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Case 1: Treatment-naïve Patient with PDR and DME


Carl Danzig, MD, presents a case involving a patient with both DME and PDR, showcasing the impressive anatomic improvement achieved by treating with a dual anti-VEGF and Ang2 inhibitor.

Arghavan Almony, MD: Hello, and welcome to this Ophthalmology Times® Grand Rounds discussion. My name is Arghavan Almony. I’m a retina surgeon at Carolina Eye Associates in Southern Pines, North Carolina. I have 3 copanelists with me today, and I’ll ask them to introduce themselves.

Carl Danzig, MD: Thank you. My name is Dr Carl Danzig. I’m a retina specialist at Rand Eye Institute in Deerfield Beach, Florida.

Adrienne Scott, MD: Hello, my name is Dr Adrienne Scott. I’m a retina specialist at the Wilmer Eye Institute, Johns Hopkins University School of Medicine in Baltimore, Maryland.

Roger Goldberg, MD: I’m Roger Goldberg. I’m a retina specialist at Bay Area Retina Associates in Walnut Creek, California.

Arghavan Almony, MD: Today, we will share 3 cases that we recently presented at a Grand Rounds event and discuss the key insights and lessons learned in the management of patients with new vascular AMD [age-related macular degeneration] and DME [diabetic macular edema]. Thank you so much for joining us. First, I’m going to ask [Carl] to present a case.

Carl Danzig, MD: Thank you very much. Our first case regards a patient who is treatment naive with PDR [proliferative diabetic retinopathy] and DME. He is a 48-year-old [White man presenting with] blurry vision in his right eye for a few weeks. He has a history of diabetes. Currently, his [hemoglobin] A1C is excellent [at] 5.6 [%], but it was 11[%] at one point. He has no history of retinal laser or intravitreal injections and no history of ocular surgery.

On examination, his visual acuity was 20/30 in each eye. His intraocular pressure was 15 [mm Hg] in the right eye and 14 [mm Hg] in the left. There was no [neovascularization of the iris] and his lens is clear. In the right eye, he had neovascularization elsewhere [NVE], dot and blot hemorrhages, cotton wool spots, preretinal hemorrhage, DME, [and] a temporal chorioretinal scar. In the left eye, there was no NVE or NVD [neovascularization of the disc]. There were dot and blot hemorrhages and a cotton wool spot with some extrafoveal edema and moderate NPDR [nonproliferative diabetic retinopathy], [which] we can see in the color fundus photo.

On January 27, 2023, his central subfield thickness [CST] was 456 µm. He had some mild vitreomacular adhesion. Fluorescein angiography was performed on this date, showing blockage from the preretinal hemorrhage. It also showed areas of late leakage from NVE without evidence of NVD. Faricimab was injected on this date. One month later, his vision improved a couple letters, but his CST had improved from 456 to 370 µm. A second dose of faricimab was injected on this date. The patient came back approximately 8 weeks later and his vision improved. He had been scheduled for a visit a few weeks prior but missed that. Fortunately for him, his CST was 331 µm and he had good vision. [A third dose of] faricimab was injected. On May 26, [2023], he returned with 20/20 vision and improving CST of 307 µm. [A fourth dose of] faricimab was injected. We can see the improvement on the color fundus photo and [optical coherence tomography]. On July 14, [2023], the patient maintained excellent vision with CST of 292 µm, and [a fifth dose of] faricimab was injected. On August 18, [2023], he had 20/20 vision, thickness of 305 µm, and [a sixth dose of] faricimab was injected. In summary, this patient had 6 injections of faricimab. His vision improved from 20/30 to 20/20. The [CST] improved from 456 to 305 µm, and he’ll be following up in 12 weeks.

Transcript is AI generated and edited for clarity and readability.

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