Abstract
The purpose of this retrospective interventional case series is to compare the functional and anatomical outcomes in eyes with diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) treated intravitreally with aflibercept or ranibizumab under the Taiwan National Insurance Bureau reimbursement policy. 84 eyes were collected and all eyes were imaged with spectral-domain optical coherence tomography (SD-OCT), color fundus photographs (CFPs), and fluorescein angiography (FA). At 24 months after therapy initiation, the logMAR BCVA improved from 0.58 ± 0.33 to 0.47 ± 0.38 (p < 0.01), the CRT decreased from 423.92 ± 135.84 to 316.36 ± 90.02 (p < 0.01), and the number of microaneurysms decreased from 142.14 ± 57.23 to 75.32 ± 43.86 (p < 0.01). The mean injection count was 11.74 ± 5.44. There was no intergroup difference in logMAR BCVA (p = 0.96), CRT (p = 0.69), or injection count (p = 0.81). However, the mean number of microaneurysms was marginally reduced (p = 0.06) in eyes treated with aflibercept at the end of the follow-up, and the incidence rates of supplementary panretinal photocoagulation (PRP) (p = 0.04) and subthreshold micropulse laser (SMPL) therapy sessions (p = 0.01) were also reduced. Multivariate analysis revealed that only initial logMAR BCVA influenced the final VA improvements (odds ratio (OR) 0.49, 95% confidence interval (CI) 0.21 ~ 0.93, p < 0.01); in contrast, age (OR − 0.38, 95% CI − 6.97 ~ − 1.85, p < 0.01) and initial CRT (OR 0.56, 95% CI 0.34 ~ 0.84, p < 0.01) both influenced the final CRT reduction at 24 months. To sum up, both aflibercept and ranibizumab are effective in managing DME with PDR in terms of VA, CRT and MA count. Eyes receiving aflibercept required less supplementary PRP and SMPL treatment than those receiving ranibizumab. The initial VA influenced the final VA improvements at 24 months, while age and initial CRT were prognostic predictors of 24-month CRT reduction.
Highlights
Anti-vascular endothelial growth factor agents have been accepted as the first-line treatment for diabetic macular edema (DME)
At 24 months after the initiation of the treatment, the mean number of injections was 11.74 ± 5.44 (p = 0.91), the logMAR best-corrected visual acuity (BCVA) improved from 0.58 ± 0.33 to 0.47 ± 0.38 (p < 0.01), the central retinal thickness (CRT) decreased from 423.92 ± 135.84 to 316.36 ± 90.02 (p < 0.01), and the counts of microaneurysms (MAs) decreased from 142.14 ± 57.23 to 75.32 ± 43.86 (p < 0.01)
There was no difference in the injection count, logMAR BCVA or CRT between the two groups (Table 2)
Summary
Anti-vascular endothelial growth factor (anti-VEGF) agents have been accepted as the first-line treatment for diabetic macular edema (DME). Eyes receiving ranibizumab had a reduced chance of Scientific Reports | (2022) 12:711. Anti-VEGF agents, including both ranibizumab and aflibercept, have been reimbursed by the National Taiwan Health Insurance Bureau for DME but not PDR since 2014. A lifetime maximum of 8 injections per eye are eligible for reimbursement, and patients are not allowed to shift from one anti-VEGF agent to another.
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