Ranibizumab For Diabetic Macular Edema Research Articles

Transitioning from Aflibercept to Biosimilar Ranibizumab in Diabetic Macular Edema (DME): (The TRANSFORM-DME Trial) a Multicenter Observational Study.

To evaluate visual and anatomical outcomes following a switch from intravitreal Aflibercept (IVI AFL) (T1) to biosimilar Ranibizumab (B-RBZ) (T2) in patients with diabetic macular edema (DME). This was a multicenter observational study, analysing medical records of consecutive, treatment-naïve centre-involving DME patients having a baseline visual acuity (VA) of ≥55 Early Treatment Diabetic Retinopathy Study (ETDRS) letters. DME patients, having received monthly loading doses of IVI AFL(T1) and responsive to it, who subsequently shifted to B-RBZ(T2) motivated by financial constraints rather than a lack of efficacy to IVI AFL were identified. This study included 57 participants (mean age: 54.23 ± 6.91 years), with 80.7% male patients. VA improved during T1, from 61.4 ± 11.74 ETDRS letters at baseline to 72.7 ± 8.05 ETDRS letters (mean change: +11.2 letters, 95% CI: 9.1 to 13.4; p < 0.001). During T2, VA declined slightly over 12 months with a mean VA of 69.9 ± 3.78 ETDRS letters at the 12-month mark (+8.5 letters from baseline; p < 0.001). Mean central macular thickness (CMT) during T1 reduced from 411.9 ± 34.62 μm at baseline to 279.3 ± 9.96 μm (mean change: -132.6μm, 95% CI: -142.2 to -122.9μm; p < 0.001). CMT remained stable over the 12-month follow-up period, with minimal fluctuations. Subretinal fluid (SRF) and intra retinal fluid (IRF) were present in 84.2% and 91.2% of eyes, respectively, decreasing to 5.3% and 7.0% at the time of switch (p < 0.001). In T2 phase, 22.8% and 21.1% exhibited SRF and IRF, respectively, at the end of the study. Transitioning to biosimilar Ranibizumab (Razumab) after initial treatment with aflibercept in patients with DME preserved visual and anatomical benefits over a 12-month period, with only minor variations in SRF and IRF. These results underscore the efficacy of biosimilar Ranibizumab as a cost-effective option for managing DME.

Elevated aqueous TNF-α levels are associated with more severe functional and anatomic findings in eyes with diabetic macular oedema.

Intravitreal ranibizumab for diabetic macular oedema (DMO) has been recently shown to modulate levels of aqueous cytokines. This study investigates the associations between changes in aqueous cytokine levels following intravitreal ranibizumab therapy and the corresponding anatomical and functional changes in the eye. Twenty-five patients comprising 30 eyes diagnosed with DMO were prospectively recruited. All eyes received three loading dose ranibizumab injections at baseline, week 4 and week 8, followed by pro re nata treatment based on best-corrected visual acuity (BCVA) and central macular thickness (CMT) up to week 48. Prior to ranibizumab administration, aqueous samples were collected from all eyes, and subsequent sampling was performed at week 8. Levels of 32 cytokines were assessed at baseline and at week 8. At baseline, higher aqueous TNF-α levels were associated with poorer BCVA (p = 0.033), greater macular volume (p = 0.017) and worse diabetic retinopathy (p = 0.047). Higher levels of IL-7 were associated with poorer BCVA and greater macular volume (MV). Following treatment with ranibizumab there was a significant correlation with reduction of aqueous TNF-α and improvements in BCVA and MV, both at 6 months (BCVA [r = -0.558, p = 0.001], MV [r = 0.410, p = 0.024]) and 12-months (BCVA [r = -0.413, p = 0.023], MV [r = 0.482, p = 0.008]). The change in VEGF concentration following ranibizumab treatment did not correlate with either BCVA or MV improvements (p > 0.05). Higher levels of aqueous TNF-α and IL-7 correlated with worse DMO, both anatomically and functionally. Reductions in levels of aqueous TNF-α, but not VEGF, post ranibizumab treatment were associated with improvement in BCVA and MV.

