Yuichiro Ogura1, Fumio Shiraga2, Hiroko Terasaki3, Masahito Ohji4, Susumu Ishida5, Taiji Sakamoto6, Akito Hirakata7, Tatsuro Ishibashi8. 1. Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan. ogura@med.nagoya-cu.ac.jp. 2. Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. 3. Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan. 4. Department of Ophthalmology, Shiga University of Medical Science, Otsu, Japan. 5. Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan. 6. Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan. 7. Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan. 8. Kyushu University Hospital, Fukuoka, Japan.
Abstract
PURPOSE: To elucidate the current clinical practice patterns of diabetic macular edema (DME) management by retinal specialists in Japan in the era of anti-vascular endothelial growth factor (VEGF) therapy. METHODS: Forty-six retinal specialists were administered a survey regarding the pathology and clinical practice of DME. RESULTS: Nearly, half of the specialists (45.2 %) think that the main biochemical factor involved in DME development is the vascular permeability-potentiating action of VEGF-A. Most specialists (70.6 %) use three modalities for detecting DME: optical coherence tomography, fluorescein angiography, and fundus examination. For focal macular edema, focal laser is used as first-line therapy by 70.3 % of specialists, whereas 21.6 % use medical treatment in combination with focal/grid laser. For diffuse macular edema, anti-VEGF therapy is the first choice (72.5 %), irrespective of visual acuity, whereas 17.5 % select off-label sub-Tenon's steroid injections. Vitrectomy is often performed for vitreomacular traction (86.5 %) or when anti-VEGF agent/laser therapy is ineffective (73.2 %). For persistent DME after vitrectomy, anti-VEGF agents (46.3 %) or steroids (intravitreal injections, 14.6 %; sub-Tenon's injections, 36.6 %) are selected. When applying anti-VEGF treatment regimen, most specialists continue loading injections until central retinal thickness stabilized (51.4 %) or both visual acuity and central retinal thickness stabilized (24.3 %). In the maintenance phase, many specialists provide injections with pro re nata (76.3 %), whereas 50.0 % responded that the treat-and-extend regimen is ideal. CONCLUSIONS: Our survey presents the current views about the DME management and practice patterns of anti-VEGF therapy by one part of the retinal specialists in Japan, and highlights the differences or gaps between evidence and actual clinical practice.
PURPOSE: To elucidate the current clinical practice patterns of diabetic macular edema (DME) management by retinal specialists in Japan in the era of anti-vascular endothelial growth factor (VEGF) therapy. METHODS: Forty-six retinal specialists were administered a survey regarding the pathology and clinical practice of DME. RESULTS: Nearly, half of the specialists (45.2 %) think that the main biochemical factor involved in DME development is the vascular permeability-potentiating action of VEGF-A. Most specialists (70.6 %) use three modalities for detecting DME: optical coherence tomography, fluorescein angiography, and fundus examination. For focal macular edema, focal laser is used as first-line therapy by 70.3 % of specialists, whereas 21.6 % use medical treatment in combination with focal/grid laser. For diffuse macular edema, anti-VEGF therapy is the first choice (72.5 %), irrespective of visual acuity, whereas 17.5 % select off-label sub-Tenon's steroid injections. Vitrectomy is often performed for vitreomacular traction (86.5 %) or when anti-VEGF agent/laser therapy is ineffective (73.2 %). For persistent DME after vitrectomy, anti-VEGF agents (46.3 %) or steroids (intravitreal injections, 14.6 %; sub-Tenon's injections, 36.6 %) are selected. When applying anti-VEGF treatment regimen, most specialists continue loading injections until central retinal thickness stabilized (51.4 %) or both visual acuity and central retinal thickness stabilized (24.3 %). In the maintenance phase, many specialists provide injections with pro re nata (76.3 %), whereas 50.0 % responded that the treat-and-extend regimen is ideal. CONCLUSIONS: Our survey presents the current views about the DME management and practice patterns of anti-VEGF therapy by one part of the retinal specialists in Japan, and highlights the differences or gaps between evidence and actual clinical practice.
Authors: M Miyazaki; M Kubo; Y Kiyohara; K Okubo; H Nakamura; K Fujisawa; Y Hata; S Tokunaga; M Iida; Y Nose; T Ishibashi Journal: Diabetologia Date: 2004-07-28 Impact factor: 10.122
Authors: Christian Prünte; Franck Fajnkuchen; Sajjad Mahmood; Federico Ricci; Katja Hatz; Jan Studnička; Vladimir Bezlyak; Soumil Parikh; William John Stubbings; Andreas Wenzel; João Figueira Journal: Br J Ophthalmol Date: 2015-10-09 Impact factor: 4.638