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Publications (10 of 17) Show all publications
Aurell, S., Sjövall, K., Paul, A., Morén, Å. & Granstam, E. (2019). Better visual outcome at 1 year with antivascular endothelial growth factor treatment according to treat-and-extend compared with pro re nata in eyes with neovascular age-related macular degeneration. Acta Ophthalmologica, 97(5), 519-524
Open this publication in new window or tab >>Better visual outcome at 1 year with antivascular endothelial growth factor treatment according to treat-and-extend compared with pro re nata in eyes with neovascular age-related macular degeneration
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2019 (English)In: Acta Ophthalmologica, ISSN 1755-375X, E-ISSN 1755-3768, Vol. 97, no 5, p. 519-524Article in journal (Refereed) Published
Abstract [en]

Purpose: To evaluate treatment outcome at 12 months in eyes with neovascular age-related macular degeneration (nAMD) treated with antivascular endothelial growth factor (anti-VEGF) injections according to either pro re nata (PRN)- or treat-and-extend (TE)-regimen in one clinical setting in Sweden.

Methods: Data were obtained retrospectively from the Swedish Macula Register, optical coherence tomography-database and electronic patient charts. The study included 443 eyes; 223 PRN- and 220 TE-treated eyes. Baseline (BL) characteristics and follow-up data at 6 and 12 months were collected. Statistical regression analysis was performed to evaluate association between treatment strategy and visual outcome at 12 months.

Results: Baseline (BL) characteristics were well balanced between cohorts. Visual acuity at 12 months was higher in TE-cohort 66.5 (13.1) compared to PRN-cohort 60.1 (17.6) (p = 0.000). Visual improvement at 12 months was +5.2 (11.8) and +1.2 (12.7) letters Early Treatment Diabetic Retinopathy Study (ETDRS) in TE- and PRN-cohorts, respectively (p = 0.002). Number of administered injections at 12 months was 10.2 (2.1) and 6.3 (2.1) in the two cohorts (p = 0.000). Statistical analysis demonstrated a strong association between TE treatment strategy and improvement in visual acuity at 12 months.

Conclusion: Eyes treated according to TE had better visual outcome at 12 months. The results indicate that treatment according to proactive TE-regimen is superior to treatment according to PRN-regimen in clinical routine care of nAMD.

Place, publisher, year, edition, pages
WILEY, 2019
Keywords
anti-VEGF, neovascular AMD, pro re nata, real-world data, treat-and-extend, treatment regimen, visual acuity
National Category
Ophthalmology
Identifiers
urn:nbn:se:uu:diva-390501 (URN)10.1111/aos.13989 (DOI)000474806400011 ()30511374 (PubMedID)
Available from: 2019-08-14 Created: 2019-08-14 Last updated: 2019-08-14Bibliographically approved
Moren, Å., Sundbom, M., Ottosson, J. & Granstam, E. (2019). Response: Debate continues. Gastric bypass surgery does not increase the risk for sight-threatening diabetic retinopathy [Letter to the editor]. Acta Ophthalmologica, 97(5), E807-E808
Open this publication in new window or tab >>Response: Debate continues. Gastric bypass surgery does not increase the risk for sight-threatening diabetic retinopathy
2019 (English)In: Acta Ophthalmologica, ISSN 1755-375X, E-ISSN 1755-3768, Vol. 97, no 5, p. E807-E808Article in journal, Letter (Other academic) Published
Place, publisher, year, edition, pages
John Wiley & Sons, 2019
National Category
Ophthalmology
Identifiers
urn:nbn:se:uu:diva-390414 (URN)10.1111/aos.14022 (DOI)000474806400034 ()30632673 (PubMedID)
Available from: 2019-08-12 Created: 2019-08-12 Last updated: 2019-08-12Bibliographically approved
Morén, Å., Sundbom, M., Ottosson, J. & Granstam, E. (2018). Gastric bypass surgery does not increase the risk for sight-threatening diabetic retinopathy. Acta Ophthalmologica, 96(3), 279-282
Open this publication in new window or tab >>Gastric bypass surgery does not increase the risk for sight-threatening diabetic retinopathy
2018 (English)In: Acta Ophthalmologica, ISSN 1755-375X, E-ISSN 1755-3768, Vol. 96, no 3, p. 279-282Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To study the occurrence and level of diabetic retinopathy (DRP) before and after planned bariatric surgery and to investigate potential risk factors for deterioration of DRP.

