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3-year outcomes similar in vitrectomized, non-vitrectomized eyes after ranibizumab treatment for DME
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BOSTON — Vitrectomized eyes fared as well as non-vitrectomized eyes after treatment with ranibizumab for diabetic macular edema, according to a study presented at Macula 2015.
“The efficacy of ranibizumab in the treatment of diabetic retinopathy is well established, but there remain some uncertainties in clinical management with ranibizumab for DME,” Jack Wells, MD, said. “There’s a common clinical impression that the duration of action of anti-VEGF injected in eyes with prior vitrectomy would be shorter than in eyes without prior vitrectomy due to more rapid clearing of the drug, and therefore the treatment would be less effective.”
To investigate that theory, Wells and colleagues at the Diabetic Retinopathy Clinical Research Network used 3-year data from the DRCR.net Protocol I to analyze eyes with and without vitrectomy before enrollment assigned to intravitreal Lucentis (ranibizumab, Genentech) with prompt or deferred laser.
“In this small group of eyes with vitrectomy prior to enrollment, the change in vision and OCT [central subfield thickness and volume] from baseline and the number of injections and lasers were fairly similar in eyes with and without prior vitrectomy, after you adjust for baseline imbalances,” he said.
Baseline differences in ocular characteristics of vitrectomized eyes included worse visual acuity and thinner maculas, as well as a greater likelihood to have undergone cataract surgery and previous treatment for DME. Non-vitrectomized eyes had milder diabetic severity scores, and vitrectomized eyes had greater tendency for proliferative disease.
“There was less rapid improvement in macular edema in vitrectomized eyes, but overall at the end of the 3 years, there were really no differences,” Wells said.
Disclosure: Wells is a consultant for Iconic and Panoptics and an investigator for Allergan, Amplo, Emmes, Genentech, Iconic, JCHR, KalVista, Lpath, Ophthotech, Regeneron and Panoptics.