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Anti-vascular endothelial growth factor therapy in diabetic macular edema: real-life outcomes from a multicenter study in Turkey over 36 months

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Abstract

Purpose

This study aimed to report the visual and anatomical outcomes of intravitreal anti-VEGF treatment for diabetic macular edema (DME) in a real-world clinical setting from Turkey over 36 months.

Methods

This is a retrospective, multicenter (7 sites) study. The medical records of 1072 eyes (both previously treated and naive eyes) of 706 consecutive patients with visual impairment due to center-involving DME treated with intravitreal anti-VEGF injections between April 2007 and February 2017 were reviewed. The eyes were divided into mutually exclusive three groups based on the duration of follow-up (12, 24, or 36 months). Primary outcome measures were changes in visual acuity (VA) and central macular thickness (CMT) from baseline to final visit in each cohort, frequency of visits and intravitreal anti-VEGF injections. As secondary endpoints, VA outcomes were assessed in subgroups stratified by baseline VA [<70 ETDRS letters and ≥70 ETDRS letters] and loading dose status of anti-VEGF injections.

Results

VA increased by a mean of 8.2 letters (12-month cohort, p < 0.001), 5.3 letters (24-month cohort, p < 0.001), and 4.4 letters (36-month cohort, p = 0.017) at final visits. The eyes with <70 VA letters achieved more significant VA improvement at final visits in all cohorts compared with eyes with >70 VA letters (p < 0.001). The mean decreases in CMT from baseline to last visits at 12-, 24-, and 36- month cohorts were −100.5 µm, −107.7 µm, and −114.3 µm, respectively (p < 0.001). The mean number of injections given were 4.6, 2.3, and 1.8 during years 1 to 3, respectively. Patients who received loading dose showed greater VA gains than those who did not in all follow-up cohorts.

Conclusion

Our study revealed that anti-VEGF treatment improved VA and CMT over a follow-up of 36 months. Although these real-life VA outcomes following anti-VEGF therapy for DME were similar to other real-life studies, they were inferior to those noted in randomized controlled trials, mainly due to undertreatment.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Ophthalmology, University of Health Sciences, Gulhane School of Medicine, Ankara, Turkey

    Ali Hakan Durukan, Yağmur Seda Yeşiltaş & Murat Kucukevcilioglu

  2. Department of Ophthalmology, Ankara Training and Research Hospital, Ankara, Turkey

    Nurten Unlu, Mehmet Akif Acar & Dicle Hazirolan

  3. Department of Ophthalmology, Ankara City Hospital, Ankara, Turkey

    Mehmet Onen, Mehmet Numan Alp, Defne Kalayci, Yasin Toklu, Nagihan Ugurlu, Zeliha Yazar, Nil Irem Ucgun, Mucella Arikan Yorgun & Ceyda Baskan

  4. Department of Ophthalmology, Ankara Ulucanlar Eye Education and Research Hospital, Ankara, Turkey

    Mehmet Ali Sekeroglu, Mehmet Citirik, Ayse Gul Kocak Altintas, Pinar Cakar Ozdal, Ozlem Budakoglu, Sibel Doguizi, Yasemin Ozdamar Erol, Cemile Ucgul Atilgan, Dilek Ozcelik Soba & Nilufer Berker

  5. Department of Ophthalmology, Dışkapı Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey

    Tolga Bicer

  6. Augenland MVZ Goethaplatz, Frankfurt, Germany

    Kurtulus Serdar

  7. Biostatistics, Novo Nordisk LTD, Ankara, Turkey

    Esra Safak Yilmaz

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  1. Ali Hakan Durukan
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  2. Nurten Unlu
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Contributions

All authors contributed equally to this work. All authors have approved the final version of the manuscript.

Corresponding author

Correspondence to Ali Hakan Durukan.

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The authors declare no competing interests.

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The authors declare that they have no conflicts of interest.

Ethics approval

This study was conducted in compliance with the tenets of the Declaration of Helsinki. The study was approved by the Research Ethics Committee of Gulhane Training and Research Hospital.

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Durukan, A.H., Unlu, N., Onen, M. et al. Anti-vascular endothelial growth factor therapy in diabetic macular edema: real-life outcomes from a multicenter study in Turkey over 36 months. Int Ophthalmol 42, 3777–3787 (2022). https://doi.org/10.1007/s10792-022-02375-6

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