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Intraocular pharmacokinetics of antia??vascular endothelial growth factor agents by intraoperative subretinal versus intravitreal injection in silicone oila??filled eyes of proliferative diabetic retinopathy: a randomized controlled pilot study
摘要： Purpose: Intraoperative subretinal anti-vascular endothelial growth factor (VEGF) injections have been used clinically in some case, but the pharmacokinetic characteristics have not yet been determined. In this pilot study, we investigate the pharmacokinetic parameters of anti-VEGF agents by intraoperative subretinal or intravitreal injection in silicone oil (SiO)-filled eyes of patients with proliferative diabetic retinopathy (PDR). Methods: Randomized controlled trial including 13 patients (16 eyes) with PDR underwent pars plana vitrectomy (PPV) with SiO tamponade and randomly received a subretinal (8 eyes) or intravitreal (8 eyes) conbercept injection (0.5 mg/0.05 ml) intraoperatively. Aqueous humour (AH) was obtained on the 1st, 3rd, 7th, 10th, 14th, 21st and 28th day after the injection. Drug concentrations in the AH were determined by enzyme-linked immunosorbent assay (ELISA). The last best-corrected visual acuity (BCVA) was examined 6 months postoperatively. Results: The clearance rate of anti-VEGF agents by subretinal injection was reduced in vitrectomized eyes with SiO tamponade (p < 0.05). With the same drug dose, subretinal injection (5.49 (cid:1) 6.11 lg/ml) resulted in higher drug concentrations in the AH when compared with intravitreal injection (0.42 (cid:1) 0.46 lg/ml, p = 0.001) 4 weeks after the treatment. The mean residence time last (MRT0-t) by subretinal injection (11.57 (cid:1) 0.83 days) was significantly longer than the mean MRT0-t by intravitreal injection (7.10 (cid:1) 1.00 days, p < 0.001). A self-paired analysis showed that subretinal injection led to the BCVA improvement by +28.59 letters 6 months postoperatively (p = 0.028) while the BCVA did not improve significantly by intravitreal injection (p = 0.715). Conclusions: The drug maintenance phase was prolonged by intraoperative subretinal injection in SiO-filled eyes of PDR. The results suggest that subretinal injection might be a valuable treatment option for the management of PDR.
关键词： proliferative diabetic retinopathy,pharmacokinetics,subretinal injection,anti-VEGF agents,pars plana vitrectomy
更新于2025-09-16 10:30:52
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Efficacy and safety of ranibizumab with or without panretinal laser photocoagulation versus laser photocoagulation alone in proliferative diabetic retinopathy – the PRIDE study
摘要： Purpose: Panretinal photocoagulation (PRP) is the current standard of care in proliferative diabetic retinopathy (PDR). However, treatment with anti-vascular endothelial growth factor agents might offer better patient outcomes with fewer side-effects. The PRIDE study aimed to assess the efficacy and safety of ranibizumab with or without PRP compared with PRP alone in patients with PDR. Methods: A total of 106 PDR patients without diabetic macular oedema were randomized to receive ranibizumab 0.5 mg monotherapy (n = 35), PRP (n = 35) or combined ranibizumab 0.5 mg/PRP (n = 36). The primary objective of this 12-month, multicentre, phase II study was to investigate the change in area of retinal neovascularization (NV). Complete regression of leakage and best-corrected visual acuity (BCVA) were key secondary end-points. Results: At Month 12, there was a statistically significant difference of ?2.83 mm2 in the least square mean change in NV area between the ranibizumab monotherapy and PRP group, favouring ranibizumab (95% CI [?5.45; ?0.21], p = 0.0344). At Month 3, 67%/0%/67% of the patients in the ranibizumab/PRP/combination groups, respectively, showed complete regression of leakage from NVs, while at Month 12, 28%/8%/18% showed complete regression of leakage from NVs. BCVA change was greater in the ranibizumab group compared with the PRP monotherapy group at Month 12 (+1.6 letters; 95% CI [?2.3; 5.5] versus ?3.9 letters; 95% CI [?7.8; ?0.1], p = 0.0495). Conclusions: Ranibizumab monotherapy is an alternative treatment option to laser treatment in patients with PDR. Ranibizumab showed stronger effects on NV leakage and area reduction while offering better visual acuity results than PRP alone.
