Impact of Pachychoroid and DRIL on the Treatment of Diabetic Macular Oedema with Intravitreal Bevacizumab

Abstract

Purpose To evaluate the long-term outcome of intravitreal bevacizumab in eyes with diabetic macular oedema (DME) following a PRN (pro re nata) regimen. Additionally, we investigated the effect of the presence of disorganisation of the retinal inner layers (DRILs) and pachychoroid (PC) at baseline on clinical outcome.

Methods This retrospective study included 112 naïve eyes with DME that were followed up for 2 years. All eyes were treated with six initial bevacizumab injections at monthly intervals and then received treatment according to a PRN regimen. In case of poor response to bevacizumab, therapy was switched to other agents. Main outcome measures included: best-corrected visual acuity (BCVA), central macular thickness (CMT), and number of intravitreal injections (IVI s). In addition, we examined the effect of the presence of DRILs and PC at baseline on clinical outcome.

Results BVCA improved significantly and CMT decreased significantly during the first 2 years of treatment. The number of IVI s per eye was 11.1 ± 4.8 at the end of the second year. Treatment had to be switched to other agents in 47 eyes (42%). The timing of switching was 12.4 ± 6.1 months after a mean of 9.2 ± 3.3 IVI s. Patients with DRILs at baseline (29.5%) had significantly worse BCVA at all time points before and after treatment, although CMT was significantly lower before treatment and comparable to patients without DRILs during treatment. Patients with PC at baseline (35.7%) had no significant differences in BVCA and CMT at all time points compared with patients without PC.

Conclusions This study demonstrates statistically significant functional and anatomical improvement in patients with DME treated with intravitreal bevacizumab after 2 years. However, more than 40% of eyes required a switch in therapy. The presence of DRILs at baseline had a negative effect whereas the presence of PC at baseline had no effect on clinical outcome.

Zusammenfassung

Hintergrund Ziel der Studie war es, die Langzeitergebnisse der intravitrealen Bevacizumab-Behandlung von Augen mit diabetischem Makulaödem (DME) nach einem PRN (pro re nata) Schema zu untersuchen. Darüber hinaus untersuchten wir die Auswirkung des Vorliegens einer Desorganisation der retinalen Innenschichten (DRIL) und des Pachychoroids (PC) zu Beginn der Studie auf das klinische Ergebnis.

Methoden Diese retrospektive Studie umfasste 112 naive Augen mit DME, die 2 Jahre lang nachbeobachtet wurden. Alle Augen wurden zunächst mit sechs Bevacizumab-Injektionen in monatlichen Abständen behandelt und erhielten anschließend eine Behandlung nach einem PRN-Schema. Bei schlechtem Ansprechen auf Bevacizumab wurde die Therapie auf andere Präparate gewechselt. Zu den Hauptzielgrößen gehörten: bestkorrigierter Visus (BCVA), zentrale Makuladicke (CMT) und die Anzahl der intravitrealen Injektionen (IVI). Darüber hinaus untersuchten wir die Auswirkungen des Vorhandenseins von DRIL und PC bei Studienbeginn auf das klinische Ergebnis.

Ergebnisse In den ersten 2 Jahren der Behandlung verbesserte sich der BVCA signifikant und die CMT ging deutlich zurück. Die Anzahl der IVI pro Auge betrug am Ende des zweiten Jahres 11,1 ± 4,8. Bei 47 Augen (42%) musste die Behandlung auf andere Präparate gewechselt werden. Der Zeitpunkt des Wechsels lag bei 12,4 ± 6,1 Monaten nach durchschnittlich 9,2 ± 3,3 IVI. Patienten mit DRIL zu Studienbeginn (29,5%) hatten zu allen Zeitpunkten vor und nach der Behandlung einen signifikant schlechteren Visus, obwohl die CMT vor der Behandlung signifikant niedriger und während der Behandlung vergleichbar mit Patienten ohne DRIL war. Bei Patienten mit PC zu Behandlungsbeginn (35,7%) gab es zu allen Zeitpunkten keine signifikanten Unterschiede bei BVCA und CMT im Vergleich mit Patienten ohne PC.

Schlussfolgerungen Diese Studie zeigt eine statistisch signifikante funktionelle und anatomische Verbesserung bei Patienten mit DME, die innerhalb von 2 Jahren mit intravitrealem Bevacizumab behandelt wurden. Allerdings war bei mehr als 40 % der Augen ein Therapiewechsel erforderlich. Das Vorhandensein von DRIL bei Studienbeginn hatte einen negativen Effekt, während das Vorhandensein von PC bei Studienbeginn keinen Einfluss auf das klinische Ergebnis hatte.

Key words

retina - DME - DRIL - pachychoroid - bevacizumab

Schlüsselwörter

Retina - DRIL - Pachychoroid - DMÖ - Bevacizumab

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