Real life structural outcomes in optical coherence tomography for patients treated with anti-VEGF for diabetic macular oedema

Abstract

Purpose : The frequency of intravitreal anti-VEGF treatments for diabetic macular oedema (DMO) in real-life clinical settings is reported to be less than in pivotal studies. In light of this, there is increasing controversy as to what extent this practice compromises structural outcomes in everyday clinic patient cohorts. We performed a retrospective data-warehouse study including optical coherence tomography (OCT) images to report structural outcomes in eyes undergoing intravitreal therapy for DMO in a real-life setting.

Methods : A data-warehouse query for all eyes receiving receiving intravitreal injections for DMO between March 2013 and October 2018 was performed. Corresponding raw OCT files per eye were exported to a virtual network to extract retinal thickness values following the 9 circula macular grids defined by the Early Treatment Diabetic Retinopathy Study (ETDRS) group. Mean central retinal thickness values were reported and stratified by baseline visual acuity for two years of observation period. Means of non-parametric groups were compared to baseline using Wilcoxon Signed-rank test. Multiple pairwise-analyses was carried out for more than two groups.

Results : At baseline, 1220 eye were included in this cohort. Mean CRT was 421μm at baseline, 343μm (p<0.01) after 12 and 376μm (p=0.83) after 24 months (Figure 1). The mean number of anti-VEGF injections delivered per eye was 7.8±2.0 after 12 and 12.0±3.8 after 24 months of treatment. The change of mean CRT after 12 months was higher in the subgroup of eyes with baseline visual acuity <25 letters than with 25-70 letters and >70 letters (-349μm; -128μm; -63μm; p<0.01). After 24 months change in CRT was the highest for eyes with 25-70 letters at baseline (-104μm) compared to <25 letters (-62μm) and >70 letters (-64μm) (p<0.01).

Conclusions : Randomized clinical trials achieve better results than real-life data with a higher number of administered injections per eye. Even though, intravitreal Anti-VEGF is an effective treatment for DMO patients to achieve and maintain structural improvement in OCT in a real life setting. The worse baseline visual acuity, the higher is the benefit of intravitreal injections in the first year of treatment.

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

 

Plot of mean (a) total CRT (µm; left y-axis) and VA (ETDRS letters; right y-axis), as well as, (b) change in CRT and VA from baseline from baseline (0) over a 24 month period.