Diabetic Macular Edema Patients with Poor Baseline Visual Acuity Treated with Ranibizumab in Real Life and Optical Coherence Tomography Based Predictor Factors for Visual Outcomes

Abstract

Purpose: We aimed to evaluate the real life outcomes of ranibizumab in the treatment of diabetic macular edema (DME) patients with a baseline visual acuity<0.05 in decimals.

Methods: Newly diagnosed DME patients with a visual acuity ≤0.05, treated with ranibizumab monotherapy, and completed a follow-up time of 12 months were included retrospectively. Patients were evaluated in regards to change in best corrected visual acuity (BCVA) and central retinal thickness, and the total visit and injection numbers.

Results: A total of 24 eyes of 24 patients were included. Mean BCVA at baseline, month 3, 6, 9, and 12 was, 0.04±0.01, 0.12±0.12, 0.12±0.11, 0.17±0.19, and 0.21±0.21 (p<0.05 for all), respectively. One eye (4.2%) had VA loss of ≥3 lines, and six eyes (25.0%) had stable vision (loss of <3 line, or remained stable, or gained <1 lines), and 17 eyes (70.8%) had VA gain of ≥3 lines at month 12.The mean visit number at month 12 was 4.8±1 and the mean injection number was 4.0 ±1.4.

Conclusion: Ranibizumab seemed to be effective in the treatment of DME patients with a low visual acuity in real life.

Keywords

Diabetic macular edema - intravitreal injection - ranibizumab - visual acuity

Publication History

Received: 13 October 2017

Accepted: 10 May 2018

Article published online:
20 April 2020

• References

• 1 Jusufbegovic D, Mugavin MO, Schaal S. Evolution of controlling diabetic retinopathy: changing trends in the management of diabetic macular edema at a single institution over the past decade. Retina 2015; 35:929-34.
• 2 Early Treatment Diabetic Retinopathy Study Research Group: Photocoagulation for diabetic macular edema: ETDRS report No.4. Int Ophtahlmol Clin 1987; 27:265-72.
• 3 Ozkaya A, Alagoz C, Alagoz N, Gunes H, Yilmaz I, Perente I, et al. Dexamethasone implant in pseudophakic and nonglaucomatous subgroup of diabetic macular edema patients: a real life experience. Eur J Ophthalmol. 2016; 26:351-5.
• 4 Fechter C, Frazier H, Marcus WB, Faroog A, Singh H, Marcus DM. Ranibizumab 0.3 mg for persistent diabetic macular edema after recent, frequent, and chronic bevacizumab: The Rotate Trial. Ophthalmic Surg Lasers Imaging Retina 2016; 47:1-18.
• 5 Elman MJ, Aiello LP, Beck RW, Bressler NM, Bressler SB, Edwards AR, et al. Diabetic Retinopathy Clinical Research Network. randomized trial evaluating ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema . Ophthalmology 2010; 117:1064–1077.
• 6 Nguyen QD, Brown DM, Marcus DM, Boyer DS, Patel S, Feiner L, et al. Ranibizumab for diabetic macular edema: results from 2 phase III randomized trials: RISE and RIDE. Ophthalmology 2012; 119:789–801.
• 7 Payne JF, Wykoff CC, Clark WL, Bruce BB, Boyer DS, Brown DM, et al; TREX-DME Study Group. Randomized Trial of Treat and Extend Ranibizumab with and without Navigated Laser for Diabetic Macular Edema: TREX-DME 1 Year Outcomes. Ophthalmology. 2017; 124:74-81.
• 8 Menchini U, Bandello F, De Angelis V, Ricci F, Bonavia L, Viola F, et al. Ranibizumab for visual impairment due to diabetic macular edema: realworld evidence in the Italian population (PRIDE Study). J Ophthalmol 2015;2015:324841.
• 9 Vorum H, Kruse Olesen T, Zinck J, Størling Hedegaard M. Real world evidence of use of anti-VEGF therapy in Denmark. Current Medical Research and Opinion 2016;32:1943-1950.
• 10 Murakami T, Yoshimura N. Structural changes in indiviual retinal layers in diabetic macular edema. J Diabetes Res 2013;2013:920713.
• 11 Sophie R, Lu N, Campochiaro PA. Predictors of functional and anatomic outcomes in patients with diabetic macular edema treated with ranibizumab. Ophthalmology 2015;122:1395- 1401.
• 12 Radwan SH, Soliman AZ, Tokarev J, Zhang L, van Kujik FJ, Koozekanani DD. Association of disorganization of retinal inner layers with vision after resolution of center-involved diabetic macular edema. JAMA Ophthalmol 2015;133:820-825.
• 13 Seo KH, Yu SY, Kim M, Kwak HW. Visual and morphological outcomes of intravitreal ranibizumab for diabetic macular edema based on optical coherence tomography patterns. Retina 2016;36:588-595.
• 14 Ozkaya A, Alkin Z, Agca A, Satici T, Karakucuk Y, Yazici AT, et al. One-year results of treatment with bevacizumab alone or ranibizumab alone for low visual acuity due to neovascular age-related macular degeneration. J Ocul Pharmacol Ther 2013;29:865-869.
• 15 Ruia S, Saxena S, Gemmy Cheung CM, Gilhotra JS, Lai TY. Spectral domain optical coherence tomography features and classification systems for diabetic macular edema: A review. Asia Pac J Ophthalmol (Phila) 2016;5:360-367.
• 16 Ozkaya A, Alkin Z, Karakucuk Y, Karatas G, Fazil K, Gurkan Erdogan M, et al. Thickness of the retinal photoreceptor outer segment layer in healthy volunteers and in patients with diabetes mellitus without retinopathy, diabetic retinopathy, or diabetic macular edema. Saudi J Ophthalmol 2017;31:69-75.
• 17 Vujosevic S, Berton M, Bini S, Casciano M, Cavarzeran F, Midena E. Hyperreflective retinal spots and visual function after anti-vascular endothelial growth factor treatment in center-involving diabetic macular edema. Retina 2016;36:1298-1308.
• 18 Bresnick GH, Condit R, Syrjala S, Palta M, Groo A, Korth K. Abnormalities of the foveal avascular zone in diabetic retinopathy. Arch Ophthalmol 1984;102:1286-93.