The effect of posterior vitreous detachment on aflibercept response in diabetic macular oedema

Abstract

PurposeTo investigate the effect of posterior vitreous detachment (PVD) on aflibercept response in treatment-naïve diabetic macular oedema (DME).DesignA retrospective cohort study.MethodsOne hundred and fifty eyes of 150 treatment-naïve patients with DME were enrolled. The patients were divided into three groups according to their PVD status: group 1 (no PVD during injections), group 2 (PVD during injections) and group 3 (PVD already present initially). Three consecutive aflibercept injections at intervals of 1 month were applied to all patients. The efficacy of the aflibercept treatment on DME was assessed by comparing changes in central retinal thickness (CRT) and best-corrected visual acuity (BCVA) values after three loading dose injections.ResultsAfter three consecutive injections, the mean reduction of CRT in groups 1, 2 and 3 were −199.6±106.9, −224.9±124.1 and −210.7±126.3, respectively. The decrease in CRT was significant in all groups (p<0.001 in all groups, paired-samples t-test); however, mean changes in CRT were similar among groups (all p>0.05, one-way analysis of variance (ANOVA)). The mean improvement in BCVA in groups 1, 2 and 3 was 6.6±0.9, 6.5±0.8 and 6.1±0.4 ETDRS letters, respectively. The improvement of BCVA was significant in all groups (p<0.001 in all groups, paired-samples t-test) and mean changes were similar between groups (p>0.05, one-way ANOVA). There was no significant relationship between the presence or development of PVD and the mean decrease of CRT and improvement of BCVA (for CRT r=−0.052, p=0.531 and for BCVA r=−0.078, p=0.342).ConclusionIn the present study, it was observed that the efficacy of aflibercept treatment in patients with DME did not depend on PVD status.

Comparison of Posterior Hyaloid Assessment Using Preoperative Optical Coherence Tomography and Intraoperative Triamcinolone Acetonide Staining During Vitrectomy

“…In a clinical setting, posterior hyaloid status has been found not to affect the efficacy of intravitreal injection courses for diabetic macular edema or age-related macular degeneration. [10][11][12] However, in patients who have received therapy with intravitreal ocriplasmin for symptomatic vitreoretinal adhesion, 13 ellipsoid zone disruption has been suggested to be a preexisting finding of the disease, leading to lack of visual improvement after treatment.…”

One-Year Outcome of Aflibercept Intravitreal Injection in Vitrectomized Eyes with Diabetic Macular Edema

“…13,22 In the same way, Ozsaygili et al also reported that the efficacy of Aflibercept is independent of the posterior vitreousdetachment (PVD) in DME. 23 In the APOLLON study 24 including real-world patients with DME treated in France, change in VA was +7.8 ± 12.3 letters in treatment-naïve patients and +5 ±11.3 letters in previously treated eyes with mean number of 7.6 injections. Visual gain of +4.6 letters at 6 months and of +6 letters at 1 year in our study is encouraging since these vitrectomized eyes presented multiple indicative of disease severity and worse visual prognosis of OCT biomarkers (hyperreflective foci, DRIL, EZ disruption, ELM disruption) at baseline.…”

“… 13 , 22 In the same way, Ozsaygili et al also reported that the efficacy of Aflibercept is independent of the posterior vitreousdetachment (PVD) in DME. 23 …”