Long-term outcomes of intravitreal therapy for symptomatic diabetic macular oedema in a real-world setting in Switzerland

Abstract

Objective To assess the long-term visual outcomes in eyes with symptomatic diabetic macular oedema (DME) under intravitreal treatment (IVT) in a clinical routine setting. Methods Patients with newly diagnosed DME were included in this retrospective study if they had received at least three IVTs and a follow-up period ≥ 2 years. Due to altered treatment patterns since the approval of ranibizumab for DME in 2012, patients were subdivided according to their first IVT before 2013 (group 1) or thereafter (group 2). The primary outcome measure was the evolution of best-corrected visual acuity (BCVA) over time. Results Of 217 eyes (191 patients) with DME, 151 eyes (117 patients) fulfilled the inclusion criteria (63 eyes in the first period, 88 in the second period). Mean follow-up time was 7.9 ± 3.1 (group 1) and 4.1 ± 1.4 years (group 2; p < 0.001). Visual gains were similar in the first year (group 1: + 5.3 ± 15.5, group 2: + 7.3 ± 12.2 Early Treatment Diabetic Retinopathy Study (ETDRS) letters; p = 0.44), but not thereafter (after 2 years in group 1: + 4.4 ± 15.0, group 2: + 8.3 ± 13.0 ETDRS letters; p = 0.038). During the first year, group 1 patients received less clinical examinations (group 1: 6.6 ± 3.3, group 2: 7.5 ± 2.1; p = 0.007) and less injections (group 1: 3.6 ± 2.7, group 2: 6.1 ± 2.7; p < 0.001). Conclusion A greater visual gain, in response to more intensive treatment during the first year, was maintained for at least 5 years in group 2 subjects. Our data confirm that in a real-world setting, early intensive treatment results in satisfying long-term visual outcomes.

Anti-VEGF Treatment of Diabetic Macular Edema in Denmark: Incidence, Burden of Therapy, and Forecasting Analyses

“…Here, the median number of injections for all patients was 5.0 in the first year, which fell to 3.0, 1.0, 0.0, and 0.0 in the 2nd, 3rd, 4th, and 5th years, respectively [ 19 ]. Zirpel et al reported Swiss long-term outcome data for 191 patients with DME and found that number of injections fell dramatically after the first year, and that loss to long-term follow-up was mainly due to discontinuation and referral back to the private ophthalmologist for screening and observation [ 20 ]. A multicenter retrospective study of 12 institutions in Latin America and Spain included 201 patients with DME for a study of 5-year outcomes after anti-VEGF therapy [ 21 ].…”

“…From a healthcare planning perspective, it is important to understand the number of injections over time in relation to patient burden to better plan adequate treatment facilities and services [ 11 , 12 ]. Unlike neovascular age-related macular degeneration (AMD), which requires continuing treatment for years for the majority of patients [ 13 , 14 , 15 , 16 ], in DME, studies report that the burden of anti-VEGF treatment is mainly in the first years of therapy [ 17 , 18 , 19 , 20 , 21 ]. This circumstance for DME presents an entirely different consideration than, e.g., neovascular AMD, in terms of the number of patients in active therapy when planning a large-scale, anti-VEGF therapy service for DME.…”

Visual outcomes of observation, macular laser and anti-VEGF in diabetic macular edema in type 1 diabetes: a real-world study

“…This is of particular importance when considering the necessity of functional vision for these working-aged, relatively young patients with T1D. Accordingly, the benefits of early intensive treatment with anti-VEGF has recently been shown to result in satisfying long-term visual outcomes [ 23 ]. Even in the cases of no BCVA improvement, anti-VEGF treatment may improve contrast sensitivity in DME patients [ 20 ], and thus provide the best long-time safety in maintaining good visual function.…”

Brolucizumab in Neovascular Age-Related Macular Degeneration and Diabetic Macular Edema: Ophthalmology and Diabetology Treatment Aspects

“…VEGF plays an essential role in diabetic retinopathy and is involved in the development of DME. As such, anti-VEGF therapies have shown efficacy in DME [9], and DME-related vision loss has decreased since their introduction [10,11]. Anti-VEGF therapy is now considered the standard of care, with additional laser photocoagulation and steroid injections as second-line options if required [12].…”

“…In 258 patients with DME, only 16% of patients had no fluid after 12 months of treatment with intravitreal aflibercept [30]. This lack of maintenance has been shown to differ depending on intensity of treatment, with increased healthcare visits and injection frequency associated with greater improvements in vision [11,26,31].…”