| Long-term Outcomes of Diabetic Macular Edema Following Initial Intravitreal Ranibizumab Injection Based on Morphologic Pattern. |
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Kiyoung Kim, Eung Suk Kim, Hyung Woo Kwak, Seung Young Yu |
1Division of Ophthalmology, Department of Medicine, Kyung Hee University Graduate School, Seoul, Korea.
2Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea. syyu@khu.ac.kr |
| 당뇨황반부종의 형태학적 분류에 따른 유리체강 내 라니비주맙 초기치료 후의 장기 임상결과 |
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김기영1⋅김응석2⋅곽형우2⋅유승영2 |
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경희대학교 대학원 의학과 안과학교실1, 경희대학교 의학전문대학원 경희대학교병원 안과학교실2 |
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| Abstract |
PURPOSE
To evaluate the 3-year visual and morphological outcomes of diabetic macular edema (DME) based on the morphological pattern observed on optical coherence tomography (OCT) after intravitreal ranibizumab injections. METHODS: Thirty-two eyes of 32 patients with DME were classified according to the following OCT features: diffuse retinal thickening (DRT), cystoid macular edema (CME), and serous retinal detachment (SRD). All patients received 3 consecutive monthly intravitreal injections of 0.5 mg ranibizumab. After 3 injections, patients received ranibizumab or dexamethasone implantation as needed. The primary outcome was the number of treatments received based on the DME type over 36 months. Best-corrected visual acuity (BCVA), central subfoveal thickness, and macular volume changes were also evaluated. RESULTS: The eyes were classified as DRT (n = 16), CME (6), or SRD (10). The mean number of injections over 3 years was significantly different among the groups: DRT (4.25), CME (7.5), SRD (7.6; p = 0.048). The number of patients who did not need additional treatment after the initial 3 injections was 13 with DRT (81.3%), 2 with CME (33.3%), and 5 with SRD (50%; p = 0.045). BCVA at 36 months significantly improved from baseline in the DRT group (p = 0.003). The CME group showed the worst BCVA among the groups (p = 0.023). Six patients who received intravitreal dexamethasone implantation showed no significant improvement of BCVA but significant decrease in macular volume from 12 to 36 months. CONCLUSIONS: Clinical courses varied according to the morphological pattern of DME after intravitreal ranibizumab injection, and patients with DRT maintained visual and anatomical improvement with fewer injections over 36 months. Additional dexamethasone implantation showed limited effect in reducing macular edema with persistent macular cystic change, but no significant improvement in visual acuity. |
| Key Words:
Dexamethasone implantation;Diabetic macular edema;Optical coherence tomography;Ranibizumab |
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