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Franck Fajnkuchen, Philippe Margaron, Jonathan Wright, Audrey Giocanti Auregan; Value of a dry retina during DME treatment by ranibizumab: sub-Analysis of RESTORE, REVEAL, RESPOND and RETAIN studies. Invest. Ophthalmol. Vis. Sci. 2018;59(9):3619.
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© ARVO (1962-2015); The Authors (2016-present)
Several studies have shown a modest correlation between visual acuity (VA) improvement and central retinal thickness (CRT) in patients with diabetic macular edema (DME) treated with an anti VEGF. But few studies have investigated the value of a dry retina. The purpose of this study was to determine whether a dry retina influenced visual outcomes during DME treatment.
We conducted a sub-analysis of 678 patients from the RESTORE, REVEAL, and RESPOND studies and the pro re nata (PRN) regimen group of the RETAIN study. All patients received a loading dose of three monthly intravitreal injections of ranibizumab followed by a PRN regimen. Retreatment was based on loss of visual acuity (VA) due to DME activity.Patients were categorized into four groups according to whether or not they had at least one drying of their retina, and whether or not they exceeded the threshold of 69 letters at least once during the first 12 months of the respective study. The maximum mean VA reached during the follow-up period for each group was also collected (VA max).
During the 12-month follow-up period, 262 patients (38.65%) had a dry retina at least once, whereas 416 patients (61.35%)did not.In Group 1, dry retina and VAmax> 69 (n=201): VA max (80.0 letters) was reached at 8.0 months, mean VA was 75.4 letters (+9.1 letters vs baseline) at 1 year.In Group 2, dry retina and VAmax<69 (n=61): VA max (61.4 letters) was reached at 7.9 months, mean VA was 58.0 letters (+ 7.8 letters vs baseline) at 1 year.In Group 3, non-dry retina and VAmax> 69 (n=312): VA max (78.6 letters) was reached at 6.9 months, mean VA was 74.5 letters (+7.4 letters vs baseline) at 1 year.In Group 4, non-dry retina and VAmax <69 (n=104): VA max (60.5 letters) was reached at 5.3 months, mean VA was 54.5 letters (+3.6 letters vs baseline) at 1 year.
Among patients with dry retina, we observe a moderate VA loss between VA max and 12 months. In patients with persistent macular edema, the 12-month VA differed according to VA max. Patients with a VA max <69 letters experienced a loss of vision after this VA max.This study suggests that among patients who do not achieve a dry retina during their first year of treatment, VA max could be a predictive factor of tolerance to persistant macular edema.
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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