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Yayla U, Sevik MO, Karabaş VL, Şahin Ö, Özkaya A, Yenerel NM, Açıkalın Öncel B, Kaplan FB, Önder Tokuç E, Kanar HS, Kutlutürk Karagöz I, Başaran Emengen E, Demirciler Sönmez A, Aykut A, Limon U, Bozkurt E, Özsoy Saygın I, Aydoğan Gezginaslan T, Aydın Öncü Ö, Türkseven Kumral E, Erçalık NY, Çelik E. Real-World Outcomes of Intravitreal Anti-Vascular Endothelial Growth Factor Treatment for Diabetic Macular Edema in Türkiye: MARMASIA Study Group Report No. 1. Turk J Ophthalmol 2023; 53:356-368. [PMID: 38126607 PMCID: PMC10750085 DOI: 10.4274/tjo.galenos.2023.56249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/27/2023] [Indexed: 12/23/2023] Open
Abstract
Objectives This study aimed to report the demographic and clinical characteristics of diabetic macular edema (DME) patients treated with intravitreal injection (IVI) of anti-vascular endothelial growth factors (anti-VEGF) and provide an overview of outcomes during routine clinical practice in Türkiye. Materials and Methods This retrospective, real-world study included 1,372 eyes (854 patients) treated with a pro re nata protocol by 21 ophthalmologists from 8 tertiary clinics on the Asian side of the Marmara region of Türkiye (MARMASIA Study Group). Five cohort groups were established by collecting the patients' baseline and 3, 6, 12, 24, and 36-month follow-up data, where each subsequent cohort may include the previous. Changes in best-corrected visual acuity (BCVA, approximate ETDRS letters) and central macular thickness (CMT, μm), number of visits and IVI, and rates of anti-VEGF switch and intravitreal dexamethasone implant (IDI) combination were evaluated. Results The 3, 6, 12, 24, and 36-month cohorts included 1372 (854), 1352 (838), 1185 (722), 972 (581), and 623 (361) eyes (patients), respectively. The mean baseline BCVA and CMT were 51.4±21.4 letters and 482.6±180.3 μm. The mean changes from baseline in BCVA were +7.6, +9.1, +8.0, +8.6, and +8.4 letters, and in CMT were -115.4, -140.0, -147.9, -167.3, and -215.4 μm at the 3, 6, 12, 24, and 36-month visits (p<0.001 for all). The median cumulative number of anti-VEGF IVI was 3.0, 3.0, 5.0, 7.0, and 9.0, respectively. The overall anti-VEGF switch and IDI combination rates were 18.5% (253/1372 eyes) and 35.0% (480/1372 eyes), respectively. Conclusion This largest real-life study of DME from Türkiye demonstrated BCVA gains inferior to randomized controlled trials, mainly due to the lower number of IVI. However, with the lower baseline BCVA and higher IDI combination rates in our cohorts, these gains were relatively superior to other real-life study counterparts.
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Affiliation(s)
- Uğur Yayla
- University of Health Sciences Türkiye, Derince Training and Research Hospital, Clinic of Ophthalmology, Kocaeli, Türkiye
| | - Mehmet Orkun Sevik
- Marmara University Faculty of Medicine, Department of Ophthalmology, İstanbul, Türkiye
| | - Veysel Levent Karabaş
- Kocaeli University Faculty of Medicine, Department of Ophthalmology, Kocaeli, Türkiye
| | - Özlem Şahin
- Marmara University Faculty of Medicine, Department of Ophthalmology, İstanbul, Türkiye
| | - Abdullah Özkaya
- Memorial Şişli Hospital, Clinic of Ophthalmology, İstanbul, Türkiye
| | - Nursal Melda Yenerel
- University of Health Sciences Türkiye, Haydarpaşa Numune Training and Research Hospital, Clinic of Ophthalmology, İstanbul, Türkiye
| | - Banu Açıkalın Öncel
- University of Health Sciences Türkiye, Fatih Sultan Mehmet Training and Research Hospital, Clinic of Ophthalmology, İstanbul, Türkiye
| | - Fatih Bilgehan Kaplan
- University of Health Sciences Türkiye, Fatih Sultan Mehmet Training and Research Hospital, Clinic of Ophthalmology, İstanbul, Türkiye
| | - Ecem Önder Tokuç
- Kocaeli University Faculty of Medicine, Department of Ophthalmology, Kocaeli, Türkiye
| | - Hatice Selen Kanar
- University of Health Sciences Türkiye, Kartal Dr. Lütfi Kırdar City Hospital, Clinic of Ophthalmology, İstanbul, Türkiye
| | - Işıl Kutlutürk Karagöz
- University of Health Sciences Türkiye, Şişli Hamidiye Etfal Training and Research Hospital, Clinic of Ophthalmology, İstanbul, Türkiye
| | - Ece Başaran Emengen
- Kocaeli University Faculty of Medicine, Department of Ophthalmology, Kocaeli, Türkiye
| | - Ayşe Demirciler Sönmez
- University of Health Sciences Türkiye, Fatih Sultan Mehmet Training and Research Hospital, Clinic of Ophthalmology, İstanbul, Türkiye
| | - Aslan Aykut
- Marmara University Faculty of Medicine, Department of Ophthalmology, İstanbul, Türkiye
| | - Utku Limon
- University of Health Sciences Türkiye, Ümraniye Training and Research Hospital, Clinic of Ophthalmology, İstanbul, Türkiye
| | - Erdinç Bozkurt
- University of Health Sciences Türkiye, Ümraniye Training and Research Hospital, Clinic of Ophthalmology, İstanbul, Türkiye
| | - Işılay Özsoy Saygın
- University of Health Sciences Türkiye, Ümraniye Training and Research Hospital, Clinic of Ophthalmology, İstanbul, Türkiye
| | - Tuğba Aydoğan Gezginaslan
- University of Health Sciences Türkiye, Ümraniye Training and Research Hospital, Clinic of Ophthalmology, İstanbul, Türkiye
| | - Özlem Aydın Öncü
- University of Health Sciences Türkiye, Haydarpaşa Numune Training and Research Hospital, Clinic of Ophthalmology, İstanbul, Türkiye
| | - Esra Türkseven Kumral
- University of Health Sciences Türkiye, Haydarpaşa Numune Training and Research Hospital, Clinic of Ophthalmology, İstanbul, Türkiye
| | - Nimet Yeşim Erçalık
- University of Health Sciences Türkiye, Haydarpaşa Numune Training and Research Hospital, Clinic of Ophthalmology, İstanbul, Türkiye
| | - Erkan Çelik
- Sakarya University Faculty of Medicine, Department of Ophthalmology, Sakarya, Türkiye
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