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Predictive factors for the treatment outcome of refractory diabetic macular edema with ranibizumab in a clinical setting

Session Details

Session Title: Vascular Diseases and Diabetic Retinopathy II

Session Date/Time: Friday 18/09/2015 | 16:30-18:00

Paper Time: 16:38

Venue: Calliope

First Author: : I.Papandreou UNITED KINGDOM

Co Author(s): :    S. Srikaran   E. Mensah           

Abstract Details

PURPOSE:To evaluate possible predictive factors the treatment outcome of patients with refractory diabetic macular oedema with intravitreal ranibizumab (Lucentis).

Setting:

Prospective data was entered into an in house database of all patients being treated for refractory diabetic macular oedema at the Ophthalmology Department, Central Middlesex Hospital, London, UK.

Methods:

All patients received ranibizumab on a pro re nata basis after an initial loading phase of three injections. Best corrected visual acuity (BCVA) on the logMAR chart and the central retinal thickness (CRT) on the optical coherence tomography (OCT) scan were recorded at each visit. OCT images at baseline were graded for the integrity of the inner ellipsoid zone and external limiting membrane (ELM), form of the fovea contour and the existence of epiretinal membrane, vitreomacular traction, pigment epithelium detachment and exudates at the fovea. OCT was performed with the Spectralis OCT device (Heidelberg Engineering, Heidelberg, Germany) using the standard protocol of the clinic. Statistical analysis involved the Wilcoxon signed rank test, the Spearmann correlation test and the repeated measures ANCOVA test.

Results:

118 eyes of 86 patients were included in this study. The mean age was 67 years (range 43 - 83). 34 patients had received bevacizumab injections prior to ranibizumab licensing in the UK. The mean logMAR BCVA at baseline was 0.61 and correlated with the BVCA and CRT at 12 months (p=0.001 and 0.002 for bevacizumab naïve, p=0.001 and 0.006 for bevacizumab pretreated patients). The mean CRT was 531 μm and correlated with the CRT (p=0.001 and 0.031 for bevacizumab naïve and pretreated patients respectively) but not the BCVA at 12 months. In the patient group without previous bevacizumab treatment, an intact inner ellipsoid zone (p=0.017) and ELM (p=0.005) as well as the absence of ERM (p=0,022) resulted in a better BCVA after 12 months. The foveal contour, the existence of VMT, exudates or PED did not influence the outcome. A normal foveal contour and the absence of a PED led to a lower CRT during the first 12 months of treatment.In the group with previous bevacizumab treatment only the integrity of the inner ellipsoid zone seemed to influence the development of the BCVA and none of the OCT characteristics had a statistically significant effect on the CRT.

Conclusions:

The baseline BCVA is an important predictive factor for the structural and functional outcome of refractory diabetic macular oedema with ranibizumab. SD-OCT can also be a useful tool for predicting the functional results of diabetic macular oedema treatment with ranibizumab.

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