13.3 Medical Retina – Age-Related Macular Degeneration (AMD)
13.4 Medical Retina - Diabetes
13.5 Medical Retina – Retinal Vein Occlusion (RVO)
13.6 Vitreoretinal Surgery
13.11 Ocular Oncology
Kaiser, P.K. 2006. Verteporfin therapy of subfoveal choroidal neovascularization in age-related macular degeneration: 5-year results of two randomized clinical trials with an open-label extension: TAP report no. 8. Graefes Arch Clin Exp Ophthalmol 244(9) 1132-1142
Keech, A., Simes, R.J., Barter, P. et al. 2005. Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet 366(9500) 1849-1861.
Keech, A.C., Mitchell, P., Summanen, P.A. et al. 2007. Effect of fenofibrate on the need for laser treatment for diabetic retinopathy (FIELD study): a randomised controlled trial. Lancet 370(9600) 1687-1697.
Intensive BSL and lipid control reduced rate of progression of retinopathy in those with high risk of cardiovascular disease
Intensive BSL control caused more systemic hypoglycaemic episodes
2016. Persistent Effects of Intensive Glycemic Control on Retinopathy in Type 2 Diabetes in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Follow-On Study. Diabetes Care 39(7) 1089-1100.
Chew, E.Y., Ambrosius, W.T., Davis, M.D. et al. 2010. Effects of medical therapies on retinopathy progression in type 2 diabetes. N Engl J Med 363(3) 233-244.
Macular laser for “CSMO” reduces moderate visual loss
CSMO = 1. DMO within 500 microns of the fovea, 2. Hard exudate within 500 microns of the fovea associated with DMO, 3. Disc area of DMO within disc diameter of the fovea
PRP for high risk PDR; severe NPDR defined (any of: 4 quadrants retinal haemorrhages, 2 quadrants venous beading, 1 IRMA)
PRP can worsen DMO in the short-term
1985. Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1. Early Treatment Diabetic Retinopathy Study research group. Arch Ophthalmol 103(12) 1796-1806.
Abraham, P., Yue, H. and Wilson, L. 2010. Randomized, double-masked, sham-controlled trial of ranibizumab for neovascular age-related macular degeneration: PIER study year 2. Am J Ophthalmol 150(3) 315-324.e311.
IVR + prompt or deferred laser better than focal/grid laser alone
IVTA + prompt laser better than focal/grid laser alone in pseudophakes but causes IOP rise
5 Year results: IVR + prompt laser no better than IVR + deferred laser
Bressler, S.B., Glassman, A.R., Almukhtar, T. et al. 2016. Five-Year Outcomes of Ranibizumab With Prompt or Deferred Laser Versus Laser or Triamcinolone Plus Deferred Ranibizumab for Diabetic Macular Edema. American Journal of Ophthalmology 164 57-68.
Elman, M.J., Ayala, A., Bressler, N.M. et al. 2015. Intravitreal Ranibizumab for Diabetic Macular Edema with Prompt versus Deferred Laser Treatment: 5-Year Randomized Trial Results. Ophthalmology (Rochester, Minn) 122(2) 375-381.
IVR = IVA = IVB for DMO when VA ≥ 6/12 (20/40)
At 1 year: IVA superior for DMO when VA ≤ 6/15 (20/50)
At 2 years: IVA no longer superior for DMO when VA ≤ 6/15 (20/50)
Diabetic Retinopathy Clinical Research, N., Wells, J.A., Glassman, A.R. et al. 2015. Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema. The New England Journal of Medicine 372(13) 1193-1203.
All rights reserved. No part of this publication which includes all images and diagrams may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the authors, except in the case of brief quotations embodied in critical reviews and certain other noncommercial uses permitted by copyright law.
Vitreoretinal Surgery Online
This open-source textbook provides step-by-step instructions for the full spectrum of vitreoretinal surgical procedures. An international collaboration from over 90 authors worldwide, this text is rich in high quality videos and illustrations.