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.
PURPOSE
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.
MATERIAL AND METHODS
The study included 72 patients (132 eyes): the 1st group — 22 patients (40 eyes) with stage I POAG and DME, the 2nd group — 25 patients (46 eyes) with DME receiving anti-VEGF therapy. The 3rd 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.
RESULTS
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%) mm3, decrease in the area of RA by 0.3 mm2 (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.
CONCLUSION
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.
