Skip to main content

Advertisement

SpringerLink
Log in

The effects of epiretinal membranes on the treatment outcomes of intravitreal aflibercept injection in diabetic macular edema: a real-life study

  • Original Paper
  • Published:
International Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the effects of epiretinal membrane (ERM) formation on the anatomic and functional results of subjects with diabetic macular edema (DME) who are receiving intravitreal aflibercept injections (IAIs).

Materials and methods

This retrospective comparative study includes 29 eyes with DME (Group 1) and 43 eyes with DME and ERM (Group 2). After three consecutive monthly 2.0 mg IAIs, subjects received monthly follow-ups and retreatment was performed if needed. Corrected visual acuity (CVA), central macular thickness (CMT), and central macular volume (CMV) parameters were recorded tri-monthly, and the 36-month follow-up was designated the primary endpoint of the study.

Results

There was no significant difference between groups when comparing the mean ages and male-to-female ratios (p > 0.05, for both). At the baseline, the mean CVA value was significantly worse (p = 0.002), and the mean CMT was significantly lower (p = 0.016) in Group 1, while there was no significant difference in terms of the mean CMV (p = 0.625). The mean number of IAIs was similar at the first (p < 0.102), second (p = 0.363), and third year (p = 0.850) follow-ups. The mean CVA was significantly worse, and CMT was significantly lower in Group 1 at most of the visits in the first half of the follow-up period (p < 0.05, for all), while there was no significant difference in the second half of the follow-up period. There was no significant difference between groups in terms of CMV at any visit (p > 0.05, for all).

Conclusion

Despite a similar number of IAIs needed, worse baseline clinical parameters are associated with poorer early- or mid-term outcomes. At the long-term follow-up, CVA and CMT became similar in DME independent of ERM.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Klein R, Klein BE, Moss SE, Cruickshanks KJ (1995) The Wisconsin Epidemiologic Study of Diabetic Retinopathy. XV. The long-term incidence of macular edema. Ophthalmology 102(1):7–16

    Article  CAS  Google Scholar 

  2. Behl T, Kotwani A (2015) Exploring the various aspects of the pathological role of vascular endothelial growth factor (VEGF) in diabetic retinopathy. Pharmacol Res 99:137–148

    Article  CAS  Google Scholar 

  3. Antonetti DA, Barber AJ, Khin S, Lieth E, Tarbell JM, Gardner TW et al (1998) Vascular permeability in experimental diabetes is associated with reduced endothelial occludin content: vascular endothelial growth factor decreases occludin in retinal endothelial cells. Penn State Retina Research Group. Diabetes 47:1953–1959

    Article  CAS  Google Scholar 

  4. Kaya M, Kaya D, Idiman E, Kocak N, Ozturk T, Ayhan Z et al (2019) A novel biomarker in diabetic macular edema with serous retinal detachment: serum chitinase-3-like protein 1. Ophthalmologica 241:90–97

    Article  CAS  Google Scholar 

  5. Chang CK, Cheng CK, Bai CH, Peng CH, Hu CC (2012) Development of vitreomacular interface abnormality in patients with diabetic macular edema. Taiwan J Ophthalmol 2(3):93–98

    Article  Google Scholar 

  6. Knyazer B, Schachter O, Plakht Y et al (2016) Epiretinal membrane in diabetes mellitus patients screened by non-mydriatic fundus camera. Can J Ophthalmol 51:41–46

    Article  Google Scholar 

  7. Yamamoto T, Akabane N, Takeuchi S (2001) Vitrectomy for diabetic macular edema: the role of posterior vitreus detachment and epimacular membrane. Am J Ophthalmol 132(3):369–377

    Article  CAS  Google Scholar 

  8. Yoon D, Rusu I, Barbazetto I (2014) Reduced effect of anti-vascular endothelial growth factor agents on diabetics with vitreomacular interface abnormalities. Int Ophthalmol 34(4):817–823

    Article  Google Scholar 

  9. Seko Y, Seko Y, Fujikura H, Pang J, Tokoro T, Shimokawa H (1999) Induction of vascular endothelial growth factor after application of mechanical stress to retinal pigment epithelium of the rat in vitro. Invest Ophthalmol Vis Sci 40(13):3287–3291

    CAS  PubMed  Google Scholar 

  10. Wu PC, Lai CH, Chen CL, Kuo CN (2012) Optical coherence tomographic patterns in diabetic macula edema can predict the effects of intravitreal bevacizumab injection as primary treatment. J Ocul Pharmacol Ther 28:59–64

