Abstract
The early remission of diabetic macular edema (DME) often occurs in eyes treated with anti-vascular endothelial growth factor (VEGF) treatment. We retrospectively reviewed and characterized eyes with early remission of DME at six months in 80 eyes under pro re nata (PRN) intravitreal ranibizumab (IVR) injections. The number of eyes without center-involved DME gradually increased and 14 and 20 eyes achieved remission of DME at 3 or 6 months, respectively, under the PRN regimen following three monthly loading doses. In particular, eyes with early remission at 6 months had smaller CSF thickness than those without the remission before and after the treatment except at the 1-month visit (P < 0.05); however, the changes in CSF thickness did not differ between them. VA and its changes were not different between eyes with and without remission. Multivariate analysis revealed that smaller CSF thickness at baseline predicted the early remission of DME under PRN IVR injections (odds ratio, 0.989; 95% confidence interval, 0.982–0.997; P = 0.008). These data elucidate the clinical characteristics of early remission of DME under PRN IVR injections and suggest that smaller CSF thickness at baseline is a novel predictor of early remission under PRN IVR injections for DME.
Highlights
Despite the anatomical and functional efficacy, clinicians have to consider the rare but severe adverse effects of anti-vascular endothelial growth factor (VEGF) treatment, e.g., endophthalmitis and lethal arteriothrombotic diseases[11]
diabetic macular edema (DME) is generally known as a chronic disease, 20 (25.0%) of 80 eyes achieved early remission under pro re nata (PRN) dosing of this anti-VEGF drug with transient effects
Visual prognosis or efficacy did not differ between eyes with and without early remission of DME, eyes with early remission had smaller central subfield (CSF) thickness at most time points than those without remission
Summary
Despite the anatomical and functional efficacy, clinicians have to consider the rare but severe adverse effects of anti-VEGF treatment, e.g., endophthalmitis and lethal arteriothrombotic diseases[11]. Anti-VEGF management requires a much higher cost-per-quality-adjusted life years than other conventional interventions for DME These concerns encourage clinicians to select the pro re nata (PRN) regimen and to discontinue the injections after DME has become stable[5,15]. The number of intravitreal ranibizumab (IVR) injections is dramatically reduced during the second year or later in DME patients treated according to the PRN regimen, despite chronic nature of this disease[16]. This suggests that anti-VEGF treatment can lead to the resolution or remission of DME in some cases, which would guarantee stable visual function. Parameter Eyes/patients Age (years) Men/women Hemoglobin A1c (%) Systemic hypertension (patients) LogMAR VA International classification Mild NPDR Moderate NPDR Severe NPDR PDR Pseudophakia Panretinal photocoagulation CSF thickness (μm) Cystoid abnormalities Subretinal fluid Vitreoretinal abnormalities Disrupted EZ line (%) Hyperreflective foci in the inner retinal layers Hyperreflective foci in the outer retinal layers
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