INVICTUS: Intravitreal anti-VEGF and dexamethasone implant comparison for the treatment of diabetic macular edema: A 12?months follow-up study

摘要

Purpose: To compare the efficacy of intravitreal injections (IVI) of ranibizumab (Lucentis~(?), Novartis, Basel, Switzerland; RAN), aflibercept (Eylea~(?), Bayer, Leverkusen, Germany; AFL) and dexamethasone implant (Ozurdex~(?), Allergan, Irvine, California; DXI) in the treatment of naive diabetic macular oedema (DME) during a 12-month follow-up, in real life. Methods: Nineteen eyes treated with RAN, 20 with AFL and 21 with DXI were analysed from inclusion up to 12?months (M12) with intermediate analysis at M6. Best corrected visual acuity (BCVA), fundus and central retinal thickness (CRT) using spectral-domain optical coherence tomography (SD-OCT; Spectralis/HRA, Heidelberg Engineering, Germany) were performed at inclusion, M3, M6 and M12. Results: BCVA improved until 67.9 letters ±13.3 SD (+5.5 letters) at M6 and 69.6 letters ±12 SD (+7.2 letters) at 12?months for RAN group ( p ?=?0.036). For the AFL group it improved until 63.6 letters ±15.2 SD (+6.6 letters) at M6 and 67.5 letters ±12.2 SD (+8.5 letters) at 12?months ( p ?=?0.014). Lastly DXI group improved by 66.9 letters ±15.1 SD (+7.9 letters) at M6 and 68.4 letters ±11.2 SD (+9.4 letters) at 12?months ( p ?=?0.0023). CRT decreased by 124.4?μm at M6 and 99.3?μm at M12 in RAN group, 144.3?μm and 101.5?μm in AFL group and finally 95.6?μm and 162.7?μm in DXI group. Conclusion: In summary, these three drugs provide an efficient treatment option with an acceptable benefit-risk ratio for the treatment of naive patients with DME, whether on BCVA or CRT on the first year of treatment.