Diabetic Macular Oedema – Patient Characteristics and the Reality of Treatment in a German University Hospital

Abstract

Background Diabetic macular oedema (DME) is associated with significant loss of visual acuity. Intravitreal VEGF inhibitor injection is the gold standard in treating this disease; second-line treatment consists of intravitreal steroid injections. This treatment has already undergone extensive investigation in large randomised controlled trials. The aim of this study is to evaluate patient population and treatment options in a real-world setting.

Material and Methods A retrospective analysis was conducted on data from 176 eyes in 114 patients diagnosed with diabetic macular oedema who had received at least one intravitreal injection during 2018 at Marburg University Hospital Department of Ophthalmology. The analysis examined demographic characteristics, prior treatment, and treatments performed as well as visual acuity and central retinal thickness development during therapy. Multiple linear regression analyses were used to investigate the influence of different variables on changes in dependent variables in visual acuity (logMAR), changes in retinal thickness (µm), and number of injections, while also taking interactions between the independent variables themselves into account.

Results Patients were on average 64.45 ± 13.79 years old and predominantly male (61.93%). Most (71.59%) had already been treated for DME. Baseline visual acuity averaged 0.42 logMAR ± 0.34; baseline central retinal thickness averaged 369.1 µm ± 118.81. A total of 688 intravitreal injections were administered at 3.91 ± 2.22 per eye during the study period. Visual acuity improved by 0.04 logMAR ± 0.18 on average; eyes with poorer baseline visual acuity showed a greater increase in visual acuity. CRT values decreased by 44.54 µm ± 133.95 on average. Eyes with higher baseline values showed greater reduction. Using regression analysis, this is the first study to demonstrate that eyes may continue to require additional injections after prior treatment.

Conclusion This study demonstrated the reality of treatment for patients with diabetic macular oedema at a German university clinic as accurately as possible. We were able to demonstrate the differences from RCTs and the characteristics of the patient cohort.

Fazit

Bereits bekannt:

• IVOMs mit VEGF-Inhibitoren und Steroiden können den Visus und die zentrale Netzhautdicke bei Augen mit einem diabetischen Makulaödem verbessern.

• Eine Überlegenheit einzelner Medikamente konnte bisher nicht eindeutig gezeigt werden.

Neu beschrieben:

• Das reale Patientenkollektiv in einem deutschen Universitätsklinikum ist deutlich komplexer als das in RCTs. Dies hat einen Einfluss auf die zu erwartenden Ergebnisse.

• Augen, die aufgrund ihres DMÖs bereits intravitreale Injektionen in der Vergangenheit erhalten haben, brauchten im Behandlungsverlauf vermehrt weitere Injektionen.

Conclusion

Already known:

• IVOM therapy comprising VEGF inhibitors and steroids may improve visual acuity and central retinal thickness in eyes with diabetic macular oedema.

• No clear superiority of any individual drug has yet been clearly demonstrated.

New:

• Actual patient populations in a German university hospital are far more complex than those covered in RCTs. This has an impact on outcome expectations.

• Eyes previously administered intravitreal injections for DME required additional injections during treatment.

Keywords

pharmacology - retina - diabetic macular oedema - IVOM therapy

Publication History

Received: 17 May 2024

Accepted: 16 September 2024

Article published online:
18 November 2024

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