Bibliometric and visualized analysis of DME from 2012 to 2022.

Diabetic macular edema (DME) is the main cause of irreversible vision loss in patients with diabetes mellitus (DM), resulting in a certain burden to patients and society. With the increasing incidence of DME, more and more researchers are focusing on it. The papers related to DME between 2012 and 2022 from the Web of Science core Collection were searched in this study. Based on CiteSpace and VOS viewer, these publications were analyzed in terms of spatiotemporal distribution, author distribution, subject classification, topic distribution, and citations. A total of 5165 publications on DME were included. The results showed that the research on DME is on a steady growth trend. The country with the highest number of published documents was the US. Wong Tien Yin from Tsinghua University was the author with the most published articles. The journal of Retina, the Journal of Retinal and Vitreous Diseases had a large number of publications. The article "Mechanisms of macular edema: Beyond the surface" was the highly cited literature and "Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema" had the highest co-citation frequency. The treatment, diagnosis, pathogenesis, as well as etiology and epidemiological investigation of DME, have been the current research direction. Deep learning has been widely used in the medical field for its strong feature representation ability. The study revealed the important authoritative literature, journals, institutions, scholars, countries, research hotspots, and development trends in in the field of DME. This indicates that communication and cooperation between disciplines, universities, and countries are crucial. It can advance research in DME and even ophthalmology.

Aflibercept or ranibizumab for diabetic macular edema.

Vascular endothelial growth factor (VEGF) is the primary substance involved in retinal barrier breach. VEGF overexpression may cause diabetic macular edema (DME). Laser photocoagulation of the macula is the standard treatment for DME; however, recently, intravitreal anti-VEGF injections have surpassed laser treatment. Our aim was to evaluate the efficacy of intravitreal injections of aflibercept or ranibizumab for managing treatment-naive DME. This single-center, retrospective, interventional, comparative study included eyes with visual impairment due to treatment-naive DME that underwent intravitreal injection of either aflibercept 2 mg/0.05 mL or ranibizumab 0.5 mg/0.05 mL at Al-Azhar University Hospitals, Egypt between March 2023 and January 2024. Demographic data and full ophthalmological examination results at baseline and 1, 3, and 6 months post-injection were collected, including the best-corrected distance visual acuity (BCDVA) in logarithm of the minimum angle of resolution (logMAR) notation, slit-lamp biomicroscopy, dilated fundoscopy, and central subfield thickness (CST) measured using spectral-domain optical coherence tomography. Overall, the 96 eyes of 96 patients with a median (interquartile range [IQR]) age of 57 (10) (range: 20-74) years and a male-to-female ratio of 1:2.7 were allocated to one of two groups with comparable age, sex, diabetes mellitus duration, and presence of other comorbidities (all P >0.05). There was no statistically significant difference in baseline diabetic retinopathy status or DME type between groups (both P >0.05). In both groups, the median (IQR) BCDVA significantly improved from 0.7 (0.8) logMAR at baseline to 0.4 (0.1) logMAR at 6 months post-injection (both P = 0.001), with no statistically significant difference between groups at all follow-up visits (all P >0.05). The median (IQR) CST significantly decreased in the aflibercept group from 347 (166) µm at baseline to 180 (233) µm at 6 months post-injection, and it decreased in the ranibizumab group from 360 (180) µm at baseline to 190 (224) µm at 6 months post-injection (both P = 0.001), with no statistically significant differences between groups at all follow-up visits (all P >0.05). No serious adverse effects were documented in either group. Ranibizumab and aflibercept were equally effective in achieving the desired anatomical and functional results in patients with treatment-naïve DME in short-term follow-up without significant differences in injection counts between both drugs. Larger prospective, randomized, double-blinded trials with longer follow-up periods are needed to confirm our preliminary results.