METHODS: The Scandinavian Obesity Surgery Registry (SOReg) was used to identify diabetic patients who underwent gastric bypass (GBP) surgery at three centres in Sweden during 2008-2010. Information regarding DRP screening was obtained from ophthalmological patient charts. Patients who had DRP screening before and after GBP surgery were included in the study.

RESULTS: The survey included 117 patients. Mean age was 50 (SD 10) years, body mass index (BMI) 43 (SD 8) kg/m(2) and HbA1c 64 (SD 18) mmol/mol before surgery. One year post-GBP, BMI was reduced to 31 (SD 6) kg/m(2) . HbA1c was 43 (SD 10) mmol/mol, and in 66% (77/117) treatment for diabetes had been discontinued. Occurrence of DRP before GBP was as follows: no DRP 62%, mild 26%, moderate 10%, severe 0% and proliferative DRP 2%. No significant changes in occurrence of DRP after surgery were observed. Twelve patients (16%) developed mild DRP. In seven patients with pre-existing DRP, deterioration was observed and two of these patients required treatment for sight-threatening DRP. No association between preoperative BMI, HbA1c or reduction in HbA1c and worsening of DRP was found.

CONCLUSION: In a majority of patients, no deterioration of DRP following GBP was observed. Screening for DRP before planned surgery is recommended for all diabetic patients about to undergo bariatric surgery to identify any pre-existing DRP.

Keywords
bariatric surgery, diabetes mellitus, diabetic retinopathy, gastric bypass, registry study
National Category
Ophthalmology
Identifiers
urn:nbn:se:uu:diva-333266 (URN)10.1111/aos.13555 (DOI)000430912700035 ()28857463 (PubMedID)
Available from: 2017-11-09 Created: 2017-11-09 Last updated: 2018-07-31Bibliographically approved
Westborg, I., Granstam, E., Albrecht, S., Rosso, A., Karlsson, N. & Lovestam-Adrian, M. (2017). Seven years treatment outcome of neovascular age-related macula degeneration. Data from the Swedish Macula Register.. Paper presented at Annual Meeting of the Association-for-Research-in-Vision-and-Ophthalmology (ARVO), MAY 07-11, 2017, Baltimore, MD. Investigative Ophthalmology and Visual Science, 58(8), Article ID 1527.
Open this publication in new window or tab >>Seven years treatment outcome of neovascular age-related macula degeneration. Data from the Swedish Macula Register.
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2017 (English)In: Investigative Ophthalmology and Visual Science, ISSN 0146-0404, E-ISSN 1552-5783, Vol. 58, no 8, article id 1527Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
ASSOC RESEARCH VISION OPHTHALMOLOGY INC, 2017
National Category
Ophthalmology
Identifiers
urn:nbn:se:uu:diva-377423 (URN)000432170304052 ()
Conference
Annual Meeting of the Association-for-Research-in-Vision-and-Ophthalmology (ARVO), MAY 07-11, 2017, Baltimore, MD
Available from: 2019-02-20 Created: 2019-02-20 Last updated: 2019-02-20Bibliographically approved
Westborg, I., Granstam, E., Rosso, A., Albrecht, S., Karlsson, N. & Lovestam-Adrian, M. (2017). Treatment for neovascular age-related macular degeneration in Sweden: outcomes at seven years in the Swedish Macula Register. Acta Ophthalmologica, 95(8), 787-795
Open this publication in new window or tab >>Treatment for neovascular age-related macular degeneration in Sweden: outcomes at seven years in the Swedish Macula Register
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2017 (English)In: Acta Ophthalmologica, ISSN 1755-375X, E-ISSN 1755-3768, Vol. 95, no 8, p. 787-795Article in journal (Refereed) Published
Abstract [en]

Purpose: To present Swedish Macula Register (SMR) data regarding treatment of neovascular age-related macular degeneration (AMD) in clinical practice since 2008.

Methods: A retrospective register-based study was conducted. Evaluation of baseline demographics, visual outcome and number of injections during this period is presented.

