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Multicenter Study
. 2020 Sep;104(9):1209-1215.
doi: 10.1136/bjophthalmol-2019-315199. Epub 2019 Nov 29.

Real-world management of treatment-naïve diabetic macular oedema in Japan: two-year visual outcomes with and without anti-VEGF therapy in the STREAT-DME study

Masahiko Shimura  1 , Shigehiko Kitano  2 , Daisuke Muramatsu  3 , Harumi Fukushima  2 , Yoshihiro Takamura  4 , Makiko Matsumoto  5 , Masahide Kokado  6 , Jiro Kogo  7 , Mariko Sasaki  8 , Yuki Morizane  9 , Osamu Kotake  10 , Takashi Koto  11 , Shozo Sonoda  12 , Takao Hirano  13 , Hiroto Ishikawa  14 , Yoshinori Mitamura  15 , Fumiki Okamoto  16 , Takamasa Kinoshita  17 , Kazuhiro Kimura  18 , Masahiko Sugimoto  19 , Kenji Yamashiro  20 , Yukihiko Suzuki  21 , Taiichi Hikichi  22 , Noriaki Washio  23 , Tomohito Sato  24 , Kishiko Ohkoshi  25 , Hiroki Tsujinaka  26 , Sentaro Kusuhara  27 , Mineo Kondo  19 , Hitoshi Takagi  7 , Toshinori Murata  13 , Taiji Sakamoto  12 ; Japan Clinical Retina Study (J-CREST) group
Affiliations
Multicenter Study

Real-world management of treatment-naïve diabetic macular oedema in Japan: two-year visual outcomes with and without anti-VEGF therapy in the STREAT-DME study

Masahiko Shimura et al. Br J Ophthalmol. 2020 Sep.

Abstract

Background/aims: To investigate real-world outcomes for best-corrected visual acuity (BCVA) after 2-year clinical intervention for treatment-naïve, centr-involving diabetic macular oedema (DME).

Methods: Retrospective analysis of longitudinal medical records obtained from 27 institutions specialising in retinal diseases in Japan. A total of 2049 eyes with treatment-naïve DME commencing intervention between 2010 and 2015 who were followed for 2 years were eligible. Interventions for DME included anti-vascular endothelial growth factor (VEGF) therapy, local corticosteroid therapy, macular photocoagulation and vitrectomy. Baseline and final BCVA (logMAR) were assessed. Eyes were classified by the treatment pattern, depending on whether anti-VEGF therapy was used, into an anti-VEGF monotherapy group (group A), a combination therapy group (group B) and a group without anti-VEGF therapy (group C).

Results: The mean 2-year improvement of BCVA was -0.04±0.40 and final BCVA of >20/40 was obtained in 46.3% of eyes. Based on the treatment pattern, there were 427 eyes (20.9%) in group A, 807 eyes (39.4%) in group B and 815 eyes (39.8%) in group C. Mean improvement of BCVA was -0.09±0.39, -0.02±0.40 and -0.05±0.39, and the percentage of eyes with final BCVA of >20/40 was 49.4%, 38.9%, and 52.0%, respectively.

Conclusion: Following 2-year real-world management of treatment-naïve DME in Japan, BCVA improved by 2 letters. Eyes treated by anti-VEGF monotherapy showed a better visual prognosis than eyes receiving combination therapy. Despite treatment for DME being selected by specialists in consideration of medical and social factors, a satisfactory visual prognosis was not obtained, but final BCVA remained >20/40 in half of all eyes.

Keywords: diabetic macular oedema; multicentre study; real-world outcomes; treatment pattern.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
(A) Percentage of eyes with improvement by >15 letters from baseline. (B) Percentage of eyes with deterioration by >15 letters from baseline. Each graph shows all eyes (black bar), eyes given anti-vascular endothelial growth factor (VEGF) monotherapy (white bar), eyes given combination therapy (light-grey bar) and eyes not treated with anti-VEGF agents (dark-grey bar). Adapted from Shimura et al.
Figure 2
Figure 2
Percentage of eyes with ‘good’ final best-corrected visual acuity >20/40 (%). All eyes (black bar), eyes given anti-vascular endothelial growth factor (VEGF) monotherapy (white bar), eyes given combination therapy (light-grey bar) and eyes not treated with anti-VEGF agents (dark-grey bar). Adapted from Shimura et al.
Figure 3
Figure 3
(A) Percentage of eyes with both ‘good’ final best-corrected visual acuity (BCVA) >20/40 and ‘good’ baseline BCVA >20/40. (B) Percentage of eyes improving to ‘good’ final BCVA >20/40 from ‘poor’ baseline BCVA <20/40. Each graph shows all eyes (black bar), eyes given anti-vascular endothelial growth factor (VEGF) monotherapy (white bar), eyes given combination therapy (light-grey bar) and eyes not treated with anti-VEGF agents (dark-grey bar). Adapted from Shimura et al.
See this image and copyright information in PMC

References

    1. Yau JWY, Rogers SL, Kawasaki R, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care 2012;35:556–64. 10.2337/dc11-1909 - DOI - PMC - PubMed
    1. Das A, McGuire PG, Rangasamy S. Diabetic macular edema: pathophysiology and novel therapeutic targets. Ophthalmology 2015;122:1375–94. 10.1016/j.ophtha.2015.03.024 - DOI - PubMed
    1. Barham R, El Rami H, Sun JK, et al. Evidence-Based treatment of diabetic macular edema. Semin Ophthalmol 2017;32:56–66. 10.1080/08820538.2016.1228388 - DOI - PubMed
    1. Early Treatment Diabetic Retinopathy Study Research Group Photocoagulation for Diabetic Macular Edema, Report #1. Arch Ophthalmol 1985;103:1796–806. - PubMed
    1. Lewis H, Abrams GW, Blumenkranz MS, et al. Vitrectomy for diabetic macular traction and edema associated with posterior hyaloidal traction. Ophthalmology 1992;99:753–9. 10.1016/S0161-6420(92)31901-3 - DOI - PubMed

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