Visual Acuity, Vitreous Hemorrhage, and Other Ocular Outcomes After Vitrectomy vs Aflibercept for Vitreous Hemorrhage Due to Diabetic Retinopathy
| Autor: | Lee M. Jampol, Adam R. Glassman, Michael J. Elman, Andrew N. Antoszyk, Hani Salehi-Had, Wesley T. Beaulieu, Clement C Chow, Jennifer K. Sun, Maureen G. Maguire |
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| Rok vydání: | 2021 |
| Předmět: |
Male
Vascular Endothelial Growth Factor A medicine.medical_specialty Visual acuity genetic structures Recombinant Fusion Proteins medicine.medical_treatment Visual Acuity Angiogenesis Inhibitors Vitrectomy law.invention Randomized controlled trial law Interquartile range Ranibizumab Ophthalmology Post-hoc analysis Diabetes Mellitus medicine Humans Original Investigation Aflibercept Diabetic Retinopathy business.industry Diabetic retinopathy Middle Aged medicine.disease eye diseases Vitreous Hemorrhage Receptors Vascular Endothelial Growth Factor Treatment Outcome Intravitreal Injections Vitreous hemorrhage Female sense organs medicine.symptom business medicine.drug |
| Zdroj: | JAMA Ophthalmol |
| ISSN: | 2168-6165 |
| Popis: | IMPORTANCE: Although there were no differences in mean visual acuity (VA) over 24 weeks after vitrectomy with panretinal photocoagulation (PRP) vs aflibercept in a randomized clinical trial among eyes with vitreous hemorrhage due to proliferative diabetic retinopathy (PDR), post hoc analyses may influence treatment choices. OBJECTIVE: To compare exploratory outcomes between treatment groups that may affect treatment choices for patients with vitreous hemorrhage due to PDR. DESIGN, SETTING, AND PARTICIPANTS: This post hoc analysis of a randomized clinical trial conducted at 39 DRCR Retina Network sites included adults with vision loss due to PDR-related vitreous hemorrhage for whom vitrectomy was considered. Data were collected from November 2016 to January 2020. INTERVENTIONS: Random assignment to 4 monthly injections of aflibercept vs vitrectomy with PRP. Both groups could receive aflibercept or vitrectomy during follow-up based on protocol-specific criteria. MAIN OUTCOMES AND MEASURES: Visual acuity area under the curve (adjusted for baseline VA) and clearance of vitreous hemorrhage. RESULTS: A total of 205 eyes were included in the analysis (115 male [56%] and 90 [44%] female participants; mean [SD] age, 57 [11] years). Among 89 eyes with a baseline VA of 20/32 to 20/160 (47 receiving aflibercept, including 4 [9%] that had undergone vitrectomy; 42 undergoing vitrectomy, including 3 [7%] that had received aflibercept), the adjusted mean difference in VA letter score over 24 weeks between the aflibercept and vitrectomy groups was −4.3 (95% CI, −10.6 to 1.9) compared with −16.7 (95% CI, −24.4 to −9.1) among 59 eyes with baseline VA worse than 20/800 (P = .02 for interaction; 26 in the aflibercept group, including 6 [23%] that had undergone vitrectomy; 33 in the vitrectomy group, including 8 [24%] that had received aflibercept). In the full cohort, the median time to clearance of the initial vitreous hemorrhage was 36 (interquartile range [IQR], 24-52) weeks in the aflibercept group vs 4 (IQR, 4-4) weeks in the vitrectomy group (difference, 32 [95% CI, 20-32] weeks; P |
| Databáze: | OpenAIRE |
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