Topographical Response of Retinal Neovascularization to Afli
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A research was carried out to look into the distribution of NV in patients with proliferative diabetic retinopathy, as well as the topographical response of NV to treatment with aflibercept or PRP. Treatment with panretinal photocoagulation (PRP) or anti–vascular endothelial growth factor agents has a variable response in eyes with proliferative diabetic retinopathy. The site of neovascularization (NV) is related to outcomes (eg, patients with disc NV [NVD] have poorer visual prognosis than those with NV elsewhere [NVE]).

This post hoc analysis of the phase 2b randomized clinical trial was conducted, among 120 treatment-naive patients with proliferative diabetic retinopathy to evaluate the topography of NVD and NVE in 4 quadrants of the retina on color fundus photography at baseline and at 12 and 52 weeks after treatment.

In the CLARITY trial, patients were randomized to receive intravitreal aflibercept (2 mg/0.05 mL at baseline, 4 weeks, and 8 weeks, and as needed from 12 weeks onward) or PRP (completed in initial fractionated sessions and then on an as-needed basis when reviewed every 8 weeks).

Results:
--The study included 120 treatment-naive patients with proliferative diabetic retinopathy (there was a 1:1 ratio of eyes to patients).

--At baseline, NVD with or without NVE was observed in 42 eyes (35.0%), and NVE only was found in 78 eyes (65.0%); NVE had a predilection for the nasal quadrans.

--Rates of regression with treatment were higher among eyes with NVE (89 of 102) compared with eyes with NVD (23 of 43) by 52 weeks, with NVD being more resistant to either treatment with higher rates of persistence than NVE (20 of 39 vs 29 of 100).

--Considering NVE, the regression rate in the temporal quadrant was lowest (32 of 42).

--Eyes treated with aflibercept showed higher rates of regression of NVE compared with those treated with PRP (50 of 52 vs 39 of 50; difference, 18.2%), but no difference was found for NVD (11 of 17 vs 12 of 26; difference, 18.6%).

In conclusion, this post hoc study discovered that NVD is less common than NVE but is associated with greater resistance to currently available therapies. Aflibercept outperformed PRP in treating NVE, but neither drug was especially successful in treating NVD after 52 weeks.

Source: https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2777497
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