Benefits of anti-vascular endothelial growth factor therapy for diabetic macular edema with and without vitreomacular adhesions

Abstract

Purpose: We aimed to evaluate the effect of vitreomacular adhesion (VMA) in visual and anatomic outcomes in patients with diabetic macular edema (DME) after intravitreal injection of ranibizumab (Lucentis®). Patients and Methods: This was a prospective cohort study that included thirty eyes of DME patients, divided into two groups according to their spectral-domain-optical coherence tomography image analysis at the baseline visit to identify the presence (VMA+) or absence (VMA−) of VMA. Patients with any degree of vitreomacular traction were not included in this study. VMA was classified by the size of adhesion into either focal (<1500 mm) or broad (>1500 mm). All patients received monthly 0.5 mg of intravitreal ranibizumab injection for 6 months. Patients were observed monthly for a 6-month period and their best-corrected visual acuity (BCVA) and central macular thickness (CMT) were recorded. The incidence of posterior vitreous detachment (PVD) was observed. Results: Compared with baseline, there was a significant decrease in CMT after 6 months by 151.46 ± 121.47 and 139.33 ± 144.23 μm in VMA+ and VMA− groups, respectively (P = 0.681). The mean average improvement in BCVA was 10.21 ± 6.33 and 6.68 ± 6.35 letters in the VMA+ and VMA− groups, respectively. The difference between the two groups was statistically significant (P = 0.007). At 6 months, among the 15 eyes of VMA+ at baseline, 4 eyes demonstrated PVD and 11 eyes showed no change in VMA status. Conclusion: Patients having DME with VMA may achieve higher visual gain with anti-vascular endothelial growth factor therapy. Presence of VMA should not preclude patients with DME from receiving anti-vascular endothelial growth factor therapy.