Effect of initial retinal thickness on outcome of intravitreal bevacizumab therapy for diabetic macular edema

Bushra Mushtaq, Niall J. Crosby, Antonios T. Dimopoulos, Peck Lin Lip, Panagiota Stavrou, Samer El-Sherbiny, Yang Yit

Research output: Contribution to journalArticle

Abstract

Purpose: To investigate whether eyes with diabetic macular edema (DME) and central retinal thickness (CRT) >400 μm had better visual and anatomical outcomes compared to eyes with a CRT <400 μm when treated with intravitreal bevacizumab in a real-world setting. Patients and methods: Patients undergoing intravitreal bevacizumab therapy for DME were identified from the departmental database of a tertiary referral unit. Following the initial injection, a retreatment was performed for any persistent macular edema, unless there had been no previous response to repeated doses. Recorded parameters included visual acuity, CRT on optical coherence tomography (spectral domain optical coherence tomography [SD-OCT]), and SD-OCT characteristics. Comparisons were made between data at baseline and 12 months after the first injection, and differences were tested for statistical significance using the Student's t-test. Results: In all, 175 eyes of 142 patients were analyzed. Patients in group 2 (CRT >400 μm) had significantly more injections than group 1 (CRT <400 μm) (4.0 versus 3.3; P=0.003). Both groups had similar numbers of eyes with preexisting epiretinal membrane and/or vitreomacular traction at baseline. The reduction in CRT was significantly greater in group 2 when compared to group 1 (P<0.0001). In terms of visual gain between baseline and month 12, each gained significantly by a mean of 0.12 logarithm of the minimum angle of resolution units (P=0.0001), but there was no difference between groups 1 and 2 (P=0.99). Conclusion: These results do not support a 400 μm baseline CRT cut-off for treating DME with bevacizumab, in contrast to published data on ranibizumab. Our results also indicate that patients with a thicker CRT require more bevacizumab injections, making treatment less cost-effective for these patients. Our results could be used by practitioners to support the use of bevacizumab in DME without applying a CRT cut-off.

Original languageEnglish
Pages (from-to)807-812
Number of pages6
JournalClinical Ophthalmology
Volume8
DOIs
Publication statusPublished - 28 Apr 2014

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Macular Edema
Epiretinal Membrane
Injections
Traction
Health Care Costs
Therapeutics
Bevacizumab

Bibliographical note

This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution - Non Commercial (unported, v3.0) License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php

Keywords

  • anti-VEGF therapy
  • central retinal thickness
  • intravitreal injection
  • optical coherence tomography
  • ranibizumab

Cite this

Mushtaq, B., Crosby, N. J., Dimopoulos, A. T., Lip, P. L., Stavrou, P., El-Sherbiny, S., & Yit, Y. (2014). Effect of initial retinal thickness on outcome of intravitreal bevacizumab therapy for diabetic macular edema. Clinical Ophthalmology, 8, 807-812. https://doi.org/10.2147/OPTH.S56624
Mushtaq, Bushra ; Crosby, Niall J. ; Dimopoulos, Antonios T. ; Lip, Peck Lin ; Stavrou, Panagiota ; El-Sherbiny, Samer ; Yit, Yang. / Effect of initial retinal thickness on outcome of intravitreal bevacizumab therapy for diabetic macular edema. In: Clinical Ophthalmology. 2014 ; Vol. 8. pp. 807-812.
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Mushtaq, B, Crosby, NJ, Dimopoulos, AT, Lip, PL, Stavrou, P, El-Sherbiny, S & Yit, Y 2014, 'Effect of initial retinal thickness on outcome of intravitreal bevacizumab therapy for diabetic macular edema', Clinical Ophthalmology, vol. 8, pp. 807-812. https://doi.org/10.2147/OPTH.S56624

Effect of initial retinal thickness on outcome of intravitreal bevacizumab therapy for diabetic macular edema. / Mushtaq, Bushra; Crosby, Niall J.; Dimopoulos, Antonios T.; Lip, Peck Lin; Stavrou, Panagiota; El-Sherbiny, Samer; Yit, Yang.

