Real-world management of treatment-naïve diabetic macular oedema : 2-year visual outcome focusing on the starting year of intervention from STREAT-DMO study

Background/aims To investigate the yearly change of real-world outcomes for best corrected visual acuity (BCVA) after 2-year clinical intervention for treatment-naïve diabetic macular oedema (DMO). Methods Retrospective analysis of aggregated, longitudinal medical records obtained from 27 retina specialised institutions in Japan from Survey of Treatment for DMO database. A total of 2049 treatment-naïve centre involving DMO eyes of which the initial intervention started between 2010 and 2015, and had been followed for 2 years, were eligible. As interventions, antivascular endothelial growth factor (VEGF) agents, local corticosteroids, macular photocoagulation and vitrectomy were defined. In each eye, baseline and final BCVA, the number of each intervention for 2 years was extracted. Each eye was classified by starting year of interventional treatment. Results Although baseline BCVA did not change by year, 2-year improvement of BCVA had been increased, and reached to +6.5 letters in the latest term. There is little difference among starting year about proportions of eyes which BCVA gained >15 letters, in contrast to those which lost >15 letters were decreased by year. The proportion of eyes receiving anti-VEGF therapy was dramatically increased, while those receiving the other therapies were gradually decreased. The proportion of eyes which maintained socially good vision of BCVA>20/40 has been increased and reached to 59.0% in the latest term. Conclusion For recent years, treatment patterns for DMO have been gradually but certainly changed; as a result, better visual gain, suppression of worsened eyes and better final BCVA have been obtained. Anti-VEGF therapy has become the first-line therapy and its injection frequency has been increasing

Real-world management of treatment-naïve diabetic macular oedema in Japan : two-year visual outcomes with and without anti-VEGF therapy in the STREAT-DME study

Background/Aims To investigate real-world outcomes for best-corrected visual acuity (BCVA) after 2-year clinical intervention for treatment-naïve, centr-involving diabetic macular oedema (DME). Methods Retrospective analysis of longitudinal medical records obtained from 27 institutions specialising in retinal diseases in Japan. A total of 2049 eyes with treatment-naïve DME commencing intervention between 2010 and 2015 who were followed for 2 years were eligible. Interventions for DME included anti-vascular endothelial growth factor (VEGF) therapy, local corticosteroid therapy, macular photocoagulation and vitrectomy. Baseline and final BCVA (logMAR) were assessed. Eyes were classified by the treatment pattern, depending on whether anti-VEGF therapy was used, into an anti-VEGF monotherapy group (group A), a combination therapy group (group B) and a group without anti-VEGF therapy (group C). Results The mean 2-year improvement of BCVA was −0.04±0.40 and final BCVA of >20/40 was obtained in 46.3% of eyes. Based on the treatment pattern, there were 427 eyes (20.9%) in group A, 807 eyes (39.4%) in group B and 815 eyes (39.8%) in group C. Mean improvement of BCVA was −0.09±0.39, –0.02±0.40 and −0.05±0.39, and the percentage of eyes with final BCVA of >20/40 was 49.4%, 38.9%, and 52.0%, respectively. Conclusion Following 2-year real-world management of treatment-naïve DME in Japan, BCVA improved by 2 letters. Eyes treated by anti-VEGF monotherapy showed a better visual prognosis than eyes receiving combination therapy. Despite treatment for DME being selected by specialists in consideration of medical and social factors, a satisfactory visual prognosis was not obtained, but final BCVA remained >20/40 in half of all eyes

Correlation between the Outcome of Vitrectomy for Proliferative Diabetic Retinopathy and Erythrocyte Hematocrit Level and Platelet Function

We investigate-d whether biomarkers such as red blood cell hematocrit (Hct), platelet count (PLT), mean platelet volume (MPV), and platelet distribution width (PDW) are useful prognostic indicators of postoperative macular edema (ME) after vitrectomy for proliferative diabetic retinopathy (PDR). A total of 42 eyes of 42 patients with PDR who underwent vitrectomy between January 2018 and May 2020 were analyzed retrospectively. We divided them into two groups according to whether treatment was required for postoperative ME and compared the relationship between Hct, PLT, MPV, and PDW and the onset of postoperative ME. The group that received postoperative treatment (group T) comprised 11 eyes of 11 patients, and the group that did not (group N) comprised 31 eyes of 31 patients. The age (years) was 52.0 ± 3.1 in group T and 60.0 ± 11.6 in group N. When appropriate statistical analysis was performed for comparison between groups, significant differences were found in age (p = 0.05), insulin use (p = 0.03), preoperative intraocular pressure (p = 0.05), diastolic blood pressure (p = 0.03), and Hct (p = 0.04). Multivariate logistic regression analysis was performed, and a significant difference was found in Hct (p = 0.02). These results suggest that Hct might be useful as a predictor of ME after PDR surgery

