Does HbA1c affect ranibizumab and aflibercept injection regimens for treatment of diabetic macular oedema?

Poster Details

First Author: A.Bruynseels UK

Co Author(s):    Z. Shalchi   R. Amin   R. Hamilton   R. Rajendram                    

Abstract Details


To investigate the effect of glycaemic control in patients with diabetes macular oedema on the number and frequency of ranibizumab and aflibercept treatment.


Moorfields Eye Hospital NHS Foundation Trust


This retrospective cohort study used data from eyes previously selected at random for use in another study. This cohort now has new data from over 3 years of injection treatment. Data has now also been divided into three patient groups according to glycaemic control measured through HbA1c level; HbA1c ≤ 59 mmol/mol (7.5%)), poor (HbA1c 60 – 86 mmol/mol (7.6%-10.0%)) and very poor (HbA1c ≥ 87 mmol/mol (10.1%)). This method separates injection treatment regimens for eyes with very poor HbA1c control. The eyes were of patients with diabetic macular oedema treated with ranibizumab and aflibercept from July 2013 to February 2017 across several sites: City Road, Ealing, Northwick Park and St George’s Hospital. Data were taken from Moorfields OpenEyes and diabetes nursing databases. Exclusion criteria were receiving fewer than 3 injections and incomplete follow up (less than 12 months). The first treated eye was chosen in patients where both eyes had received treatment. Where both eyes received initial treatment on the same day, random number tables selected the eye for analysis. Data were also collected on baseline characteristics including gain in visual acuity ETDRS letters, central subfoveal thickness (CSFT) and macular volume (MV).


311 eyes of 311 patients were included in this study. Of these, 141 (45%) patients had good glycaemic control, 139 (45%) poor control and 31 (10%) very poor control. The mean±standard deviation (SD) number of injections in the first year of treatment were not significantly different between all three glycaemic control groups (6.12±2.59 vs 6.40±2.27 vs 5.48±2.30, F(2,307) = 1.86, p=0.157). Furthermore the mean quarterly injection demand (ie mean number of injections in a 3 month period) were also similar across the three groups (2.55±2.02 vs 2.23±1.28 vs 2.52±2.06, F(2,308) = 1.24, p=0.289), as was the mean annual injection demand (10.19±8.11 vs 8.91±5.14 vs 10.07±8.25, F(2,308) = 1.26, p=0.284).


Glycaemic control does not affect the number and frequency of ranibizumab and aflibercept injections for treatment of diabetic macular oedema.

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