In: Clinical Ophthalmology, Vol. 8, 28.04.2014, p. 807-812.

Research output: Contribution to journalArticle

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T1 - Effect of initial retinal thickness on outcome of intravitreal bevacizumab therapy for diabetic macular edema

AU - Mushtaq, Bushra

AU - Crosby, Niall J.

AU - Dimopoulos, Antonios T.

AU - Lip, Peck Lin

AU - Stavrou, Panagiota

AU - El-Sherbiny, Samer

AU - Yit, Yang

N1 - This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution - Non Commercial (unported, v3.0) License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php

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Y1 - 2014/4/28

N2 - Purpose: To investigate whether eyes with diabetic macular edema (DME) and central retinal thickness (CRT) >400 μm had better visual and anatomical outcomes compared to eyes with a CRT <400 μm when treated with intravitreal bevacizumab in a real-world setting. Patients and methods: Patients undergoing intravitreal bevacizumab therapy for DME were identified from the departmental database of a tertiary referral unit. Following the initial injection, a retreatment was performed for any persistent macular edema, unless there had been no previous response to repeated doses. Recorded parameters included visual acuity, CRT on optical coherence tomography (spectral domain optical coherence tomography [SD-OCT]), and SD-OCT characteristics. Comparisons were made between data at baseline and 12 months after the first injection, and differences were tested for statistical significance using the Student's t-test. Results: In all, 175 eyes of 142 patients were analyzed. Patients in group 2 (CRT >400 μm) had significantly more injections than group 1 (CRT <400 μm) (4.0 versus 3.3; P=0.003). Both groups had similar numbers of eyes with preexisting epiretinal membrane and/or vitreomacular traction at baseline. The reduction in CRT was significantly greater in group 2 when compared to group 1 (P<0.0001). In terms of visual gain between baseline and month 12, each gained significantly by a mean of 0.12 logarithm of the minimum angle of resolution units (P=0.0001), but there was no difference between groups 1 and 2 (P=0.99). Conclusion: These results do not support a 400 μm baseline CRT cut-off for treating DME with bevacizumab, in contrast to published data on ranibizumab. Our results also indicate that patients with a thicker CRT require more bevacizumab injections, making treatment less cost-effective for these patients. Our results could be used by practitioners to support the use of bevacizumab in DME without applying a CRT cut-off.

AB - Purpose: To investigate whether eyes with diabetic macular edema (DME) and central retinal thickness (CRT) >400 μm had better visual and anatomical outcomes compared to eyes with a CRT <400 μm when treated with intravitreal bevacizumab in a real-world setting. Patients and methods: Patients undergoing intravitreal bevacizumab therapy for DME were identified from the departmental database of a tertiary referral unit. Following the initial injection, a retreatment was performed for any persistent macular edema, unless there had been no previous response to repeated doses. Recorded parameters included visual acuity, CRT on optical coherence tomography (spectral domain optical coherence tomography [SD-OCT]), and SD-OCT characteristics. Comparisons were made between data at baseline and 12 months after the first injection, and differences were tested for statistical significance using the Student's t-test. Results: In all, 175 eyes of 142 patients were analyzed. Patients in group 2 (CRT >400 μm) had significantly more injections than group 1 (CRT <400 μm) (4.0 versus 3.3; P=0.003). Both groups had similar numbers of eyes with preexisting epiretinal membrane and/or vitreomacular traction at baseline. The reduction in CRT was significantly greater in group 2 when compared to group 1 (P<0.0001). In terms of visual gain between baseline and month 12, each gained significantly by a mean of 0.12 logarithm of the minimum angle of resolution units (P=0.0001), but there was no difference between groups 1 and 2 (P=0.99). Conclusion: These results do not support a 400 μm baseline CRT cut-off for treating DME with bevacizumab, in contrast to published data on ranibizumab. Our results also indicate that patients with a thicker CRT require more bevacizumab injections, making treatment less cost-effective for these patients. Our results could be used by practitioners to support the use of bevacizumab in DME without applying a CRT cut-off.

KW - anti-VEGF therapy

KW - central retinal thickness

KW - intravitreal injection

KW - optical coherence tomography

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