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    Impact of Insulin Treatment in Diabetic Macular Edema Therapy in Type 2 Diabetes
    (Elsevier B.V., 2015-02-01) Matsuda, Simone [UNIFESP]; Tam, Tiffany; Singh, Rishi P.; Kaiser, Peter K.; Petkovsek, Daniel; Zanella, Maria Teresa [UNIFESP]; Ehlers, Justis P.; Cleveland Clin Fdn; Universidade Federal de São Paulo (UNIFESP)
    Objective: To evaluate the impact of insulin therapy on the outcomes of diabetic macular edema (DME) treatment with vascular endothelial growth factor (VEGF) inhibitors in people with type 2 diabetes.Methods: A retrospective consecutive case series of 95 patients with type 2 diabetes and DME who were treated with anti-VEGF therapy. We examined 2 cohorts: patients taking only oral antidiabetic agents and patients on insulin therapy. the main outcome measures were change in visual acuity and change in central subfield macular thickness measured by spectral-domain optical coherence tomography. the additional variables analyzed included glycated hemoglobin (A1C), creatinine, blood pressure and body mass index and their correlations with clinical findings.Results: Both groups had a statistically significant improvement in visual acuity (oral antidiabetic agents group: 20/61 to 20/49, p=0.003; insulin therapy group: 20/76 to 20/56, p=0.005). There was no difference between groups at initial or 12-month examination (p=0.239 and p=0.489, respectively). From an anatomic standpoint, central subfield macular thickness also improved significantly in both groups: from 454.7 mu m to 354.9 mu m (p<0.001) in the oral antidiabetic agents group and from 471.5 mu m to 368.4 mu m (p<0.001) in the insulin therapy group. Again, there was no significant difference between groups at initial or 12-month follow-up examinations (p=0.586 and p=0.591, respectively). Mean A1C levels remained relatively stable during the follow up in both groups.Conclusion: Anti-VEGF therapy is a useful treatment for DME. This study Suggests that chronic insulin therapy, compared with oral antidiabetic agents, does not modify the anatomic or functional effectiveness of DME treatment. (C) 2015 Canadian Diabetes Association
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    INTRAVITREAL BEVACIZUMAB FOR CHOROIDAL NEOVASCULARIZATION IN AGE-RELATED MACULAR DEGENERATION 5-Year Results of The Pan-American Collaborative Retina Study Group
    (Lippincott Williams & Wilkins, 2016) Arevalo, J. Fernando; Lasave, Andres F.; Wu, Lihteh; Acon, Dhariana; Berrocal, Maria H.; Diaz-Llopis, Manuel; Gallego-Pinazo, Roberto; Serrano, Martin A.; Alezzandrini, Arturo A.; Rojas, Sergio; Maia, Mauricio [UNIFESP]; Lujan, Silvio
    Purpose: To report the long-term anatomical and functional outcomes of patients with choroidal neovascularization secondary to age-related macular degeneration treated with intravitreal bevacizumab (IVB). Methods: Retrospective case series. Patients diagnosed with subfoveal choroidal neovascularization secondary to age-related macular degeneration that were treated with at least 1 intravitreal injection of 1.25 mg of IVB and had a minimum follow-up of 60 months. Patients underwent best-corrected Snellen visual acuity testing, optical coherence tomography, and ophthalmoscopic examination at baseline and follow-up visits. Results: Two hundred and forty-seven consecutive patients (292 eyes) were included. The mean number of IVB injections per eye was 10.9 +/- 6.4. At 5 years, the BCVA decreased from 20/150 (logMAR 0.9 +/- 0.6) at baseline to 20/250 (logMAR 1.1 +/- 0.7) (P = <0.0001). The mean CMT decreased from 343.1+ 122.3 mm at baseline to 314.7 +/- 128.8 mm at 60 months of follow-up (P = 0.009). Geographic atrophy (GA) was observed at baseline in 47 (16%) of 292 eyes. By 5 years, GA developed or progressed in 124 (42.5%) of 292 eyes (P < 0.0001). Conclusion: The early visual gains obtained from IVB were not maintained at 5 years of follow-up. In addition, IVB may play a role in the development or progression of GA.