Diabetic Retinopathy

Experts discussed the use of antiVEGF and wide-field optical coherence tomographic angiography (OCTA)

in diabetic retinopathy (DR) on the first day of the 36th Asia-Pacific Academy of Ophthalmology Virtual Congress (APAO 2021). Anti-VEGF therapy

Dr. Srinivas Sadda from the Doheny Eye Institute, USA, talked about anti-VEGF therapy and retinal non-perfusion (RNP), as investigated in the RECOVERY Study.

“Anti-VEGF therapy has been suggested to slow RNP progression but does it reverse it?” he asked.

He shared that the Phase 2 RECOVERY trial shows that at the primary 1-year endpoint, in eyes with proliferative diabetic retinopathy (PDR) without diabetic macular edema (DME), ลาวสามัคคี

 monthly administration of aflibercept 2mg was associated with less RNP progression compared with quarterly treatment.

 “Overall, non-perfusion progresses despite apparent improvement in diabetic retinopathy severity scale (DRSS) score.

 Despite overall progression of RNP, some zones of apparent reperfusion were noted both on ultrawidefield (UWF) fluorescein angiography (FA) as well as OCTA.

OCTA was limited to the macula and did not identify changes

in RNP within the macular region,” he said. Meanwhile,

Dr. Michael Ip from the University of California, USA, shared about updates of DRCR Retina Networks’ Protocol W, which investigates

the use of intravitreal aflibercept for the prevention of vision-threatening complications of DR. The DRCR Retina Network was formed in 2002 and funded by the National Institutes of Health (USA).

 It currently includes over 160 participating sites with over 500 physicians throughout the U.S.

and Canada, and has been responsible for landmark clinical trials, including Protocols I, T and S. “Anti-VEGF treatment can improve DR,

 but can it prevent vision-threatening complications in high-risk eyes, and if so, is there any benefit (2 and 4 years) associated with preventing these complications?” he asked.

Protocol W is a randomized multicenter clinical trial across 64 sites involving patients who are 18-years-old

and older with type 1 or 2 diabetes and severe non-proliferative diabetic retinopathy (NPDR) in at least one eye.

Three hundred and ninety-nine eyes were randomized to receive 2 mg intravitreal aflibercept versus sham injection.

The primary outcome investigates the cumulative probability of developing PDR or center-involving diabetic macular edema (CI-DME) with vision loss.

“Results show that among eyes with moderate to severe NPDR, the proportion

that developed PDR or CI-DME was lower with periodic aflibercept treatment compared with sham through at least 2 years.

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