Two Year Visual Acuity and Structural Outcomes in Patients with Diabetic Macular Oedema Treated with Intravitreal Aflibercept – A Retrospective Cohort Study

ABSTRACTPURPOSETo evaluate visual acuity (VA) outcomes of intravitreal anti-vascular endothelial growth factor (VEGF) in diabetic macular oedema (DMO).METHODSIn this retrospective cohort study, electronic medical records for all patients undergoing intravitreal injections (IVI) in a tertiary referral centre between March 2013 and October 2018 were analysed. Treatment response in terms of visual acuity outcomes were reported for all eyes over a 4-year observation period.RESULTSOur cohort includes 2616 DMO eyes of 1965 patients over 48 months. Cox proportional hazards modelling identified injection number (hazard ratio [HR] = 1.18), male gender (HR = 1.13), and baseline VA (HR = 1.09) as independent predictors to reach a favorable visual outcome of more than 70 Early Treatment Diabetic Retinopathy Study (ETDRS) letters. Half of our cohort reached 70 letters 1.9 months after starting anti-VEGF therapy. Of those that reached 70 letters, 50% fell below 70 by 14.7 months.CONCLUSIONTo date, this is the largest single centre cohort study and over the longest observation period reporting on real-life outcomes of anti-VEGF in DMO. We have made an anonymised version of our dataset available on an open-source data repository as a resource for all clinical researchers globally.SYNOPSISUsing time-to-event analysis in patients receiving anti-VEGF for DMO: age, baseline visual acuity and injection number are independent predictors of visual outcomes.

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Intravitreal aflibercept for diabetic macular oedema: Moorfields’ real-world 12-month visual acuity and anatomical outcomes

European Journal of Ophthalmology ◽

10.1177/1120672119833270 ◽

2019 ◽

Vol 30 (3) ◽

pp. 557-562 ◽

Cited By ~ 3

Author(s):

Marko Lukic ◽

Gwyn Williams ◽

Zaid Shalchi ◽

Dawn Sim ◽

Praveen J Patel ◽

...

Keyword(s):

Visual Acuity ◽

Diabetic Retinopathy ◽

Standard Deviation ◽

Early Treatment ◽

Macular Oedema ◽

Diabetic Macular Oedema ◽

Foveal Thickness ◽

Central Foveal Thickness ◽

Intravitreal Aflibercept ◽

The Mean

Objectives: To assess structural and functional outcomes of treatment with intravitreal aflibercept (Eylea®) for diabetic macular oedema in treatment-naive patients. Design: This is a retrospective, real-life, cohort study. Participants and Methods: In all, 92 diabetic patients (102 eyes) receiving intravitreal anti–vascular endothelial growth factor therapy were included. A total of 99 aflibercept-treated eyes were included in the statistical analysis. Each patient had corrected visual acuity in Early Treatment Diabetic Retinopathy Study letters and optical coherence tomography central foveal thickness and macular volume performed at baseline and 12 months. Patients were initiated on a loading phase of five monthly intravitreal aflibercept injections, followed by injections if needed as per clinicians’ discretion. Results: The mean number of aflibercept injections received was 6.92. At baseline, the mean visual acuity (standard deviation; Snellen) was 59.7 (16.1) (20/63) Early Treatment Diabetic Retinopathy Study letters, the mean central foveal thickness (standard deviation) was 431 (129) µm, while the mean macular volume (standard deviation) was 9.53 (1.79) mm3. At 12 months, the mean visual acuity (standard deviation; Snellen) was 69.6 (15.2; 20/40) Early Treatment Diabetic Retinopathy Study letters (p < .0001). Mean central foveal thickness (standard deviation) was 306 (122) μm (p < .0001) and mean macular volume (standard deviation) was 8.43 (1.58) mm3 (p < .0001) at 12 months; 33 (33.67%) eyes gained ⩾15 Early Treatment Diabetic Retinopathy Study letters at month 12, and 50 (55.55%) eyes had a decrease in central foveal thickness of ⩾100 µm. Conclusion: There was a significant improvement in visual acuity and in anatomical outcomes in aflibercept-treated eyes at 12 months after commencing treatment for diabetic macular oedema in real-life settings.

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Baseline visual acuity and interdigitation zone as predictors in idiopathic epiretinal membranes: A retrospective cohort study

European Journal of Ophthalmology ◽

10.1177/1120672120932094 ◽

2020 ◽

pp. 112067212093209 ◽

Cited By ~ 1

Author(s):

Tiago Filipe Fernandes ◽

Keissy Sousa ◽

Inês Azevedo ◽

Petra Gouveia ◽

Gil Calvão-Santos ◽

...

