Abstract
PurposeTo determine whether the presence of vitreomacular interface abnormalities (VMIA) in patients with diabetic macular oedema (DMO) modifies the response to ranibizumab.MethodsMedical records and spectral-domain optical coherence tomography (SD-OCT) scans of consecutive patients with centre-involving DMO initiating therapy with ranibizumab between December 2013 and March 2014 at the Belfast Health and Social Care Trust were reviewed. Patients were identified through an electronic database. Demographics; systemic baseline characteristics; history of previous ocular surgery/laser; best-corrected visual acuity (BCVA), central retinal thickness (CRT) and stage of retinopathy at presentation; and BCVA, CRT and presence/absence of fluid at the last follow-up were recorded. OCT scans were reviewed by a masked investigator who graded them for the presence/absence of VMIA at baseline and during follow-up and for the change in the posterior hyaloid face during follow-up. The association between (1) VMIA at baseline and (2) the change in the posterior hyaloid face during the follow-up and functional/anatomical outcomes was evaluated.ResultsOne hundred forty-six eyes of 100 patients (mean age 63.5 years) followed for a mean of 9 months (range 2–14 months; only 9/146 dropped to follow-up before month 6) were included. Statistically significant differences were observed at baseline in BCVA (p = 0.007), previous macular laser and panretinal photocoagulation (PRP) (p = 0.006) and previous cataract surgery (p = 0.01) between eyes with and without VMIA, with better levels of vision, higher frequency of macular laser and lower frequency of PRP in eyes where no VMIA was present. Multivariable regression analysis did not disclose any statistically significant associations between VMIA at baseline or change in the posterior hyaloid face during the follow-up and functional and anatomical outcomes following treatment.ConclusionVMIA are associated with worse presenting vision in patients with DMO; VMIA or change in the posterior hyaloid face during the follow-up did not modify the response to ranibizumab in this study.
Highlights
The vitreomacular interface (VMI) gained greater scientific interest since the advent of optical coherence tomographyPresented at the 39th Annual Meeting of the USA Macula Society, February 24–27, 2016, Miami, Florida, USA (OCT)
We present findings on a large cohort of patients receiving intravitreal anti-VEGF therapy with ranibizumab for diabetic macular oedema (DMO) and investigate the potential relationship between (1) VMI abnormalities (VMIA) at baseline and (2) the change in the posterior hyaloid face during the follow-up and functional/anatomical outcomes following anti-VEGF therapy
In keeping with the standard clinical practice at our site, all patients initiating anti-VEGF therapy received an ocular examination, which included refraction undertaken by an optometrist and best-corrected visual acuity (BCVA) measured with Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity charts at baseline, visual acuity testing obtained using ETDRS visual acuity charts and, following the refraction obtained at baseline, intraocular pressure measurement and slit-lamp biomicroscopy
Summary
The vitreomacular interface (VMI) gained greater scientific interest since the advent of optical coherence tomographyPresented at the 39th Annual Meeting of the USA Macula Society, February 24–27, 2016, Miami, Florida, USA (OCT). Spectral-domain OCT (SD-OCT) allows excellent visualisation of the VMI, enabling the study of the role of VMI abnormalities (VMIA) in the development of macular disease and the response to treatment. Vitreomacular traction (VMT), a form of VMIA [1], has been proposed as one of many aetiological factors for the development of diabetic macular oedema (DMO) [2]. The reported prevalence of VMIA in patients with DMO ranges from 6.6 to 52.1%, depending on the diagnostic criteria and retinal imaging modality used [2, 6,7,8,9,10]. A few of these studies, used SD-OCT [9, 10]. Akbar Khan et al used SD-OCT to image a cohort of patients
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