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Maximilian Weiß, Michael Müller, Tina Herold, Raffael Liegl, Christoph Kern, Johannes Schiefelbein, Dawn A Sim, Siegfried Priglinger, Karsten Ulrich Kortuem; Differences in visual acuity and OCT parameters in patients under intravitreal aflibercept therapy due to diabetic macular edema depending on baseline visual acuity. Invest. Ophthalmol. Vis. Sci. 2018;59(9):3614.
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To investigate differences in visual acuity (VA) and optical coherence (OCT) parameters depending on VA before intravitreal aflibercept treatment due to diabetic macula edema (DME) in a real-life setting in a tertiary referral center.
We analyzed 126 DME patients/139 eyes (mean age: 62±12 years; 33% women) 30, 60, 90, 120, 150, 180, 360, 540, and 720 days after their first aflibercept injection. We formed two groups: Group one having a baseline visual acuity below 30 ETDRS letters (56 patients/65 eyes; mean age: 64±11 years; 40% women) and group two with a VA higher than 30 ETDRS-letters (70 patients/74 eyes; mean age: 61±12 years; 27% women). VA was recorded in ETDRS-letters. In OCT, we assessed the central retinal thickness (CRT) and the total retinal volume (TVOL). Wilcoxon-Test was used to analyze results during therapy by comparing consecutive results and the difference to day 0. If patients were treated shorter than two years, we used an intention-to-treat analysis.
Patients received an average amount of 2.85 injections after 90 days, 5.8 injections after the first year and 8.4 injections after 720 days.VA increased in both groups significantly after 60 days of therapy (group 1 p= 0.014) respectively 90 days (group 2 p=0.014) in comparison to day 0. Group 1 had a constant VA gain until day 720, while group 2 only increased during the first year. There was never a significance difference between consecutive appointments.We investigated a significantly decreased CRT for both groups between two consecutive appointments only after the first injection (p=0.001). Thereafter, CRT remained on a stable level. The TVOL dropped significantly after 60 days (group 2: 30 days) (p=0,006).There was no significant difference regarding the average age of both groups.
Our study showed significant improvement during the course of the therapy. In conclusion, both groups benefited significantly from aflibercept therapy. We found a prolonged VA gain in patients with worse baseline VA. In both groups, CRT dropped significantly after the first injection and remained stable. Between form (OCT) and function (VA) there is a delay of up to 60 days, so it’s important to have this in mind and motivate the patient to stay adherent to their therapy.
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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