First Author: O.Eski Yucel TURKEY
Co Author(s): H. Birinci Y. Sullu
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To determine the role of baseline demographics, ocular and optic coherens tomography characteristics in predicting visual outcome in patients with diabetic macular edema (DME) treated with ranibizumab.
This retrospective study was conducted at the Ondokuz Mayis University Hospital, Samsun, Turkey.
The charts of 62 patients (97 eyes) who received pro re nata ranibizumab 0.5 mg for macular edema (ME) due to proliferative diabetic retinopathy were reviewed. The data recorded included demographic characteristics, ocular and spectral-domain optical coherence tomography (OCT) findings. Change from baseline in mean best-corrected visual acuity (BCVA) (Snellen Line) and central macular thickness (CMT) during 2 years were analysed. Eyes were divided into groups according to the level of visual acuity (VA) at the second year as decreased, unchanged and increased VA. Baseline demographics, ocular and optical coherence tomography findings were analyzed to determine the association with the VA at 2 year.
Thirty five (56.5%) males and 27 (43.5%) females with a mean age of 62.6±8.3 (47-86) years were included in the study. The mean durations of diabetes and ME were 14.6±3.6 (7-21) years and 5.1±3.5 (1-12) months. Macular edema was cystic in 58 (59.8%) and diffuse in 39 (40.2%) eyes. The proportions of serous retinal detachment, hard exudate (HE), vitreomacular adhesion, epiretinal membrane (ERM) and ellipsoid zone (EZ) disruption were 31 (32%), 44 (45.4%), 30 (30.9%), 13 (13.4%) and 17 (17.5%) at baseline. During the follow-up, ERM in 5 (5.2%), vitreomacular traction (VMT) in 7 (7.2%), and posterior vitreous detachment in 9 (9.3%) eyes developed. Nineteen (19.6%) eyes received macular laser theraphy. Cataract surgery was required in 4 (4.9%) of 82 phacic eyes. BCVA changed from 0.36±0.2 (0.1-0.9) to 0.46±0.2 (0.1-1.0), and CMT changed from 448.6±113.6 (306-829) to 340.2±96.8 (185-775)μ within 2 years (p<0.001). The average number of injections in the two-year period was 6.6±2.2 (2-11). The proportion of eyes with decreased, unchanged and increased VA were 13 (13.4%), 29 (29.9%), and 55 (56.7%), respectively. Cystic ME was higher in eyes with decreased VA (p=0.023). Females sex and HE were higher in eyes with unchanged VA (p=0.036 and p=0.017). Absence of HE and EZ disruption were higher in eyes with increased VA (p=0.026 and p=0.048). There was no association between other characteristics-findings and visual outcome.
Intravitreal ranibizumab provides significant benefits in visual acuity gain and anatomic improvement in eyes with DME. Cystic ME is a predictor for VA decreases. Females sex and HE are predictors for stable VA. Absence of HE and EZ disruption are predictors for VA increases.