Efficacy of Anti-VEGF Therapy in Diabetic Macular Edema-Bashundhara Eye Hospital & Research Institute Experience

Author(s): Saleh Ahmed, Moutushi Islam, Tasruba Shahnaz, RubinaAkther, Bilkis Akhter, SM Monowarul Islam.

Introduction: Diabetic macular edema (DME) is a common eye complication of diabetes mellitus (DM) that may cause severe visual impairment if left unattended. Vascular endothelial growth factor (VEGF) is an important factor in ocular homeostasis. Anti-VEGF therapy is an effective tool in the management of DME. Aim: The study aimed to evaluate the efficacy of different types of anti- VEGF therapy in DME regarding the improvement of best corrected visual acuity (BCVA) and the reduction of central macular thickness (CMT).

Methods: A retrospective study was conducted in Bashundhara Eye Hospital & Research Institute, from January, 2018 to March, 2022. A total of 416 patients having DME who received ≥3 anti-VEGF therapy (monthly interval) for reduced vision BCVA <20/40 & CMT >275 μm were enrolled in the study.

Result: More than half of the study population were female 61.77%. The single eye was affected by 80% of patients and the both eye was affected by 20% of patients. The majority of the patients 73.56% received Bevacizumab, 17.54% of patients were administered Ranibizumab, and one-tenth 8.90% of the patients received Aflibercept. The mean number of anti-VEGF injections applied to the patients was 6±SD. Around half of the study population 52.3 % was injected more than thrice, and the rest of the patients were injected with anti-VEGF three times during the study period. Only three 0.72% patients received Anti-VEGF injections up to 11 doses. After the application of injection, the visual acuity (VA) was improved in 93.26% patients. After the application of three consecutive Anti-VEGF injections, the visual acuity (VA) was improved in one-eighty patients 46.40% and after the application of more than three anti-VEGF therapy, the vision was improved in two hundred eight patients 53.60%. The mean CMT level of the study population after three consecutive anti-VEGF therapy (n=180) was 280±17.02μm. Mean CMT level of study population after more than three anti-VEGF therapy (n=208) was 250±7.42 μm.

Conclusion: The visual outcomes in this retrospective analysis appear to be comparable to previously reported outcomes in routine clinical practice. Our analysis provides information about the effectiveness of anti- VEGF treatment in routine clinical practice in Bashundhara Eye Hospital & Research Institute. Consecutive ≥5 anti-VEGF therapy for DME with reduced vision may be implemented in the management of patients in order to achieve better vision.