Diversity when interpreting evidence in network meta-analyses (NMAs) on similar topics: an example case of NMAs on diabetic macular oedema

BackgroundDifferent network meta-analyses (NMAs) on the same topic result in differences in findings. In this review, we investigated NMAs comparing aflibercept with ranibizumab for diabetic macular oedema (DME) in the hope of illuminating why the differences in findings occurred.MethodsStudies were searched for in English and Chinese electronic databases (PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, VIP; see detailed search strategy in the main body). Two independent reviewers systematically screened to identify target NMAs that included a comparison of aflibercept and ranibizumab in patients with DME. The key outcome of interest in this review is the change in best-corrected visual acuity (BCVA), including various ways of reporting (such as the proportion of participants who gain ≥ 10 ETDRS letters at 12 months; average change in BCVA at 12 months).ResultsFor the binary outcome of BCVA, different NMAs all agreed that there is no clear difference between the two treatments, while continuous outcomes all favour aflibercept over ranibizumab. We discussed four points of particular concern that are illustrated by five similar NMAs, including network differences, PICO (participants, interventions, comparators, outcomes) differences, different data from the same measures of effect, and differences in what is truly significant.ConclusionsA closer inspection of each of these trials shows how the methods, including the searches and analyses, all differ, but the findings, although presented differently and sometimes interpreted differently, were similar.

Aflibercept versus ranibizumab for diabetic macular edema: A meta-analysis.

The purpose of this study was to compare the efficacy and safety of aflibercept (AFL) versus ranibizumab (RAN) for the treatment of diabetic macular edema (DME). The PubMed, Embase, Cochrane Library, and CNKI databases were searched up to September 2022 to identify prospective randomized controlled trials (RCTs) comparing AFL with RAN for the treatment of DME. Review Manager 5.3 software was used for data analysis. We used the GRADE system to evaluate the quality of the evidence for each outcome. A total of 8 RCTs involving 1067 eyes (939 patients) were included; there were 526 eyes in the AFL group and 541 eyes in the RAN group. Meta-analysis revealed that there was no significant difference between RAN and AFL in the best-corrected visual acuity (BCVA) of DME patients at 6 months (WMD: -0.05, 95% CI = -0.12 to 0.01, moderate quality) and 12 months after injection (WMD: -0.02, 95% CI = -0.07 to 0.03, moderate quality). Additionally, there was no significant difference between RAN and AFL in the reduction of central macular thickness (CMT) at 6 months (WMD: -0.36, 95% CI = -24.99 to 24.26, very low quality) and 12 months after injection (WMD: -6.36, 95% CI = -16.30 to 3.59, low quality). Meta-analysis showed that the number of intravitreal injections (IVIs) for AFL was significantly lower than that for RAN (WMD: -0.47, 95% CI = -0.88 to -0.05, very low quality). There were fewer adverse reactions to AFL than to RAN, but the difference was not significant. This study found that there was no difference in BCVA, CMT or adverse reactions between AFL and RAN at 6 and 12 months of follow-up, but AFL needed fewer IVIs than RAN.

Topical bromfenac as adjunctive treatment with intravitreal ranibizumab for diabetic macular edema

PurposeTo determine the safety and efficacy of adding topical bromfenac 0.09% in the treatment of diabetic macular edema.MethodsSeventy patients (70 eyes) with center involved diabetic macular edema with macular thickness (300–500 μm) were included. Patients were divided randomly into two groups: 35 eyes in each group. Both groups were treated with intravitreal ranibizumab monthly for three consecutive months. Bromfenac 0.09% eye drops twice daily was added to the treatment of study group for six months from commencement of treatment. The efficacy of topical bromfenac was evaluated by comparing both groups through follow-up period as regards to visual acuity, central and average thickness and the need for re-injection.ResultsPatients treated with topical bromfenac in addition to intravitreal ranibizumab revealed significant improvement in visual acuity, more reduction in central and average macular thickness and less tendency to need reinjection compared to those treated with ranibizumab alone (p 0.013, p 0.010 and p 0.022, respectively). No side effects was encountered with the use of topical bromfenac.ConclusionTopical bromfenac 0.09% twice a day could enhance and sustain the efficacy of intravitreal ranibizumab in the treatment of diabetic macular edema without increasing the incidence of corneal side effects.

