Vitrectomy may be cost-effective alternative to pharmacotherapy in DME

FLORENCE, Italy — In well-selected cases, vitrectomy might be a good and cost-effective alternative to pharmacotherapy for the treatment of diabetic macular edema, according to one specialist.

At the FLOREtina meeting, J. Fernando Arevalo, MD, said that there is a rationale for vitrectomy because surgery removes traction, eliminates vasoproliferative factors, improves oxygenation and consequently reduces edema. However, the use of vitrectomy in DME is not supported by good clinical evidence.

J. Fernado Arevalo

“Most studies on this topic, including the DRCR.net studies, lacked consistent enrollment criteria, control groups and standardized measurements of VA, but most importantly did not include SD-OCT,” he said.

More recent studies using spectral-domain OCT found that intact IS/OS lines are predictors of best visual outcomes after surgery and potentially established some criteria for selecting patients.

Interesting evidence also came from the European VitreoRetinal Society Macular Edema Study, involving 86 retina specialists from 29 countries. They provided information on 2,503 patients with macular edema, including 870 patients with DME. In this subset of patients, treatment with vitrectomy and internal limiting membrane peeling alone resulted in better visual improvement compared with other therapies.

“With diabetes growing to epidemic proportions, private insurers and national health care systems will be unable to sustain anti-VEGF costs. A long-lasting, reasonably priced treatment of DME is needed,” Arevalo said.

Costs associated with vitrectomy are generally front-loaded, and in a 2-year perspective, they are only one-tenth of those incurred by anti VEGF therapy, he said. – by Michela Cimberle

Reference:

Adelman R, et al. Biomed Res Int. 2015;doi:10.1155/2015/352487.

Disclosure: Arevalo reports he is a consultant to Alcon and DORC.