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Lauren Ciulla, Thomas A Ciulla, retina; Ranibizumab for diabetic macular edema refractory to multiple prior treatments. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1768.
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Diabetic macular edema (DME) can be refractory to multiple treatment modalities, such as laser photocoagulation, intravitreal triamcinolone (TA), and intravitreal bevacizumab (BEV). There have been anecdotal reports of ranibizumab (RAN) showing efficacy when these other modalities provided limited benefit. This study sought to investigate this observation further.
A retrospective chart review was conducted in DME patients refractory to multiple prior treatments who were being treated with 0.3 mg RAN every 4 to 6 weeks on average. Number and type of prior treatments, Snellen visual acuity and OCT central subfield thickness at each RAN injection were reviewed.
38 eyes of 24 patients with refractory DME were treated with RAN. Prior to treatment with RAN, this group of eyes received an average of 1.5 macular laser treatments, 0.5 TA, and 3.4 BEV. The mean visual acuity prior to the initial RAN injection was 20/155 and the mean CSFT was 438 um. There was a linear relationship between the number of RAN injections and mean CSFT, improving with nearly each RAN injection to 288 um by the sixth RAN injection (R2 = 0.86, P = 0.022). Visual acuity did not improve however.
RAN improves DME refractory to prior treatments with laser photocoagulation, TA, and BEV. Visual acuity did not improve; this could be due to photoreceptor dysfunction from chronic DME, ischemia or both. Further study is warranted.
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