Track topics on Twitter Track topics that are important to you
Recurrent vitreous hemorrhage after vitrectomy for complications of diabetic retinopathy is a common occurrence. The hemorrhage may appear within the first few weeks after surgery or months later. This complication may delay visual rehabilitation significantly and sometimes requires additional procedures or surgery, jeopardizing previous successful operation. The causes of bleeding are diverse. While evidence suggests fibrovascular proliferation from the sclerotomy sites or in the vitreous base may be an important source of recurrent vitreous hemorrhage, other origins of hemorrhage exist including lysed clot from residual vitreous skirt, injured retinal vessels from surgery, and incompletely removed fibrovascular tissues. The latter three conditions may be the major sources of early postoperative vitreous hemorrhage. We have shown that peripheral retinal cryotherapy along with cryo treatment at the sclerotomy sites may effectively reduce the incidence of fibrovascular proliferation at the inner surface of sclerotomy sites and prevent the late-onset recurrent vitreous hemorrhage. However, many patients still experience disturbing vitreous hemorrhage within the first two to three weeks after post-operative transient clear-up of the vitreous. We hypothesize that gas bubble within the vitreous cavity may mechanically temponade the fragile retinal vessels, and concentrate the coagulation factors in the vitreous cavity, allowing the integrity of vessel walls gradually recovers and thus preventing the occurrence of early postoperative recurrent vitreous hemorrhage.
To test this hypothesis, a clinical study was undertaken to investigate the effect of long-acting gas infused into the vitreous cavity at the end of diabetic vitrectomy in the prevention of recurrent vitreous hemorrhage.
The study consisted of two parts. Part one was prospective clinical observational study; part two was case control study.
From January 2005 to May 2005, consecutive patients undergoing primary pars plana vitrectomy for complications of proliferative diabetic retinopathy were recruited for the prospective study. The selection criteria were: 1) anticoagulant therapy should not have been used prior to surgery or during post-operative follow-up period; 2) ther should be no medical history of blood diseases associated with abnormal blood coagulation. During operation, removal of the fibrovascular tissues as well as old and fresh blood was attempted as completely as could be safely done in all cases; blood clots adherent to the peripheral vitreous skirt was removed as much as possible; peripheral retinal cryotherapy (10 to 12 spots in one row), and sclerotomy sites cryo (2 spots, each 6 seconds, for 3 sclerotomy sites) were performed. For those cases without retinal detachment and breaks, fluid-gas exchange with 7.5% C3F8 was done at the end of the surgery; For those with preexisting breaks or iatrogenic breaks induced retinal detachment, fluid-gas exchange with 15% C3F8 was performed before cryotherapy. After surgery, patients without breaks were kept in a prone position overnight, and maintained head down during waking hours and lied on either side, during sleep for 3 weeks. Other patients assumed head positions depending on the location of breaks. Ophthalmological examinations were performed in the first 4 days after surgery, then weekly for 6 weeks and then monthly for 4 months. The preoperative, intraoperative and postoperative data were collected for each patient. These included age, gender, study eye, types and duration of diabetes mellitus, intraoperative diagnosis, and the use of scleral buckle, silicone oil temponade; data regarding the time, duration, frequency and treatment of recurrent vitreous hemorrhage and the duration of post-operation follow-up were also compiled. Results of ophthalmological examinations, including best corrected visual acuity, intraocular pressures, corneal conditions, anterior chamber reactions, lens status, intravitreal gas amount, and retina conditions were recorded. The amount of vitreous blood was assessed by indirect ophthalmoscopy with patients in both sitting and face-up position. The degree of vitreous opacity was recorded according to criteria set for grading vitreous opacity in uveitis.
Patients who had silicone oil infusion, failed to achieve retinal attachment for at least 3 months, or followed for less than a minimum of 5-month were excluded from the study.
