Effect of Macular Ischemia on Intravitreal Ranibizumab Treatment for Diabetic Macular Edema

Abstract

Purpose: To evaluate the impact of macular ischemia on the functional and anatomical outcome after intravitreal injections of ranibizumab for the treatment of diabetic macular edema (DME). Procedures: Participants were 49 patients with diabetes mellitus, divided into two groups based on the presence of ischemia on fluorescein angiography: (i) nonischemic group (n = 32) and (ii) ischemic group (n = 17). All patients were treated with intravitreal ranibizumab and were followed up for 6 months. The main outcome measures were changes in visual acuity (VA) and central foveal thickness (CFT). Results: There was a statistically significant improvement in VA and CFT between baseline and the end of the follow-up in the nonischemic group, while in the ischemic group there was no significant difference in VA but CFT differed significantly at the 6-month follow-up. Conclusions: Macular ischemia may have a negative impact on functional outcomes 6 months after intravitreal ranibizumab treatment in patients with DME but has no effect on anatomical outcomes.

Intravitreal injection of a Rho-kinase inhibitor (fasudil) combined with bevacizumab versus bevacizumab monotherapy for diabetic macular oedema: a pilot randomised clinical trial

“…The FAG images were evaluated according to the consensus of two independent graders blinded to the experimental treatments; the graders defined macular ischaemia as a foveal avascular zone (FAZ) wider than 1000µm and/or broken perifoveal capillary rings at the borders of the FAZ with distinct areas of capillary non-perfusion within one disc diameter of the foveal centre in the transit phase of FAG. 12 Based on these criteria, diabetic macular ischaemia was identified as absent or present. The agreement between the two graders was κ=75.6% (95%CI 55.6% to 95.76%).…”

Clinical effect of conbercept on improving diabetic macular ischemia by OCT angiography

“…Macular ischemia is a contraindication of anti-VEFG therapy, but some patients developed capillary nonperfusion after such therapy. Severe macular ischemia may be a limitation of visual acuity outcomes in patients with DME after receiving anti-VEGF therapy [16]. However, trials in DME suggested that anti-VEGF therapy did not induce retinal ischemia at least in healthy retina.…”

Reply to the Comment by Ilhan et al. on Our Paper Entitled ‘Effect of Macular Ischemia on Intravitreal Ranibizumab Treatment for Diabetic Macular Edema'

“…Our results demonstrated that macular ischemia may have a negative impact on functional outcome at the 6-month follow-up after intravitreal ranibizumab treatment in patients with diabetic macular edema (DME), while an anatomical improvement was noticed, as indicated by the decrease in central retinal thickness [2]. This finding is in line with Chung et al [3] who reported that, after a short-term follow-up, macular ischemia is a negative prognostic factor of visual outcome in patients with DME treated with intravitreal bevacizumab.…”

“…This finding is in line with Chung et al [3] who reported that, after a short-term follow-up, macular ischemia is a negative prognostic factor of visual outcome in patients with DME treated with intravitreal bevacizumab. Both studies suggested that macular ischemia and subsequent chronic hypoxia cause irreversible damage to photoreceptors, resulting in poor visual outcome despite the structural restoration and resolution of DME after the use of anti-vascular endothelial growth factor agents [2,3]. Therefore, the principal message of our study was not to avoid intravitreal anti-vascular endothelial growth factor agents in patients with ischemic DME, but to use them with caution, taking into account that the final visual outcome may not be promising.…”