Ranibizumab Plus Prompt or Deferred Laser for Diabetic Macular Edema in Eyes with Vitrectomy Prior to Anti-Vascular Endothelial Growth Factor Therapy

Abstract

Background

The approach to managing diabetic macular edema (DME) in eyes with prior vitrectomy is based on limited evidence. Therefore, an exploratory post-hoc assessment of 3-year data from eyes with and without vitrectomy prior to randomization in a DRCR.net trial that evaluated ranibizumab+prompt or deferred laser for DME is presented.

Methods

Visual acuity (VA) and ocular coherence tomography (OCT) outcomes were compared between eyes with and without prior vitrectomy.

Results

At baseline eyes with prior vitrectomy (n = 25) had longer duration of diabetes, worse VA, less thickened central subfield measurements on OCT, and were more apt to have worse diabetic retinopathy severity level or prior treatment for macular edema or cataract surgery than eyes without a history of vitrectomy (n = 335). Analyses adjusted for these baseline imbalances did not identify substantial differences between eyes with and without prior vitrectomy at each annual visit through 3 years for the favorable VA, OCT central subfield thickness or volume outcomes, although OCT improvement appeared slower in vitrectomy eyes during the first year.

Conclusion

This study provides little evidence that the beneficial clinical outcomes for patients with center-involved DME treated with anti-VEGF are affected in the long term by prior vitrectomy.