Impact of ranibizumab on visual impairment in patients with bilateral diabetic macular edema
Diabetic macular edema (DME) frequently presents bilaterally. In case of bilateral retinal disease, the visual impairment (VI) and the visual acuity (VA) are strongly correlated to the better eye. The aim of this study was to assess the impact of ranibizumab intravitreal injections (IVR) on VI in patients with simultaneous VA loss due to DME.
This was a retrospective two-center study including consecutive DME patients with visual loss treated with ranibizumab since November 2011 and with a minimum follow-up of 6 months. Patients with bilateral visual decrease from DME undergoing IVR within 6 months of each other were included.
Twenty-nine DME patients who received bilateral IVR within a 6-month interval in the second eye were included. At baseline, 82.8% (n = 24) of patients had a VA < 20/40 in their better eye versus 44.8% (n = 13) of patients at the end of follow-up, i.e. a reduction by 45.9% of VI. In the better eye, the mean VA was 57.3, 65.0 and 65.5 ETDRS letters, respectively, at baseline, month 3 and month 6 (mean VA gain +8.2 letters). In the worse eye, the mean VA was 44.2, 53.5 and 53.8 ETDRS letters, respectively, at baseline, M3 and M6 (mean VA gain +9.6 letters).
In patients with bilateral DME, subsequent ranibizumab IVR reduced VI frequency.
KeywordsBilateral diabetic macular edema Anti-VEGF Disability Visual impairment
Compliance with ethical standards
Conflict of interest
Dr. Franck Fajnkuchen, Dr. Sylvia Nghiem-Buffet, and Dr. Audrey Giocanti-Aurégan report having received personal fees from Novartis, Bayer, Allergan, outside the scope of the submitted work. Dr. Dante Pieramici is consultant for Genentech, Regeneron, Thrombogenics, Novartis, and reports having received research Genentech, Regeneron, Ophthea, Regenerative Patch, RegenX Bio, Clearside Biomedical. Dr. Typhaine Grenet reports having received personal fees from Novartis, Bayer, outside the scope of the submitted work. Dr. Linda Hrarat, Dr. Anne-Laurence Best, Dr. Corinne Delahaye-Mazza and Prof. Bodaghi have nothing to disclose. Dr. Gabriel Quentel reports having received personal fees from Novartis outside the scope of the submitted work. Prof. Salomon Y. Cohen reports having received personal fees from Novartis, Bayer, Allergan, Alcon, Thea, outside the scope of the submitted work.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.
Informed consent was obtained from all patients for being included in the study.
- 3.(1991) Early photocoagulation for diabetic retinopathy. ETDRS report number 9. Early treatment diabetic retinopathy study research group. Ophthalmology 98:766–785Google Scholar
- 6.Menchini U, Bandello F, De Angelis V et al (2015) Ranibizumab for Visual Impairment due to Diabetic Macular Edema: Real-World Evidence in the Italian Population (PRIDE Study). J Ophthalmol 2015:324841Google Scholar
- 8.Hrarat L, Fajnkuchen F, Boubaya M et al (2016) Outcomes after a 1-year treatment with ranibizumab for diabetic macular edema in a clinical setting. Ophthalmol J Int Ophtalmol Int J Ophthalmol Z Augenheilkd 236:207–214Google Scholar
- 11.(2018) Vision 2020 Global initiative for the elimination of avoidable blindness: action plan 2006–2011. http://www.who.int/mediacentre/factsheets/fs213/en/
- 12.Colenbrander A, De Laey JA (2006) Vision requirements for driving safety. Report of the International Council of Ophthalmology. http://www.icoph.org/dynamic/attachments/resources/visionfordriving.pdf
- 19.Rubin GS, Muñoz B, Bandeen-Roche K, West SK (2000) Monocular versus binocular visual acuity as measures of vision impairment and predictors of visual disability. Invest Ophthalmol Vis Sci 41:3327–3334Google Scholar