on optical coherence tomography, cost effectiveness, burden of care, and safety. Read More

    Practical Lessons from Protocol I for the Management of Diabetic Macular Edema.
    Dev Ophthalmol 2017 20;60:91-108. Epub 2017 Apr 20.
    Protocol I, a multicenter randomized clinical trial, compared the visual outcomes of patients treated with 0.5 mg intravitreal ranibizumab with either prompt or deferred (by 24 weeks laser), 4 mg intravitreal triamcinolone with prompt laser, or sham injection with prompt laser for the treatment of center-involving diabetic macular edema (DME). A total of 854 adult patients with type I or II diabetes and any level of non-proliferative diabetic retinopathy or proliferative retinopathy with adequate panretinal photocoagulation, with best-corrected visual acuity (BCVA) of 78 to 24 ETDRS letters (Snellen equivalent of 20/32 to 20/320) and visual loss attributed to macular edema, or retinal thickening with central subfield thickness of at least 250 µm by OCT were enrolled. Read More

    Intravitreal Steroids in Diabetic Macular Edema.
    Dev Ophthalmol 2017 20;60:78-90. Epub 2017 Apr 20.
    Over the past decade, great strides have been made in the management of diabetic macular edema (DME). Therapeutic alternatives now include focal/grid laser photocoagulation, vitreo-retinal surgery, and intraocular injection of anti-angiogenic and steroid molecules. Intravitreal administration of steroids represents a fundamental alternative for recalcitrant and naive eyes with DME, especially in those cases when anti-vascular endothelial growth factor (VEGF) agents are contraindicated or a treatment regimen with fewer intravitreal injections is required. Read More

    Intravitreal Aflibercept in Diabetic Macular Edema: Long-Term Outcomes.
    Dev Ophthalmol 2017 20;60:71-77. Epub 2017 Apr 20.
    For decades, macular laser photocoagulation has been the standard of care in the treatment of diabetic macular edema (DME). With the relatively recent advent of anti-vascular endothelial growth factor (VEGF) agents, DME treatment has entered a new era. VEGF is a well-known pro-angiogenic and pro-permeability factor involved in the pathogenesis of DME. Read More

    Intravitreal Ranibizumab in Diabetic Macular Edema: Long-Term Outcomes.
    Dev Ophthalmol 2017 20;60:63-70. Epub 2017 Apr 20.
    Intravitreal ranibizumab (RBZ) has been shown in multiple randomized clinical trials to be a valuable treatment for diabetic macular edema (DME), promoting a significant improvement in best-corrected visual acuity (BCVA) and in anatomic outcomes. Compared to sham (RISE and RIDE studies), RBZ rapidly and sustainably improved BCVA and decreased macular edema at 2 years, reducing the risk of further vision loss, with low rates of local or systemic side effects. Compared to macular laser photocoagulation (READ-2 study), RBZ provided a greater improvement in BCVA and regression in foveal thickness, but required a higher number of injections compared to patients treated with both RBZ and laser. Read More

    Optical Coherence Tomography Angiography in Diabetic Maculopathy.
    Dev Ophthalmol 2017 20;60:38-49. Epub 2017 Apr 20.
    Fluorescein angiography (FA) and indocyanine green angiography have provided information about the normal retinal and choroidal anatomy, nearly comparable to histological findings. These tests have been fundamental in the evaluation of all retinal and choroidal vascular diseases and have allowed clinicians to define and diagnose several pathological conditions. FA became the "gold standard" in retinal imaging due to the capacity to visualize the retinal capillary bed and its changes, both in the macular area and in the periphery. Read More

    Emerging Issues for Optical Coherence Tomography.
    Dev Ophthalmol 2017 20;60:28-37. Epub 2017 Apr 20.
    Almost 25 years after its introduction, optical coherence tomography (OCT) is still a crucial test in the evaluation of patients affected by diabetic retinopathy. In this chapter, the authors provide an extensive overview of the posterior segment pathological changes induced by diabetes, characterized using OCT. OCT plays a key role in diabetic macular edema (DME) as it assesses related retinal changes both in a qualitative (i. Read More

    Emerging Insights into Pathogenesis.
    Dev Ophthalmol 2017 20;60:16-27. Epub 2017 Apr 20.
    Diabetic retinopathy (DR) is a frequent complication of diabetes mellitus (DM). Persistent hyperglycemia leads to the activation of multiple cellular pathways involved in the pathogenesis of DR, resulting in increased inflammation, oxidative stress, and vascular dysfunction. DR has been considered a "chronic, low-grade inflammatory disease of the retina". Read More

    Retina 2017 Apr 19. Epub 2017 Apr 19.
    *Department of Ophthalmology, Bagcilar Education and Research Hospital, Istanbul, Turkey; and †Department of Ophthalmology, Bulent Ecevit University, Zonguldak, Turkey.
    Purpose: To evaluate the effectiveness of a single intravitreal injection of dexamethasone implant in resistant diabetic macular edema that have different morphological types.

    Methods: In this retrospective study, 31 patients (35 eyes) with persistent diabetic macular edema, who underwent a single injection of dexamethasone implant, were evaluated. Diabetic macular edema was classified into three types: diffuse retinal thickening (n = 10), cystoid macular edema (n = 13), and serous retinal detachment (n = 12). Read More

    Retina 2017 Apr 19. Epub 2017 Apr 19.
    Ophthalmic Research Center, Ophthalmology Department of Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
    Purpose: To assess the effect of intravitreal injection of bevacizumab on central choroidal thickness (CCT) and its relationship with central macular thickness (CMT) and best-corrected visual acuity (BCVA) changes in eyes with center-involving diabetic macular edema.

    Methods: This prospective interventional case series included 20 eyes of 20 patients with center-involving diabetic macular edema naive to treatment. The BCVA assessment, complete eye examination, enhanced depth optical coherence tomography, and fluorescein angiography were performed at baseline followed by 3 monthly intravitreal injection of bevacizumab. Read More

    Guidelines for the Management of Diabetic Macular Edema by the European Society of Retina Specialists (EURETINA).
    Ophthalmologica 2017 Apr 20. Epub 2017 Apr 20.
    Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.
    Diabetic retinal disease is envisioned to become the plague of the coming decades with a steep increase of worldwide diabetes incidence followed by a substantial rise in retinal disease. Improvements in diagnostic and therapeutic care have to cope with this dilemma in a clinically and socioeconomically efficient manner. Laser treatment has found a less destructive competitor in pharmacological treatments. Read More

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