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Erschienen in: Current Diabetes Reports 9/2021

01.09.2021 | Microvascular Complications—Retinopathy (R Channa, Section Editor)

Management of Complications and Vision Loss from Proliferative Diabetic Retinopathy

verfasst von: Gordon S. Crabtree, Jonathan S. Chang

Erschienen in: Current Diabetes Reports | Ausgabe 9/2021

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Abstract

Purpose of Review

Diabetes can be associated with profound visual loss due to several mechanisms. As the duration of diabetes and blood glucose levels increase, these changes become more severe. The proliferation of new blood vessels, vitreous hemorrhage, and tractional retinal detachments may ultimately result and can be devastating to visual function. New advances, including anti-vascular endothelial growth factor (VEGF) medications and innovative microsurgical instruments, have provided additional methods for the management of diabetic retinopathy in the clinic and in the operating room, leading to improved outcomes.

Recent Findings

Advances in earlier treatment of proliferative diabetic retinopathy, especially with anti-VEGF injections, allow for a reduction in severity, improved vision, and more controlled and successful surgery. Modern surgical techniques and instrumentation have also allowed for improved patient outcomes. Future research into sustained delivery and release of anti-VEGF, reducing the need for frequent in-office injections, may prove to be additionally beneficial.

Summary

Over the last decade, anti-VEGF has become an increasingly common treatment modality for the management of proliferative diabetic retinopathy, vitreous hemorrhages, and tractional retinal detachments. Further research is needed to determine the ideal method of delivery and timing of the treatment.
Literatur
8.
Zurück zum Zitat Early photocoagulation for diabetic retinopathy. ETDRS report number 9. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology 1991;98(5 Suppl):766-85. Early photocoagulation for diabetic retinopathy. ETDRS report number 9. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology 1991;98(5 Suppl):766-85.
12.
Zurück zum Zitat Photocoagulation treatment of proliferative diabetic retinopathy. Clinical application of Diabetic Retinopathy Study (DRS) findings, DRS Report Number 8. The Diabetic Retinopathy Study Research Group. Ophthalmology 1981;88(7):583-600. Photocoagulation treatment of proliferative diabetic retinopathy. Clinical application of Diabetic Retinopathy Study (DRS) findings, DRS Report Number 8. The Diabetic Retinopathy Study Research Group. Ophthalmology 1981;88(7):583-600.
17.
22.•
Zurück zum Zitat Bourry J, Courteville H, Ramdane N, Drumez E, Duhamel A, Subtil D, et al. Progression of diabetic retinopathy and predictors of its development and progression during pregnancy in patients with type 1 diabetes: a report of 499 pregnancies. Diabetes Care. 2021;44(1):181–7. https://doi.org/10.2337/dc20-0904. This study retrospectively evaluated progression of diabetic in type 1 diabetics with pregnancy and showed that the rate of diabetic retinopathy progression was 22%, and 25% developed diabetic retinopathy with no prior retinopathy present. Bourry J, Courteville H, Ramdane N, Drumez E, Duhamel A, Subtil D, et al. Progression of diabetic retinopathy and predictors of its development and progression during pregnancy in patients with type 1 diabetes: a report of 499 pregnancies. Diabetes Care. 2021;44(1):181–7. https://​doi.​org/​10.​2337/​dc20-0904. This study retrospectively evaluated progression of diabetic in type 1 diabetics with pregnancy and showed that the rate of diabetic retinopathy progression was 22%, and 25% developed diabetic retinopathy with no prior retinopathy present.
25.••
