Sanjeewa S Wickremasinghe1,2, Samantha Fraser-Bell3, Elizabeth Alessandrello1, Hemal Mehta3,4, Mark C Gillies3, Lyndell L Lim1,2. 1. Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia. 2. Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia. 3. Department of Ophthalmology, Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia. 4. Royal Free London NHS Foundation Trust, London, UK.
Abstract
PURPOSE: To compare changes in retinal vascular calibre after 2 years of treatment with intravitreal bevacizumab (BVZ) or dexamethasone implant (DEX) in patients with centre-involving diabetic macular oedema (DMO). METHODS: At baseline, 88 eyes of 61 patients with DMO were recruited in a prospective, multicentre, randomised, single-masked clinical trial. Of these subjects, 22 BVZ-treated (52%) and 22 DEX-treated (48%) eyes of 34 patients (56%) had gradable retinal photographs at both the baseline and 24-month visits. Retinal vascular calibre was measured from digital fundus photographs and summarised as central retinal artery (CRAE) and vein (CRVE) equivalents in all gradable eyes at baseline and 24 months. RESULTS: At 24 months, 40.9% of BVZ and 45.5% of DEX eyes gained 10 or more letters (p=0.77). There was concurrent reduction in mean central macular thickness, -157.7 μm in BVZ and -192.5 μm in DEX-treated eyes (p=0.40). DEX-treated eyes showed a statistically significant reduction in CRVE compared with BVZ-treated eyes, with a mean change from baseline of -31.78 to +4.34 µm, respectively (p<0.001). CRAE showed a non-statistically significant trend towards reduction over time in DEX-treated eyes compared with BVZ-treated eyes, with a mean change from baseline of -6.09 and +1.66, respectively (p=0.077). CONCLUSIONS:DEX had a significant narrowing effect on venular diameter in eyes with DMO not seen with BVZ. The changes in retinal vascular calibre suggest that these agents have a differing actions effects retinal vasculature and thereby suggest a potentially different mechanism of action on reducing DMO. TRIAL REGISTRATION NUMBER: NCT01298076. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
RCT Entities:
PURPOSE: To compare changes in retinal vascular calibre after 2 years of treatment with intravitreal bevacizumab (BVZ) or dexamethasone implant (DEX) in patients with centre-involving diabetic macular oedema (DMO). METHODS: At baseline, 88 eyes of 61 patients with DMO were recruited in a prospective, multicentre, randomised, single-masked clinical trial. Of these subjects, 22 BVZ-treated (52%) and 22 DEX-treated (48%) eyes of 34 patients (56%) had gradable retinal photographs at both the baseline and 24-month visits. Retinal vascular calibre was measured from digital fundus photographs and summarised as central retinal artery (CRAE) and vein (CRVE) equivalents in all gradable eyes at baseline and 24 months. RESULTS: At 24 months, 40.9% of BVZ and 45.5% of DEX eyes gained 10 or more letters (p=0.77). There was concurrent reduction in mean central macular thickness, -157.7 μm in BVZ and -192.5 μm in DEX-treated eyes (p=0.40). DEX-treated eyes showed a statistically significant reduction in CRVE compared with BVZ-treated eyes, with a mean change from baseline of -31.78 to +4.34 µm, respectively (p<0.001). CRAE showed a non-statistically significant trend towards reduction over time in DEX-treated eyes compared with BVZ-treated eyes, with a mean change from baseline of -6.09 and +1.66, respectively (p=0.077). CONCLUSIONS:DEX had a significant narrowing effect on venular diameter in eyes with DMO not seen with BVZ. The changes in retinal vascular calibre suggest that these agents have a differing actions effects retinal vasculature and thereby suggest a potentially different mechanism of action on reducing DMO. TRIAL REGISTRATION NUMBER: NCT01298076. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Authors: Carol Y Cheung; Dejiang Xu; Ching-Yu Cheng; Charumathi Sabanayagam; Yih-Chung Tham; Marco Yu; Tyler Hyungtaek Rim; Chew Yian Chai; Bamini Gopinath; Paul Mitchell; Richie Poulton; Terrie E Moffitt; Avshalom Caspi; Jason C Yam; Clement C Tham; Jost B Jonas; Ya Xing Wang; Su Jeong Song; Louise M Burrell; Omar Farouque; Ling Jun Li; Gavin Tan; Daniel S W Ting; Wynne Hsu; Mong Li Lee; Tien Y Wong Journal: Nat Biomed Eng Date: 2020-10-12 Impact factor: 25.671