Impact of baseline vitreomacular interface status on the treatment choice between aflibercept, bevacizumab or ranibizumab for diabetic macular edema

Abstract

Purpose : To investigate the impact of baseline vitreomacular interface (VMI) status and anti-vascular endothelial growth factor (Anti-VEGF) therapy on treatment outcomes in patients with diabetic macular edema (DME) treated with aflibercept, bevacizumab or ranibizumab.

Methods : Post hoc analysis of prospective randomized 12-month multicenter clinical trial data from patients enrolled in the DRCR.net Protocol T study. The source of the data is the DRCR Retina Network, but the analyses, content and conclusions presented herein are solely the responsibility of the authors and have not been reviewed or approved by DRCR Retina Network. In this study, 660 patients with DME were randomly assigned to aflibercept, bevacizumab or ranibizumab. Optical coherence tomography images from patients who completed the month 12 visit of the study were analyzed at the baseline and at the last visit to identify the presence of total vitreomacular adhesion (VMA), partial vitreomacular adhesion, vitreomacular traction syndrome and total posterior vitreous detachment (PVD). Grading for all the above-mentioned variables were made by two trained and certified readers of the Vienna Reading Center.

Results : Six hundred sixty eyes (660 patients) were randomized in the Protocol T study. Six hundred twenty-nine were eligible for this post hoc analysis based on the study criteria. Total adhesion patient group gained 3.7 more ETDRS letters whereas patients with partial VMA gained 3.1 more ETDRS letters on average compared to the total PVD group at the end of the 12 months follow up (p<0.001). Baseline VMI status had no significant influence on CST at the 12 months visit (p=0.144). All three investigated agents used in the Protocol T study showed equal effectiveness on the improvement of VA and on the reduction of macular edema, independently of baseline VMI status.

Conclusions : This study adds evidence that the VMI status impacts functional outcomes in patients with DME treated with anti-VEGF agents. Patients with total or partial VMA at baseline may derive greater improvements in visual acuity after anti-VEGF treatment compared with those with total PVD.

This is a 2021 ARVO Annual Meeting abstract.