Keyword(s):

Visual Acuity ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Outer Nuclear Layer ◽

Internal Limiting Membrane ◽

Epiretinal Membranes ◽

Pars Plana ◽

Interdigitation Zone ◽

Baseline Visual Acuity

Objective: Determine which functional and anatomical characteristics may be predictors of final visual acuity in patients with idiopathic ERM (iERM) submitted to pars plana vitrectomy (PPV) with ERM and internal and internal limiting membrane (ILM) peeling. Design: Retrospective cohort study. Subjects: Patients with iERM submitted to PPV between 2016 and 2017. Methods: Data regarding the best-corrected visual acuity (BCVA) and the characteristics of the retinal layers observed in SD-OCT were collected preoperatively and until 12 months postoperatively. Central macular thickness (CMT), disorganization of the retinal inner layers (DRIL), outer nuclear layer (ONL) thickness, integrity of subfoveal external limiting membrane (ELM), ellipsoid zone (EZ), and interdigitation zone (IZ) were evaluated. Results: A total of 128 eyes with iERM from 121 patients were included. BCVA improved significantly ( p < 0.001). Significant improvement of BCVA, CMT, DRIL, ONL, ELM, and EZ were obtained. The final IZ was not different from baseline until the end of the study. A significant correlation was observed between the baseline BCVA, EZ, IZ, and the postoperative BCVA ( p < 0.001). However, only the baseline BCVA and the integrity of the subfoveal baseline IZ were predictive factors for final BCVA ( p < 0.005 and p < 0.001, respectively). Conclusion: PPV provides a significant improvement of BCVA and retinal anatomy recovery in iERM eyes. Baseline IZ didn’t change during the 12 months following surgery. Baseline BCVA and subfoveal IZ at baseline were prognostic factors for the final BCVA.

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Effect of ethnicity and other sociodemographic factors on attendance at diabetic eye screening: a 12-month retrospective cohort study

BMJ Open ◽

10.1136/bmjopen-2020-046264 ◽

2021 ◽

Vol 11 (9) ◽

pp. e046264

Author(s):

Abraham Olvera-Barrios ◽

Michael Seltene ◽

Tjebo F C Heeren ◽

Ryan Chambers ◽

Louis Bolter ◽

...

Keyword(s):

Visual Acuity ◽

Cohort Study ◽

South Asian ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Black People ◽

Reference Group ◽

North East ◽

Eye Screening ◽

Diabetic Eye Screening

ObjectivesTo examine the association of sociodemographic characteristics with attendance at diabetic eye screening in a large ethnically diverse urban population.DesignRetrospective cohort study.SettingScreening visits in the North East London Diabetic Eye Screening Programme (NELDESP).Participants84 449 people with diabetes aged 12 years or older registered in the NELDESP and scheduled for screening between 1 April 2017 and 31 March 2018.Main outcome measureAttendance at diabetic eye screening appointments.ResultsThe mean age of people with diabetes was 60 years (SD 14.2 years), 53.4% were men, 41% South Asian, 29% White British and 17% Black; 83.4% attended screening. Black people with diabetes had similar levels of attendance compared with White British people. However, South Asian, Chinese and 'Any other Asian' background ethnicities showed greater odds of attendance compared with White British. When compared with their respective reference group, high levels of deprivation, younger age, longer duration of diabetes and worse visual acuity, were all associated with non-attendance. There was a higher likelihood of attendance per quintile improvement in deprivation (OR, 1.06; 95% CI, 1.03 to 1.08), with increasing age (OR per decade, 1.17; 95% CI, 1.15 to 1.19), with better visual acuity (OR per Bailey-Lovie chart line 1.12; 95% CI, 1.11 to 1.14) and with longer time of NELDESP registration (OR per year, 1.02; 95% CI, 1.01 to 1.03).ConclusionEthnic differences in diabetic eye screening uptake, though small, are evident. Despite preconceptions, a higher likelihood of screening attendance was observed among Asian ethnic groups when compared with the White ethnic group. Poorer socioeconomic profile was associated with higher likelihood of non-attendance for screening. Further work is needed to understand how to target individuals at risk of non-attendance and reduce inequalities.