关键词： ranibizumab,proliferative diabetic retinopathy,retinal neovascularization,panretinal laser photocoagulation,PRIDE study,anti-VEGF therapy
更新于2025-09-12 10:27:22
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COMPARATIVE EVALUATION OF ANTERIOR SEGMENT OPTICAL COHERENCE TOMOGRAPHY, ULTRASOUND BIOMICROSCOPY, AND INTRAOCULAR PRESSURE CHANGES AFTER PANRETINAL PHOTOCOAGULATION BY PASCAL AND CONVENTIONAL LASER
摘要： Purpose: To compare intraocular pressure, anterior segment optical coherence tomography, and ultrasound biomicroscopy parameters over 3 months after panretinal photocoagulation (PRP) for proliferative diabetic retinopathy after 1 of 2 sittings by conventional laser (half PRP) and a single sitting of Pattern Scan Laser (PASCAL) PRP. Methods: This was a prospective, randomized, interventional study. All tests were performed at baseline, and at 1, 6, and 24 hours, and 1, 4, 8, and 12 weeks after PRP. Results: The intraocular pressure at 1 hour and 6 hours after PRP was significantly raised in both groups. Mean intraocular pressure was 21.17 ± 4.01 mmHg after PASCAL and 17.48 ± 3 mmHg after conventional laser at 1 hour, P , 0.001. On anterior segment optical coherence tomography, conventional laser PRP caused a more significant narrowing of angle-opening distance (AOD750) and trabecular-iris space area (TISA 500), P = 0.03 and 0.04, respectively, on Day 1. Ultrasound biomicroscopy showed a significantly narrow angle in both groups on Day 1. A significant increase in ciliary body thickness was observed in both groups, with 57.1% of PASCAL and 100% of conventionally treated eyes showing ciliary effusion on Day 1 that decreased but persisted for the next 3 months. Conclusion: Performing PRP in sittings, prescribing previous glaucoma medications in patients at risk, and recording intraocular pressure an hour after the PRP could decrease complications.
关键词： panretinal photocoagulation,proliferative diabetic retinopathy,conventional laser and PASCAL
更新于2025-09-12 10:27:22
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Ganglion cell layer thickening in well‐controlled patients with type 1 diabetes: an early sign for diabetic retinopathy?
摘要： Purpose: To evaluate early changes in retinal layers using optical coherence tomography (OCT) in patients with long-standing type 1 diabetes (DM1) receiving intensi?ed insulin therapy. Methods: In a cross-sectional case–control study 150 patients with DM1 and 150 age- and sex-matched healthy control participants underwent OCT imaging. Scans of both eyes were analysed for di?erent layers (NFL, GCL (+IPL), INL, outer layer complex (OLC, including OPL, ONL and ELM) and photoreceptors (PR)) in all sub?elds of an ETDRS grid. All analyses were performed semi-automatically using custom software by certi?ed graders of the Vienna Reading Center. ANOVA models were used to compare the mean thickness of the layers between patients and controls. Results: Six hundred eyes with 512 datapoints in 49 b-scans in each OCT were analysed. Mean thickness in patients/controls was 31.35 lm/30.65 lm (NFL, p = 0.0347), 76.7 lm/73.15 lm (GCL, p ≤ 0.0001), 36.29 lm/37.13 lm (INL, p = 0.0116), 114.34 lm/112.02 lm (OLC, p < 0.0001) and 44.71 lm/44.69 lm (PR, p = 0.9401). When evaluating the ETDRS sub?elds separately for clinically meaningful hypotheses, a signi?cant swelling of the GCL in patients could be found uniformly and a central swelling for the OLC, whereas the distribution of NFL and INL thickening suggests that their statistical signi?cance was not clinically relevant. Conclusion: These preliminary results demonstrate that preclinical retinal changes in patients with long-standing DM1 can be found by retinal layer evaluation. However, the changes are layer-speci?c, with signi?cant thickening of the GCL and less so of the OLC suggesting a role as an early sign for di?use swelling and the evolution of DME even in well-controlled diabetes.
关键词： diabetic retinopathy – early detection – early disease – image analysis – OCT
更新于2025-09-11 14:15:04
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Comparison of navigated laser and conventional single-spot laser system for induced pain during panretinal photocoagulation
摘要： To compare the panretinal photocoagulation (PRP)–induced pain response between novel navigated laser (Navilas) and conventional single-spot laser. The eyes were randomly assigned to Navilas or conventional laser. Contralateral eyes underwent PRP with the other system with 30 min resting interval. Pulse duration was 100 ms in conventional laser and 30 ms or 100 ms in Navilas and power setting was enough to create gray-white light burn on both devices. Pain response was evaluated by verbal scale (VS) (0–4) and visual analog scale (VAS) (0–10) after each PRP application. The mean age of 70 patients (140 eyes) was 62.52 ± 9.49 years. Mean power and spot numbers for Navilas and conventional laser were 291.9 ± 85.3 mW vs 368.4 ± 72.0 mW, and 375.4 ± 108.4 vs 374.2 ± 105.0 (p < 0.001 and p = 0.53, respectively). Pain scores for Navilas and conventional laser were 1.19 ± 0.73 and 1.99 ± 0.84 for VS and 2.41 ± 1.65 and 4.74 ± 2.17 for VAS (p < 0.001 and p < 0.001). More comfortable PRP is achieved with Navilas system in comparison with conventional single-spot laser system. However, small number of patients treated with same pulse duration and different contact lenses used for two systems should be taken into consideration. Besides, we did not report comparative clinical efficiency of either laser system.
关键词： Proliferative diabetic retinopathy,PRP,Navilas,Pain,Panretinal photocoagulation
更新于2025-09-11 14:15:04
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Retinal and Choroidal Perfusion Status in the Area of Laser Scars Assessed With Swept-Source Optical Coherence Tomography Angiography
摘要： To evaluate the perfusion status of the retina and choriocapillaris in the area of laser scars on swept-source optical coherence tomography angiography (OCTA) images of eyes previously treated with panretinal photocoagulation (PRP).