Retrospective analysis of the efficacy of early switching from bevacizumab to aflibercept or ranibizumab in diabetic macular edema.

The study aimed to compare the anatomical and functional gains of switching to ranibizumab or aflibercept in eyes with treatment-naive diabetic macular edema (DME) which has an inadequate response to three consecutive bevacizumab injections. This observational, retrospective, comparative study presented 12-month results of 80 patients with DME. One eye of each patient was enrolled, and bevacizumab was switched as aflibercept (40 eyes) or ranibizumab (40 eyes). DME was diagnosed based on a fundoscopic examination, fundus fluorescein angiography (FFA), central macular thickness (CMT), and best-corrected visual acuity (BCVA). Forty-one patients (51.2%) were male, and 39 (48.8%) were female, with a mean age of 62.3 ± 6.7 years. At the end of the study, the mean number of intravitreal injections was 8.1 ± 1.8 in the aflibercept group, whereas 8.9 ± 1.4 in the ranibizumab (p = 0.091). The mean CMT decreased from 449.2 ± 69.3 µm to 311.0 ± 48.9 µm in the aflibercept group, and from 444.9 ± 109.2 µm to 316.3 ± 54.5 µm in the ranibizumab group (for both, p < 0.0001). The mean BVCA increased from 49.2 ± 11.1 ETDRS letters to 62.5 ± 9.9 in the aflibercept group (p < 0.0001) and from 49.9 ± 12.0 ETDRS letters to 61.1 ± 9.1 in the ranibizumab group (p < 0.0001). Macular laser treatment was required in 17.5% of the aflibercept group and 22.5% of the ranibizumab group (p = 0.781). Significant improvement was observed with ranibizumab and aflibercept treatments in initial bevacizumab-resistant DME. Early switching therapy may contribute to better visual and anatomical outcomes.

Short-Term Outcomes of Switching Therapy from Bevacizumab Non-Responder to Ranibizumab in Diabetic Macular Edema

Objective: To evaluate the short-term efficacy of ranibizumab therapy in terms of visual function and retinal thickness in patients with diabetic macular edema (DME) who failed to respond to treatment with repeated bevacizumab injections. Additionally, parameters affecting outcomes after switching were investigated. Materials and Methods: The present study was a multicenter, retrospective study of 70 eyes with DME non-responding to bevacizumab. All patients were initially treated with at least three consecutive injections of bevacizumab then switched to at least one injection of ranibizumab. A monthly follow-up after the first ranibizumab injection to the last injection within six months was monitored. Primary outcomes included mean change in best-corrected visual acuity (BCVA) and central subfield thickness (CSFT) changes from baseline. Exploratory outcomes included parameters affecting prognosis after switching. Results: Seventy eyes with DME were included in the present study. The mean change of BCVA (logMAR) was 0.075±0.375 (95% CI 0.014 to 0.164, p=0.098). The mean change of CSFT was 58.85±110.37 μm (95% CI 32.54 to 85.17, p&lt;0.001). Forty-two percent of patients had BCVA improvement and 75.71% had CSFT improvement after switching to ranibizumab. Factors associated with BCVA and CSFT improvement were baseline BCVA, baseline CSFT, and older than 50 years old. Conclusion: Switching to ranibizumab therapy in DME patients unresponsive to repeated bevacizumab injection provides better anatomical outcomes than visual acuity improvement. This will help ophthalmologists better understand the benefits on switching therapy to ranibizumab in terms of visual function and retinal thickness in patients with DME in the real-world setting. Keywords: Diabetes, macular edema; Anti-vascular endothelial growth factor (VEGF); Intravitreal injection; Non-responder; Persistent diabetic macular edema

Treat-and-Extend vs. Pro Re Nata Regimen of Ranibizumab for Diabetic Macular Edema-A Two-Year Matched Comparative Study.