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Long-Term Visual, Refractive and Topographic Outcomes of KeraRings Combined with Accelerated Transepithelial Crosslinking for Management of Different Grades of Progressive Keratoconus: A Retrospective Cohort Study

The Open Ophthalmology Journal ◽

10.2174/1874364102115010054 ◽

2021 ◽

Vol 15 (1) ◽

pp. 54-69

Author(s):

Mohammed Iqbal ◽

Amr Mounir ◽

Khaled Abd-Elaziz ◽

Omar M. Said

Keyword(s):

Visual Acuity ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Distance Visual Acuity ◽

Uncorrected Distance Visual Acuity ◽

Corrected Distance Visual Acuity ◽

Group A ◽

Group B

Purpose: To evaluate long-term visual, refractive, and topographic outcomes of KeraRings intrastromal implantation combined with accelerated transepithelial cross-linking for management of different stages of progressive keratoconus. Materials and Methods: This retrospective cohort study included 70 eyes of 70 patients with Amsler-Krumeich grades 1 to 4 keratoconus. They were divided into two groups: group-A included 37 eyes with grades 1-2 keratoconus, and group-B included 33 eyes with grades 3-4 keratoconus. Both groups underwent combined Keraring implantation with TCXL treatment. The main outcome measures included the preoperative and postoperative visual acuity, refraction, keratometry readings, and pachymetry. Results: At postoperative month 60, group-B exhibited significantly higher values of all mean uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), sphere/cylinder/spherical equivalent/defocus equivalent (DEQ), and K1/K2/Kaverages/Kmax parameters compared to that of group A. However, group-A exhibited better stability of postoperative improvements. Keratoconus progression (KCP) was greater in group-B (45.5%) than group-A (10.8%). Two eyes revealed segments' migration while one eye showed tunnel vascularization and opacification with segments' migration. Conclusion: The diagnostic criteria of preoperative-KCP are not adequate for the diagnosis of postoperative-KCP following ICRS implantation. UDVA and K average posterior seemed to be more sensitive parameters than K max in documenting early postoperative-KCP. We suggest that deterioration of UDVA≥0.10 log MAR and/or K average posterior ≥0.25 D are highly suspicious of post-ring implantation keratoconus progression (PR-KCP). The occurrence of two of the following parameters: Kmax≥0.50 D, Kaverageanterior≥0.50 D, K average posterior ≥0.25 D, or pachymetry≥1.5% thinning, is diagnostic of PR-KCP. The occurrence of two or more of the following parameters: Kmax≥0.50 D, Kaverageanterior≥0.50 D, Kaverageposterior ≥0.25 D, pachymetry≥ 1.5% thinning or UDVA≥0.10 logMAR, is diagnostic of PR-KCP. We also suggest that Kmax≥0.75 D alone is diagnostic of PR-KCP.

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Evaluation of standard of care intravitreal aflibercept treatment of diabetic macular oedema treatment-naive patients in the UK: DRAKO study 12-month outcomes

Eye ◽

10.1038/s41433-021-01624-9 ◽

2021 ◽

Author(s):

Sobha Sivaprasad ◽

Faruque Ghanchi ◽

Simon P. Kelly ◽

Ajay Kotagiri ◽

James Talks ◽

...

Keyword(s):

Visual Acuity ◽

Macular Oedema ◽

Safety Data ◽

Diabetic Macular Oedema ◽

Clinical Importance ◽

Standard Of Care ◽

Naive Patient ◽

Intravitreal Aflibercept ◽

Treatment Naïve ◽

The Uk

Abstract Objectives DRAKO (NCT02850263) is a 24-month, prospective, non-interventional, multi-centre cohort study which enroled patients diagnosed with centre-involving diabetic macular oedema (DMO). The study aims to evaluate standard of care with intravitreal aflibercept (IVT-AFL) treatment in the UK. This analysis describes the anti-vascular endothelial growth factor (anti-VEGF) treatment-naive patient cohort after 12-month follow-up. Methods Study eyes were treated with IVT-AFL as per local standard of care. The mean change in best-corrected visual acuity (BCVA) and central subfield thickness (CST) from baseline at 12 months were measured and stratified by baseline factors. The number of injections and safety data were also evaluated. Results A total of 507 patients were enroled from 35 centres. Mean (SD) baseline BCVA was 71.4 (12.0) letters and CST was 448.7 (88.7) µm, with 63.1% of patients presenting with baseline BCVA ≥ 70 letters (mean 78.1). Mean (SD) change in BCVA of 2.5 (12.2) letters and CST of −119.1 (116.4) µm was observed at month 12. A 7.3 letter gain was observed in patients with baseline BCVA < 70 letters. Mean number (SD) of injections in year one was 6.4 (2.1). No significant adverse events were recorded. Conclusion Year one results indicated that IVT-AFL was an effective treatment for DMO in standard of care UK clinical practice, maintaining or improving visual acuity in treatment-naive patients with good baseline visual acuity, despite some patients being undertreated versus the summary of product characteristics. These results also demonstrated the clinical importance and meaningful impact of diabetic retinopathy screening in the UK.

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