Effectiveness of Intravitreal Ranibizumab in Nonvitrectomized and Vitrectomized Eyes with Diabetic Macular Edema: A Two-Year Retrospective Analysis.

Ozgun Melike Gedar Totuk,Sevil Ari Yaylalı,Mohammed Nadim Bromand,Aylin Ardagil Akcakaya,Ayse Yagmur Kanra,Guler Kilic Tezanlayan,Irem Turkmen

doi:10.1155/2020/2561251

Ozgun Melike Gedar Totuk, Sevil Ari Yaylalı + Show 5 more

Open Access

https://doi.org/10.1155/2020/2561251

Copy DOI

Abstract

The aim of this study was to compare the effectiveness of intravitreal ranibizumab (IVR) injections for the treatment of diabetic macular edema (DME) in eyes with and without previous vitrectomy. The medical records of 28 eyes (11 vitrectomized and 17 nonvitrectomized) of 28 patients (mean age, 59.0 ± 9.6 years; male to female ratio 1 : 1) who were diagnosed with DME and had received IVR treatment were reviewed retrospectively. The indications of vitrectomy in 11 vitrectomized eyes were intravitreal hemorrhage (n = 8) and epiretinal membrane (n = 3). The best-corrected visual acuity (BCVA), central macular thickness (CMT), and total macular volume (TMV) were measured at baseline and at months 6, 12, 18, and 24 of the follow-up. The number of IVR injections, the duration between diagnosis of DME and IVR injection, and the hemoglobin A1c (HbA1c) level at baseline were also recorded. Baseline demographics, HbA1c, BCVA, CMT, and TMV values were similar between two groups (p > 0.05). The duration between diagnosis of DME and IVR injections was similar in both groups (16 ± 5 months vs. 13 ± 4 months, respectively; p=0.11). IVR injection was performed 6.3 times in vitrectomized eyes and 6.1 times in nonvitrectomized eyes during the 24-month period (p > 0.05). The mean BCVA improved significantly during the 24-month period in both groups. The improvements in BCVA, in CMT, and in TMV were more significant at month 6 (p=0.036) group, at month 12 (p=0.013), at month 12 (p=0.021), and month 24 (p=0.021) in nonvitrectomized eyes, respectively, while there was no difference in improvements of BCVA, CMT, and TMV in vitrectomized group at each visit. Treatment effected by time in terms of BCVA, CMT, and TMV values in all groups (p=0.0004, p < 0.0001, p < 0.0001, respectively), not by time-group interaction and group (all p values >0.05). In conclusion, IVR treatment for DME is equally effective in both groups. However, the response to treatment is seen earlier in nonvitrectomized eyes compared to vitrectomized eyes.

Highlights

Diabetic macular edema (DME) is the most common cause of visual impairment in patients with diabetic retinopathy with a prevalence of 2.7%–11% [1].e ophthalmic treatment of DME includes intravitreal antivascular endothelial growth factor drug injections, intravitreal corticosteroid injections, focal/grid argon laser photocoagulation, subthreshold micropulse diode laser photocoagulation, and vitrectomy
In this retrospective comparative study, we reviewed the medical records of 11 vitrectomized eyes of 11 patients and 17 nonvitrectomized eyes of 17 patients with severe nonproliferative diabetic retinopathy or proliferative diabetic retinopathy who received naıve intravitreal ranibizumab (IVR) injections and were treated by panretinal photocoagulation previously (Table 1). ey were followed up for at least 24 months between April 2013 and December 2017 at Atakoy Dunyagoz Hospital
A total of 28 patients were included, 17 in the nonvitrectomized group and 11 in the vitrectomized group. e two groups were similar with respect to age and gender distribution, baseline hemoglobin A1c (HbA1c), best-corrected visual acuity (BCVA), central macular thickness (CMT), and total macular volume (TMV) values (Tables 1 and 2, all p > 0.05)

Summary

Introduction

Diabetic macular edema (DME) is the most common cause of visual impairment in patients with diabetic retinopathy with a prevalence of 2.7%–11% [1].e ophthalmic treatment of DME includes intravitreal antivascular endothelial growth factor (anti-VEGF) drug injections, intravitreal corticosteroid injections, focal/grid argon laser photocoagulation, subthreshold micropulse diode laser photocoagulation, and vitrectomy. Since 2010, Journal of Ophthalmology anti-VEGF drug injections have become standard therapy for DME with the proven benefit of improved visual acuity [1,2,3,4,5,6]. Vitrectomy, as treatment for DME, was first introduced for eyes with proliferative diabetic retinopathy (PDR), unresolving vitreous hemorrhage, significant vitreomacular traction commonly associated with shallow traction macular detachment, and persistent DME despite previous focal laser or intravitreal injections. Vitrectomy has recently been studied as potential primary therapy in eyes with more severe edema and greater visual acuity loss at presentation [7, 8]. Ere is a controversy regarding the effects of vitrectomy on the diffusion and clearance of intravitreal anti-VEGF drugs for DME. Faster clearance of intravitreal drugs could mean decreased effectiveness in vitrectomized eyes [9, 10]

Methods

Results

Conclusion