Results: Mean age at diagnosis was 79(SD) 8years; 65% were female. The proportion of patients with <2months' duration of symptoms increased from 26% in 2008 to 41% in 2014 (p=0.001). Mean visual acuity (VA) at baseline increased from 54.3 +/- 15.0 early treatment diabetic retinopathy study (ETDRS) letters in 2008 to 57.8 +/- 15.6 letters in 2014 (CI95 2.6; 4.3; p<0.001). Mean VA after 1year of treatment increased from 57.8 +/- 17.7 ETDRS letters for patients who started the treatment in 2008 to 62.8 +/- 16.4 ETDRS letters in patients starting treatment in 2014 (CI95 2.67; 4.64; p<0.001). During all study years, the proportion of patients with an improvement in VA of between 5 and 15 letters was around 30%, while 14% had VA improvement of more than 15 letters. The mean number of injections during the first treatment year increased from 4.3 +/- 1.9 in 2008 to 5.9 +/- 2.9 in 2014 (CI95 1.40; 1.67; p<0.001). Seven-year follow-up of 322 eyes showed a mean change of -1 letters from baseline, with a mean of 21 injections for the entire period.

Conclusion: The duration of symptoms before treatment decreased, while VA at baseline and after 1year of treatment increased over the years and so did the number of injections. Long-term follow-up demonstrated stable VA.

Keywords
age-related macular degeneration, anti-vascular endothelial growth factor, anti-VEGF, ETDRS, neovascular AMD, Swedish Macula Register
National Category
Ophthalmology
Identifiers
urn:nbn:se:uu:diva-343909 (URN)10.1111/aos.13539 (DOI)000417645900022 ()28834299 (PubMedID)
Available from: 2018-03-02 Created: 2018-03-02 Last updated: 2018-03-08Bibliographically approved
Granstam, E., Sjovall, K., Paul, A. & Moren, A. (2016). Anti VEGF-treatment for wet-AMD According to a Treat-and-Extend Protocol at a Swedish County Hospital: clinical outcomes at 12 Months. Paper presented at Annual Meeting of the Association-for-Research-in-Vision-and-Ophthalmology (ARVO), MAY 01-05, 2016, Seattle, WA. Investigative Ophthalmology and Visual Science, 57(12)
Open this publication in new window or tab >>Anti VEGF-treatment for wet-AMD According to a Treat-and-Extend Protocol at a Swedish County Hospital: clinical outcomes at 12 Months
2016 (English)In: Investigative Ophthalmology and Visual Science, ISSN 0146-0404, E-ISSN 1552-5783, Vol. 57, no 12Article in journal, Meeting abstract (Refereed) Published
Place, publisher, year, edition, pages
ASSOC RESEARCH VISION OPHTHALMOLOGY INC, 2016
National Category
Ophthalmology
Identifiers
urn:nbn:se:uu:diva-320109 (URN)000394210201043 ()
Conference
Annual Meeting of the Association-for-Research-in-Vision-and-Ophthalmology (ARVO), MAY 01-05, 2016, Seattle, WA
Available from: 2017-04-25 Created: 2017-04-25 Last updated: 2017-04-25Bibliographically approved
Aurell, S. & Granstam, E. (2016). Bacterial keratitis in a Swedish county hospital: management and clinical outcome [Letter to the editor]. Acta Ophthalmologica, 94(3), E248-E249
Open this publication in new window or tab >>Bacterial keratitis in a Swedish county hospital: management and clinical outcome
2016 (English)In: Acta Ophthalmologica, ISSN 1755-375X, E-ISSN 1755-3768, Vol. 94, no 3, p. E248-E249Article in journal, Letter (Refereed) Published
National Category
Ophthalmology
Identifiers
urn:nbn:se:uu:diva-299177 (URN)10.1111/aos.12935 (DOI)000374693000022 ()26694979 (PubMedID)
Available from: 2016-07-15 Created: 2016-07-15 Last updated: 2017-11-28Bibliographically approved
Granström, T., Forsman, H., Leksell, J. & Granstam, E. (2016). Patient reported outcomes and visual function among patients with diabetes related macular edema. Quality of Life Research, 25, 130-131
Open this publication in new window or tab >>Patient reported outcomes and visual function among patients with diabetes related macular edema
2016 (English)In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 25, p. 130-131Article in journal (Refereed) Published
Place, publisher, year, edition, pages
SPRINGER, 2016
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-321270 (URN)000398451600315 ()
Available from: 2017-05-02 Created: 2017-05-02 Last updated: 2017-05-02Bibliographically approved
Granström, T., Forsman, H., Olinder, A. L., Gkretsis, D., Eriksson, J. W., Granstam, E. & Leksell, J. (2016). Patient-reported outcomes and visual acuity after 12 months of anti-VEGF-treatment for sight-threatening diabetic macular edema in a real world setting. Diabetes Research and Clinical Practice, 121, 157-165
Open this publication in new window or tab >>Patient-reported outcomes and visual acuity after 12 months of anti-VEGF-treatment for sight-threatening diabetic macular edema in a real world setting
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2016 (English)In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 121, p. 157-165Article in journal (Refereed) Published
Abstract [en]

