Prognosis of patients with diabetic macular edema before Japanese approval of anti-vascular endothelial growth factor

Purpose To examine the prognosis of patients with diabetic macular edema (DME) before Japanese approval of antivascular endothelial growth factor (VEGF). Methods This retrospective study included 135 eyes of 115 patients who received treatments (photocoagulation, pharmacological treatments, vitrectomy) for DME between January 2003 and August 2012. The best-corrected visual acuity (BCVA) before and 1, 3, 6, 12, and 24 months after treatment was examined. BCVA was classified based on the decimal value of BCVA before treatment as good (BCVA > 0.7, BCVA = 0.7), moderate (BCVA > 0.7 but < 0.2), or poor (BCVA < 0.2, BCVA = 0.2), and each prognosis of BCVA was investigated. Results Thirty-five (25.9 %) patients were classified with good BCVA, while 69 (51.1 %) had moderate and 31 (23.0 %) poor BCVA. Following 24 months of treatment, the averaged good BCVA maintained its value (0.0513 +/- 0.0954 to 0.0773 +/- 0.258). Similarly, the averaged moderate BCVA maintained its value (0.449 +/- 0.169 to 0.441 +/- 0.431), whereas the averaged poor BCVA significantly improved (1.070 +/- 0.291 to 0.879 +/- 0.361: p < 0.001). Specifically, the averaged BCVA of patients who initially received vitrectomy increased 0.380 logMAR after 24 months (0.859 +/- 0.414 to 0.479 +/- 0.549). Conclusions DME patients with good BCVA at the time of initial treatment generally maintained the averaged BCVA at 24 months, while patients with moderate BCVA did not significantly improve without a standard regimen of anti-VEGF therapy. However, the results indicate that early vitrectomy is a potential treatment option for DME patients with poor BCVA.