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Waseem Ansari, Siraj Ul Haq, Michael Myung-Sup Han, Felipe Conti, Fabiana Queiroga de Paula Araujo Silva, Rishi P Singh; Baseline Ocular Characteristics of Patients With Diabetic Macular Edema Undergoing Initiation of Anti-VEGF Therapy. Invest. Ophthalmol. Vis. Sci. 2018;59(9):3597.
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Clinical studies have demonstrated that baseline visual acuity (VA) can result in a variable response to anti-VEGF treatment. However, little is known about the presentation of diabetic macular edema (DME) in routine clinical practice. The aim of the current study is to report the baseline ocular characteristics of patients presenting with DME who received anti-VEGF in routine clinical practice.
A retrospective study was performed at a single institution from April 2012-December 2016. Inclusion criteria were age ≥18, diagnosis of diabetes, foveal-involving DME, and initiation of intravitreal anti-VEGF therapy. Patients were excluded for non-diabetic macular edema or intraocular surgery within 3 months of presentation. Ocular variables and both qualitative and quantitative data were collected on ocular coherence tomography (OCT). Relationships between VA group and categorical variables were assessed with Pearson chi-square tests and continuous OCT variables were assessed with T-tests.
A total of 638 eyes were enrolled. Eyes were divided into two VA groups: ETDRS <70 (Snellen 20/50 or worse, n=326) and ETDRS 70 (Snellen 20/40 or better, n=312). The overall cohort had an average CST of 363.5µm, cube volume of 11.7mm3, and cube average thickness (CAT) of 326.1 µm. Qualitatively, 21.5% had subretinal fluid (SRF) and 50.5% had hard exudates on presentation. Eyes with ETDRS<70 had greater CAT (338.5 µm3 vs. 313.2 µm3, p <0.001), greater cube volume (12.2 mm3 vs. 11.3 mm 3 p <0.001), greater CST (383.5 vs 350.0 p<0.001), and SRF (25.5% vs 17.3% p=0.012).Overall, 7.64% had glaucoma, 1.3% had dry age-related macular degeneration, 4.5% of patients were vitrectomized, 28.7% were pseudophakic, and 37% had proliferative diabetic retinopathy (PDR). Patients within the lower VA cohort were more likely to have a history of vitrectomy (7.1% vs. 1.9%, p=0.002) and presence of PDR (42.3% vs. 31.4%, p=0.004). Usage frequency of anti-VEGF for initiation of therapy was aflibercept (3.0%), ranibizumab (1.7%), and bevacizumab (94.8%) with no difference between cohorts.
Patients with DME who received anti-VEGF treatment in routine clinical practice demonstrated significant visual impairment and eyes within the lower VA cohort displayed key differences with regards to baseline ocular anatomic characteristics and comorbidities.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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