PurposeTo compare 2-year treatment outcomes of ranibizumab using treat-and-extend (T&E) or pro re nata (PRN) regimens for diabetic macular edema (DME) in clinical settings.MethodsWe retrospectively enrolled 34 patients (34 eyes) with DME treated with ranibizumab using the T&E regimen, and 34 patients (34 eyes) treated with ranibizumab using the PRN regimen and matched to cases in the treat-and-extend group by baseline best-corrected visual acuity (BCVA) and central foveal thickness (CFT). BCVA and CFT changes, number of injections and recurrence of macular edema over 2 years were compared between the groups.ResultsThe average BCVA gain in the T&E and PRN groups was 16.2 and 7.6 ETDRS letters at 2 years (p = 0.011), respectively. The mean CFT reduction was 145.5 ± 127.3 and 97.3 ± 152.5 μm in the T&E and PRN groups at 2 years (p = 0.035), respectively. The T&E group had a higher proportion of patients with BCVA gain ≥ 15 letters at months 18 (p = 0.015) and 24 (p = 0.029) than the PRN group. During the 2-year treatment periods, the T&E group received more injections than the PRN group (11.0 ± 3.2 vs. 6.2 ± 2.0; p < 0.001), while the PRN group had more recurrence of macular edema than the T&E group (71 vs. 41%; p = 0.015).ConclusionsAfter 2-year ranibizumab treatment for DME, better visual and anatomical improvement and less recurrence of macular edema were achieved in the T&E group, with more injections administered.

Aflibercept versus ranibizumab in diabetic macular edema associated with epiretinal membrane

Aflibercept versus ranibizumab in diabetic macular edema associated with epiretinal membrane

Cost-Effectiveness of Conbercept vs. Ranibizumab for Age-Related Macular Degeneration, Diabetic Macular Edema, and Pathological Myopia: Population-Based Cohort Study and Markov Model.

Background: With the advent of aging society of China, fundus diseases related to pathological neovascularization, including age-related macular degeneration (AMD), diabetic macular edema (DME), and pathological myopia (PM), have become an increasingly serious medical and health problems. As effective drugs of the treatment, conbercept and ranibizumab have been commonly used and covered by the national basic medical insurance in China. However, the pharmacoeconomic evaluation of conbercept vs. ranibizumab for DME and PM remains lacking. This study would assess the cost-effectiveness of conbercept and ranibizumab for the treatment of AMD, DME, and PM from the perspective of Chinese payers.Methods: A Markov chain model was constructed based on the visual conditions of the patient indicated by the number of letters in best corrected visual acuity (BCVA). We conducted models based on real-world scenario to calculate the cost per the quality-adjusted life-year (QALY) gained. A 1-year cycle length and a 10-year simulation treatment were applied and the number of injections of conbercept and ranibizumab was assumed to the average number within 10 years. Transition probabilities, costs, utility data, and other parameters were obtained from literature searches. A 3.5% discounting rate was applied for both the costs and utilities.Results: The incremental cost-effectiveness ratios (ICERs) were more favorable for conbercept than ranibizumab in treatment of AMD, DME, and PM, with associated ICER of 66,669 renminbi (RMB), −258,813 RMB, and −373,185 RMB per QALY gained. Compared with ranibizumab, the incremental effectiveness of conbercept in treatment of AMD, DME, and PM was −0.665 QALYs, 0.215 QALYs, and 0.029 QALYs, respectively. The sensitivity analysis showed the same findings, although the ICER is sensitive to the costs of this program.Conclusion: Under the current Chinese healthcare setting, conbercept is suitable and cost-effective in treatment of AMD, DME, and PM compared with ranibizumab.

