Treatment of Diabetic Macular Edema with Intravitreal Antivascular Endothelial Growth Factor and Prompt versus Deferred Focal Laser during Long-Term Follow-Up and Identification of Prognostic Retinal Markers

Birgit Weingessel,Christopher Schütze,Florian Sulzbacher,Kata Miháltz,Andreas Gleiss,Pia V Vécsei-Marlovits

doi:10.1155/2018/3082560

Abstract

Purpose Long-term follow-up of patients with diabetic macular edema (DME) treated with intravitreal antivascular endothelial growth factor (anti-VEGF) combined focal laser and identification of prognostic morphological characteristics. Methods Prospective clinical trial (50 treatment-naive eyes) with DME randomized 1 : 1 receiving intravitreal ranibizumab (0.5 mg/0.05 ml) and prompt grid laser compared with ranibizumab and deferred laser. Morphological characteristics potentially relevant for prognosis were assessed at baseline, month 6, month 9, and years 1, 2, 3, 4, and 5 of follow-up. Results Although functional results were slightly higher in the prompt group at week 12 (0.5; 20/40 Snellen (SD = 0.04, 0.3 logMAR) versus 0.4; 20/50 Snellen (SD = 0.04, logMAR: 0.4), p=0.4) and month 9 (prompt group: 0.5; 20/40 Snellen (SD = 0.03, 0.3 logMAR) versus deferred group: 0.4; 20/50 Snellen (SD = 0.04, 0.4 logMAR), p=0.4), these were statistically insignificant. There was no significant benefit regarding functionality during long-term follow-up in the prompt group compared to the deferred group. BCVA in the eyes with clusters of hyperreflective foci in the central macular region was inferior compared with the eyes without these alterations at year 5 (0.39; 20/50 Snellen, (SD = 0.25, 0.4 logMAR) versus 0.63; 20/80 Snellen (SD = 0.22, 0.2 logMAR), p < 0.01). Conclusion Grid laser and ranibizumab therapy are effective in DME management during the long-term follow-up. Intraretinal hyperreflective material in SD-OCT is negatively related to BCVA.

Highlights

Diabetic macular edema (DME) is the most common cause of visual impairment in diabetic patients [1]
Diabetic retinopathy (DR) is a retinal vascular disorder that occurs as a complication of diabetes mellitus (DM) and is the leading cause of blindness in the developed world [1, 10, 11]
Retinopathy occurs in most patients with DM of longer duration, though its incidence can be reduced by aggressive control of hyperglycemia and hypertension [12]

Summary

Introduction

Diabetic macular edema (DME) is the most common cause of visual impairment in diabetic patients [1]. E study presented here provides additional information to functional/anatomical outcomes in eyes with DME treated with anti-VEGF combined with prompt compared to deferred laser therapy and identifies prognostically relevant morphological characteristics using highresolution spectral domain optical coherence tomography (SD-OCT) during long-term follow-up.

Results

Conclusion