Journal of Diabetes Investigation (Aug 2022)

Treatment of diabetic macular edema in real‐world clinical practice: The effect of aging

  • Sentaro Kusuhara,
  • Masahiko Shimura,
  • Shigehiko Kitano,
  • Masahiko Sugimoto,
  • Daisuke Muramatsu,
  • Harumi Fukushima,
  • Yoshihiro Takamura,
  • Makiko Matsumoto,
  • Masahide Kokado,
  • Jiro Kogo,
  • Mariko Sasaki,
  • Yuki Morizane,
  • Takuya Utsumi,
  • Osamu Kotake,
  • Takashi Koto,
  • Hiroto Terasaki,
  • Takao Hirano,
  • Hiroto Ishikawa,
  • Yoshinori Mitamura,
  • Fumiki Okamoto,
  • Takamasa Kinoshita,
  • Kazuhiro Kimura,
  • Kenji Yamashiro,
  • Yukihiko Suzuki,
  • Taiichi Hikichi,
  • Noriaki Washio,
  • Tomohito Sato,
  • Kishiko Ohkoshi,
  • Hiroki Tsujinaka,
  • Mineo Kondo,
  • Hitoshi Takagi,
  • Toshinori Murata,
  • Taiji Sakamoto,
  • Japan Clinical Retina Study (J‐CREST) group

DOI
https://doi.org/10.1111/jdi.13801
Journal volume & issue
Vol. 13, no. 8
pp. 1339 – 1346

Abstract

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ABSTRACT Aims/Introduction In older patients, the management of diabetic macular edema (DME) can be complicated by comorbidities, geriatric syndrome, and socioeconomic status. This study aims to evaluate the effects of aging on the management of DME. Materials and Methods This is a real‐world clinical study including 1,552 patients with treatment‐naïve center‐involved DME. The patients were categorized into 4 categories by age at baseline (C1, <55; C2, 55–64; C3, 65–74; and C4, ≥75 years). The outcomes were the change in logarithm of the minimum angle of resolution best‐corrected visual acuity (logMAR BCVA) and central retinal thickness (CRT), and the number of treatments from baseline to 2 years. Results From baseline to 2 years, the mean changes in logMAR BCVA from baseline to 2 years were −0.01 in C1, −0.06 in C2, −0.07 in C3, and 0.01 in C4 (P = 0.016), and the mean changes in CRT were −136.2 μm in C1, −108.8 μm in C2, −100.6 μm in C3, and −89.5 μm in C4 (P = 0.008). Treatments applied in the 2 year period exhibited decreasing trends with increasing age category on the number of intravitreal injections of anti‐VEGF agents (P = 0.06), selecting local corticosteroid injection (P = 0.031), vitrectomy (P < 0.001), and laser photocoagulation outside the great vascular arcade (P < 0.001). Conclusions Compared with younger patients with DME, patients with DME aged ≥75 years showed less frequent treatment, a lower BCVA gain, and a smaller CRT decrease. The management and visual outcome in older patients with DME would be unsatisfactory in real‐world clinical practice.

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