January 19, 2016
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Anti-VEGF treatment may benefit patients with DME, vitreomacular adhesions

The READ-3 substudy evaluates the effect of two different doses of ranibizumab on vitreomacular adhesions in patients with DME.

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Anti-VEGF injections may improve visual outcomes in patients with diabetic macular edema who have vitreomacular adhesions, according to a substudy of READ-3.

“VMA does not adversely influence treatment outcomes and therefore should not preclude patients with DME from receiving treatment with anti-VEGF agents,” study author Yasir J. Sepah, MBBS, told Ocular Surgery News.

Previous research

Because vitreomacular interface diseases are reported to occur in 7% to 16% of eyes with DME, previous studies have been conducted to evaluate the role of vitreomacular traction and epiretinal membrane in affecting treatment outcomes.

However, there are no reports to determine the effect of vitreomacular adhesions (VMA) in the treatment outcomes of patients with DME.

“We already know that patients with DME and vitreomacular traction have a suboptimal visual gain following anti-VEGF therapy. However, the role of vitreomacular adhesion that has not yet developed into full-blown traction on treatment outcomes has not been reported,” Sepah said.

READ-3 study

The retrospective cohort study, published in Ophthalmology, evaluated 26 patients with DME who had VMA and 98 patients with DME who did not have VMA. Patients were randomized to receive monthly injections of either 0.5 mg or 2.0 mg of Lucentis (ranibizumab, Genentech).

At the 6-month follow-up, best corrected visual acuity increased by a mean of 11.31 ± 6.67 letters in the group with VMA and 6.86 ± 7.58 letters in the group without VMA. Both increases were significant compared with baseline (P < .05), and the difference between the two groups was significant (P = .007).

Sepah attributed the higher visual gains in the group with VMA to an increased concentration of growth factors in the pre-macular hyaloid secondary to increased enzyme mediated collagen cross-linking in the vitreous.

“Detachment of the posterior hyaloid in these eyes may remove this reservoir of growth factor from the vicinity of the retina and therefore lead to improved outcomes,” he said. “In addition, it is also hypothesized that there is improved transvitreal oxygenation in these patients after vitreous detachment that may lead to improvement in visual acuity.”

Both groups showed a significant reduction in central retinal thickness at month 6, with mean decreases of 173.81 ± 132.31 µm in the VMA group and 161.84 ± 131.34 µm in the non-VMA group.

At month 6, spectral-domain OCT images of the patients with VMA demonstrated that seven eyes experienced posterior vitreous detachment, 17 eyes had no change in VMA status, and two eyes were excluded because of ungradable images.

Sepah and colleagues chose SD-OCT imaging for this study because it is a rapid non-contact imaging modality that allows detailed imaging of the retina and vitreous, Sepah said.

“It is a useful tool for assessing retinal structures because of its ability to acquire high-resolution images of retinal morphology. The ability of OCT to visualize the vitreomacular interface may allow ophthalmologists to make informed treatment decisions,” he said.

Treatment options

Sepah believes this study can assist both ophthalmologists and patients in making informed decisions regarding possible treatment options with identification of anatomical factors associated with treatment outcomes.

“The results of our study suggest that patients with DME and VMA have a higher potential for improvement in visual and anatomic outcomes after treatment with anti-VEGF agents and, therefore, should not preclude these patients from receiving treatment with anti-VEGF agents,” he said.

In the future, Sepah would like to conduct a longer follow-up to observe the gain in visual and anatomic outcomes in patients who did not develop posterior vitreous detachment over the course of the study.

“Patients with DME have shown a variable response to anti-VEGF therapy over the years. The Ocular Imaging Research and Reading Center at the Truhlsen Eye Institute has made it one of its goal to identify biomarkers that will allow us to predict response to therapy,” Sepah said. – by Kristie L. Kahl

Disclosure: Sepah reports no relevant financial disclosures.