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

Bernardete Pessoa, João Leite, João Heitor, João Coelho, Sérgio Monteiro, Constança Coelho, João Figueira, Angelina Meireles, João Nuno Melo-Beirão, Bernardete Pessoa, João Leite, João Heitor, João Coelho, Sérgio Monteiro, Constança Coelho, João Figueira, Angelina Meireles, João Nuno Melo-Beirão

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.

Conflict of interest statement

The authors declare no competing interests.

© 2021. The Author(s).

Figures

Figure 1
Figure 1
BCVA evolution from baseline to the end of follow-up. Mean ± 95% CI. p = ns at each time point using the Mann–Whitney U test.
Figure 2
Figure 2
CFT evolution from baseline to the end of follow-up. Mean ± 95% CI. p = ns at each time point using the Mann–Whitney U test.
Figure 3
Figure 3
Retinal layers were identified by automatic segmentation in SD-OCT—retinal nerve fibre layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL) and outer retinal layer (ORL)—between the external limiting membrane and the bruch membrane (top panel). The mean thickness of each individual retinal layer was analysed in: (1) the nine individual ETDRS subfields (A); the fovea (or central circle with a diameter of 1 mm) (B); the inner ring ETDRS subfields (C); the outer ring ETDRS subfields (D); and globally (I). For RNFL and GCL the mean layer thicknesses of the outer and inner temporal (E), nasal (F), superior (G) and inferior (H) (bottom panel). Bottom panel adapted from Won et al..

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