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Emilia Maggio, Antonio Polito, Mauro Sartore, Grazia Pertile; Long-term outcomes of anti-VEGF treatment for diabetic macular edema in a real-world clinical setting. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1900.
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to report spectral domain optical coherence tomography (OCT) outcomes with intravitreal anti-VEGF for diabetic macular edema (DME) and to assess long-term visual outcomes both in eyes responsive and in eyes receiving subsequent alternative treatments for suboptimal response to anti-VEGF,
medical records of consecutive patients with center-involving DME treated with 3 monthly intravitreal anti-VEGF from august 2008 to june 2015 - with or without prompt or deferred laser - followed by PRN re-treatment were reviewed. All eyes were divided into one of the four following categories based on whether they had a sustained reduction in central macular thickness (CMT) of at least 20%: early responder and consistent, late responder, early but inconsistent, non-responder. Most of the eyes in the last two categories received alternative treatments including: switching to another anti-VEGF drug, intravitreal dexamethasone injection, vitrectomy.
a total of 170 eyes were included in the study. The early and consistent group included 91 (53,5%) eyes and experienced a mean improvement of visual acuity (VA) of 2 ETDRS lines after a mean follow-up of 44 months; the late responder group included 33 (19,4%) eyes with an improvement of 1 ETDRS line after 46,5 months; the early but inconsistent and non-responder groups included 13 (7,6%) and 33 (19,4%) eyes, respectively, and did not experience any improvement in VA after anti-VEGF treatment. No additional improvement was found by switching to another anti-VEGF. Twenty three eyes treated with intravitreal dexamethasone and 12 with vitrectomy exhibited a significant reduction in CMT with variable functional response; in these eyes better VA gain was found in case of previous treatment duration of less than 12 months.
in a real-life clinical setting the treatment with intravitreal anti-VEGF was effective for a long term improvement of VA and CMT in most cases. However nearly one third showed suboptimal response and required alternative treatments. In these eyes, better outcomes may be obtained by an early change of the treatment strategy.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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