Catharina Busch1, Samantha Fraser-Bell2, Matias Iglicki3, Marco Lupidi4, Aude Couturier5, Voraporn Chaikitmongkol6, Ermete Giancipoli7,8, Patricio J Rodríguez-Valdés9, Pierre-Henry Gabrielle10,11, Inês Laíns12,13,14, Ana Rita Santos13,15, Zafer Cebeci16, Atchara Amphornphruet17, Valentin Degenhardt18,19, Jan-Darius Unterlauft18, Carlo Cagini4, Valérie Mané-Tauty5, Giuseppe D'Amico Ricci7,8, Isaac Hindi20,21, Kushal Agrawal22, Jay Chhablani23,24, Anat Loewenstein20,21,25, Dinah Zur20,21, Matus Rehak18. 1. Department of Ophthalmology, University Hospital Leipzig, Liebigstr. 10-14, 04103, Leipzig, Germany. busch.catharina@gmail.com. 2. Department of Ophthalmology, Sydney University, Sydney, Australia. 3. Private Retina Service, University of Buenos Aires, Buenos Aires, Argentina. 4. Department of Biomedical and Surgical Sciences, Section of Ophthalmology, University of Perugia, Perugia, Italy. 5. Department of Ophthalmology, Hôpital Lariboisière, AP-HP, Université Paris, 7 - Sorbonne Paris Cité, Paris, France. 6. Retina Division, Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. 7. Department of Surgical, Microsurgical and Medical Sciences, Eye Clinic, University of Sassari, Sassari, Italy. 8. Department of Biomedical Sciences, University of Sassari, Sassari, Italy. 9. Instituto de Oftalmología y Ciencias Visuales, Escuela de Medicina, Tecnológico de Monterrey, Monterrey, Mexico. 10. Department of Ophthalmology, Dijon University Hospital, Dijon, France. 11. UMR1324, INRA, Center for Taste and Feeding Behaviour, Dijon, France. 12. Faculty of Medicine, University of Coimbra, Coimbra, Portugal. 13. Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal. 14. Massachusetts Eye and Ear, Harvard Medical School, Boston, USA. 15. School of Allied Health Technologies, Polytechnic Institute of Porto, Porto, Portugal. 16. Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. 17. Department of Ophthalmology, Faculty of Medicine, Rajavithi Hospital, Rangsit University, Bangkok, Thailand. 18. Department of Ophthalmology, University Hospital Leipzig, Liebigstr. 10-14, 04103, Leipzig, Germany. 19. Department of Ophthalmology, University Hospital Heidelberg, Heidelberg, Germany. 20. Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. 21. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 22. Jupiter Hospital, Thane, India. 23. UPMC Eye Center, University of Pittsburgh, Pittsburgh, USA. 24. L.V. Prasad Eye Institute, Banjara Hills, Hyderabad, India. 25. Incumbent, Sydney A. Fox Chair in Ophthalmology, Tel Aviv University, Tel Aviv, Israel.
Abstract
AIMS: To provide 2-year follow-up data on eyes with diabetic macular edema (DME) that were non-responsive after three initial anti-vascular endothelial growth factor (VEGF) injections, comparing functional and anatomical outcomes under continued anti-VEGF therapy versus dexamethasone (DEX) implant. METHODS: Multicenter, retrospective chart review comparing eyes with treatment-naïve DME and a suboptimal response to a loading phase of anti-VEGF therapy (3 injections given monthly) which were then treated with (a) further anti-VEGF (n = 72) or (b) initially switched to DEX implant (n = 38). Main outcome measures were change in visual acuity (VA) and central subfield thickness (CST) from the end of the loading phase to 24 months. RESULTS: In 79% of the 12-month study population (87/110 eyes), 24-month data were available. One quarter of eyes in each group switched treatments during the second year. Eyes that were switched early to DEX implant maintained the functional and anatomical improvements at 24 months which were seen in the first year (from month 3: + 8.9 letters, - 214 µm). Eyes that were switched from anti-VEGF therapy to steroids in the second year improved VA and reduced CST at 24 months (from month 12: + 6.8 letters, p = 0.023; - 226 µm, p = 0.004). In eyes continued on anti-VEGF therapy, VA and CST were stable at 24 months (from month 3: + 2.8 letters, p = 0.254; - 24 µm, p = 0.243). Eyes that were non-responsive to anti-VEGF therapy for 12 months had similar chances to experience a VA gain from further therapy as eyes that were non-responsive for 3 months only (23.8 vs. 31.0%, p = 0.344). CONCLUSIONS: The beneficial effect of an early switch to DEX implant in DME non-responders seen at month 12 was maintained during the second year. A later switch from anti-VEGF to steroids still provided significant improvement. Eyes continued on anti-VEGF over a period of 24 months maintained vision. A quarter of eyes, which had not improved vision at 12 months, exhibited a delayed response to treatment.
AIMS: To provide 2-year follow-up data on eyes with diabetic macular edema (DME) that were non-responsive after three initial anti-vascular endothelial growth factor (VEGF) injections, comparing functional and anatomical outcomes under continued anti-VEGF therapy versus dexamethasone (DEX) implant. METHODS: Multicenter, retrospective chart review comparing eyes with treatment-naïve DME and a suboptimal response to a loading phase of anti-VEGF therapy (3 injections given monthly) which were then treated with (a) further anti-VEGF (n = 72) or (b) initially switched to DEX implant (n = 38). Main outcome measures were change in visual acuity (VA) and central subfield thickness (CST) from the end of the loading phase to 24 months. RESULTS: In 79% of the 12-month study population (87/110 eyes), 24-month data were available. One quarter of eyes in each group switched treatments during the second year. Eyes that were switched early to DEX implant maintained the functional and anatomical improvements at 24 months which were seen in the first year (from month 3: + 8.9 letters, - 214 µm). Eyes that were switched from anti-VEGF therapy to steroids in the second year improved VA and reduced CST at 24 months (from month 12: + 6.8 letters, p = 0.023; - 226 µm, p = 0.004). In eyes continued on anti-VEGF therapy, VA and CST were stable at 24 months (from month 3: + 2.8 letters, p = 0.254; - 24 µm, p = 0.243). Eyes that were non-responsive to anti-VEGF therapy for 12 months had similar chances to experience a VA gain from further therapy as eyes that were non-responsive for 3 months only (23.8 vs. 31.0%, p = 0.344). CONCLUSIONS: The beneficial effect of an early switch to DEX implant in DME non-responders seen at month 12 was maintained during the second year. A later switch from anti-VEGF to steroids still provided significant improvement. Eyes continued on anti-VEGF over a period of 24 months maintained vision. A quarter of eyes, which had not improved vision at 12 months, exhibited a delayed response to treatment.
Authors: Peter M Maloca; Christine Seeger; Helen Booler; Philippe Valmaggia; Ken Kawamoto; Qayim Kaba; Nadja Inglin; Konstantinos Balaskas; Catherine Egan; Adnan Tufail; Hendrik P N Scholl; Pascal W Hasler; Nora Denk Journal: Sci Rep Date: 2021-10-19 Impact factor: 4.379
Authors: Raymond S Douglas; Yao Wang; Roger A Dailey; Gerald J Harris; Sara T Wester; Jade S Schiffman; Rosa A Tang; Brian Fowler; James Fleming; Terry J Smith Journal: J Neuroophthalmol Date: 2021-12-01 Impact factor: 4.415