ABSTRACT

Aim:

To evaluate the role of small gauge PPV as a first line treatment for naïve DME with a follow-up of 24 months and to investigate biomarkers and predictive factors for visual and anatomical outcome.

Patients & Method:

One hundred and twenty eyes, from 120 patients with a mean age of 67.0±14.9 years, were evaluated.

Results:

The mean baseline BCVA was 0.66 ± 0.14 logMAR, improved to 0.52 ± 0.21 logMAR after 12 months (p<0.001) and remained stable over 24 months (0.53 ± 0.21 logMAR, p<0.001). Fifty-seven (47.5%) and 52 patients (43.3%) gained ≥ 5 letters in vision after 12 and 24 months, respectively. Forty-three (35.8%) and 38 patients (31.7%) gained ≥ 10 letters in vision after 12 and 24 months, respectively. Mean baseline CST was 593 ± 92 µm and decreased to 236 ± 31 µm at 12 months (p<0.001) and remained stable at 24 months (230 ± 30 µm, p<0.001). Shorter time from DME diagnosis until PPV (OR: 0.98, 95% CI: 0.97– 0.99, p<0.001) was identified as clinical predictors for good functional treatment response (i.e. gain of ≥ 5 and ≥ 10 ETDRS letters, area under the curve 0.828). For every day PPV is postponed, the patient’s chances to gain ≥5 letters at 24 months decrease by 1.8%. Baseline HbA1C, duration of diabetes and lens status were not correlated with functional outcome. Presence of SRF was identified as an anatomical predictor of a better visual outcome, since patients with SRF at baseline were more likely to gain ≥ 5 letters after 24 months compared to those without SRF at baseline (OR: 6.29, 95% CI: 1.16 – 34.08, p=0.033, Figure). Baseline CST and MRT were not correlated with functional outcome. In univariate analysis baseline CST and MRT were not predictive for functional outcome.

Discussion:

Our results reveal a significant functional and anatomical improvement 24 months after primary PPV, without the need for additional DME therapy (such as intravitreal treatment or macular laser) within the follow-up period. Forty-three percent and 31.7% of the patients gained ≥ 5 and ≥ 10 letters in vision, respectively. Results from real-life studies about intravitreal treatment for DME have shown an improvement of ≥ 5 and ≥ 10 letters in vision in 41-53% and 28-36% of cases treated by anti-VEGF therapy. Hence, our data indicate a similar long-term outcome of primary PPV compared to intravitreal treatments in real-world conditions.


CONTACT DETAILS

Matias IGLICKI, Alejandro LAVAQUE*, Malgorza OZIMEK, Herminio NEGRI, Mali OKADA, Jay CHHABLANI, Catharina BUSCH, Anat LOEWENSTEIN, Dinah ZUR
Centro Especialidades Oftalmologicas
San Miguel de Tucumán
Argentina
Email : alavaque@intramed.net
Cell Phone: +5493914496341
Work Phone: +5494916582222