Nondamaging retinal laser therapy in recurrent diabetic macular edema after antiVEGF injections.

Subthreshold yellow nondamaging retinal laser therapy (NRT) could provide a greater safety profile when compared to conventional laser methods. NRT may also improve diabetic macular edema (DME). This study aims to assess whether the severity of DME affects the efficacy of subthreshold yellow NRT. The study included 70 eyes that had previously been treated with ranibizumab for DME and then developed recurrent macular edema, which was treated with NRT once. The central foveal thickness (CFT) and best-corrected visual acuity (BCVA) were evaluated retrospectively 2 months following the NRT. The eyes in the study were divided into 4 different groups according to the baseline CFT values. The initial CFT was 250-300 μm in Group 1 (n = 26), 301-400 μm in Group 2 (n = 24), and >401 μm in Group 3 (n = 20). Group 4 (n = 20) included control subjects with 250-300 µm CFT, diagnosed with DME, and not previously treated. The alterations in the BCVA and CFT were measured. In the study, it was determined that 45 right eyes and 45 left eyes were involved. Statistically significant decrements (42.84 m reduction) in CFT were detected only in the Group 1 (p = 0.01). There was no significant improvement in CFT within Group 2, 3 and 4 (p = 0.29, p = 0.73, p = 0.22, respectively). Solely Group 1 had statistically significant improvement (from 0.54 to 0.39 LogMAR) in BCVA (p = 0.01), while groups 2, 3 and 4 had no improvement at all (p = 0.74, p = 0.96, p = 0.66 respectively). Based on the results, NRT provided an improvement in BCVA and CFT in eyes with CFT less than 300 µm at the shortterm follow-up. However, CFT and BCVA outcomes after NRT were inferior to those achieved after previous ranibizumab treatment. No positive effect of NRT was not observed in patients with moderate and severe macular edema in DME treatment.

Long-term outcomes of intravitreal therapy for symptomatic diabetic macular oedema in a real-world setting in Switzerland

ObjectiveTo assess the long-term visual outcomes in eyes with symptomatic diabetic macular oedema (DME) under intravitreal treatment (IVT) in a clinical routine setting.MethodsPatients with newly diagnosed DME were included in this retrospective study if they had received at least three IVTs and a follow-up period ≥ 2 years. Due to altered treatment patterns since the approval of ranibizumab for DME in 2012, patients were subdivided according to their first IVT before 2013 (group 1) or thereafter (group 2). The primary outcome measure was the evolution of best-corrected visual acuity (BCVA) over time.ResultsOf 217 eyes (191 patients) with DME, 151 eyes (117 patients) fulfilled the inclusion criteria (63 eyes in the first period, 88 in the second period). Mean follow-up time was 7.9 ± 3.1 (group 1) and 4.1 ± 1.4 years (group 2; p < 0.001). Visual gains were similar in the first year (group 1: + 5.3 ± 15.5, group 2: + 7.3 ± 12.2 Early Treatment Diabetic Retinopathy Study (ETDRS) letters; p = 0.44), but not thereafter (after 2 years in group 1: + 4.4 ± 15.0, group 2: + 8.3 ± 13.0 ETDRS letters; p = 0.038). During the first year, group 1 patients received less clinical examinations (group 1: 6.6 ± 3.3, group 2: 7.5 ± 2.1; p = 0.007) and less injections (group 1: 3.6 ± 2.7, group 2: 6.1 ± 2.7; p < 0.001).ConclusionA greater visual gain, in response to more intensive treatment during the first year, was maintained for at least 5 years in group 2 subjects. Our data confirm that in a real-world setting, early intensive treatment results in satisfying long-term visual outcomes.

