Outcomes of intravitreal ranibizumab injections in treatment-naive diabetic macular edema patients with poor visual acuity

Session Details

Session Title: Free Paper Session 11: Vascular Diseases & Diabetic Retinopathy III

Session Date/Time: Friday 08/09/2017 | 11:00-12:30

Paper Time: 12:24

Venue: Room 114

First Author: : T.Ozturk TURKEY

Co Author(s): :    E. Catel   Z. Ayhan   M. Kaya   N. Kocak   S. Kaynak                 

Abstract Details

Purpose:

To report the outcomes of intravitreal ranibizumab injections (IRI) in treatment-naive diabetic macular edema (DME) patients with poor visual acuity.

Setting:

Dokuz Eylul University School of Medicine, Izmir, Turkey.

Methods:

The charts of 79 eyes of 60 treatment-naive DME patients with initial best-corrected visual acuity (BCVA) of ≥1.0 logMAR who underwent at least 3 consecutive monthly 0.5 mg IRI were reviewed retrospectively. Cases with a follow-up period of <6 months were excluded. Detailed ophthalmologic examinations including BCVA assessments, slit-lamp biomicroscopy, dilated fundoscopy, and optical coherence tomography (OCT) scans was performed at baseline and every follow-up visits scheduled monthly in the first 6 months of treatment procedure and maximum 2 month intervals thereafter; whereas fluorescein angiography (FA) was performed at baseline and every required visits. After the third injection, additional IRI was performed in eyes with more than 5 letters loss in BCVA and >100 µm increase in central macular thickness (CMT) when compared to scores obtained in the previous visit; however, a salvage panretinal photocoagulation (PRP) was scheduled in eyes with proliferative retinopathy.

Results:

Of the 60 patients with a mean age of 62.2±9.0 years, 24 (40%) were female and 36 (60%) were male. Mean duration of diabetes and HbA1c levels were 15.7±6.3 years and 7.8±1.1%, respectively. Mean number of IRI was 6.4±2.5, and PRP was performed in 89.9% of the study eyes within a mean follow-up of 12.2±5.8 months. Initial BCVA and CMT scores were found as 1.17±0.14 logMAR and 580.6±177.1 µm; whereas they were 0.91±0.28 logMAR and 452.0±156.7 μm at the last visit (p<0.001 for both). Initial OCT scans revealed external limiting membrane (ELM), ellipsoid zone (EZ), cone outer segment tips (COST) and retinal pigment epithelium (RPE) line integrities in 19.0%, 11.4%, 3.8%, and 83.5% of the study eyes; however, the integrity of such OCT layers were 25.3%, 11.4%, 10.1%, and 93.7% in the last visit, respectively. Alterations in the integrity of such layers were not found to be related with both 1 and 3 lines of increase in BCVA (p>0.05 for all).

Conclusions:

Scheduling a close follow-up and efficient treatment protocol are crucial for providing either stabilization or slightly increase in visual functions in DME cases with poor initial visual acuity. Deteriorations in outer retinal layers are prominent and mostly do not respond well to our treatment modalities in such cases who usually have inadequately metabolic controls.

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