The online version of this article (doi:10.1007/s00417-016-3562-0) contains supplementary material, which is available to authorized users.
Intravitreal anti-vascular endothelial growth factor (VEGF) agents are effective in the treatment of central involving diabetic macular oedema (DMO). Vitreoretinal interface abnormalities (VRIA) are common in patients with DMO, and the effect of these on the response to anti-VEGF treatment is unclear. Furthermore the effect of anti-VEGF agents on the VRIA itself is uncertain.
Prospective study of consecutive patients treated with ranibizumab (RZB) for DMO as part of routine clinical care in one eye unit over a 1-year period. Visual acuity (Va), central retinal thickness (CRT) and injection frequency data was recorded on an electronic database. Treatment was initiated with four monthly RZB injections and then a monthly PRN regime. All patients underwent high-density spectral-domain optical coherence tomography (SDOCT) at baseline and 12 months. The SDOCTs were graded by two observers masked to the outcome.
One hundred and four eyes (77 patients) were included in the analysis. The mean age was 62 years, and 62% were male. The mean presenting vision was 62 letters and CRT 472 μm. Eighty eyes retained stable Va, and 17 had an improvement in Va. At baseline, 39 eyes had associated focal vitreomacular adhesion (VMA) and by 12 months this reduced to 30 (p = 0.04), with 12 releasing VMA and three developing it. Patients with VMA had significantly better final Va than those without VMA. Improvement in CRT was greatest in those where VMA released during the study. Forty-five eyes had some degree of foveal involving epiretinal membrane (ERM) at baseline, and 28 were considered to have clinically significant ERM. There was no clinically relevant change in ERM during the study. Patients with significant ERM at baseline had a lower final vision. Multivariate analysis showed that ERM and more severe retinopathy at baseline were predictive of less visual improvement (p < 0.01). Shorter intraretinal cyst length, ERM and the absence of VMA at baseline were predictive of a worsened anatomical response (p < 0.001).
VRIA are related to outcome in patients treated with RZB. ERM was associated with a worsened visual and anatomic response, and VMA with an improved anatomical response particularly when spontaneous VMA release occurred during treatment. The presence and severity of ERM was not affected by RZB treatment.
Khan A, Mohamed MD, Mann SS, Hysi PG, Laidlaw DA (2015) Prevalence of vitreomacular interface abnormalities on spectral domain optical coherence tomography of patients undergoing macular photocoagulation for centre involving diabetic macular oedema. Br J Ophthalmol 99:1078–1081 CrossRef
Elman MJ, Aiello LP, Beck RW, Bressler NM, Bressler SB, Edwards AR, Ferris FL, Friedman SM, Glassman AR, Miller KM, Scott IU, Stockdale CR, Sun JK (2010) Randomized trial evaluating ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema. Ophthalmology 117:1064–1077 CrossRefPubMedPubMedCentral
Van Geest RJ, Lesnik-Oberstein SY, Tan HS, Mura M, Goldschmeding R, Van Noorden CJ, Klaassen I, Schlingemann RO (2012) A shift in the balance of vascular endothelial growth factor and connective tissue growth factor by bevacizumab causes the angiofibrotic switch in proliferative diabetic retinopathy. Br J Ophthalmol 96:587–590 CrossRefPubMedPubMedCentral
Bressler SB, Qin H, Beck RW, Chalam KV, Kim JE, Melia M, Wells JA (2012) Diabetic Retinopathy Clinical Research Network. Factors associated with changes in visual acuity and central subfield thickness at 1 year after treatment for diabetic macular edema with ranibizumab. Arch Ophthalmol 130:1153–1161 CrossRefPubMedPubMedCentral
Ciulla TA, Ying GS, Maguire MG, Martin DF, Jaffe GJ, Grunwald JE, Daniel E, Toth CA (2015) Comparison of Age-Related Macular Degeneration Treatments Trials Research Group. Influence of the vitreomacular interface on treatment outcomes in the comparison of age-related macular degeneration treatments trials. Ophthalmology 122:1203–1211 CrossRefPubMed
Montero JA, Ruiz-Moreno JM, De La Vega C (2008) Incomplete posterior hyaloid detachment after intravitreal pegaptanib injection in diabetic macular edema. Eur J Ophthalmol 18:469–472 PubMed
Erdurman FC, Pellumbi A, Durukan AH (2012) Lamellar macular hole formation in a patient with diabetic CME treated by intravitreal bevacizumab injections. Ophthalmic Surg Lasers Imaging 30:43
Gonzalez VH, Campbell J, Holekamp NM, Kiss S, Loewenstein A, Augustin AJ, Ma J, Ho AC, Patel V, Whitcup SM, Dugel PU (2016) Early and long-term responses to anti-vascular endothelial growth factor therapy in diabetic macular edema: analysis of Protocol I data. Am J Ophthalmol 172:72–79
- Vitreoretinal interface abnormalities in patients treatedwith ranibizumab for diabetic macular oedema
David H. W. Steel
Maged S. Habib
Peter J. Avery
The Sunderland Eye Infirmary study group
- Springer Berlin Heidelberg
- Graefe's Archive for Clinical and Experimental Ophthalmology
Incorporating German Journal of Ophthalmology
Print ISSN: 0721-832X
Elektronische ISSN: 1435-702X
Neu im Fachgebiet Augenheilkunde