Age, Initial Central Retinal Thickness, and OCT Biomarkers Have an Influence on the Outcome of Diabetic Macular Edema Treated With Ranibizumab- Tri-center 12-Month Treat-and-Extend Study.

Objective: We report the tri-center 1-year outcomes of a treat-and-extend (T&E) regimen in four-week intervals with ranibizumab for diabetic macular edema (DME).Methods: In this retrospective study, all eyes received 3 monthly loading injections of 0.5 mg ranibizumab, followed by a T&E regimen for DME. Regression models were used to evaluate the associating factors for visual and anatomical outcomes.Results: Ninety one eyes from 64 patients were enrolled. Mean LogMAR best-corrected visual acuity (BCVA) improved from 0.58 at baseline to 0.36 at month 12 and mean central retinal thickness (CRT) decreased from 411 μm at baseline to 290 μm at month 12. Younger age and eyes having thinner baseline CRT, with ellipsoid zone disruption (EZD), and without epiretinal membrane (ERM) were associated with better final CRT. Moreover, eyes with thicker baseline CRT tend to receive more injections. Among the parameters, only having ERM or EZD was associated with significant BCVA recovery.Conclusions: A T&E regimen with ranibizumab by 4-week intervals is effective in improving BCVA and reducing CRT with efficacy notable starting from the third month. Clinical parameters including age, initial CRT, and presence of ERM or EZD significantly influenced therapeutic outcomes. Moreover, the presence of ERM should not preclude DME patients from receiving anti-VEGF therapy. Future studies with larger cohorts are warranted.

Intravitreal Aflibercept versus Ranibizumab for Diabetic Macular Edema in a Taiwanese Health Service Setting

ABSTRACT Purpose: To compare the visual and anatomical outcomes between intravitreal aflibercept and ranibizumab for diabetic macular edema Methods: A total of 194 eyes from 194 patients (aflibercept n = 95, ranibizumab n = 99) were retrospectively enrolled in the study. All eyes fulfilled the key criteria including a baseline best-corrected visual acuity (BCVA) between 20 and 70 ETDRS letters, a central subfield thickness (CST) 300 µm or more. Primary outcomes were BCVA and CST at 1, 3, 6, and 12 months. Maintenance of vision was defined as visual loss of less than 5 letters over 6 to 12 months. Predictors for final visual acuity and visual maintenance were analyzed using multivariate regression models. Results: Both agents achieved comparable visual and anatomical outcomes at any time point over the course of follow-up (all p > .05). At 12 months, aflibercept group had higher proportions of visual gains 5, 10 and 15 letters or more (p = .014, p = .011, and p = .034, respectively). The mean number of injections was 5.0 ± 1.9 in ranibizumab group and 4.5 ± 1.9 in aflibercept group (p = .09). Ranibizumab predicted poor maintenance of vision (p = .009), but not the final visual acuity (univariate p = .1). Ranibizumab was more likely to have recurrence of subretinal fluid than aflibercept in 12 months after resolution of subretinal fluid at baseline (p = .016). Both aflibercept and ranibizumab had similar rates of loss to follow-up (p = .47) and occurrence of vitreous hemorrhage (p = .21). Conclusion: While both agents improved vision with resolution of edema, aflibercept maintained vision more effectively with less recurrence of subretinal fluid at 12 months in real-world settings.

Real-World Treatment Patterns and Vision Outcomes with Ranibizumab for Diabetic Macular Edema.

