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Brian B Berger, Diabetic Retinopathy Clinical Research Network; The Course of Eyes with Vitrectomy Prior to Enrollment in a Randomized Trial Evaluating Ranibizumab Plus Prompt or Deferred Laser for Diabetic Macular Edema. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1771.
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To evaluate and compare the visual and optical coherence tomography (OCT) outcomes in eyes with and without prior vitrectomy receiving anti-Vascular Endothelial Growth Factor (anti-VEGF) treatment for center involved diabetic macular edema (DME) with reduced visual acuity
A post hoc exploratory evaluation was performed on eyes in a Diabetic Retinopathy Clinical Research Network (DRCR.net) study that received intravitreal ranibizumab plus prompt or deferred laser for DME. Visual acuity (VA), OCT metrics, and number of intravitreal injections and focal/grid laser treatments were compared in eyes with previous vitrectomy (N = 25) and eyes without previous vitrectomy (N = 335).
At baseline, eyes with prior vitrectomy had worse VA, thinner maculas, more advanced retinopathy, and more pseudophakia than eyes without a history of vitrectomy. Analysis adjusted for these covariates did not identify any differences between the vitrectomy subgroups at each annual visit through 3 years for VA. At the 16 and 32 week visits, the adjusted mean decrease in OCT central subfield thickness was greater for eyes without prior vitrectomy compared with eyes with prior vitrectomy. However, after 1 year and through 3 years, a difference in thickness between the subgroups could not be identified.
Early in the course of managing eyes with DME and prior vitrectomy, the rate of anatomic, but not visual acuity, improvement appears to be slower than eyes without vitrectomy, and appears to require more monthly anti-VEGF treatments. However, there is little evidence that eyes similar to those enrolled and treated in this trial with center-involved DME and a history of prior vitrectomy would have long term clinically important differences with respect to visual acuity outcomes, OCT outcomes, or number of injections compared with those without vitrectomy.
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