July 2019
Volume 60, Issue 9
Free
ARVO Annual Meeting Abstract  |   July 2019
Real world data of management of treatment-naïve diabetic macular edema in JAPAN: Two years visual outcome with and without anti-VEGF therapy
Author Affiliations & Notes
  • Daisuke Muramatsu
    Ophthalmology, Tokyo Medical University, Shinjuku-ku, TOKYO, Japan
    Musashisakai Eye Clinic, Tokyo, Japan
  • Masahiko Shimura
    Tokyo Medical University, Hachioji Medical Center, Tokyo, Japan
  • Shigehiko Kitano
    Diabetes Center, Tokyo Women's Medical University, Tokyo, Japan
  • Taiji Sakamoto
    Kagoshima University, Kagoshima, Japan
  • Footnotes
    Commercial Relationships   Daisuke Muramatsu, Alcon (F), Bayer (F), Kowa (F), Santen (F); Masahiko Shimura, Alcon (F), Bayer (F), wakamoto (C); Shigehiko Kitano, Alcon (F); Taiji Sakamoto, None
  • Footnotes
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Investigative Ophthalmology & Visual Science July 2019, Vol.60, 2641. doi:https://doi.org/
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      Daisuke Muramatsu, Masahiko Shimura, Shigehiko Kitano, Taiji Sakamoto; Real world data of management of treatment-naïve diabetic macular edema in JAPAN: Two years visual outcome with and without anti-VEGF therapy. Invest. Ophthalmol. Vis. Sci. 2019;60(9):2641. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : In the treatment of diabetic macular edema (DME), a multicenter retrospective survey of a 2-year treatment course in clinical practice has been conducted. Here, we report change of visual acuity (VA) before and after treatment focusing on the treatment with or without anti-VEGF therapy.

Methods : Based on clinical records, 2049 treatment naïve DME eyes whose interventional treatment started from 2010 to 2015 with follow-up for 2 years or longer at 27 facilities were registered. The VA (logMAR), central retinal thickness (CRT) and the required number of each intervention (anti-VEGF drugs, corticosteroid, macular photocoagulation (MPC), Vitrectomy) during the clinical course were extracted. The change of each variable before and after 2 year was analyzed.

Results : Of total 2049 eyes, 427 (20.9%) received anti-VEGF monotherapy (Group 1), 807 (39.4%) received combination therapies with anti-VEGF drugs (Group 2), and 815 (39.8%) received alternative therapies without anti-VEGF drugs (Group 3). Mean improvement of VA in each group was -0.09±0.39 (0.45 to 0.37), -0.02±0.40 (0.48 to 0.46), and -0.05±0.39 (0.40 to 0.35) in Group 1, Group 2 and Group 3 respectively. The proportions of eyes keeping VA better than logMAR 0.3 for 2 years was 49.4%, 38.9% and 52.0%, in Group 1, Group 2 and Group 3 respectively. Mean number of anti-VEGF drug injections was 4.3±3.6 injections/2year in Group 1 and 3.6±3.1 in Group 2. In group 3, 553 eyes (67.9%) were treated with corticosteroid, 385 eyes (47.2%), MPC, and 302 eyes (37.1%) with vitrectomy.

Conclusions : From this real-world data, DME treated with anti-VEGF monotherapy resulted in significant improvement of VA after 2 years. While DME with anti-VEGF drugs in combination with other interventions showed worse prognosis.
In contrast, DME with better initial VA did not received anti-VEGF drugs, and kept better VA. Although we, retina specialists, made efforts to choose better treatments as order-made protocols for DME, there is still more room for considering various treatment options.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

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