ABSTRACT
The apparent success of antiangiogenic therapy in patients with neovascular age-related macular degeneration (nAMD) shows the significance of effect prognosis and continuous observation. PURPOSE: to study the influence of prognostic factors on the dynamics of functional and morphological response during anti-VEGF therapy in patients with nAMD. MATERIAL AND METHODS: Retrospective analysis of anti-angiogenic therapy results was performed on the data of 1020 patients with nAMD. Some patients were put into two subgroups: 100 patients with retinal pigment epithelium detachment (PED) and 100 patients without PED. Comparative analysis of functional and morphological parameters was performed in the subgroups. RESULTS: Baseline visual acuity (VA) in patients with PED (0.14±0.1) was significantly (Ñ<0.05) lower than in patients without PED (0.32±0.21) and had negative correlation with PED presence (r=-0.61, Ñ<0.05). By the end of the 12 months follow-up Best Corrected Visual Acuity (BCVA) was 0.52±0.28 and 0.62±0.28 (Ñ>0.05) in patients with PED and without PED respectively. Mean number of injections in patients with PED was 5.7±2.5 compared to 3.5±1.2 in patients without PED (Ñ<0.05). After 12 months VA in patients with PED was associated with baseline BCVA (r=0.59, Ñ<0.05), VA after 4th injection (r=0.84, Ñ<0.05) and baseline retinal thickness (r=0.60, Ñ<0.05). CONCLUSION: PED in patients with nAMD was shown to be an unfavorable factor associated with significantly lower baseline BCVA that requires careful monitoring. At least three 'loading' injections are required to determine drug responsiveness and acquire functional and morphological response data. Correlation of BCVA values at different timepoints (baseline/after 3 'loading' doses/after 12 month) was found.
Subject(s)
Macular Degeneration , Neovascularization, Pathologic , Retinal Detachment , Angiogenesis Inhibitors , Humans , Intravitreal Injections , Prognosis , Ranibizumab , Retinal Pigment Epithelium , Retrospective Studies , Tomography, Optical Coherence , Visual AcuityABSTRACT
AIM: to investigate morphological changes and visual acuity response to ranibizumab therapy in patients with different OCT-types of diabetic macular edema (DME) as well as different state of the inner and outer photoreceptor segments (IS and OS) and the outer limiting membrane (OLM); to study relationships between functional and morphological parameters before and after the treatment; to study the effect of glycated hemoglobin levels on morphological parameters and ME duration. MATERIAL AND METHODS: The study included 113 patients (113 eyes) with DME, who underwent 3 once-monthly intravitreal injections of ranibizumab (the mean patient age, 63.5±2.2 years; men, 51.3%; type 2 diabetes, 81.4%). Basing on the results of OCT, 3 groups were formed: group 1 (40 patients) - intact IS and OS; group 2 (32 patients) - disturbed photoreceptor segments integrity, but intact OLM; group 3 (41 patients) - destruction of both layers. RESULTS: Visual acuity at baseline and after the treatment was the highest in group 1 (p<0.05). In all groups, most parameters that indicated the state of photoreceptor segments and the OLM improved. Correlation analysis revealed a statistically significant negative correlation between visual acuity at baseline and after the treatment and morphological parameters (p<0.05). There was also a direct correlation between the morphometric parameters at baseline and after the treatment (p<0.05). The most favorable type of DME in terms of preserving the integrity of photoreceptor segments and the OLM was sponge-like edema, while DME with neuroepithelial detachment and mixed-type DME were prognostically unfavorable. Moreover, the state of photoreceptors and the OLM depended on the duration of ME and the level of glycated hemoglobin. Thus, the integrity of the inner and outer photoreceptor segments as well as the outer limiting membrane can contribute to prognosis for functional outcomes in DME patients that receive antiangiogenic therapy.
Subject(s)
Diabetes Mellitus, Type 2/complications , Diabetic Retinopathy , Macular Edema , Photoreceptor Cells, Vertebrate , Ranibizumab , Visual Acuity/drug effects , Angiogenesis Inhibitors/administration & dosage , Angiogenesis Inhibitors/pharmacokinetics , Biological Availability , Diabetic Retinopathy/diagnosis , Diabetic Retinopathy/drug therapy , Diabetic Retinopathy/etiology , Female , Humans , Macular Edema/diagnosis , Macular Edema/drug therapy , Macular Edema/etiology , Male , Middle Aged , Photoreceptor Cells, Vertebrate/drug effects , Photoreceptor Cells, Vertebrate/pathology , Prognosis , Ranibizumab/administration & dosage , Ranibizumab/pharmacokinetics , Recovery of Function , Treatment OutcomeABSTRACT
AIM: to describe baseline functional and anatomical parameters of the macular region and how they change under ranibizumab therapy depending on the type of diabetic macular edema (DME) determined with optical coherence tomography (OCT). MATERIAL AND METHODS: The study included 100 patients (100 eyes) with diabetes mellitus and DME (38 men and 62 women) aged 61.9±5.6 years with the mean disease duration of 8.48 years. Basing on OCT findings, 4 groups (25 patients each) were formed: sponge-like DME, cystoid DME, DME with serous neuroepithelium detachment (NED), and mixed DME (cystoid DME and serous NED). All patients received 3 consecutive monthly injections of 0.5 mg ranibizumab. The relationship between anatomical, functional, and clinical parameters was analyzed. RESULTS: The lowest visual acuity (VA) at baseline was found in patients with mixed DME (Ñ<0.05). The greatest increase in VA after the 3 injections was noted in patients with sponge-like DME - 0.34±0.18. Retinal thickness was significantly lower (Ñ<0.05) in sponge-like DME as compared to other groups both at baseline and after the treatment. Foveolar thickness decreased after the treatment in all groups, the effect being the most pronounced (the edema got reduced by 42.4%, Ñ<0.05) in cystoid DME. The most significant reduction in macular volume (by 2.7 mm3) as well as its lowest absolute post-treatment values were reported for patients with cystoid edema (9.01 mm3, Ñ<0.05 as compared to sponge-like and mixed DME). Correlation analysis revealed an evident relationship between the improvement in VA (ΔVA) and the decrease in macular volume (Ñ<0.05). Of clinical parameters, only diabetes duration correlated with the extent of VA improvement (r=-0.3; p<0.05). CONCLUSION: The effectiveness of intravitreal ranibizumab therapy for diffuse DME depends on the morphological type of macular edema by OCT. Moreover, it correlates with diabetes duration.