First Author: C.Farinha PORTUGAL
Co Author(s): C. Coelho A. Neves F. Gomes P. Neves R. Soares R. Silva
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Anti-VEGF therapy is currently the mainstay for diabetic macular edema (DME) treatment. The purpose of this study was to evaluate the 2-year outcome of ranibizumab for DME in the real-life clinical practice of 5 ophthalmology centres of the National Health Service in Portugal.
Centro Hospitalar e Universitário de Coimbra, Ophthalmology Department, Coimbra, Portugal
Multicentre retrospective study. The clinical records of consecutive patients with DME from regular clinical practice treated with 0.5 mg intravitreal ranibizumab and 24-months follow-up were reviewed. Efficacy outcomes included change in BCVA and CMT evaluated with Spectralis OCT (Heidelberg Engineering, Germany), or Cirrus OCT (ZEISS, California, USA). Multivariate regression analysis was performed to determine predictors of BCVA.
122 eyes of 93 patients were included. Median BCVA and CMT at baseline were 60.0 (IQR 28.0) letters and 443.0 (IQR 184.0) µm, respectively. Median change at 24 months was +5.0 (IQR 12.0) letters and -89.0 (IQR 165.0) µm (p<0.001). At 24 months 21.4% of eyes gained ≥15 letters and 8.6% lost ≥15 letters. The median number of injections given over the 24-month period was 5.0 (IQR 4.0). In multivariate analysis, a higher CMT and more disrupted ELM status at baseline were predictive of worse BCVA at 24 months (p≤0.015).
Although our outcomes were inferior to those reported in major clinical trials, ranibizumab treatment still provided functional gain in the real-world clinical setting. However, this is also evidence that undertreating patients is the norm, and awareness of this is fundamental to redefining the retreatment paradigm in countries with more restrict access to these medications.