Anti-angiogenesis therapy of diabetic macular edema in patients with primary open-angle glaucoma

• Published in: Vestnik oftal'mologii Vol. 136; no. 6. Vyp. 2; p. 185
• Main Authors: Fursova, A Zh, Gamza, Yu A, Derbeneva, A S, Vasilyeva, M S
• Format: Journal Article
• Language: Russian
• Published: Russia (Federation) 2020
• Subjects: Diabetes Mellitus; Diabetic Retinopathy - complications; Diabetic Retinopathy - diagnosis; Diabetic Retinopathy - drug therapy; Glaucoma, Open-Angle - complications; Glaucoma, Open-Angle - diagnosis; Glaucoma, Open-Angle - drug therapy; Humans; Intraocular Pressure; Macular Edema - diagnosis; Macular Edema - drug therapy; Macular Edema - etiology; Nerve Fibers; Optic Disk; Tomography, Optical Coherence; anti-angiogenesis therapy; diabetes mellitus; glaucoma progression; optical coherence tomography
• ISSN: 0042-465X
• DOI: 10.17116/oftalma2020136062185

Despite the high clinical effectiveness and widespread introduction of anti-angiogenesis (anti-VEGF) therapy into practice, its long-term effect on the development of structural changes in the treatment of primary open-angle glaucoma (POAG) patients with diabetic macular edema (DME) hasn't been studied sufficiently and so presents certain interest. To study the effect of anti-VEGF therapy on the structural and functional state of the retina and optic nerve in patients with DME and POAG. The study included 72 patients (132 eyes): the 1 group - 22 patients (40 eyes) with stage I POAG and DME, the 2 group - 25 patients (46 eyes) with DME receiving anti-VEGF therapy. The 3 group (control) consisted of 25 patients (46 eyes) with stage I POAG. The observation period lasted 24 months. The average number of injections was 8.48±3.65. The indicators for evaluation were: visual acuity, tonometry, perimetry, optical coherence tomography (OCT) of the optic nerve and macular region. By the end of the observation period, the increase in IOP in the groups was +0.82 (4.4%), 0.41 (2.4%), 0.65 (3.6%) mm Hg. In the group of comorbid patients, a small-scale increase trend of BCVA was noted: +0.05 (6.6%), a decrease in MD by -2.48 Db (92.1%), an increase in excavation volume by 0.16 (43.2%) mm , decrease in the area of RA by 0.3 mm (12.7%). A decrease in retinal nerve fibers layer (RNFL) thickness of 6.55 μm (7.8%), mainly the superior (9.2%), inferior (7.3%) and nasal sectors (7.9%). Loss of GCL+IPL 8.68 μm (12.7%) in the superior (19%), superonasal (20.2%) and inferonasal (20.7%) sectors. The combined course of POAG and DME is accompanied by a decrease in the functional and structural parameters of the retina and optic nerve, and a higher rate of progression of glaucomatous optic neuropathy. Long-term results did not reveal a significant deterioration in the structural parameters of the optic disc and retina against the background of anti-VEGF therapy when comparing the study groups.