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Author Spotlight: Overcoming Anti-VEGF Resistance Through Advanced Vascular Morphology Assessment in Choroidal Neovascularization
Published on: August 11, 2023
COMPARE COMBINED USE OF ANTI-VEGF DRUGS DURING OR AFTER PARS PLANA VITRECTOMY FOR DIABETIC MACULAR EDEMA GUIDED BY
Jian Zhu1, Jiao Liu, Yi-Xun Chen
1Department of Ophthalmology, Affiliated Hospital of Nantong University, Nantong, China .
Purpose:
This study used microscope-integrated optical coherence tomography (MIOCT) to identify patients with proliferative diabetic retinopathy with concurrent diabetic macular edema (DME) during vitrectomy and compared the efficacy of immediate versus delayed anti-VEGF treatment, as well as ranibizumab versus conbercept.
Methods:
A prospective randomized controlled trial was conducted on patients with proliferative diabetic retinopathy undergoing pars plana vitrectomy (PPV). Patients with preoperatively unconfirmed DME were evaluated intraoperatively using MIOCT. Those with MIOCT-confirmed DME were randomly assigned to three groups: Group A received intravitreal ranibizumab during PPV with additional injections at 1 and 2 months postoperatively. Group B received intravitreal conbercept during PPV with additional injections at 1 and 2 months postoperatively. Group C received ranibizumab at 1, 2, and 3 months postoperatively. All groups followed a 3+ PRN protocol. Best-corrected visual acuity and central macular thickness were measured at 1 day; 1 week; 1, 3, and 6 months post-PPV.
Results:
A total of 115 eyes from 115 patients with proliferative diabetic retinopathy (one eye per patient) with MIOCT-confirmed concurrent DME during PPV were enrolled and randomly assigned to treatment groups. Six eyes were lost to follow-up, and 109 eyes (94.8%) completed the entire 6-month study. Groups A and B showed significant best-corrected visual acuity and central macular thickness improvements compared with Group C throughout the follow-up period, with Group B demonstrating superior early and sustained efficacy. Immediate anti-VEGF treatment during PPV, particularly with conbercept, was associated with reduced complications and accelerated recovery of visual function.
Conclusion:
In patients with proliferative diabetic retinopathy with MIOCT-identified DME during vitrectomy, immediate anti-VEGF treatment provides superior best-corrected visual acuity and central macular thickness improvements compared with delayed treatment, with conbercept demonstrating better efficacy.
Insights
Immediate anti-VEGF treatment for proliferative diabetic retinopathy (PDR) with concurrent diabetic macular edema (DME) during vitrectomy improves visual acuity and reduces macular thickness. Conbercept showed superior efficacy compared to ranibizumab.
Area of Science:
- Ophthalmology
- Retinal Diseases
- Medical Technology
Background:
- Proliferative diabetic retinopathy (PDR) often coexists with diabetic macular edema (DME).
- Intraoperative identification of DME during vitrectomy is crucial for effective management.
- Anti-vascular endothelial growth factor (anti-VEGF) therapy is a standard treatment for DME.
Purpose of the Study:
- To compare the efficacy of immediate versus delayed anti-VEGF treatment in PDR patients with concurrent DME identified during vitrectomy.
- To evaluate ranibizumab versus conbercept for treating DME in this patient population.
Main Methods:
- A prospective randomized controlled trial involving 115 PDR patients undergoing pars plana vitrectomy (PPV).
- Intraoperative MIOCT identified concurrent DME, with patients randomized to immediate (Groups A & B) or delayed (Group C) anti-VEGF treatment.
- Groups received intravitreal ranibizumab or conbercept during PPV or postoperatively, followed by a 3+PRN protocol. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were assessed over 6 months.
Main Results:
- Immediate anti-VEGF treatment (Groups A & B) resulted in significant BCVA and CMT improvements compared to delayed treatment (Group C).
- Group B (immediate conbercept) demonstrated superior early and sustained efficacy.
- Immediate treatment, especially with conbercept, was linked to fewer complications and faster visual recovery.
Conclusions:
- Immediate anti-VEGF administration during vitrectomy is more effective than delayed treatment for PDR patients with MIOCT-identified DME.
- Conbercept appears to be more efficacious than ranibizumab in this setting.
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