Anti-VEGF therapy improves 5-year VA of eyes in diabetic macular oedema

Visual acuity (VA) of eyes initially treated with antivascular endothelial growth factor (anti-VEGF) therapy has improved from baseline to 5 years without protocol-defined treatment after follow-up ended at 2 years, a study has found. Additionally, mean retinal thickness is comparable at 2 and 5 years, but mean VA has worsened during this period.

This multicentre cohort study randomly assigned participants with diabetic macular oedema (DMO) and VA 20/32 to 20/320 to receive aflibercept, bevacizumab, or ranibizumab with protocol-defined follow-up and retreatment for 2 years. Afterwards, participants were managed at clinician discretion and recalled for a 5-year visit.

Of the 463 eligible participants, 317 (68 percent) completed the 5-year visit. Two-thirds (217/317; 68 percent) of study eyes received at least one anti-VEGF treatment (median, 4; interquartile range [IQR], 0–12) between 2 and 5 years.

Mean VA improved from baseline to 5 years by 7.4 letters (95 percent confidence interval [CI], 5.9–9.0) but decreased 4.7 letters (95 percent CI, 3.3–6.0) between 2 and 5 years.

When baseline VA was 20/50 to 20/230, mean VA at 5 years was 11.9 letters (95 percent CI, 9.3–14.5) better than baseline but 4.8 letters (95 percent CI, 2.5–7.09) worse than 2 years. When baseline VA was 20/32 to 20/40, mean VA at year 5 was 3.2 letters (95 percent CI, 1.04–5.0) better than baseline but 4.6 letters (95 percent CI, 3.1–6.1) worse than 2 years.

From baseline to 5 years, mean central subfield thickness decreased by 154 μm (95 percent CI, 142–166) and was stable between 2 and 5 years (−1 μm, 95 percent CI, −12 to 9).

“Additional investigation into strategies to improve long-term outcomes in eyes with DMO seems warranted to determine if VA can be better maintained with different management approaches,” the investigators said.