Purpose To assess injection patterns and vision outcomes in patients receiving intravitreal ranibizumab injections for diabetic macular edema in a real-world clinical setting. Methods Retrospective chart review involving 74 eyes of 62 patients who started ranibizumab treatment for diabetic macular edema at the Hospital of the Lithuanian University of Health Sciences Kauno Klinikos. Data collected included follow-up visits, injections administered, and best-corrected visual acuity (BCVA). Results Median follow-up duration was 652.5 days (min 365; max 914). Over the first year, eyes received a median of 4 injections (min 1; max 10). Among eyes with 2-year follow-up and injections during the second year, there was a median of 3 injections (min 1; max 6) over the second year. The BCVA improved by a median of 5 letters 365 ± 60 days and 730 ± 60 days after baseline. At the first visit ≥365 days after baseline, 13.5% of eyes gained ≥15 letters from baseline while 6.8% of eyes lost ≥15 letters. For 74.3% of eyes, BCVA improved (gain of ≥5 letters) or remained stable (gain/loss of ≤4 letters). Conclusion Intravitreal ranibizumab for diabetic macular edema was effective in a real-world clinical setting, with most eyes gaining or maintaining vision. Compared with randomized prospective clinical trials, patients received less frequent injections and achieved lower vision gains.

Comparison of choroidal thickness before and after injection of ranibizumab in patients with diabetic macular edema

ObjectiveTo compare choroidal thickness before and after injection of ranibizumab in patients with diabetic macular edema (DME) using enhanced depth optical coherence tomography (EDI-OCT).BackgroundDME is one of the most common complications of diabetic retinopathy (DR) and the most common cause of visual impairment. Intravitreal injection of antivascular endothelial growth factor is currently the most commonly used procedure for the treatment of DME.Patients and methodsA prospective clinical study was conducted on 30 eyes of 27 patients of DME who underwent intravitreal injection of ranibizumab. A complete history was taken from all cases, and a full ophthalmologic examination was done. Fluorescein angiography and EDI-OCT were performed before injection and also at 1 month after injection. The difference between preoperative and postoperative subfoveal choroidal thickness was calculated.ResultThe mean preoperative choroidal thickness measured subfoveally using EDI-OCT was 233.1 ± 20.22, whereas the mean of postoperative choroidal thickness after 1 month was 214.4 ± 19.61. The range of difference between preoperative and 1 month postoperative choroidal thickness using EDI-OCT was from 23 to 28 μm and the mean was 18.67 ± 8.99; the difference was calculated by subtracting the preoperative choroidal thickness from 1-month postoperative choroidal thickness.ConclusionThere is a significant difference between the preoperative and 1-month postoperative choroidal thickness using EDI-OCT after injection of intravitreal ranibizumab in DME.

Comment on "Anatomical and functional changes after dexamethasone implant and ranibizumab in diabetic macular edema: a retrospective cohort study".

Comment on "Anatomical and functional changes after dexamethasone implant and ranibizumab in diabetic macular edema: a retrospective cohort study".

Association Between First- and Third-Month Responses to Intravitreal Ranibizumab for Diabetic Macular Edema.

This work examines the relationship between first- and third-month anatomical and visual response with antivascular endothelial growth factor for diabetic macular edema. We prospectively evaluated 58 eyes with center-involved diabetic macular edema. Response was categorized upon the anatomical status after 3 monthly doses based on the reduction of central macular thickness (CMT) from baseline (≥20% or not). Correlation analysis between the anatomical response status, gained letters, optical coherence tomography morphological features, and other baseline characteristics were obtained. Twenty-five eyes (43.1%) achieved an anatomical reduction of ≥20% at the third month. Those with a reduction of ≥20% of CMT had subretinal fluid (P < .01), lower hemoglobin A1c values (P < .01), lower proportion of intraretinal cysts (P < .01), a greater anatomical reduction, and visual improvement at the first month of treatment. Multiple logistic regression analysis, showed that the change of CMT after the first injection was an independent predictor for the anatomical reduction of ≥20% after the loading phase (P < .05). Best corrected visual acuity gain after the first dose showed a significant association with an improvement of ≥10 letters after the loading phase (P < .05), but not for macular thickness reduction. First month anatomical reduction was associated with the anatomical response at 3 months (P = .042) after monthly ranibizumab therapy. Visual improvement at the first month was predictive only for the visual outcome after the 3 monthly doses (P = .032).