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006 - Assèchement de la rétine au cours de traitement de l’OMD par ranibizumab : sous-analyses des études RESTORE, REVEAL, RESPOND et RETAIN

Several studies have shown a modest correlation between visual acuity (VA) improvement and central retinal thickness (CRT) in patients with diabetic macular edema (DME) treated with an anti VEGF. But few studies have investigated the value of a dry retina. The purpose of this study was to determine whether a dry retina influenced visual outcomes during DME treatment.

We conducted a sub-analysis of 678 patients from the RESTORE, REVEAL, and RESPOND studies and the pro re nata (PRN) regimen group of the RETAIN study. All patients received a loading dose of three monthly intravitreal injections of ranibizumab followed by a PRN regimen. Retreatment was based on loss of visual acuity (VA) due to DME activity.

Patients were categorized into four groups according to whether or not they had at least one drying of their retina, and whether or not they exceeded the threshold of 69 letters at least once during the first 12 months of the respective study. The maximum mean VA reached during the follow-up period for each group was also collected (VA max).  

During the 12-month follow-up period, 262 patients (38.65%) had a dry retina at least once, whereas 416 patients (61.35%)did not .

In Group 1, dry retina and VA max> 69 (n=201): VA max (80.0 [SS2] letters) was reached at 8.0 months, mean VA was 75.4 letters (+9.1 letters vs baseline) at 1 year.

In Group 2, dry retina and VA max<69 (n=61): VA max (61.4 letters) was reached at 7.9 months, mean VA was 58.0 letters (+ 7.8 letters vs baseline) at 1 year.

In Group 3, non-dry retina and VA max> 69 (n=312): VA max (78.6 letters) was reached at 6.9 months, mean VA was 74.5 letters (+7.4 letters vs baseline) at 1 year.

In Group 4, non-dry retina and VA max <69 (n=104): VA max (60.5 letters) was reached at 5.3 months, mean VA was 54.5 letters (+3.6 letters vs baseline) at 1 year.

Among patients with a dry retina , we observe significative visual gain at 1 year, with a moderate VA loss between VA max and 12 months.

In patients with persistent macular edema, the 12-month VA differed according to the maximum VA level achieved during treatment. Patients with a VA max  ≥ 69 letters maintained their VA for up to 12 months with a moderate VA loss between VA max and 12 months irrespective of the persistence of fluid in their retina . Conversely, patients with a VA max <69 letters experienced a loss of vision after this VA max.

Among patients, who do not achieve a dry retina, VA max could be a predictive factor of tolerance to persistant macular edema.