Vitreoretinal interface abnormalities in patients treatedwith ranibizumab for diabetic macular oedema

Abstract

PurposeIntravitreal anti-vascular endothelial growth factor (VEGF) agents are effective in the treatment of central involving diabetic macular oedema (DMO). Vitreoretinal interface abnormalities (VRIA) are common in patients with DMO, and the effect of these on the response to anti-VEGF treatment is unclear. Furthermore the effect of anti-VEGF agents on the VRIA itself is uncertain.MethodProspective study of consecutive patients treated with ranibizumab (RZB) for DMO as part of routine clinical care in one eye unit over a 1-year period. Visual acuity (Va), central retinal thickness (CRT) and injection frequency data was recorded on an electronic database. Treatment was initiated with four monthly RZB injections and then a monthly PRN regime. All patients underwent high-density spectral-domain optical coherence tomography (SDOCT) at baseline and 12 months. The SDOCTs were graded by two observers masked to the outcome.ResultsOne hundred and four eyes (77 patients) were included in the analysis. The mean age was 62 years, and 62% were male. The mean presenting vision was 62 letters and CRT 472 μm. Eighty eyes retained stable Va, and 17 had an improvement in Va. At baseline, 39 eyes had associated focal vitreomacular adhesion (VMA) and by 12 months this reduced to 30 (p = 0.04), with 12 releasing VMA and three developing it. Patients with VMA had significantly better final Va than those without VMA. Improvement in CRT was greatest in those where VMA released during the study. Forty-five eyes had some degree of foveal involving epiretinal membrane (ERM) at baseline, and 28 were considered to have clinically significant ERM. There was no clinically relevant change in ERM during the study. Patients with significant ERM at baseline had a lower final vision. Multivariate analysis showed that ERM and more severe retinopathy at baseline were predictive of less visual improvement (p < 0.01). Shorter intraretinal cyst length, ERM and the absence of VMA at baseline were predictive of a worsened anatomical response (p < 0.001).ConclusionVRIA are related to outcome in patients treated with RZB. ERM was associated with a worsened visual and anatomic response, and VMA with an improved anatomical response particularly when spontaneous VMA release occurred during treatment. The presence and severity of ERM was not affected by RZB treatment.Electronic supplementary materialThe online version of this article (doi:10.1007/s00417-016-3562-0) contains supplementary material, which is available to authorized users.

Vitreomacular interface abnormalities in patients with diabetic macular oedema and their implications on the response to anti-VEGF therapy

“…It is lower than that reported in a recently published study, which found an ERM prevalence of 43% in a group of 77 patients (104 eyes) [10]. This study included eyes with higher stages of diabetic retinopathy (DR) at presentation [10]. …”

“…Wong and colleagues recently reported that the presence of an ERM at presentation was predictive of a more limited functional (visual acuity) and anatomical (CRT) response in a study including 77 patients (104 eyes) with DMO [10]. The prevalence of ERM in this study was high compared with that observed in the current study (43 versus 13%), and patients had higher stages of severity of diabetic retinopathy (80% with pre-proliferative and proliferative disease versus 51% with severe/very severe non-proliferative diabetic retinopathy (NPDR) or proliferative DR).…”

“…The reported prevalence of VMIA in patients with DMO ranges from 6.6 to 52.1%, depending on the diagnostic criteria and retinal imaging modality used [2, 6–10]. Only a few of these studies, however, used SD-OCT [9, 10].…”

“…Only a few of these studies, however, used SD-OCT [9, 10]. Recently, Akbar Khan et al used SD-OCT to image a cohort of patients with centre-involving DMO undergoing macular laser treatment and found a VMIA prevalence of 26% in this group [9].…”

“…Intravitreal injections of anti-VEGFs (or other substances) may alter the anatomical structure of the vitreous leading to changes in the status of the posterior hyaloid [10, 12]. The posterior hyaloid, previously attached, could detach as a result of these changes, and this could potentially modify the course of DMO, even leading to its resolution.…”