Zurück zum Zitat Bhavsar AR, Torres K, Glassman AR, Jampol LM, Kinyoun JL. Evaluation of results 1 year following short-term use of ranibizumab for vitreous hemorrhage due to proliferative diabetic retinopathy. JAMA Ophthalmol. 2014;132(7):889–90. https://doi.org/10.1001/jamaophthalmol.2014.287. This prospective multi-center study evaluated use of intravitreal ranibizumab for vitreous hemorrhage secondary to proliferative diabetic retinopathy. It showed that treatment allowed for more prompt laser, patients still may require vitrectomy surgery for non-clearing vitreous hemorrhage. Bhavsar AR, Torres K, Glassman AR, Jampol LM, Kinyoun JL. Evaluation of results 1 year following short-term use of ranibizumab for vitreous hemorrhage due to proliferative diabetic retinopathy. JAMA Ophthalmol. 2014;132(7):889–90. https://​doi.​org/​10.​1001/​jamaophthalmol.​2014.​287. This prospective multi-center study evaluated use of intravitreal ranibizumab for vitreous hemorrhage secondary to proliferative diabetic retinopathy. It showed that treatment allowed for more prompt laser, patients still may require vitrectomy surgery for non-clearing vitreous hemorrhage.
26.••
Zurück zum Zitat Antoszyk AN, Glassman AR, Beaulieu WT, Jampol LM, Jhaveri CD, Punjabi OS, et al. Effect of intravitreous aflibercept vs vitrectomy with panretinal photocoagulation on visual acuity in patients with vitreous hemorrhage from proliferative diabetic retinopathy: a randomized clinical trial. JAMA. 2020;324(23):2383–95. https://doi.org/10.1001/jama.2020.23027. This prospective multi-center study evaluated use of intravitreal aflibercept for vitreous hemorrhage secondary to proliferative diabetic retinopathy. It showed that mean visual acuity in eyes treated with aflibercept was similar to those that underwent vitrectomy however the study may be underpowered. Antoszyk AN, Glassman AR, Beaulieu WT, Jampol LM, Jhaveri CD, Punjabi OS, et al. Effect of intravitreous aflibercept vs vitrectomy with panretinal photocoagulation on visual acuity in patients with vitreous hemorrhage from proliferative diabetic retinopathy: a randomized clinical trial. JAMA. 2020;324(23):2383–95. https://​doi.​org/​10.​1001/​jama.​2020.​23027. This prospective multi-center study evaluated use of intravitreal aflibercept for vitreous hemorrhage secondary to proliferative diabetic retinopathy. It showed that mean visual acuity in eyes treated with aflibercept was similar to those that underwent vitrectomy however the study may be underpowered.
27.
Zurück zum Zitat Early vitrectomy for severe vitreous hemorrhage in diabetic retinopathy. Two-year results of a randomized trial. Diabetic Retinopathy Vitrectomy Study report 2. The Diabetic Retinopathy Vitrectomy Study Research Group. Arch Ophthalmol. 1985;103(11):1644-52. Early vitrectomy for severe vitreous hemorrhage in diabetic retinopathy. Two-year results of a randomized trial. Diabetic Retinopathy Vitrectomy Study report 2. The Diabetic Retinopathy Vitrectomy Study Research Group. Arch Ophthalmol. 1985;103(11):1644-52.
29.
Zurück zum Zitat Early vitrectomy for severe proliferative diabetic retinopathy in eyes with useful vision. Clinical application of results of a randomized trial--Diabetic Retinopathy Vitrectomy Study Report 4. The Diabetic Retinopathy Vitrectomy Study Research Group. Ophthalmology 1988;95(10):1321-34. https://doi.org/10.1016/s0161-6420(88)33014-9. Early vitrectomy for severe proliferative diabetic retinopathy in eyes with useful vision. Clinical application of results of a randomized trial--Diabetic Retinopathy Vitrectomy Study Report 4. The Diabetic Retinopathy Vitrectomy Study Research Group. Ophthalmology 1988;95(10):1321-34. https://​doi.​org/​10.​1016/​s0161-6420(88)33014-9.
40.•
Zurück zum Zitat Sokol JT, Schechet SA, Rosen DT, Ferenchak K, Dawood S, Skondra D. Outcomes of vitrectomy for diabetic tractional retinal detachment in Chicago's county health system. PLoS One. 2019;14(8):e0220726. https://doi.org/10.1371/journal.pone.0220726. This retrospective trial showed that 98.6% of patients undergoing vitrectomy for complex traction retinal detachment secondary to diabetic retinopathy had reattachment with a single surgery. Sokol JT, Schechet SA, Rosen DT, Ferenchak K, Dawood S, Skondra D. Outcomes of vitrectomy for diabetic tractional retinal detachment in Chicago's county health system. PLoS One. 2019;14(8):e0220726. https://​doi.​org/​10.​1371/​journal.​pone.​0220726. This retrospective trial showed that 98.6% of patients undergoing vitrectomy for complex traction retinal detachment secondary to diabetic retinopathy had reattachment with a single surgery.
