June 2015
Volume 56, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2015
Impact of cataract surgery during treatment with ranibizumab in patients with diabetic macular edema (DME)
Author Affiliations & Notes
  • Andrew A Moshfeghi
    University of Southern California, Los Angeles, CA
  • Howard Shapiro
    Genentech, Inc., South San Francisco, CA
  • Anne E. Fung
    Genentech, Inc., South San Francisco, CA
  • Footnotes
    Commercial Relationships Andrew Moshfeghi, Alimera Sciences (C), Allergan (C), Genentech, Inc. (C), Regeneron (C); Howard Shapiro, Genentech, Inc. (E); Anne Fung, Genentech, Inc. (E)
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2015, Vol.56, 1747. doi:
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    • Get Citation

      Andrew A Moshfeghi, Howard Shapiro, Anne E. Fung; Impact of cataract surgery during treatment with ranibizumab in patients with diabetic macular edema (DME). Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1747.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

Ophthalmologists may be hesitant to perform cataract surgery in patients with DME because of concerns that edema may worsen. We sought to determine how outcomes after cataract surgery were impacted in patients with DME treated with ranibizumab during the RIDE/RISE phase 3 trials.

 
Methods
 

In RIDE/RISE, patients were randomized 1:1:1 to 0.3 mg or 0.5 mg ranibizumab or sham injections. Patient records were examined for cataract surgeries using the following terms: cataract extraction, cataract removal, cataract surgery, lens implant and lensectomy. For this analysis, the visit prior to cataract surgery was used as the redefined baseline to examine changes in BCVA after cataract surgery. Months post-cataract surgery were defined as 30 ± 15 days to account for variability in when surgery was performed relative to prespecified monthly study visits. Up to ≈20% of post-surgery BCVA assessments could be missing. Cataract surgeries were identified during the 36-month study period for fellow (non-study) and study eyes of ranibizumab-treated patients and fellow (non-study) eyes of sham-treated patients. Due to crossover to 0.5 mg ranibizumab at month 24, study eyes of sham-treated patients were only assessed for cataract surgery during the first 24 study months. Pooled results from RIDE and RISE are presented.

 
Results
 

Cataract surgeries were performed in 21 and 71 study eyes and 34 and 76 fellow eyes, in the sham and pooled 0.3/0.5 mg ranibizumab groups, respectively. Eleven study eyes in the sham arm underwent cataract surgery after month 24. The mean BCVA at the last visit prior to cataract surgery (redefined baseline) was higher in the study eyes of patients in the ranibizumab group compared with study eyes receiving sham treatment (Tables 1, 2). All groups experienced improvement in mean BCVA in the months following cataract surgery (Tables 1, 2).

 
Conclusions
 

These results suggest that patients with DME who undergo cataract surgery in the midst of monthly ranibizumab therapy are not subject to detrimental post-surgery outcomes and on average gain 2 lines of vision within 1 month following cataract surgery.  

 
Table 1. Vision before and after cataract surgery among patients randomized to sham injection
 
Table 1. Vision before and after cataract surgery among patients randomized to sham injection
 
 
Table 2. Vision before and after cataract surgery among patients randomized to ranibizumab (0.3 mg and 0.5 mg doses pooled)
 
Table 2. Vision before and after cataract surgery among patients randomized to ranibizumab (0.3 mg and 0.5 mg doses pooled)

 
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