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Real-world management of treatment-naïve diabetic macular oedema: 2-year visual outcome focusing on the starting year of intervention from STREAT-DMO study.

Department of Ophthalmology, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan masahiko@v101.vaio.ne.jp. Diabetes Center, Tokyo Women's Medical University School of Medicine, Shinjuku-ku, Tokyo, Japan. Department of Ophthalmology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan. Department of Ophthalmology, University of Fukui, Yoshida, Japan. Department of Ophthalmology, Nagasaki University School of Medicine Graduate School of Biomedical Sciences, Nagasaki, Japan. Department of Ophthalmology, Wakayama Medical University, Wakayama, Japan. Department of Ophthalmology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan. Department of Ophthalmology, Tachikawa Hospital, Tachikawa, Japan. Department of Ophthalmology, National Hospital Organisation Tokyo Medical Center, Meguro-ku, Tokyo, Japan. Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. Department of Ophthalmology, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan. Kyorin Eye Center, Kyorin University School of Medicine, Mitaka, Tokyo, Japan. Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan. Deparment of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan. Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan. Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Tokushima, Japan. Department of Ophthalmology, University of Tsukuba Faculty of Medicine, Tsukuba, Ibaraki, Japan. Department of Ophthalmology, Sapporo City General Hospital, Sapporo, Japan. Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan. Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Mie, Japan. Department of Ophthalmology, Japanese Red Cross Otsu Hospital, Otsu, Japan. Department of Ophthalmology, Hirosaki University School of Medicine Graduate School of Medicine, Hirosaki, Aomori, Japan. Hikichi Eye Clinic, Sapporo, Hokkaido, Japan. Department of Ophthalmology, Showa General Hospital, Kodaira, Tokyo, Japan. Department of Ophthalmology, National Defense Medical College, Tokorozawa, Saitama, Japan. Department of Ophthalmology, St. Luke's International Hospital, Tokyo, Japan. Department of Ophthalmology, Nara Medical University, Kashihara, Nara, Japan. Department of Surgery Related, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan.

The British journal of ophthalmology. 2020;(12):1755-1761
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Abstract

BACKGROUND/AIMS: To investigate the yearly change of real-world outcomes for best corrected visual acuity (BCVA) after 2-year clinical intervention for treatment-naïve diabetic macular oedema (DMO). METHODS Retrospective analysis of aggregated, longitudinal medical records obtained from 27 retina specialised institutions in Japan from Survey of Treatment for DMO database. A total of 2049 treatment-naïve centre involving DMO eyes of which the initial intervention started between 2010 and 2015, and had been followed for 2 years, were eligible. As interventions, antivascular endothelial growth factor (VEGF) agents, local corticosteroids, macular photocoagulation and vitrectomy were defined. In each eye, baseline and final BCVA, the number of each intervention for 2 years was extracted. Each eye was classified by starting year of interventional treatment. RESULTS Although baseline BCVA did not change by year, 2-year improvement of BCVA had been increased, and reached to +6.5 letters in the latest term. There is little difference among starting year about proportions of eyes which BCVA gained >15 letters, in contrast to those which lost >15 letters were decreased by year. The proportion of eyes receiving anti-VEGF therapy was dramatically increased, while those receiving the other therapies were gradually decreased. The proportion of eyes which maintained socially good vision of BCVA>20/40 has been increased and reached to 59.0% in the latest term. CONCLUSION For recent years, treatment patterns for DMO have been gradually but certainly changed; as a result, better visual gain, suppression of worsened eyes and better final BCVA have been obtained. Anti-VEGF therapy has become the first-line therapy and its injection frequency has been increasing.

Methodological quality

Publication Type : Multicenter Study ; Observational Study

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