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Proliferative diabetic retinopathy (PDR) is a common cause of impaired vision in diabetic patients.
It is characterized by neovascularization (NV) in any part of the optic nerve head and/or retina.
Based on 7 visual fields and color fundus three-dimensional photos, high-risk PDR is defined as: moderate to severe NV (>1/4 to 1/3 optic nerve head diameter), moderate NV with optic nerve head diameter of 1/4 to 1/3, or Moderate NV with hemorrhage in the vitreous or retinal.
For more than 40 years, panretinal photocoagulation (PRP) has been the standard treatment for high-risk PDR.
On an individual basis, it has also been used to treat low-risk PDR and very serious non-proliferative diabetic retinopathy.
Although the exact mechanism of PRP is unclear, destroying retinal capillary non-perfused areas (CNP) can reduce angiogenesis in these areas.
Previously, in a trial conducted by the diabeticretinopathy Clinical Research network, the efficacy of anti-vascular endothelial growth factor (VEGF) and PRP on the treatment of PDR was evaluated.
The results showed that compared with those receiving PRP Compared with PDR patients, PDR patients who received anti-VEGF drug treatment improved the severity score of diabetic retinopathy at 5 years, and reduced the risk of vitrectomy and new-onset diabetic macular edema.
It may be because the location of neovascularization (NV) is related to the prognosis.
Recently, studies have explored the distribution of retinal vascular endothelial cells (NV) in patients with proliferative diabetic retinopathy and the local response to Aflibercept (apacilcept, an anti-VEGFF drug) or PRP treatment.
The research results were recently published in the journal JAMA Ophthalmology.
This phase 2b randomized clinical single-blind multicenter non-inferiority trial (CLARITY) analyzed 120 untreated patients with proliferative diabetic retinopathy from November 1, 2019 to September 1, 2020, before treatment.
, Color fundus photography was used to observe the morphology of optic papillary neovascularization (NVD) and retinal neovascularization (NVE) in the 4 quadrants of the retina at 12 and 52 weeks after treatment.
In the CLARITY trial, patients were randomized to receive intravitreal injections of Aflibercept (2 mg/0.
05 mL at baseline, 4 and 8 weeks, adjusted as needed from 12 weeks) or PRP (completed in the initial fractional treatment, and then in (Adjust as needed during the review every 8 weeks).
The main results were the frequency of NV per retinal quadrant at baseline, and the frequency of NV regression, recurrence, and new episodes at 12 and 52 weeks of follow-up.
The results of the study showed that at baseline, 42 eyes (35.
0%) of NVD with or without NVE, and only 78 eyes (65.
0%) with NVE; NVE tended to be in the nasal quadrant (64[53.
3%]).
After 52 weeks of treatment, the recurrence rate of NVE patients is higher than that of NVD patients.
NVD patients have higher tolerance to both treatments, and the recurrence rate is also higher than that of NVE patients.
Compared with the PRP treatment group, the NVE regression rate of the eyes treated with Aflibercept was higher, but there was no significant difference in NVD.
The incidence of neovascularization in the treatment group and the baseline retinal position was analyzed in the 12-week and 52-week NVE and NVD treatment results.
Compared with NVE, NVD occurred less frequently, but it was more resistant to existing treatment methods.
Although Aflibercept is superior to PRP in the treatment of NVE, neither treatment is particularly effective for NVD at 52 weeks.
This finding has clinical significance because it emphasizes the importance of screening for NVD and classifying the severity of PDR, which directly affects treatment frequency and response.
References: Halim S, Nugawela M, Chakravarthy U, et al.
Topographical Response of Retinal Neovascularization to Aflibercept or Panretinal Photocoagulation in Proliferative Diabetic Retinopathy: Post Hoc Analysis of the CLARITY Randomized Clinical Trial.
JAMA Ophthalmol.
Published online March 11, 2021.
For more information, please click to read the original text to download the Metz Medical APP~
It is characterized by neovascularization (NV) in any part of the optic nerve head and/or retina.
Based on 7 visual fields and color fundus three-dimensional photos, high-risk PDR is defined as: moderate to severe NV (>1/4 to 1/3 optic nerve head diameter), moderate NV with optic nerve head diameter of 1/4 to 1/3, or Moderate NV with hemorrhage in the vitreous or retinal.
For more than 40 years, panretinal photocoagulation (PRP) has been the standard treatment for high-risk PDR.
On an individual basis, it has also been used to treat low-risk PDR and very serious non-proliferative diabetic retinopathy.
Although the exact mechanism of PRP is unclear, destroying retinal capillary non-perfused areas (CNP) can reduce angiogenesis in these areas.
Previously, in a trial conducted by the diabeticretinopathy Clinical Research network, the efficacy of anti-vascular endothelial growth factor (VEGF) and PRP on the treatment of PDR was evaluated.
The results showed that compared with those receiving PRP Compared with PDR patients, PDR patients who received anti-VEGF drug treatment improved the severity score of diabetic retinopathy at 5 years, and reduced the risk of vitrectomy and new-onset diabetic macular edema.
It may be because the location of neovascularization (NV) is related to the prognosis.
Recently, studies have explored the distribution of retinal vascular endothelial cells (NV) in patients with proliferative diabetic retinopathy and the local response to Aflibercept (apacilcept, an anti-VEGFF drug) or PRP treatment.
The research results were recently published in the journal JAMA Ophthalmology.
This phase 2b randomized clinical single-blind multicenter non-inferiority trial (CLARITY) analyzed 120 untreated patients with proliferative diabetic retinopathy from November 1, 2019 to September 1, 2020, before treatment.
, Color fundus photography was used to observe the morphology of optic papillary neovascularization (NVD) and retinal neovascularization (NVE) in the 4 quadrants of the retina at 12 and 52 weeks after treatment.
In the CLARITY trial, patients were randomized to receive intravitreal injections of Aflibercept (2 mg/0.
05 mL at baseline, 4 and 8 weeks, adjusted as needed from 12 weeks) or PRP (completed in the initial fractional treatment, and then in (Adjust as needed during the review every 8 weeks).
The main results were the frequency of NV per retinal quadrant at baseline, and the frequency of NV regression, recurrence, and new episodes at 12 and 52 weeks of follow-up.
The results of the study showed that at baseline, 42 eyes (35.
0%) of NVD with or without NVE, and only 78 eyes (65.
0%) with NVE; NVE tended to be in the nasal quadrant (64[53.
3%]).
After 52 weeks of treatment, the recurrence rate of NVE patients is higher than that of NVD patients.
NVD patients have higher tolerance to both treatments, and the recurrence rate is also higher than that of NVE patients.
Compared with the PRP treatment group, the NVE regression rate of the eyes treated with Aflibercept was higher, but there was no significant difference in NVD.
The incidence of neovascularization in the treatment group and the baseline retinal position was analyzed in the 12-week and 52-week NVE and NVD treatment results.
Compared with NVE, NVD occurred less frequently, but it was more resistant to existing treatment methods.
Although Aflibercept is superior to PRP in the treatment of NVE, neither treatment is particularly effective for NVD at 52 weeks.
This finding has clinical significance because it emphasizes the importance of screening for NVD and classifying the severity of PDR, which directly affects treatment frequency and response.
References: Halim S, Nugawela M, Chakravarthy U, et al.
Topographical Response of Retinal Neovascularization to Aflibercept or Panretinal Photocoagulation in Proliferative Diabetic Retinopathy: Post Hoc Analysis of the CLARITY Randomized Clinical Trial.
JAMA Ophthalmol.
Published online March 11, 2021.
For more information, please click to read the original text to download the Metz Medical APP~
