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

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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.

作者简介

Ernest Boiko

S.N. Fyodorov Eye Microsurgery Federal State Institution, St. Petersburg Branch

Email: boiko111@list.ru
ORCID iD: 0000-0002-7413-7478
SPIN 代码: 7589-2512

Dr. Sci. (Med.), Professor, Head of the Ophthalmology Department, Corresponding member of the Military Medical Academy, Director

俄罗斯联邦, 21, Yaroslava Gasheka st., Saint Petersburg, 192283

Dzhambulat Oskanov

S.N. Fyodorov Eye Microsurgery Federal State Institution, St. Petersburg Branch

编辑信件的主要联系方式.
Email: oskanovd@mail.ru
ORCID iD: 0000-0001-8842-2643
SPIN 代码: 9853-5775

Ophthalmologist, Departments of Vitreoretinal Surgery

俄罗斯联邦, 21, Yaroslava Gasheka st., Saint Petersburg, 192283

Irina Panova

S.N. Fyodorov Eye Microsurgery Federal State Institution, St. Petersburg Branch

Email: eyeren@yandex.ru
ORCID iD: 0000-0001-7443-4555
SPIN 代码: 1215-4238

Dr. Sci. (Med.), Professor, Deputy Director for Science

俄罗斯联邦, 21, Yaroslava Gasheka st., Saint Petersburg, 192283

Sergei Sosnovskii

S.N. Fyodorov Eye Microsurgery Federal State Institution, St. Petersburg Branch

Email: svsosnovsky@mail.ru
ORCID iD: 0000-0001-8969-6240

MD, Cand. Sci. (Med.), Assistant Professor, Ophthalmologist

俄罗斯联邦, 21, Yaroslava Gasheka st., Saint Petersburg, 192283

Roman Berezin

S.N. Fyodorov Eye Microsurgery Federal State Institution, St. Petersburg Branch

Email: berrom@yandex.ru
ORCID iD: 0000-0003-2745-3547
SPIN 代码: 2382-5831

MD, Cand. Sci. (Med.), Ophthalmologist

俄罗斯联邦, 21, Yaroslava Gasheka st., Saint Petersburg, 192283

参考

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  2. Musat O, Cernat C, Labib M, et al. Diabetic macular edema. Rom J Ophthalmol. 2015;59(3):133–136.
  3. 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
  4. 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
  5. 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
  6. 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
  7. Gatsu MV, Bayborodov YV. Kliniko-topograficheskaya klassifikatsiya diabeticheskikh makulopatiy. Diabetes mellitus. 2008;11(3):20–22. (In Russ.) doi: 10.14341/2072-0351-5353
  8. 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
  9. 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.)

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2. Fig. 1. OCT-images of a patient with diabetic macular edema with normal vitreoretinal interface before (a) and after 12 months of antiangiogenic therapy (b)

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3. Fig. 2. OCT-images of a patient with diabetic macular edema with pathological vitreoretinal interface before (а) and after 12 months of antiangiogenic therapy (b)

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4. Fig. 3. OCT-images of a patient with diabetic macular edema with the transformation of pathological to normal vitreoretinal interface before (а) and after 12 months of antiangiogenic therapy (b)

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5. Fig. 4. Final BCVA and OCT-morphometric parameters in patients with diabetic macular edema with normal, pathological and transformation of pathological into normal vitreoretinal interface

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