Optical coherence tomography findings as a predictor of clinical course in patients with branch retinal vein occlusion treated with ranibizumab

<div><p>Purpose</p><p>To examine the relationship between optical coherence tomography (OCT) images and clinical course in eyes with branch retinal vein occlusion (BRVO) treated with intravitreal ranibizumab injection (IVR).</p><p>Design</p><p>Prospective cohort study.</p><p>Participants</p><p>Thirty eyes of 30 patients with BRVO treated with IVR.</p><p>Methods</p><p>All patients received 1 initial IVR followed by repeated injections in the pro re nata (PRN) regimen. Correlations between logarithm of minimum angle of resolution best-corrected visual acuity (logMAR BCVA) or number of IVRs after 12 months and OCT parameters including the external limiting membrane (ELM), ellipsoid zone (EZ), interdigitation zone (IZ), and photoreceptor outer segment (PROS) length at first resolution of macular edema (ME) were assessed. Resolution of ME was defined as central foveal thickness <300 μm and the absence of subretinal fluid. OCT parameters influencing BCVA and number of IVRs were evaluated using multivariate analysis. Correlations between nonperfusion areas (NPAs) and thinning areas and changes in retinal thickness of BRVO-affected areas were assessed.</p><p>Results</p><p>Of the 30 patients, 27 completed this study and were included in the statistical analyses. The mean logMAR BCVA at 3, 6, and 12 months was 0.16 ± 0.19, 0.09 ± 0.20, and 0.07 ± 0.20, respectively, which improved significantly from baseline at each visit (p < 0.0001, respectively), while the mean number of IVRs at 12 months was 3.9 ± 2.2. The mean number of IVRs for the first resolution of ME was 1.6 ± 0.8. Eyes with ELM and EZ defects at the points of first resolution of ME were correlated with a significantly lower BCVA at 12 months compared with eyes with preserved ELMs and EZs (p = 0.035, p = 0.002, respectively). However, eyes with IZ defects at the points of first resolution of ME were not correlated with a significantly lower BCVA at 12 months compared with eyes with preserved IZs (p = 0.160). Defects in the EZ at the points of first resolution of ME significantly affected the number of IVRs at 12 months (p = 0.042), although the ELM and IZ did not. PROS length at the points of first resolution of ME was significantly correlated with BCVA and number of IVRs at 12 months (p = 0.006, p = 0.0008, respectively). In multivariate analysis, PROS length at the points of first resolution of ME had the most significant effect on BCVA and number of IVRs (p = 0.013, p = 0.012, respectively). NPA size on fluorescein angiography and thinning area on OCT within the macular area showed a significant correlation (p = 0.003, r = 0.971). The retinal thickness of ischemic BRVO-affected areas was significantly less than that of control areas at 10, 11, and 12 months (p = 0.001, p = 0.005, p = 0.003, respectively).</p><p>Conclusion</p><p>We showed that the 1+PRN regimen may be a useful therapy for ME due to BRVO. In addition, PROS length at points of first resolution of ME appears to be a good indicator of BCVA and number of IVRs in BRVO patients.</p></div

Relationship between optical coherence tomography (OCT) parameters and visual outcome or number of intravitreal ranibizumab injections (IVRs).

<p>(A) Correlation between logMAR BCVA at 12 months and the status of the ELM, EZ, and IZ. (B) Correlation between logMAR BCVA at 12 months and PROS length. (C) Correlation between the number of IVRs and the status of the ELM, EZ, and IZ. (D) Correlation between the number of IVRs and PROS length. OCT = optical coherence tomography; logMAR = logarithm of minimum angle of resolution; BCVA = best-corrected visual acuity; IVR = intravitreal ranibizumab injection; ELM = external limiting membrane; EZ = ellipsoid zone; IZ = interdigitation zone; PROS = photoreceptor outer segment.</p

Factors affecting BCVA and number of IVRs at 12 months in multivariate analysis.

<p>Factors affecting BCVA and number of IVRs at 12 months in multivariate analysis.</p

Fluorescein angiography (FA) images and color maps of retinal thickness using optical coherence tomography (OCT) images.

<p>(A, C) FA images of eyes with nonperfusion areas (NPAs) (shown in orange). (B, D) Color maps of eyes with NPAs which corresponded to the thinning areas (in blue) detected by OCT. (E) FA of eyes without NPAs. (F) The thinning areas were not detected in OCT.</p

Baseline patient characteristics.

<p>Baseline patient characteristics.</p