J.ophthalmol.(Ukraine).2021;5:3-9.
http://doi.org/10.31288/oftalmolzh2021539
Received: 26 August 2021; Published on-line: 23 October 2021
Morphological and ophthalmoscopic features of epiretinal membranes after intravitreal injection of various doses of aflibercept in patients with proliferative diabetic retinopathy
Vira S Ponomarchuk, V. V. Vit, M. M. Umanets
SI "The Filatov Institute of Eye Diseases and Tissue Therapy of the NAMS of Ukraine"; Odesa (Ukraine)
E-mail: v.zavodnaya@gmail.com
TO CITE THIS ARTICLE: Ponomarchuk Vira S, Vit VV, Umanets MM. Morphological and ophthalmoscopic features of epiretinal membranes after intravitreal injection of various doses of aflibercept in patients with proliferative diabetic retinopathy. J.ophthalmol.(Ukraine).2021;5:3-9. http://doi.org/10.31288/oftalmolzh2021539
Background: Although methods are available to treat proliferative diabetic retinopathy (PDR), 30% of cases progress, which is an indication for vitrectomy.
Purpose: To investigate the ophthalmoscopic and morphological features of epiretinal membranes (ERMs) in patients with PDR depending on the dose of preoperative intravitreal aflibercept (PIA).
Material and Methods: Seventy-five patients (75 eyes) with PDR and the presence of fibrovascular ERM with a marked proliferative component were involved in the study. Patients were divided into three groups: eyes of group 1 or control group (31 eyes) received vitrectomy without PIA; group 2 (17 eyes), PIA 1.0 mg; and group 3 (27 eyes), PIA 2.0 mg. We performed a histological study on specimens of fibrovascular ERMs surgically obtained from patients to determine the microscopic features of these membranes.
Results: There was ophthalmoscopic and microscopic evidence that aflibercept pretreatment in vitrectomy for PDR resulted in fibrosis of the ERM. The extent of fibrosis of the ERM and obliteration of newly formed blood vessels in the ERM depended on the dose of PIA. Complete obliteration of newly formed blood vessels in the ERM was observed as early as day 3 after 2.0-mg intravitreal aflibercept injection compared to day 5 after 1.0-mg intravitreal aflibercept injection. Pretreatment with 1.0-mg intravitreal aflibercept in vitrectomy for PDR reduced the probability of complications associated with ERM contraction, worsening of the tractional component and the development of a retinal break.
Keywords: vascular endothelial growth factor, epiretinal membranes, proliferative diabetic retinopathy
References
1.Shkvorchenko DO, Levina LV. [Retinotomy and retinectomy in the management of proliferative diabetic retinopathy complicated by anterior proliferative vitreoretinopathy]. In: [Proceedings of the National Russian Conference on Modern Technologies for the Treatment of Vitreoretinal Pathology]. Moscow; 2006. p. 205-10. Russian.
2.Hendrick AM, Gibson MV, Kulshresthra A. Diabetic Retinopathy. Prim Care. 2015 Sep;42(3):451-64. doi: 10.1016/j.pop.2015.05.005.
3.Sawa H, Ikeda T, Matsumoto Y. Neovascularization from scleral wound as cause of vitreous rebleeding after vitrectomy for proliferative diabetic retinopathy. Jpn J Ophthalmol. Mar – Apr 2000;44(2):154-60.
4.Blumenkranz MS. New developments in diabetic vitrectomy. The Vitreoretinal Frontier; Dallas, Texas. November 6–7, 1992.
5.Korol A, Kustryn T, Zadorozhnyy O, Pasyechnikova N, Kozak I. Comparison of Efficacy of Intravitreal Ranibizumab and Aflibercept in Eyes with Myopic Choroidal Neovascularization: 24-Month Follow-Up. J Ocul Pharmacol Ther. 2020 Mar;36(2):122-125.
6.Aleman I, Castillo Velazquez J, Rush SW. Ziv-aflibercept versus bevacizumab administration prior to diabetic vitrectomy: a randomised and controlled trial. Br J Ophthalmol. 2019 Dec;103(12):1740-6.