    Article  CAS  Google Scholar 

  11. Ercalik NY, Imamoglu S, Kumral ET et al (2016) Influence of the epiretinal membrane on ranibizumab therapy outcomes in patients with diabetic macular edema. Arq Bras Oftalmol 79:373–375

    Article  Google Scholar 

  12. Wong Y, Steel DHW, Habib MS et al (2017) Vitreoretinal interface abnormalities in patients treated with ranibizumab for diabetic macular oedema. Graefes Arch Clin Exp Ophthalmol 255:733–742

    Article  CAS  Google Scholar 

  13. Papadopoulos N, Martin J, Ruan Q, Rafique A, Rosconi MP, Shi E et al (2012) Binding and neutralization of vascular endothelial growth factor (VEGF) and related ligands by VEGF Trap, ranibizumab and bevacizumab. Angiogenesis 15(2):171–185

    Article  CAS  Google Scholar 

  14. Bressler SB, Qin H, Beck RW et al (2012) Diabetic retinopathy clinical research network. Factors associated with changes in visual acuity and central subfield thickness at 1 year after treatment for diabetic macular edema with ranibizumab. Arch Ophthalmol 130(9):1153–1161

    Article  CAS  Google Scholar 

  15. Cetin EN, Demirtaş Ö, Özbakış NC, Pekel G (2018) Quantitative assessment of macular contraction and vitreoretinal interface alterations in diabetic macular edema treated with intravitreal anti-VEGF injections. Graefes Arch Clin Exp Ophthalmol 256(10):1801–1806

    Article  CAS  Google Scholar 

  16. Rouvas A, Petrou P, Ladas I, Neamonitou G, Vergados I (2008) Spontaneous resolution of vitreomacular traction following ranibizumab (Lucentis) injection. Eur J Ophthalmol 18(2):301–303

    Article  CAS  Google Scholar 

  17. Maryam AK, Tafgeh M, Mahmoud M, Pasha A, Ahad S, Khalil GF (2018) Short term effect of intravitreal bevacizumab for diabetic macular edema associated with epiretinal membrane. Rom J Ophthalmol 62(3):212–216

    Article  Google Scholar 

  18. Cho HJ, Kim JM, Kim HS, Lee DW, Kim CG, Kim JW (2017) Effect of epiretinal membranes on antivascular endothelial growth factor treatment for neovascular age-related macular degeneration. J Ocul Pharmacol Ther 33(6):452–458

    Article  CAS  Google Scholar 

  19. Curry BA, Sanfilippo PG, Chan S, Hewitt AW, Verma N (2020) Clinical outcomes of a treat and extend regimen with intravitreal aflibercept injections in patients with diabetic macular edema: experience in clinical practice. Ophthalmol Ther 9(1):87–101

    Article  Google Scholar 

  20. Plaza-Ramos P, Borque E, García-Layana A (2019) Evaluation of ranibizumab and aflibercept for the treatment of diabetic macular edema in daily clinical practice. PLoS ONE 14(10):e0223793

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Ankara Ulucanlar Eye Education and Research Hospital, University of Health Sciences, Ankara, Turkey

    Ayse Gul Kocak Altintas & Mahmut Cankurtaran

  2. Hatay State Hospital, Ekinci Mah. Cevreyolu Cad. Royals Park 13/1 No: 23, Antakya, Hatay, Turkey

    Cagri Ilhan

Authors
  1. Ayse Gul Kocak Altintas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cagri Ilhan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mahmut Cankurtaran
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

The authors alone are responsible for the content and writing of this paper. The authors have indicated they have no financial relationships with any company and no external funding. Involved in design and conduct of this study (AKA, CI, MC); involved in collection, management, analysis, and interpretation of the data (CI, AKA); involved in preparation, review, or approval of the manuscript (AKA, CI, MC). All persons named in the Acknowledgments section have provided written permission to be named.

Corresponding author

Correspondence to Cagri Ilhan.

Ethics declarations

Conflict of interest

All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kocak Altintas, A.G., Ilhan, C. & Cankurtaran, M. The effects of epiretinal membranes on the treatment outcomes of intravitreal aflibercept injection in diabetic macular edema: a real-life study. Int Ophthalmol 40, 2635–2641 (2020). https://doi.org/10.1007/s10792-020-01444-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10792-020-01444-y

Keywords

Search

Navigation