DME treatment evolves in favour of intravitreal anti-VEGF injections

By Lucy Piper, Senior medwireNews Reporter

Treatment strategies for diabetic macular oedema (DME) have evolved over the past decade, with focal laser therapy being largely replaced by intravitreal injections, an observational case series of more than 1500 patients shows.

This change has led to an increased frequency of patient visits to their physician, but also significant improvements in visual and anatomical outcomes, say the researchers.

The team studied the medical charts of 1862 patients who received treatment for DME at the Kentucky Lions Eye Center at the University of Louisville in the USA between 2003 and 2013. Of these, 372 (30%) were managed by laser photocoagulation during the course of the study.

This was the primary treatment modality used between 2003 and 2004. However, its use decreased over time, with only four of the 372 patients receiving laser photocoagulation between 2010 and 2013.

While the use of laser photocoagulation declined during the 10-year period, the use of intravitreal injections grew exponentially, from 0% of patients in 2003 to 100% in 2013.

Most patients received the anti-vascular endothelial growth factor (VEGF) bevacizumab (75.8%,) or a combination of bevacizumab and triamcinolone acetonide (9.5%), while 14.6% were treated with triamcinolone acetonide alone.

“The number of patients treated with triamcinolone acetonide has decreased over time in favour of bevacizumab monotherapy”, researcher Shlomit Schaal (University of Louisville, Kentucky, USA) and colleagues note in Retina.

As the number of intravitreal injections being used by DME patients increased, so did the improvements in visual acuity, increasing from an average 0.01 logMAR units (equivalent to less than 1 Snellen line) in 2003 to 0.3 logMAR units (equivalent to 2 Snellen lines) in 2013.

Improved visual acuity was paralleled by anatomical improvements. Central retinal thickness, measured using optical coherence tomography, decreased by an average 58 µm following treatment in 2004, but by 162 µm in 2013.

The one drawback with the increased use of intravitreal injections was a rise in the mean number of clinic visits made by patients with DME, from three per year in 2003 to nine per year in 2013.

“The landscape of therapeutic options for DME has changed dramatically with the introduction of anti-VEGF agents”, say Schaal et al.

They report: “Macular laser photocoagulation has been replaced by intravitreal injections of anti-VEGF agents as a principal therapy for DME based on their clinical superiority.”

The researchers acknowledge, however, that “many clinical questions remain unanswered” in this era of anti-VEGF therapy, including its long-term effects and ability to preserve vision.

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