Efficacité du traitement par injections intravitréennes de Ranibizumab dans l’œdème maculaire diabétique

PURPOSE : To evaluate long-term functional and anatomical outcomes of intravitreal injection of Ranibizumab to treat diabetic macular edema (DME) in clinical practice.METHODS : A retrospective monocentric study was performed on patients treated for DME by intravitreal injections of Ranibizumab between 2011 and 2014, with a follow up of at least 18 months. Data collected included baseline demographics and ocular findings (initial and final visual acuity (VA), indirect biomicroscopy examination, retinal photographs, central macular thickness (CMT) on optical coherence tomography). Main outcome measures were mean change in VA at month 18 and 24. Secondary outcome measures were: proportion of eyes with gain ≥ 10 lettres ETDRS et ≥ 15 lettres ETDRS, mean change in CMT at month 18 and 24, number of injections during the follow-up, percentage of eyes in remission, and side effects during the follow-up.RESULTS : Sixty eight (68) eyes of 49 patients were included. Mean duration of follow-up was 25,2 ± 6,1 months [range 18 - 40,6 months]. Mean initial VA letter score was 53,9 ± 15,7 [1 – 83] and mean initial CMT was 532,5 ± 151,9 μm. Mean change in VA letter score was +8,7 ± 16,7 at month 18 and was maintained at month 24 (+8.7 ±14 letters). The mean change in CMT at month 18 and 24 was respectively -141,7 ± 144 μm and -152,8 ± 153 μm. The mean of number of intravitreal injections was 7,1 ± 1,9 (median = 7,5) from baseline to month 12; 2,4 ± 1,6 (median = 3) from months 12 to 18, and 2,25 ± 1,6 (median = 2) from months 18 to 24 for the 39 eyes followed during 24 months. At month 18, 19,1% of eyes (13/68 eyes) was considered in remission.CONCLUSION : Ranibizumab was effective in maintaining VA and CMT outcomes at month 18 and 24 in patients with DME in clinical practice, with a declining number of injections, confirming the results of randomized clinical trials.Objectif : Évaluer l’efficacité au long cours des injections intravitréennes de ranibizumab dans le traitement de l’oedème maculaire diabétique (OMD) en pratique clinique. Méthodes : Il s’agit d’une étude rétrospective monocentrique de patients présentant un OMD et traités par injection intravitréenne de Ranibizumab entre 2011 et 2014 et suivis au moins 18 mois. Les données recueillies étaient les données démographiques et ophtalmologiques avant et après traitement (meilleurecacuité visuelle corrigée (MAVC), examen en biomicroscopie indirecte, rétinophotographies, épaisseur maculaire centrale (EMC) par tomographie par cohérence optique). Le critère de jugement principal était la variation moyenne de la MAVC aux 18e et 24e mois. Les critères secondaires étaient : les pourcentages d’yeux ayant gagné ≥ 10 lettres ETDRS et ≥ 15 lettres ETDRS, la variation moyenne de l’EMC aux 18e et 24e mois, le nombre d’injections nécessaire au cours du suivi, le pourcentage d’yeux en rémission et les effets secondaires survenant durant le suivi. Résultats : Soixante-huit yeux de 49 patients ont été inclus. La durée moyenne de suivi était de 25,2 ± 6,1 mois. L’acuité visuelle et l’épaisseur maculaire centrale moyennes initiales étaient respectivement de 53,9 ± 15,7 lettres ETDRS, et 532,5 ± 151,9 μm. Le gain moyen d’acuité visuelle était de +8,7 ± 16,7 lettres à 18 mois et était maintenu à 24 mois après le début du traitement (+8.7 ±14 lettres). La diminution moyenne de l’EMC à 18 et 24 mois étaient respectivement de -141,7 ± 144 μm et -152,8 ± 153 μm. Le nombre d’injections intravitréennes moyen était de 7,1 ± 1,9 (médiane = 7,5) la 1ère année, 2,4 ± 1,6 (médiane = 3) entre 12 et 18 mois et 2,25 ± 1,6 (médiane = 2) entre 18 et 24 mois pour les 39 yeux suivi pendant 24 mois. À 18 mois, 19,1% des yeux (13/68) étaient considérés en rémission.CONCLUSION : Cette étude confirme l’efficacité du Ranibizumab en pratique clinique dans le traitement de l’OMD. Le gain d’acuité visuelle se maintient la 2ème année de traitement, avec une réduction du nombre d’injection

Optical Coherence Tomography Angiography to Distinguish Changes of Choroidal Neovascularization after Anti-VEGF Therapy: Monthly Loading Dose versus Pro Re Nata Regimen

Purpose. To compare the qualitative and quantitative choroidal neovascularization (CNV) changes after antivascular endothelial growth factor (anti-VEGF) therapy in treatment-naïve and treated eyes with age-related macular degeneration (AMD) using optical coherence tomography angiography (OCTA). Methods. Consecutive patients with neovascular AMD underwent multimodal imaging, including OCTA (AngioPlex, CIRRUS HD-OCT model 5000; Carl Zeiss Meditec, Inc., Dublin, OH) at baseline and at three monthly follow-up visits. Treatment-naive AMD patients undergoing anti-VEGF loading phase were included in group A, while treated patients were included in group B. Qualitative and quantitative OCTA analyses were performed on outer retina to choriocapillaris (ORCC) slab. CNV size was measured using a free image analysis software (ImageJ, open-source imaging processing software, 2.0.0). Results. Twenty-five eyes of 25 patients were enrolled in our study (mean age 78.32 ± 6.8 years): 13 treatment-naïve eyes in group A and 12 treated eyes in group B. While qualitative analysis revealed no significant differences from baseline to follow-up in the two groups, quantitative analysis showed in group A a significant decrease in lesion area (P=0.023); in group B, no significant change in the lesion area was observed during anti-VEGF therapy (P=0.93). Conclusion. Treatment-naïve and treated eyes with CNV secondary to neovascular AMD respond differently to anti-VEGF therapy. This should be taken into account when using OCTA for CNV follow-up or planning therapeutic strategies

Extended Injection Intervals after Switching from Ranibizumab to Aflibercept in Macular Edema due to Central Retinal Vein Occlusion

Purpose. To assess treatment interval extension after switching from ranibizumab to aflibercept intravitreal injections in macular edema (ME) due to central retinal vein occlusion (CRVO) with an insufficient response or frequent recurrences to initial treatment. Methods. CRVO eyes treated with ranibizumab injections on a treat-and-extend (TAE) basis with an insufficient response or frequent recurrences were switched to aflibercept. Primary endpoint was the change in injection intervals before and after the switch. Results. Eleven eyes were included in this retrospective bicentric study. Before switching, patients received a mean number of 15.3 ranibizumab injections (range, 6–34) during a mean follow-up of 23.4 months (range, 6–57). After switching to aflibercept, patients received a mean number of 12.4 injections (range, 6–20) during a mean follow-up of 25.5 months (range, 16–38). Treatment interval could be extended from 6.1 (range, 4–8) to 11 weeks (range, 8–16) (p=0.001) corresponding to a mean extension of injection interval of +4.9 weeks. Conclusion. In case of insufficient response or frequent recurrences of ME due to CRVO in patients treated with ranibizumab on a TAE basis, switching to aflibercept could allow extending treatment intervals, which could reduce the injection burden for these patients