Real-World Outcomes of Ranibizumab Treatment for Diabetic Macular Edema in a United Kingdom National Health Service Setting

Abstract

To determine visual acuity (VA) and spectral-domain optical coherence tomography (OCT) outcomes with intravitreal ranibizumab for diabetic macular edema (DME) in a United Kingdom National Health Service clinical setting. Retrospective interventional case series. Consecutive patients with DME, treated with the first ranibizumab injection between August 2013 and March 2014 across 4 sites of Moorfields Eye Hospital, London. Two hundred eyes of 164 consecutive patients with center-involving DME and VA ≤79 ETDRS letters, central subfield macular thickness (CST) ≥350μm on Topcon 3D OCT 2000, initiated on a loading phase of 3 intravitreal ranibizumab injections and who had at least 6months follow-up were reviewed. Subsequent retreatment was guided by VA and OCT with the aim of treating to stability. VA, OCT CST, and macular volume (MV) were recorded at baseline and monthly to 12months. The mean VA, mean CST, and mean MV at baseline were 54.4 (± 15.26) letters, 490.16 (± 116.54) μm, and 10.46 (± 2.28) mm3. The mean VA change at 12months was+6.6 (± 13.35) letters (P= .0003). A total of 40.3% of patients (n= 77) gained ≥10 letters and 25.1% (n= 48) gained ≥15 letters; 8.9% (n= 17) lost ≥10 letters and 6.3% (n= 12) lost ≥15 letters. At 12months, the mean change in CST and MV were-133.9 (± 160.12) μm (P= .0001) and-1.5 (± 1.96) mm3 (P= .0001), respectively. An average of 7.2 (± 2.3) injections were given over 12months. Outcomes with 3 loading injections of 0.5mg ranibizumab given monthly followed by pro re nata retreatment in a clinical setting are comparable with outcomes from clinical trials.