Vitrectomized versus non-vitrectomized eyes in diabetic macular edema response to ranibizumab—retinal layers thickness as prognostic biomarkers

Abstract

To evaluate the role of the vitreous in the management of diabetic macular edema with ranibizumab intravitreal injections in a pro re nata regimen. Prospective study of 50 consecutive eyes with diabetic macular edema treated with ranibizumab and 12 months of follow-up. Primary endpoint: to assess differences between non-vitrectomized and vitrectomized eyes in the number injections needed to control the edema. Secondary endpoints: comparison of groups regarding best corrected visual acuity, central foveal thickness and thickness of seven retinal layers. 46 eyes from 38 patients, 10 vitrectomized and 36 non-vitrectomized, completed the follow-up. At month 12, the two groups achieved an equivalent anatomical outcome and needed a similar number of ranibizumab intravitreal injections. In vitrectomized eyes final visual acuity was worse when baseline retinal nerve fiber layers in the central foveal subfield were thicker, showing a strong correlation (r = − 0.942, p < 0.001). A similar, albeit moderate correlation was observed in non-vitrectomized eyes (r = − 0.504, p = 0.002). A decrease of retinal nerve fiber layers inner ring thickness was correlated with a better final visual acuity only in vitrectomized eyes (r = 0.734, p = 0.016). The effect of diabetic macular edema seems to be worse in vitrectomized eyes, with a thinner inner retina reservoir.Clinicaltrials.govNCT04387604.

Effectiveness of intravitreal ranibizumab for diabetic macular edema in vitrectomized versus non-vitrectomized eyes: a Meta-analysis

“…After screening titles and abstracts 54 studies were excluded and 40 full-text articles were left for assessment. Finally, six non-randomized studies [13][14][15][16][17][18] in English were included in this Meta-analysis. The literature selection process is indicated in Figure 1.…”

“…The literature selection process is indicated in Figure 1. Characteristics of the Included Studies Characteristics of the included studies are shown in Table 1 [13][14][15][16][17][18] . A total of 641 eyes were included, with 112 eyes having vitrectomy before as the vitrectomized group and 529 eyes without previous vitrectomy as the non-vitrectomized group.…”

“…18, 2024 www.ijo.cn Tel: 8629-82245172 8629-82210956 Email: ijopress@163.com better final BCVA was discovered in the non-vitrectomized group than in the vitrectomized group (MD=0.18, 95%CI: 0.10 to 0.26, P<0.00001; Figure 2A). A total of 3 literatures [15][16][17] of 410 eyes compared the BCVA between vitrectomized group (45 eyes) and non-vitrectomized group (365 eyes) at 12mo, and showed statistically significant difference between two groups, in favor of the non-vitrectomized group (MD=0.13, 95%CI: 0.05 to 0.21, P=0.002; Figure 2A). The fixedmodel was applied for the evaluation of mean BCVA, and no heterogeneity was observed (I 2 =0).…”

“…Mean BCVA at 6 and 12mo At 6mo, data from four studies [13][14][16][17] assessing 247 eyes (77 vitrectomized eyes, 170 non-vitrectomized eyes) reported the BCVA. Significantly…”

Real-World Experience With Brolucizumab 6 mg for Diabetic Macular Edema

“…Besides other systemic factors involved in DME pathogenesis [ 1 , 24 , 25 ], we can hypothesize that non-responsive DME may be caused by the unaddressed mediators or by the requirement for higher or more frequent doses of anti-VEGF/corticosteroids intravitreal therapy. In these non-responsive cases, the treatment burden becomes unacceptable and requires a proactive change in therapeutic strategy to achieve efficacy such as combining anti-VEGF with CCT, considering the delivery of 0.19 mg fluocinolone acetonide implant and/or pars plana vitrectomy [ 14 , 26 ]. An improved potency and longevity of brolucizumab’s action appear to be influenced by its smaller size, molar dosage, and stronger affinity to VEGF [ 7 , 8 ].…”