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IMPACT OF LONG-TERM INTRAVITREAL ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR ON PREEXISTING MICROSTRUCTURAL ALTERATIONS IN DIABETIC MACULAR EDEMA

Wirth, Magdalena, A., MD*,†; Wons, Juliana, MD; Freiberg, Florentina, J., MD; Becker, Matthias, D.‡,§; Michels, Stephan†,‡

doi: 10.1097/IAE.0000000000001788
Original Study: PDF Only

Purpose: Evaluation of the influence of long-term intravitreal anti–vascular endothelial growth factor treatment on preexisting retinal microstructural alterations in patients with diabetic macular edema.

Methods: Eyes with diabetic macular edema and a history of ≥ 20 intravitreal anti–vascular endothelial growth factor (aflibercept and/or ranibizumab) injections were included in this retrospective study. Primary outcome was the extent of disorganization of retinal inner layers, alterations at the outer plexiform layer/Henle fiber layer junction, disruption of external limiting membrane/ellipsoid zone, disruption of retinal pigment epithelium/Bruch complex, and retinal atrophy at baseline versus after ≥ 20 intravitreal injections as visualized by spectral-domain optical coherence tomography images.

Results: Of 383 eyes screened, 37 eyes were included in the current study. With the exception of outer plexiform layer/Henle fiber layer junction restoration, no significant changes regarding microstructural alterations between baseline and end of study were encountered after long-term anti–vascular endothelial growth factor (disorganization of retinal inner layers P = 0.381, outer plexiform layer/Henle fiber layer junction P = 0.001, external limiting membrane/ellipsoid zone P = 0.524, retinal pigment epithelium/Bruch complex P = 0.122, retinal atrophy P = 0.317). Best-corrected visual acuity significantly increased over the course of the study, corresponding to central retinal thickness and intraretinal fluid reduction (all P < 0.0001). The extent of microstructural alterations was negatively correlated with best-corrected visual acuity (P < 0.05).

Conclusion: Apart from outer plexiform layer/Henle fiber layer junction layer restoration, no effect on preexisting retinal alterations was encountered after long-term intravitreal injections. Thus, intravitreal ranibizumab or aflibercept did not have a major effect (neither positive nor negative) on microstructural alterations.

To study the influence of long-term intravitreal anti–vascular endothelial growth factor (average 3.5 years) on preexisting retinal microstructural alterations, optical coherence tomography images of 37 patients with diabetic macular edema (n = 37) were analyzed. Apart from outer plexiform layer/Henle fiber layer junction layer restoration, no significant change was encountered. Thus, anti–vascular endothelial growth factor did not have a major effect (neither positive nor negative) on microstructural alterations.

*Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland;

University of Zurich, Zurich, Switzerland;

Department of Ophthalmology, City Hospital Triemli Zurich, Zurich, Switzerland; and

§University of Heidelberg, Heidelberg, Germany.

Reprint requests: Magdalena A. Wirth, MD, Department of Ophthalmology, University Hospital Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland; e-mail: m.annawirth@gmail.com

Supported by the Werner H. Spross Foundation (Zurich, Switzerland) and “Stiftung wissenschaftliche Forschung, Fonds Ophthalmologie, City Hospital Triemli.”

Parts of the data were presented at ARVO, May 2, 2016, Seattle, WA, May 2016 (#2067-B0299).

The foundation for research at the City Hospital Triemli has received funding for consultancy work, advisory boards and/or presentations of F. J. Freiberg, M. D. Becker, and S. Michels from: Novartis AG, Alcon AG, Bayer AG, Allergan, and Roche AG. The remaining authors have no any conflicting interests to disclose.

© 2018 by Ophthalmic Communications Society, Inc.