Anti-VEGF treatment of diabetic 1. type: case report


Authors: Lívia Javorská;  Mária Michalková;  Alena Kučerová
Authors‘ workplace: Očné oddelenie JZS, Nemocnica Poprad a. s., primárka MUDr. Mária Michalková
Published in: Forum Diab 2013; 2(3): 185-188
Category: Main Theme: Case Report

Overview

Objective:
To describe the clinical course of treatment with ranibizumab in young diabetic patient metabolically decompensated with diabetic macular edema (DME) and extensive neovascularization of the disc (NVD).

Case report:
23 years old diabetic patient suffering from type 1 diabetes was sent to our department for retinal laser treatment. 10 years has been treated as type 1 diabetic patient, but was still poorly metabolically compensated. The patient was sent from catchment area in March 2012. From March 2012 to June 2012 was treated with intensive panretinal photocoagulation (PRP) in both eyes. In July 2012 we observed significant NVD development, especially on the left. We decided to initiate therapy with anti-VEGF in left eye. Inspite of the 10.3 % glycated hemoglobin (HbA1c) at that time, requested therapy was approved by health insurance, especially because of the young age of the patient. Later ranibizumab was administered to the right eye. The patient had prior to initiation of therapy with anti-VEGF the best corrected visual acuity (BCVA) on the right 20/80, 54 letters, on the left 20/100, 52 letters. After the first three doses of ranibizumab to the left eye BCVA increased to 20/32, 76 letters. On the right after three doses of ranibizumab BCVA increased to 20/32, 73 letters. We observed significant regression of NVD and DEM in both eyes. We applied ranibizumab to the patient right eye 5 times and to the left eye 6 times until september 2013. Throughout course of therapy was HbA1c more than 8.5 %, reflecting poor metabolic control. In september 2013 the right BCVA was 20/40, 68 letters and left BCVA 20/40, 70 points.

Key words:
anti-VEGF – diabetes mellitus type 1 – diabetic macular edema – optic disc neovascularization – ranibizumab


Sources

1. Congdon N, O’Colmain B, Klaver CC et al. Causes and prevalence of visual impairment among adults in the United States. Arch Ophthalmol 2004; 122(4): 477–485.

2. Diabetes Control and Complication Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329(14): 977–986.

3. UK Prospective Diabetes Study Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes. UKPDS 33. Lancet 1998; 352(9131): 837–853.

4. Rodriguez-Fontal M, Kerrison JB, Alfaro DV et al. Metabolic control and diabetic retinopathy. Curr Diabetes Rev 2009; 5(1): 3–7.

5. Early Treatment Diabetic Retinopathy Study Research Group. Photocoagulation for diabetic macular edema: Early Treatment Diabetic Retinopathy Study report number 1. Arch Ophthalmol 1985; 103(12): 1796–1806.

6. The Diabetic Retinopathy Study Research Group. Photocoagulation treatment of proliferative diabetic retinopathy. Clinical application of Diabetic Retinopathy Study (DRS) findings, DRS Report Number 8. The Diabetic Retinopathy Study Research Group. Ophthalmology 1981; 88(7): 583–600.

7. Ferrara N, Gerber HP, Le Couter J. The biology of VEGF and its receptors. Nat Med 2003; 9(6): 669–676.

Labels
Diabetology Endocrinology Internal medicine
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