University of Oulu

Wirkkala, J., Kubin, AM., Ohtonen, P. et al. Visual outcomes of observation, macular laser and anti-VEGF in diabetic macular edema in type 1 diabetes: a real-world study. BMC Ophthalmol 22, 258 (2022).

Visual outcomes of observation, macular laser and anti-VEGF in diabetic macular edema in type 1 diabetes : a real-world study

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Author: Wirkkala, Joonas1,2,3; Kubin, Anna-Maria1,2,3; Ohtonen, Pasi4,5;
Organizations: 1Department of Ophthalmology, University of Oulu, Oulu University Hospital, P.O. Box 21, 90029, Oulu, OYS, Finland
2PEDEGO Research Unit, University of Oulu, Oulu, Finland
3Medical Research Center, University of Oulu, Oulu, Finland
4Research Service Unit, Oulu University Hospital, Oulu, Finland
5Research Unit of Surgery, Anesthesiology and Intensive care, University of Oulu, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.7 MB)
Persistent link:
Language: English
Published: Springer Nature, 2022
Publish Date: 2022-09-09


Background: The treatment for diabetic macular edema (DME) has revolutionized during the last 15 years after the introduction of intravitreal anti-VEGF agents. The aim of the current study is to evaluate the real-world visual outcomes of diabetic macular edema (DME) treatment in patients with type 1 diabetes (T1D) in long-term follow-up.

Methods: A real-world, descriptive, population-based cohort and follow-up of all patients with T1D and DME in 2006–2020 in 34 communities of the Northern Ostrobothnia Hospital District. The main outcome measures included age, gender, duration of T1D at the onset of DME, stage of retinopathy, treatment of DME (observation, laser, intravitreal treatments, combination), and visual outcomes.

Results: A total of 304 eyes of 206 T1D patients with DME were included. 75% (n=155) had non-proliferative diabetic retinopathy during the onset of DME. 15% of the cases were observed, 33% had macular laser, 41% intravitreal anti-VEGF and 12% combination of laser and intravitreal injections. Patients in anti-VEGF and in combination groups gained 4.9 and 5.5 ETDRS letters after the initial DME episode (p<0.001 and p%lt;0.001), and the long-term visual improvements were 4.1 and 5.1 ETDRS letters (p<0.001 and p<0.001), respectively. In observation and laser groups the initial gain of 0.1 (p>0.90) and loss of 0.4 ETDRS letter (p=0.61), respectively, was noted. After the follow-up, a 3.7 ETDRS letter decrease was documented in the observation group (p>0.90) and a 1.1 (p=0.14) ETDRS letter decline in the laser group of patients. At the beginning of treatment, eyes subjected to anti-VEGF alone or in combination with laser had lower visual acuity compared to eyes subjected to observation or macular laser. The average of a 6.1±4.8 anti-VEGF injections were needed to dry DME. Visual impairment due to DME decreased from 2.4% to 1.0% during the 15-year period.

Conclusions: Anti-VEGF alone or in combination with macular laser seems to be beneficial in terms of visual outcomes and treatment stability in T1D patients with central DME.

Moreover, satisfying long-term visual outcomes were achieved with anti-VEGF treatment in a real-world setting.

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Series: BMC ophthalmology
ISSN: 1471-2415
ISSN-E: 1471-2415
ISSN-L: 1471-2415
Volume: 22
Issue: 1
Article number: 258
DOI: 10.1186/s12886-022-02482-z
Type of Publication: A1 Journal article – refereed
Field of Science: 3125 Otorhinolaryngology, ophthalmology
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