Abstract
Objectives
This study evaluated the 1-year treatment outcomes of bevacizumab for diabetic macular oedema (DMO) in routine clinical practice.
Methods
A retrospective analysis was performed on 298 eyes of 220 patients with DMO that received intra-vitreal bevacizumab between 1 September 2013 and 31 August 2018 that were tracked by a prospectively designed, web-based observational registry—the Fight Retinal Blindness! Registry.
Results
The mean visual acuity (95% confidence interval [CI]) at 1-year was 3 (2, 5) letters better than a mean (SD) of 68 (15) letters at study entry. Nearly a quarter of eyes achieved ≥20/40. Eyes presenting with better vision (≥20/40) tended to maintain that vision during the period of observation, whereas those presenting with worse vision (<20/40) gained a mean (95% CI) of 9 (5, 13) letters. A mean reduction in the macular thickness was observed over the study period with the central subfield improving by 29 µm (95% CI 17, 40) from a mean (SD) of 402 (109) µm at study entry. Eyes that completed 1 year of follow-up received a median (Q1, Q3) of 7 (4, 9) bevacizumab injections. Sixty-two eyes, ~20%, that started with bevacizumab changed to either another VEGF inhibitor or steroid (triamcinolone) during the period of observation. This did not lead to functional improvement for eyes changed to either ranibizumab or aflibercept despite a further reduction in macular thickness. An improvement in vision and reduction in macular thickness was noted in the 13 eyes that subsequently received triamcinolone. Approximately 10% of eyes dropped out over 12 months, even though their mean visual acuity had improved by seven letters from the initial visit.
Conclusions
Bevacizumab is an effective treatment for DMO in unselected populations.
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Acknowledgements
Fight Retinal Blindness! Investigators: Auckland District Health Board, New Zealand (DS); Armadale Eye Clinic, Victoria (Dr A Cohn); Associate Professor Fred Chen’s Clinic, Western Australia (Professor F Chen); Australian Eye Specialists (Bacchus Marsh), Victoria (Dr N Jaross); Australian Eye Specialists (Wyndham), Victoria (Dr N Jaross); Bunbury and Busselton Eye Doctors, Western Australia (RB); Canberra Hospital, Australian Capital Territory (Dr R Essex, JMW); Central Coast Eye Specialist, New South Wales (Dr S Young); Eye Associates, New South Wales (MG); Eye Wide Bay, Queensland (Dr Z Louw); Gladesville Eye Specialists, New South Wales (Dr S Young); Marsden Eye Specialists, New South Wales (Dr J Arnold, Dr D Chan, TT); North Queensland Retina, Queensland (Dr I Reddie); Retina Associates, New South Wales (Dr S Fraser-Bell); Retina Specialists, New Zealand (RB); Specialist Eye Group, Victoria (Dr A Cohn); Sydney Eye Hospital, New South Wales (Dr S Fraser-Bell); Victorian Eye Surgeons, Victoria (Dr A Cohn).
Funding
The Fight Retinal Blindness! Project was supported by a grant from the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) Eye Foundation (2007–2009); a grant from the National Health and Medical Research Council, Australia (NHMRC 2010-2012); and a grant from the Macular Disease Foundation, Australia. MG is a Sydney Medical Foundation Fellow and is supported by an NHMRC practitioner fellowship. DB was supported by Walter Gertud Siegenthaler Foundation, Zurich, Switzerland and the Swiss National Foundation.
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Conception and design—SB, DS, VN, DB, MG. Analysis and Interpretation—SB, DS, VN, MG. Data collection—SB, DS, NW, JMW, TT, R Barnes, R Barry, MG. Overall responsibility—SB, DS, VN, NW, JMW, TT, R Barnes, R Barry, DB, MG.
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Conflict of interest
MG: grants from NHMRC, grants form RANZCO Eye Foundation, grants and others from Novartis, grants and other from Bayer and is an inventor of the software used to track real-world outcomes in this study. DB: received research grants from Novartis and Bayer and is an inventor of the software used to track real-world outcomes in this study. The other authors declare no competing interests.
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Bhandari, S., Squirrell, D., Nguyen, V. et al. Bevacizumab for diabetic macular oedema: one-year treatment outcomes from the Fight Retinal Blindness! Registry. Eye 36, 594–602 (2022). https://doi.org/10.1038/s41433-021-01509-x
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DOI: https://doi.org/10.1038/s41433-021-01509-x