Aims: To examine objective visual acuity measured with ETDRS, retinal thickness (OCT), patient reported outcome and describe levels of glycated hemoglobin and its association with the effects on visual acuity in patients treated with anti-VEGF for visual impairment due to diabetic macular edema (DME) during 12 months in a real world setting.

Methods: In this cross-sectional study, 58 patients (29 females and 29 males; mean age, 68 years) with type 1 and type 2 diabetes diagnosed with DME were included. Medical data and two questionnaires were collected; an eye-specific (NEI VFQ-25) and a generic health-related quality of life questionnaire (SF-36) were used.

Results: The total patient group had significantly improved visual acuity and reduced retinal thickness at 4 months and remains at 12 months follow up. Thirty patients had significantly improved visual acuity, and 27 patients had no improved visual acuity at 12 months. The patients with improved visual acuity had significantly improved scores for NEI VFQ-25 subscales including general health, general vision, near activities, distance activities, and composite score, but no significant changes in scores were found in the group without improvements in visual acuity.

Conclusions: Our study revealed that anti-VEGF treatment improved visual acuity and central retinal thickness as well as patient-reported outcome in real world 12 months after treatment start.

Keywords
Patient-reported measurements, Diabetic macular edema, Anti-VEGF treatment, Visual function
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:uu:diva-313411 (URN)10.1016/j.diabres.2016.09.015 (DOI)000390460100020 ()27718374 (PubMedID)
Funder
Magnus Bergvall Foundation
Available from: 2017-01-30 Created: 2017-01-19 Last updated: 2017-11-29Bibliographically approved
Granstam, E., Westborg, I., Barkander, A., Börjesson, M., Lindahl, S., Meszaros, E., . . . Lovestam-Adrian, M. (2016). Reduced occurrence of severe visual impairment after introduction of anti-Vascular Endothelial Growth Factor in wet age-related macular degeneration: a population- and register-based study from northern Sweden. Acta Ophthalmologica, 94(7), 646-651
Open this publication in new window or tab >>Reduced occurrence of severe visual impairment after introduction of anti-Vascular Endothelial Growth Factor in wet age-related macular degeneration: a population- and register-based study from northern Sweden
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2016 (English)In: Acta Ophthalmologica, ISSN 1755-375X, E-ISSN 1755-3768, Vol. 94, no 7, p. 646-651Article in journal (Refereed) Published
Abstract [en]

PurposeTo study the occurrence of severe visual impairment (SVI) and treatment outcome at 12months in patients treated for wet age-related macular degeneration (AMD) by use of data from the Swedish Macula Register (SMR) and referrals to the regional low vision clinics in five northern counties. MethodsReferrals to low vision clinics during 2005, 2009 and 2013 and treatment outcome at 12months from the SMR database from 2008 until 2013 in patients >65years of age in five northern counties were included in the survey. ResultsThe rate of referral due to AMD was significantly reduced during the time period (-48%; p<0.001). At 12months, a significant slight mean improvement in logMAR visual acuity (VA) was observed (-0.01, SD 0.37; p<0.001) after a mean of 5.02.3 anti-vascular endothelial growth factor (VEGF)-injections were administered. Age and low baseline VA was associated with less favourable visual outcome (p<0.001). ConclusionReferral rate to low vision clinic is a valuable tool for estimating occurrence of SVI and fell between the years 2005 until 2013. Data from the SMR showed improvement in visual acuity on the whole, but also identified patients at high risk for developing SVI during anti-VEGF-treatment.

Keywords
anti-vascular endothelial growth factor, low vision clinics, Swedish Macula Register, wet AMD
National Category
Ophthalmology
Identifiers
urn:nbn:se:uu:diva-308897 (URN)10.1111/aos.13187 (DOI)000386631400021 ()27545047 (PubMedID)
Available from: 2016-12-01 Created: 2016-12-01 Last updated: 2017-11-29Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-3164-547x

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