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Characteristics of Non-Responders in Diabetic Retinopathy

Halim, Sandra; (2023) Characteristics of Non-Responders in Diabetic Retinopathy. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Abstract

Diabetic retinopathy (DR) is the commonest microvascular complication of diabetes and the commonest cause of preventable blindness in working-aged adults globally. The prevalence of diabetes worldwide is rising rapidly. A systematic review on DR prevalence ascertained by retinal photography was done. Despite new developments in therapies of sight-threatening DR (STDR) with the advent of anti-vascular endothelial growth factor agents, a large proportion of patients with STDR do not respond adequately to best available therapy and continue to progress. Currently, there is limited data on both systemic and local risk factors that cause non-response. This thesis looked at local and systemic biomarkers that explain onset of DR, response of diabetic macular oedema (DMO) to treatment and explored whether site of retinal neovascularisation is a predictor of response and also the relation to capillary non-perfusion (CNP). A panel of systemic circulating and demographical biomarkers were identified which detected the presence of DR with area under curve of 0.9549. These must be further validated before it is incorporated into future predictive models. The functional and anatomical biomarkers of DMO non-responders to aflibercept were also evaluated. The chapter on neovascularisation topography in proliferative diabetic retinopathy (PDR) showed that neovascularisation on the optic disc is more resistant to treatment to both aflibercept and pan-retinal photocoagulation. As CNP precedes neovascularisation, it was investigated whether the location of CNP influenced the outcome of neovascularisation post therapy and the effect of treatment on CNP was investigated. There was no improvement of CNP with aflibercept therapy, suggesting that its effects on neovascularisation regression were independent of its effects on CNP. Although no correlation was found between CNP and neovascularisation or neovascularisation outcome, there was a correlation between central CNP and functional outcomes of PDR in the form of low luminance visual acuity and contrast sensitivity.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: Characteristics of Non-Responders in Diabetic Retinopathy
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Copyright © The Author 2023. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Institute of Ophthalmology
URI: https://discovery.ucl.ac.uk/id/eprint/10184259
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