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Visual acuity driven versus OCT driven: comparison of two different treatment regimens for the treatment of diabetic macular edema with ranibizumab

Session Details

Session Title: Vascular Diseases and Diabetic Retinopathy

Session Date/Time: Friday 18/09/2015 | 11:00-12:30

Paper Time: 11:32

Venue: Calliope

First Author: : M.Zinkernagel SWITZERLAND

Co Author(s): :    D. Waldmeier   A. Ebneter   S. Wolf        

Abstract Details

PURPOSE:To compare a visual acuity driven retreatment regimen with an optical coherence tomography (OCT) driven retreatment regimen in diabetic macular edema (DME).


Retrospective comparative case series at a tertiary referral center


Fourty seven eyes of 47 patients with treatment naïve DME requiring ranibizumab treatment were included in this study. Twenty two patients were treated with an OCT guided treat and extend regimen and 25 patients were treated with a visual acuity guided regimen adhering to the RESTORE study protocol. The primary outcome was the mean change in visual acuity and central retinal thickness (CRT) over the course 1 year. Secondary outcomes were number of injections and number of visits over the course of 1 year.


The mean improvement in the visual-acuity letter score at 1 year 7.6 (SD± 9) for the treat and extend group and 7.3 (SD± 12) for the RESTORE group and therefore similar between the two groups. The reduction of CRT was -109.90 μm (SD± 115) in the treat and extend group and -69.68 μm (SD± 86) in the RESTORE group which was not significant. The mean number of intravitreous injections administered (maximum possible injections, 13) was 9 (SD± 1.8) in the treat and extend group and 5.8 (SD± 1.8) in the RESTORE group (P< 0.0001).


After 1 year of continuous intravitreal treatment with ranibizumab improvement of visual acuity was similar between an OCT guided and a visual acuity guided retreatment regimen for DME. However, the visual acuity driven retreatment regimen required significantly less frequent therapy. These results suggest that OCT driven retreatment criteria may lead to overtreatment as extrafoveal fluid may influence retreatment decisions but may not affect visual acuity.

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