41.•
Zurück zum Zitat Al-Khersan H, Venincasa MJ, Kloosterboer A, Sridhar J, Smiddy WE, Townsend JH, et al. Pars plana vitrectomy reoperations for complications of proliferative diabetic retinopathy. Clin Ophthalmol. 2020;14:1559–63. https://doi.org/10.2147/opth.s252285. This retrospective trial of patients undergoing vitrectomy for complications of proliferative diabetic retinopathy showed 28% required reoperation. Al-Khersan H, Venincasa MJ, Kloosterboer A, Sridhar J, Smiddy WE, Townsend JH, et al. Pars plana vitrectomy reoperations for complications of proliferative diabetic retinopathy. Clin Ophthalmol. 2020;14:1559–63. https://​doi.​org/​10.​2147/​opth.​s252285. This retrospective trial of patients undergoing vitrectomy for complications of proliferative diabetic retinopathy showed 28% required reoperation.
42.•
Zurück zum Zitat Storey PP, Ter-Zakarian A, Philander SA. Olmos de Koo L, George M, Humayun MS et al. Visual and anatomical outcomes after diabetic traction and traction-rhegmatogenous retinal detachment repair. Retina. 2018;38(10):1913–9. https://doi.org/10.1097/iae.0000000000001793. This retrospective trial of patients with traction retinal detachments secondary to proliferative diabetic retinopathy showed that 87.6% had successful reattachment after a single surgery. Storey PP, Ter-Zakarian A, Philander SA. Olmos de Koo L, George M, Humayun MS et al. Visual and anatomical outcomes after diabetic traction and traction-rhegmatogenous retinal detachment repair. Retina. 2018;38(10):1913–9. https://​doi.​org/​10.​1097/​iae.​0000000000001793​. This retrospective trial of patients with traction retinal detachments secondary to proliferative diabetic retinopathy showed that 87.6% had successful reattachment after a single surgery.
44.
Zurück zum Zitat Abrams GW, Williams GA. "En bloc" excision of diabetic membranes. Am J Ophthalmol. 1987;103(3 Pt 1):302–8.CrossRef Abrams GW, Williams GA. "En bloc" excision of diabetic membranes. Am J Ophthalmol. 1987;103(3 Pt 1):302–8.CrossRef
54.
55.
Zurück zum Zitat Imai H, Tetsumoto A, Inoue S, Takano F, Yamada H, Hayashida M, et al. Intraoperative three-dimensional fluorescein angiography-guided pars plana vitrectomy for the treatment of proliferative diabetic retinopathy: the maximized utility of the digital assisted vitrectomy. Retina. 2020. https://doi.org/10.1097/IAE.0000000000002805. Imai H, Tetsumoto A, Inoue S, Takano F, Yamada H, Hayashida M, et al. Intraoperative three-dimensional fluorescein angiography-guided pars plana vitrectomy for the treatment of proliferative diabetic retinopathy: the maximized utility of the digital assisted vitrectomy. Retina. 2020. https://​doi.​org/​10.​1097/​IAE.​0000000000002805​.
60.•
Zurück zum Zitat Arevalo JF, Lasave AF, Kozak I, Al Rashaed S, Al Kahtani E, Maia M, et al. Preoperative bevacizumab for tractional retinal detachment in proliferative diabetic retinopathy: a prospective randomized clinical trial. Am J Ophthalmol. 2019;207:279–87. https://doi.org/10.1016/j.ajo.2019.05.007. This randomized, multi-center, prospective trial showed improved surgical time and reduced bleeding in patients receiving anti-VEGF therapy prior to vitrectomy for complications of proliferative diabetic retinopathy. Arevalo JF, Lasave AF, Kozak I, Al Rashaed S, Al Kahtani E, Maia M, et al. Preoperative bevacizumab for tractional retinal detachment in proliferative diabetic retinopathy: a prospective randomized clinical trial. Am J Ophthalmol. 2019;207:279–87. https://​doi.​org/​10.​1016/​j.​ajo.​2019.​05.​007. This randomized, multi-center, prospective trial showed improved surgical time and reduced bleeding in patients receiving anti-VEGF therapy prior to vitrectomy for complications of proliferative diabetic retinopathy.
Metadaten
Titel
Management of Complications and Vision Loss from Proliferative Diabetic Retinopathy
verfasst von
Gordon S. Crabtree
Jonathan S. Chang
Publikationsdatum
01.09.2021
Verlag
Springer US
Erschienen in
Current Diabetes Reports / Ausgabe 9/2021
Print ISSN: 1534-4827
Elektronische ISSN: 1539-0829
DOI
https://doi.org/10.1007/s11892-021-01396-2

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