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.

Keywords: Aflibercept; Anti-VEGF; Consecutive case series; Diabetic macular oedema (DME); Long-term treatment; Ranibizumab; Real-world studies.

Fig. 1

a Evolution of best-corrected visual acuity (BCVA) over time (in ETDRS letters with 85 letters representing a BCVA of 1.0; mean ± standard error (SE)) in the full cohort. The distinctive loss in BCVA after 7 years of follow-up is likely related to an inherent selection bias. All patients not further systematically requiring treatment were referred back to their private ophthalmologists until DME recurrence. b Evolution of best-corrected visual acuity (BCVA) over time (in ETDRS letters; mean ± standard error (SE)) in two groups representing the periods from 2007 to 2012 and from 2013 to 2017

Fig. 2

a Change in central retinal thickness (CRT) in the full cohort over time (mean ± standard error (SE)). b Change in central retinal thickness (CRT) over time in the different time periods (mean ± standard error (SE)): the more pronounced macular oedema at diagnosis in group 1 provides evidence for a late referral early after introduction of this therapy