[Show abstract][Hide abstract] ABSTRACT: Diabetes mellitus is a major health concern in the modern world. Several sight-threatening ocular conditions are included in the array of health problems associated with this disease. Understandably, 2 of the more sight-threatening problems, proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME), have received a great deal of attention in recent years. Pivotal studies, such as the Early Treatment Diabetic Retinopathy Study and the Diabetic Retinopathy Study, have established laser photocoagulation as the accepted treatment modality. The last decade has seen a surge in clinical data supporting the use of pharmacologic therapy in place of the often damaging laser therapy. Supporting data are based on the establishment of vascular endothelial growth factor (VEGF) as a key facilitator of disease progression in diabetic retinopathy. We will discuss the advantages and disadvantages of both selective and pan-blockade anti-VEGF agents available today in an effort to help guide physicians wishing to use these agents to treat PDR and DME.
Canadian Journal of Ophthalmology 10/2010; 45(5):501-8. · 1.30 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To compare the efficacy of intravitreal pegaptanib (IVP) with panretinal laser photocoagulation (PRP) in the treatment of active proliferative diabetic retinopathy (PDR).
A prospective, randomised, controlled, open-label, exploratory study. Twenty subjects with active PDR were randomly assigned at a 1:1 ratio to receive treatment in one eye either with IVP (0.3 mg) every 6 weeks for 30 weeks or with PRP laser. Efficacy endpoints included regression of retinal neovascularisation (NV), changes from baseline in best-corrected visual acuity (BCVA) and foveal thickness. Safety outcomes included observed and reported adverse events.
In 90% of randomised eyes to IVP, retinal NV showed regression by week 3. By week 12, all IVP eyes were completely regressed and maintained through week 36. In the PRP-treated group, at week 36, two eyes demonstrated complete regression, two showed partial regression, and four showed persistent active PDR. The mean change in BCVA at 36 weeks was +5.8 letters in pegaptanib-treated eyes and -6.0 letters in PRP-treated eyes. Only mild to moderate transient ocular adverse events were reported with pegaptanib.
IVP produces short-term marked and rapid regression of diabetic retinal NV. Regression of NV was maintained throughout the study and at the final visit.
The British journal of ophthalmology 09/2009; 93(11):1474-8. · 2.92 Impact Factor