Anti-angiogenic therapy in the treatment of diabetic macular edema in various variants of the vitreoretinal interface

Abstract

BACKGROUND: Anti-angiogenic therapy for diabetic macular edema (DME), recognized as the “gold standard”, is not always effective. When compensating for the general somatic status, it is necessary to search for local causes of DME resistance to anti-angiogenic therapy.

AIM: To study the effectiveness and features of anti-angiogenic therapy for DME in normal and pathological vitreoretinal interface (VRI).

MATERIALS AND METHODS: Patients who received anti-angiogenic therapy for 12 months, in addition to the standard examination, underwent optical coherence tomography with an assessment of morphometric parameters and VRI.

RESULTS: In addition to the groups of normal and pathological VRI, a group of transformation from pathological to normal VRI was identified. Visual acuity increases with normal VRI, decreases with pathological. OCT scores decrease in both groups. In the transformation group, an increase in vision and a decrease in OCT parameters were observed only after VRI transformation.

CONCLUSION: The pathologic condition of the VRI reduces effectiveness of anti-angiogenic therapy for DME, except for 10% of cases in which VRI is transformed into normal within 5-6 months from the start of treatment. These data should be taken into account when choosing a treatment strategy for DME.

Keywords

diabetic macular edema / vitreoretinal interface / vitreous detachment

References

[1] Dedov II, Shestakova MV, Mayorov AYu, et al., eds. Standards of specialized diabetes care. 9th edition. Diabetes mellitus. 2019;22(1S1):1–144. (In Russ.) DOI: 10.14341/DM221S1

[2] Дедов И.И., Шестакова М.В., Майоров А.Ю., и др. (ред.). Алгоритмы специализированной медицинской помощи больным сахарным диабетом. 9-й вып. // Сахарный диабет. 2019. Т. 22, № 1S1. С. 1–144. DOI: 10.14341/DM221S1

[3] Musat O, Cernat C, Labib M, et al. Diabetic macular edema. Rom J Ophthalmol. 2015;59(3):133–136.

[4] Musat O., Cernat C., Labib M., et al. Diabetic macular edema // Rom J Ophthalmol. 2015. Vol. 59, No. 3. P. 133–136.

[5] The Diabetic Retinopathy Clinical Research Network; Elman MJ, Aiello LP, Beck RW, et al. Randomized trial evaluating ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema. Ophthalmology. 2010;117(6):1064–1077. DOI: 10.1016/j.ophtha.2010.02.031

[6] Elman M.J., Aiello L.P., Beck R.W., et al.; Diabetic Retinopathy Clinical Research Network Randomized trial evaluating ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema // Ophthalmology. 2010. Vol. 117, No. 6. P. 1064–1077. DOI: 10.1016/j.ophtha.2010.02.031

[7] Mitchell P, Bandello F, Schmidt-Erfurth U, et al. The restore study: ranibizumab monotherapy or combined with laser versus laser monotherapy for diabetic macular edema. Ophthalmology. 2011;118(4):615–625. DOI: 10.1016/j.ophtha.2011.01.031

[8] Mitchell P., Bandello F., Schmidt-Erfurth U., et al. The restore study: ranibizumab monotherapy or combined with laser versus laser monotherapy for diabetic macular edema // Ophthalmology. 2011. Vol. 118, No. 4. P. 615–625. DOI: 10.1016/j.ophtha.2011.01.031

[9] Googe J, Brucker AJ, Bressler N, et al. Diabetic Retinopathy Clinical Research Network: randomized trial evaluating short-term effects of intravitreal ranibizumab or triamcinolone acetonide on macular edema after focal/grid laser for diabetic macular edema in eyes also receiving panretinal photocoagulation. Retina. 2011;31(6):1009–1027. DOI: 10.1097/IAE.0b013e318217d739

[10] Googe J., Brucker A.J., Bressler N., et al. Diabetic Retinopathy Clinical Research Network: randomized trial evaluating short-term effects of intravitreal ranibizumab or triamcinolone acetonide on macular edema after focal/grid laser for diabetic macular edema in eyes also receiving panretinal photocoagulation // Retina. 2011. Vol. 31, No. 6. P. 1009–1027. DOI: 10.1097/IAE.0b013e318217d739

[11] Yoon D, Rusu I, Barbazetto I. Reduced effect of anti-vascular endothelial growth factor agents on diabetics with vitreomacular interface abnormalities. Int Ophthalmol. 2014;34(4):817–823. DOI: 10.1007/s10792-013-9884-6

[12] Yoon D., Rusu I., Barbazetto I. Reduced effect of anti-vascular endothelial growth factor agents on diabetics with vitreomacular interface abnormalities // Int Ophthalmol. 2014. Vol. 34, No. 4. P. 817–823. DOI: 10.1007/s10792-013-9884-6

[13] Gatsu MV, Bayborodov YV. Kliniko-topograficheskaya klassifikatsiya diabeticheskikh makulopatiy. Diabetes mellitus. 2008;11(3):20–22. (In Russ.) DOI: 10.14341/2072-0351-5353

[14] Гацу М.В., Байбородов Я.В. Клинико-топографическая классификация диабетических макулопатий // Сахарный диабет. 2008. Т. 11, № 3. С. 20–22. DOI: 10.14341/2072-0351-5353

[15] Petrachkov DV, Budzinskaya MV, Arzhukhanov DD. The role of internal limiting membrane peeling in the treatment of diabetic macular edema. Vestnik Oftalmologii. 2020;136(4):359366. (In Russ.) DOI: 10.17116/oftalma2020136042359

[16] Петрачков Д.В., Будзинская М.В., Аржуханов Д.Д. Роль пилинга внутренней пограничной мембраны сетчатки в лечении диабетического макулярного отёка // Вестник офтальмологии. 2020. Т. 136, № 4. С. 359–366. DOI: 10.17116/oftalma2020136042359

[17] Faizrakhmanov RR, Bikbov MM, Kalanov MR, Gil’manshin TR. Ehffektivnost’ anti-VEGF-terapii pered vitrehktomiei u patsientov s proliferativnoi stadiei diabeticheskoi retinopatii. Modern technologies in ophthalmology. 2017;(1):310–314. (In Russ.)

[18] Файзрахманов Р.Р., Бикбов М.М., Каланов М.Р., Гильманшин Т.Р. Эффективность анти-VEGF-терапии перед витрэктомией у пациентов с пролиферативной стадией диабетической ретинопатии // Современные технологии в офтальмологии. 2017. № 1. С. 310–314.

RIGHTS & PERMISSIONS

ECO-vector LLC