К вопросу о резистентности диабетического макулярного отека

Abstract

Purpose. To evaluate the morphofunctional features of diabetic macular edema (DME) and propose a classification of the degree of its resistance. Material and methods. The study included 448 patients (448 eyes) with newly diagnosed DME. A complete ophthalmological examination was performed, including spectral optical coherence tomography of the macular area. All patients were divided into 3 study groups depending on the anti-VEGF drug used: Brolucizumab (138), Ranibizumab (142) and Aflibercept (168). All patients (110) resistant to loading doses of an anti-VEGF drug were switched to intravitreal administration of a dexamethasone-containing implant. The observation period was 6 months. Results. According to the results of our study, the overall percentage of resistance to anti-VEGF therapy in patients with DME was 24.6%. At the same time, in group 1 it was observed in 20.2% of patients, in group 2 in 28.1% and in group 3 in 25.0%. It was found that when switching to intravitreal administration of a dexamethasone-containing biodegradable implant, there was an increase in visual acuity in the studied groups, respectively, from 0.25 to 0.67, from 0.04 to 0.3 and from 0.38 to 0.6 against the background of a decrease in retinal edema. Conclusion. The use of a dexamethasone-containing biodegradable implant after 6 months improved the architectonics of the retinal layers, increased visual acuity and reduced retinal edema in group 1 in 92.9% of patients, in group 2 in 87.5% and in group 3 in 90.5%. The developed clinical classification of the degree of DME resistance, depending on the morphofunctional features of the patient's retina, contributes to making the optimal decision regarding the choice of the most effective initial intravitreal pharmacotherapy for this disease. Key words: diabetic macular edema, anti- VEGF drugs, classification of DME resistance to intravitreal pharmacotherapy, dexamethasone implant