7.Velazquez JC, Aleman I, Rush SW. Bevacizumab before Diabetic Vitrectomy: A Clinical Trial Assessing 3 Dosing Amounts. Ophthalmol Retina. 2018 Oct; 2(10):1010-20.
8.Chen HJ, Wang CG, Dou HL. Effect of intravitreal ranibizumab pretreatment on vitrectomy in young patients with proliferative diabetic retinopathy. Ann Palliat Med. 2020 Jan;9(1):82-9.
9.Umanets N, Korol A, Vit V, et al. Umanets N. Peculiarities of vitrectomy and morphologic changes in the epiretinal membrane after intravitreal aflibercept in patients with severe proliferative diabetic retinopathy. Retin Cases Brief Rep. 2017 spring;11(2):114-8.
10.Ponomarchuk Vira S, Velychko LM, Umanets MM. Vitreous VEGF levels among patients with proliferative diabetic retinopathy depending on the general clinical status and ocular status. J Ophthalmol (Ukraine). 2021;4: 19-25.
11.Bezdetko PA. [Pharmacological therapy for developing diabetic retinopathy: Problems, Questions and Solutions]. Oftalmologiia Vostochnaia Ievropa. 2016; 1 (28):109-23. Russian.
12.Velichko PB, Osmanov EM. [Current methofological approaches to the treatment of diabetic retinopathy]. Vestnik Tambovskogo universiteta. 2013; 6(18):3248–9. Russian.
13.Nicholson BP, Barkmeier AJ. Bevacizumab and diabetic vitrectomy. Int Ophthalmol Clin. 2014 Spring;54(2):111-26.
14.Konenkov VI, Klomontov VV, Chernykh VV. [Anti-VEGF agents in the treatment of diabetic macular edema]. Diabetes mellitus. 2013;16(4):78-84. Russian.
15.Papadopoulos N, Martin J., Ruan Q. Binding and neutralization of vascular endothelial growth factor (VEGF) and related ligands by VEGF Trap, Ranibizumab and Bevacizumab. Angiogenesis. 2012 Jun; 15 (2): 171–85.
16.Abd Elhamid AH, Mohamed AAEA, Khattab AM. Intravitreal Aflibercept injection with Panretinal photocoagulation versus early Vitrectomy for diabetic vitreous hemorrhage: randomized clinical trial. BMC Ophthalmol. 2020 Apr 6; 20(1):130.
17.Zhao LQ, Zhu H, Zhao PQ. A systematic review and meta-analysis of clinical outcomes of vitrectomy with or without intravitreal bevacizumab pretreatment for severe diabetic retinopathy. J Ophthalmol. 2011 Sep; 95(9):1216-22.
18.Comyn O, Wickham L, Charteris DG. Ranibizumab pretreatment in diabetic vitrectomy: a pilot randomised controlled trial (the RaDiVit study). Eye (Lond). 2017 Sep;31(9):1253-58.
19.Fechter C, Frazier H, Marcus WB. Ranibizumab 0.3 mg for Persistent Diabetic Macular Edema After Recent, Frequent, and Chronic Bevacizumab: The ROTATE Trial. Ophthalmic Surg Lasers Imaging Retina. 2016 Nov 1;47(11):1-18.
20.Hsu Y-R, Yang C-M, Yeh P-T. Clinical and histological features of epiretinal membrane after diabetic vitrectomy. Graefes Arch Clin Exp Ophthalmol Actions. 2014 Mar; 252(3)
Author Contributions:
Vira S. Ponomarchuk: conducting intravitreal injections, data collection and analysis, writing the text; V.V. Vit: histological studies, editing; M.M.Umanets: concept and design of the study, surgical interventions, and editing.
Acknowledgement:
The authors express their gratitude to O.I.Dragomiretska for assistance in statistical data processing.
Disclosures:
The authors declare no conflict of interest.
There are no external sources of funding.