Comparison of the Effectiveness of Intravitreal Ranibizumab for Diabetic Macular Edema in Vitrectomized and Nonvitrectomized Eyes

Abstract

Purpose: To compare the effectiveness of intravitreal ranibizumab (IVR) for diabetic macular edema (DME) between eyes with and without previous vitrectomy. Procedures: We prospectively assessed the best-corrected visual acuity (BCVA) and central macular thickness (CMT) after IVR for 6 months. Results: There were no significant differences in the baseline BCVA and CMT between both groups. In the nonvitrectomized group (n = 15), the mean changes of BCVA and CMT from baseline to month 6 were significant (p < 0.01). In the vitrectomized group (n = 10), the improvement appeared to be slower, and the mean BCVA improvement was not significant (p = 0.5), although the mean CMT decrease was significant (p < 0.05). There were no significant differences in the mean changes of BCVA and CMT between both groups at 6 months. Conclusions: The difference in the effectiveness of IVR between both groups was not significant. IVR can be a treatment option even for vitrectomized DME eyes.

Effectiveness of Intravitreal Ranibizumab in Nonvitrectomized and Vitrectomized Eyes with Diabetic Macular Edema: A Two-Year Retrospective Analysis

“…Chen et al [3] reported that the number of IVR injections was significantly less in nonvitrectomized than in vitrectomized eyes (4.1±0.6 vs. 5.1±0.7, respectively; p<0.001) during a 6-month period. In the study by Koyanagi et al [4], the number of IVR injections during the 6-month period was similar in both nonvitrectomized and vitrectomized eyes (4.5±1.2 vs. 4.9±1.3, respectively; p=0.484). In our study, the number of IVR injections until month 6 was significantly higher in nonvitrectomized eyes than vitrectomized eyes (3.2 vs. 1.3, respectively; p=0.04), which was probably due to the loading dose applied to the nonvitrectomized eyes in the first three months.…”

“…They reported significantly improved BCVA and central foveal thickness in nonvitrectomized eyes than in vitrectomized eyes. [3] Koyanagi et al [4] compared the efficacy of IVR in 10 vitrectomized and 15 nonvitrectomized eyes and reported no significant differences in the mean changes of BCVA and CMT between both groups at 6 months. Our short-term (6-month) findings in favor of nonvitrectomized eyes were in line with these reports.…”

“…Since 2010, anti-VEGF drug 3 injections have become standard therapy for DME with the proven benefit of improved visual acuity. [1][2][3][4][5][6] Vitrectomy as treatment for DME was first introduced for eyes with proliferative diabetic retinopathy (PDR), unresolving vitreous hemorrhage, significant vitreomacular traction commonly associated with shallow traction macular detachment, and persistent DME despite previous focal laser or intravitreal injections. Vitrectomy has recently been studied as potential primary therapy in eyes with more severe edema and greater visual acuity loss at presentation.…”

“…Compared to the baseline values, the decrease in both CMT and TMV was significant in months 6, 12, 18, and 24 in the nonvitrectomized group (p<0.05). In the vitrectomized group both CMT and TMV improved significantly only in months 18 and 24 (p<0.05) [ Figures 3,4].…”

Visual Outcomes Based on Early Response to Anti-Vascular Endothelial Growth Factor Treatment for Diabetic Macular Edema

“…This indicated that eyes with previous vitrectomy tended to show less improvement in visual acuity and that eyes with previous PRP or the disruption or disappearance of the ELM tended to show more improvement in visual acuity. Our previous studies suggested that an antiangiogenic shift occurs in the vitreous after vitrectomy and that the improvement is slower after intravitreal ranibizumab in patients with vitrectomized eyes [25,26]. This, in turn, would be expected to lead to a positive correlation with ΔBCVA M12 .…”