关键词： diabetic retinopathy,OCT angiography,laser photocoagulation,choriocapillaris
更新于2025-09-11 14:15:04
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Comparison of pain experience and time required for pre-planned navigated peripheral laser versus conventional multispot laser in the treatment of diabetic retinopathy
摘要： Purpose To compare the pain and the duration of a panretinal photocoagulation (PRP) session using a conventional multispot laser (Quantel Medical) versus the Navilas? laser. Methods Treatment-na?ve patients requiring bilateral PRP for diabetic retinopathy were included. For each patient, PRP was carried out using a conventional multispot laser (Quantel Medical, 577?nm) in one eye and the other eye was treated with the Navilas laser (OD-OS, 577?nm). For both PRP treatments, similar parameters (same power, exposure time, number, size and spacing of the spots) were used. For each eye, the duration of the session and the pain, measured using respectively a chronometer and a visual analogic scale (VAS), were recorded. Results Thirty-two eyes of sixteen patients (mean age 57 ± 13 SD, range 28–74), 11 men and 5 women, have been included. A mean of 1289 (1000–1500) spots with a mean power of 352?mW (300–450?mW) and an exposure time of 27?ms (20–30?ms) were delivered. The PRP session with the Navilas laser (mean time of 5.2 ± 0.8?min) was faster than with the conventional multispot laser (6.6 ± 1.1?min) (p = 0.02). Laser-induced pain was significantly reduced (VAS of 2.4 ± 1.6) using the Navilas laser compared to conventional laser (VAS: 7.1 ± 2) (p < 0.001). Conclusion The PRP sessions using the Navilas laser were significantly faster and less painful than with a conventional multispot laser in our series.
关键词： Diabetic retinopathy,Conventional multispot laser,Navilas?,Navigated-PRP
更新于2025-09-11 14:15:04
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QUALITY IMPROVEMENT OF LASER TREATMENT (QUILT)A New Retinal Laser Simulation System for Training in Resource-Poor Countries
摘要： In resource-poor countries, there is a reported lack of quality and structured retinal laser training in residency and hospital eye programs. This unmet training need has been validated in current international diabetic retinopathy screening centers. Quality Improvement of Laser Treatment (QUILT) is a novel laser photocoagulation simulator that contains modules for laser treatment of PDR, diabetic macular edema (DME), retinal vein occlusion, and laser retinopexy. The primary objective of the QUILT simulation is to introduce a new bespoke application to support practical skills training in retinal laser treatment in countries where laser training is suboptimal for ophthalmologists and trainees/residents. The application was first developed as an online application but has subsequently been developed as a standalone application that can be downloaded or copied onto individual laptops or computers, so that the training is not dependent on a good internet connection.
关键词： diabetes,simulator,proliferative diabetic retinopathy,laser training,simulation,pattern scan laser,retinopexy,macular edema
更新于2025-09-11 14:15:04
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PERBANDINGAN TINGKAT PENGENALAN CITRA DIABETIC RETINOPATHY PADA KOMBINASI PRINCIPLE COMPONENT DARI 4 CIRI BERBASIS METODE SVM (SUPPORT VECTOR MACHINE)
摘要： Pattern recoqnition methods for image of diabetic retinopaty are influenced by differences in pigmentation. To help diabetic retinopathy image recognition is required a software. This paper presents the results of research on pattern recognition image of diabetic retinopathy,This study used the image of the yellow canal with Gabor filter.Characteristics that are taken from each image is characteristic of the mean, variance, skewness and entropy, followed by feature extraction with PCA (Principle Component Analysis).At PCA feature extraction, square matrix whose number of columns equal to the number of features is generated.There are four features used. These features are 4 PCs (Principle Component), ie, PC1, PC2, PC3 and PC4.From the combination of these features, we obtained six pairs that consist of two traits. By using a linear model of SVM will been selected the pair with the highest accuracy value. Based on the analysis, we obtained a couple PC1 and PC2 models that have the highest levels of learning (100%) and the fastest recognition time, which is explicitly indicated by the smallest amount of support vector.
关键词： Kanal Kuning,PCA,diabetic retinopathy,SVM
更新于2025-09-11 14:15:04
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Diabetic Nephropathy (Pathophysiology and Clinical Aspects) || Microvascular Complications in the?Eye: Diabetic Retinopathy
摘要： Diabetic retinopathy (DR) is a major cause of vision loss and blindness among persons with diabetes mellitus. It is estimated that approximately 35% of diabetes patients develop some form of DR [1]. DR is a progressive disease that is predominantly characterized by alterations in the retinal microvasculature. It may develop from an asymptomatic nonproliferative form associated with capillary non-perfusion, microaneurysms, and retinal hemorrhages, into a vision-threating disorder such as diabetic macular edema (DME) and proliferative DR (PDR).
关键词： vision loss,Diabetic retinopathy,retinal microvasculature,blindness,microvascular complications,diabetic macular edema,diabetes mellitus,proliferative diabetic retinopathy
更新于2025-09-10 09:29:36