One-Year Functional and Morphological Prognosis After Intravitreal Injection Treatments According to Different Morphological Patterns of Diabetic Macular Edema in Real-Life: MARMASIA Study Group Report No.13

• Published in: Seminars in ophthalmology 2024-08, Vol.39 (6), p.460-467
• Main Authors: Limon, Dr Utku, Kaplan, Fatih Bilgehan, Saygın, Işılay, Önder Tokuç, Ecem, Kutlutürk Karagöz, Işıl, Kanar, Hatice Selen, Sevik, Mehmet Orkun, Yayla, Uğur, Çelik, Erkan, Sönmez, Ayşe, Aykut, Aslan, Kumral Türkseven, Esra, Erçalık, Nimet Yeşim, Oncu Aydın, Özlem, Bozkurt, Erdinç, Aydoğan, Tuğba, Emengen, Ece Başaran, Özkaya, Abdullah, Açıkalın Öncel, Banu, Yenerel, Nursal Melda, Şahin, Özlem, Karabaş, Levent
• Format: Article
• Language: English
• Subjects: Aged; Angiogenesis Inhibitors - administration & dosage; Angiogenesis Inhibitors - therapeutic use; Diabetic Retinopathy - diagnosis; Diabetic Retinopathy - drug therapy; Diabetic Retinopathy - physiopathology; Female; Follow-Up Studies; Glucocorticoids - administration & dosage; Humans; Intravitreal Injections; Macula Lutea - diagnostic imaging; Macula Lutea - pathology; Macular Edema - diagnosis; Macular Edema - drug therapy; Macular Edema - etiology; Macular Edema - physiopathology; Male; Middle Aged; Prognosis; Ranibizumab - administration & dosage; Receptors, Vascular Endothelial Growth Factor - administration & dosage; Receptors, Vascular Endothelial Growth Factor - therapeutic use; Recombinant Fusion Proteins - administration & dosage; Retrospective Studies; Tomography, Optical Coherence - methods; Vascular Endothelial Growth Factor A - antagonists & inhibitors; Visual Acuity - physiology
• ISSN: 0882-0538; 1744-5205; 1744-5205
• DOI: 10.1080/08820538.2024.2324450

To evaluate the responses of different optical coherence tomography (OCT) patterns of diabetic macular edema (DME) to intravitreal injection therapy. In this retrospective, comparative, and multicenter study, patients who had previously untreated DME, who received intravitreal ranibizumab (IVR) or aflibercept (IVA) and/or steroid treatment with the pro re nata (PRN) treatment regimen after a 3-month loading dose, and had a 12-month follow-up in the MARMASIA Study Group were included. Morphological patterns of DME were divided into four groups based on OCT features diffuse/spongious edema (Group 1), cystoid edema (Group 2), diffuse/spongious edema+subretinal fluid (SRF) (Group 3), and cystoid edema+SRF (Group 4). Changes in central macular thickness (CMT) and best-corrected visual acuity (BCVA) at months 3, 6, and 12, and the number of injections at month 12 were compared between the DME groups. 455 eyes of 299 patients were included in the study. The mean baseline BCVAs [Logarithm of the Minimum Angle of Resolution (logMAR)] in groups 1, 2, 3, and 4 were 0.54 ± 0.24, 0.52 ± 0.25, 0.55 ± 0.23, and 0.57 ± 0.27, respectively. There was no significant difference between the baseline mean BCVAs between the groups (  = .35). The mean BCVAs were significantly improved to 0,47 ± 0,33 in group 1, 0,42 ± 0,33 in group 2, 0,47 ± 0,31 in group 3, and 0,45 ± 0,43 at month 12. There was no significant difference between the groups in terms of BCVA change at month 12 (  = .71). The mean baseline CMTs in groups 1, 2, 3, and 4 were 387,19 ± 128,19, 447,02 ± 132,39, 449,12 ± 109,24, and 544,19 ± 178,61, respectively. At baseline, the mean CMT was significantly higher in Group 4 than in the other groups (  = .000). The mean CMTs were significantly decreased to 325,16 ± 97,55, 334,94 ± 115,99, 324,33 ± 79,20, and 332,08 ± 150,40 in four groups at month 12 respectively (  > .05). The groups had no significant difference in mean CMT at month 12 (  = .835). The change in CMT was significantly higher in Group 4 than in the other groups at month 12 (  = .000). The mean number of intravitreal anti-VEGF injections at month 12 was 4.51 ± 1.57 in Group 1, 4.63 ± 1.54 in Group 2, 4.88 ± 1.38 in Group 3, and 5.07 ± 1.49 in Group 4. The mean number of anti-VEGF injections in Group 1 and Group 2 was significantly lower than in Group 4 (  = 0,014 and  = 0,017). In real life, there was no significant difference between the DME groups in terms of visual improvement at month 12. However, bett