Retrospective Analysis of Treatment Patterns in Pseudophakic Diabetic Macular Oedema Eyes Treated with Anti-VEGF

Abstract

Background/Objectives. Currently, in England, antivascular endothelial growth factor (anti-VEGF) is the first-line treatment for diabetic macular oedema (DMO) where central macular thickness (CMT) is ≥400 microns. In pseudophakic eyes with suboptimal response to first-line therapy, intravitreal corticosteroids may also be used. In practice, despite rigorous anti-VEGF therapy, suboptimal response occurs in nearly half of all eyes with DMO. The objective of this study was to investigate structural and functional outcomes and examine anti-VEGF treatment delivery in pseudophakic eyes receiving anti-VEGF injections for DMO. Methods. We performed a retrospective review of outcomes in 81 pseudophakic eyes with DMO that received at least 6 anti-VEGF injections. We reviewed baseline and posttreatment optical coherence tomography images, visual acuity, prescribing patterns, time taken to deliver anti-VEGF injections, and structural and functional outcomes. Results. It took an average of 913 ± 454.1 days to deliver a mean of 11.1 ± 4.7 anti-VEGF injections. Time from baseline to receiving the first 6 anti-VEGF injections was longer than 9 months in 74.7% (n = 59/79) of eyes. There was a mean gain of 1.6 letters (-0.03 logMAR) from baseline to the end point. After 5 anti-VEGF intravitreal injections, the mean CMT was 391.9 μm from 474.4 μm at baseline (p<0.0001). In 52 of 79 eyes (65.8%), more than one type of anti-VEGF agent was used. Conclusions. The anti-VEGF treatment used to treat these eyes with DMO was suboptimal, a finding consistent with recently published "real-world"data. There was a strong tendency for patients to be switched within the class to a second anti-VEGF agent.