Using the same inclusion and exclusion criteria, chart review from September 2004 to May 2005 for diabetic cases operated by the same surgeon with only cryo treatment but without long-acting gas infusion at the end of vitrectomy was done. Similar data as for the prospective study (except intravitreal gas amount) were collected. These cases served as control to compare the rate of recurrent vitreous hemorrhage and the change of best-corrected visual acuity between cases with intravitreal long-acting gas and those without.
Allocation: Non-Randomized, Control: Placebo Control, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind, Primary Purpose: Treatment
Intravitreal long acting gas
National Taiwan University Hospital
National Taiwan University Hospital
Published on BioPortfolio: 2014-08-27T03:51:29-0400
Exenatide LAR is a long-acting release formulation of exenatide, which is a twice-daily dosage form currently under investigation as a potential treatment for people with type 2 diabetes m...
The purpose of this study is to examine the effects of exenatide long-acting release (LAR) on glucose control and safety in subjects with type 2 diabetes mellitus managed with diet modific...
This trial is conducted in Europe. The aim of this research is to assess the impact of three basal (long-acting) insulin treatments on blood glucose levels in people with type 1 diabetes w...
The study aims to examine the effectiveness of the short acting GLP-1 analog, Lixisenatide to achieve glycemic control in type 2 diabetes patients, in patients with failure of long acting ...
This trial is conducted in Japan. The aim of this clinical trial is to investigate the safety (with emphasis on hypoglycaemia) after switching from long-acting insulin analogue/intermediat...
To assess and compare per-day anti-diabetic medication costs for Chinese type-2 diabetes mellitus (T2DM) insulin-naïve patients between those who initiated premixed insulin analogs ("premixed group")...
The aim of the present study was to evaluate the cost effectiveness of rapid-acting analog insulin relative to regular human insulin in adults with type 1 diabetes mellitus in Germany.
Diabetes mellitus (DM) is prevalent with pancreatic ductal adenocarcinoma (PDAC). Importantly, new-onset DM is characteristic of the disease and could be an early sign of PDAC. The clinical outcome of...
Insulin glargine, a long-acting human insulin analogue, allows for once-daily basal use in patients with type 1 diabetes mellitus (T1DM). MYL-1501D is a proposed insulin glargine biosimilar.
Obesity and type 2 diabetes mellitus are prevalent all over the world. Obese patients with more visceral fat are more likely to suffer from type 2 diabetes mellitus, hypertension, dyslipidemia and obs...
A recombinant LONG ACTING INSULIN and HYPOGLYCEMIC AGENT that is used to manage BLOOD GLUCOSE in patients with DIABETES MELLITUS.
A subclass of DIABETES MELLITUS that is not INSULIN-responsive or dependent (NIDDM). It is characterized initially by INSULIN RESISTANCE and HYPERINSULINEMIA; and eventually by GLUCOSE INTOLERANCE; HYPERGLYCEMIA; and overt diabetes. Type II diabetes mellitus is no longer considered a disease exclusively found in adults. Patients seldom develop KETOSIS but often exhibit OBESITY.
A recombinant long-acting insulin and HYPOGLYCEMIC AGENT in which a MYRISTIC ACID is conjugated to a LYSINE at position B29. It is used to manage BLOOD GLUCOSE levels in patients with DIABETES MELLITUS.
A potent, long-acting synthetic SOMATOSTATIN octapeptide analog that inhibits secretion of GROWTH HORMONE and is used to treat hormone-secreting tumors; DIABETES MELLITUS; HYPOTENSION, ORTHOSTATIC; HYPERINSULINISM; hypergastrinemia; and small bowel fistula.
Diabetes mellitus induced experimentally by administration of various diabetogenic agents or by PANCREATECTOMY.
Diabetes is a lifelong condition that causes a person's blood sugar level to become too high. The two main types of diabetes are: type 1 diabetes type 2 diabetes In the UK, diabetes affects approximately 2.9 million people. There are a...
Sleep disorders disrupt sleep during the night, or cause sleepiness during the day, caused by physiological or psychological factors. The common ones include snoring and sleep apnea, insomnia, parasomnias, sleep paralysis, restless legs syndrome, circa...