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Acta Diabetol. 2019 Jul;56(7):777-784. doi: 10.1007/s00592-019-01310-z. Epub 2019 Mar 22.

Real-world outcomes of observation and treatment in diabetic macular edema with very good visual acuity: the OBTAIN study.

Author information

1
Department of Ophthalmology, University Hospital Leipzig, Liebigstr. 10-14, 04103, Leipzig, Germany. busch.catharina@gmail.com.
2
Department of Ophthalmology, Sydney University, Sydney, Australia.
3
Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
4
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
5
Instituto de Oftalmología y Ciencias Visuales, Escuela de Medicina, Tecnológico de Monterrey, Monterrey, Mexico.
6
Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul University, Istanbul, Turkey.
7
Department of Biomedical and Surgical Sciences, Section of Ophthalmology, University of Perugia, Perugia, Italy.
8
Department of Ophthalmology, Westmead Hospital, Sydney, Australia.
9
Faculty of Medicine and Health Sciences, Macquarie University Hospital, Sydney, Australia.
10
Ophthalmology Department, Dijon University Hospital, Dijon, France.
11
Center for Taste and Feeding Behaviour, INRA, UMR1324, Dijon, France.
12
Department of Surgical, Microsurgical and Medical Sciences, Eye Clinic, University of Sassari, Sassari, Italy.
13
Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
14
Retina Division, Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
15
Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia.
16
Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
17
Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal.
18
Massachusetts Eye and Ear, Harvard Medical School, Boston, USA.
19
Department of Orthoptics, Superior School of Health, Polytechnic of Porto, Porto, Portugal.
20
Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic de Barcelona, Barcelona, Spain.
21
L.V. Prasad Eye Institute, Banjara Hills, Hyderabad, India.
22
Department of General Ophthalmology and Pediatric Ophthalmology Service, Medical University in Lublin, Lublin, Poland.
23
Department of Ophthalmology, University Hospital Leipzig, Liebigstr. 10-14, 04103, Leipzig, Germany.
24
Incumbent, Sydney A. Fox chair in Ophthalmology, Tel Aviv University, Tel Aviv, Israel.
25
Private Retina Service, University of Buenos Aires, Buenos Aires, Argentina.

Abstract

AIMS:

To describe and compare the functional and anatomical outcomes of untreated and treated diabetic macular edema (DME) in eyes with very good baseline visual acuity (VA) in a real-world setting.

METHODS:

A 12-month, retrospective, multicenter, observational cohort study, including DME patients with baseline visual acuity (VA) ≤ 0.1 logMAR (≥ 20/25 Snellen) and central subfield thickness (CST) > 250 µm with intra- and/or subretinal fluid seen on optical coherence tomography.

RESULTS:

A total of 249 eyes were included, of which 155 were treated and 94 were non-treated during follow-up. Most eyes maintained vision (VA gain or VA loss < 5 letters) at 12 months (treated: 58.1%; non-treated: 73.4%). In non-treated eyes with stable VA within the first 6 months, VA was maintained throughout the follow-up in most cases (86.3%). In non-treated eyes with VA loss ≥ 5 letters within 6 months (36.7%), further observation led to worse visual outcome than treatment (- 4.2 vs. - 7.8 letters, p = 0.013). In eyes in which treatment was initiated at baseline (n = 102), treatment with 8-12 anti-VEGF injections led to better visual outcome compared to treatment with less injections (- 0.3 ± 3.6 letters vs. - 3.8 ± 6.2 letters, p = 0.003).

CONCLUSION:

In a real-world setting, the majority of DME patients with very good VA maintained vision at 12 months, regardless of whether the DME was treated or not. This study supports close observation of eyes with DME and very good VA with consideration of treatment when a one line drop in vision is observed.

KEYWORDS:

Anti-VEGF therapy; Diabetic macular edema; Good visual acuity; Intravitreal therapy; Macular laser; Observation

PMID:
30903434
PMCID:
PMC6558052
DOI:
10.1007/s00592-019-01310-z
[Indexed for MEDLINE]
Free PMC Article

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