Modern Aspects Of Anti-VEGF Therapy Of Patients With Proliferative Diabetic Retinopathy

Abstract

Objective: Diabetic retinopathy is a vision threatening disease one of the worst complications of diabetes. The aim of our study is to compare the clinical outcomes and ultrastructural changes in diabetic retinopathy patients after intravitreal ad- mission of either Ranibizumab (Lucentis) or Aflibercept (EYLEA). Methods: In our prospective study 39 patients with prolifer- ative diabetic retinopathy (PDR) were enrolled. They were divided in two groups – patients treated with Ranibizumab – 11 and EYLEA treated patients with PDR – 28. In both groups complete ophthalmologic examination including OCT was performed. In 6 patients (3 from each group) pars plana vitrectomy with excision of epiretinal membranes has been done. Transmission and scanning electron microscopy of the membranes has been performed. Results: Clinically in both groups decrease of the neovascular proliferations and macular oedema were found. Central retinal thickness (CRT) was reduced with approximately 100-120 mc. In both groups general shrinking of the neovascular proliferations with lower risk of bleeding in PDR patients has been observed. The ultra structural analysis showed more significant reduction of endothelial fenestration after EYLEA application with clustering of thrombocytes and erythrocytes in the capillary lumen. Conclusion: Our results point out that both Aflibercept as well as Ranibizumab is very effective in treating PDR. Eylea inflicts more significant reduction of endothelial fenestration and more evident thrombotic microangiopathy than other anti-VEGF drugs. Both drugs have similar action in mild to moderate PD and have very good action in combination with PPV in terms of intraocular bleeding and long term results.