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Real-world Treatment Outcomes for Diabetic Macular Edema

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  • Title:
    Real-world Treatment Outcomes for Diabetic Macular Edema
  • Author: Bhandari, Sanjeeb
  • Subjects: cataract surgery outcomes ; diabetic macular edema ; real-world outcomes ; treatment outcomes ; vascular endothelial growth factor inhibitors
  • Description: Background Diabetic macular edema (DME) impairs vision and reduces the quality of life. Clinical trials of intravitreal vascular endothelial growth factor (VEGF) inhibitors and steroids for DME have reported remarkable improvements in visual acuity (VA) that had not been previously achieved with laser treatment. Aims This research was divided into three components with a common theme of evaluating real-world treatment outcomes of DME. The first component aimed to study the changes in the treatment patterns for DME in routine clinical practice from 2009 – 2019 and 5-year outcomes. The second component aimed to assess the outcomes of cataract surgery in eyes receiving intravitreal treatments for DME in routine clinical practice. The third aimed to compare the 12-month treatment outcomes of aflibercept with ranibizumab in eyes with DME. Methods These were retrospective analyses of data from a prospectively designed web-based outcomes registry – the Fight Retinal Blindness! Registry. The registry has implemented the DME module to collect data on eyes receiving intravitreal treatment for DME in routine clinical practice. Results Treatment choice changed to predominantly VEGF inhibitors from 2011 onwards. The choice of VEGF inhibitor changed from mainly off-label (bevacizumab) to mainly on-label (ranibizumab or aflibercept). The mean VA at baseline improved from 2009 to 2014 (58 and 68 letters) as did the mean VA change at 5 years (+4.5 and +5.3 letters). Eyes received fewer treatments than those in clinical trials throughout the period studied. The mean VA 6 months after cataract surgery improved and was similar to their matched phakic controls. The mean central subfield thickness (CST) both 6 months before (341μm) and after (360μm) surgery were similar (p=0.08). However, eyes which underwent cataract surgery had thicker maculae and received more injections than their matched controls both before and after surgery. Eyes receiving aflibercept or ranibizumab had improved vision and reduced macular thickness at 12 months when the 2 drugs were compared head to head for DME. Eyes receiving aflibercept had greater reduction in CST than those receiving ranibizumab. Among eyes with initial VA ≤ 20/50, larger VA gains were observed in eyes treated with aflibercept. Conclusions VEGF inhibitors became the preferred treatment for DME in real-world setting during the period studied, although they were given less often than in the pivotal clinical trials. Visual outcomes of cataract surgery in eyes with DME treatment were acceptable. Aflibercept outcomes were somewhat better than ranibizumab over the first 12 months of DME treatment. These findings may be a useful guide to clinicians as to the optimal management of eyes with DME. Source: TROVE
  • Creation Date: 2020
  • Language: English
  • Source: Trove Australian Thesis (Full Text Open Access)
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