Study of the effectiveness of antiangiogenic therapy for diabetic macular edema in avitreal eyes in real clinical practice

Abstract

Despite the vitrectomy performed for diabetic macular edema (DME), some patients still have symptoms of the disease due to overproduction of VEGF by the ischemic retina, which requires regular administration of an antiangiogenic drug. Studies of the pharmacokinetics of antiangiogenic drugs after vitrectomy in humans have not been carried out. Data from the DRCR.net (Post-Hawk Protocol I) study and real-life clinical practice studies show similar results for anti-VEGF DMO therapy in vitreous eyes and after vitrectomy (2, 7). Purpose. To assess the effectiveness of antiangiogenic therapy with aflibercept for DMO in avitreal eyes in real clinical practice. Methods. The initial and after vitrectomy best corrected visual acuity (BCVA) and central retinal thickness (CRT) were determined according to OCT data, then these parameters were monitored by 1, 3, 6 and 12 months after the start of antiangiogenic therapy with aflibercept. 14 patients (14 eyes) with persistent DME underwent vitrectomy with removal of the internal limiting membrane, in 5 of them the epiretinal fibrosis was removed and 3 of them with a traction retinal detachment that was also removed with air tamponade. Results. Aflibercept intravitreal injections were started with 5 loading doses by 1-11 months after vitrectomy. On average, after 12 months, patients received 7.2 injections, while there was no need for laser surgery of the macular zone. By the end of the study, the CRT decreased by 255 ±86 µm, the BCVA was 0.35 ± 0.2 in comparison with the initial 0.07±0.03 (on a decimal scale). Conclusions. The effectiveness of the anti-VEGF therapy with aflibercept for DME in avitreal eyes was confirmed by an increase in functional (BCVA) and normalization of morphological (CRT on OCT) parameters after the first injections during the period of loading doses. Previous vitrectomies in patients with DMO do not affect the long-term favorable clinical outcomes of anti-VEGF therapy with aflibercept. Key words: vitrectomy, diabetic macular edema, aflibercept, anti-VEGF, OCT, best corrected visual acuity, central retinal thickness.