REal-world treatment outcomes after delayed intRavitreal therapy in center-involving diabetic macular edema – RETORT study

PURPOSE: To compare real-life data on delayed intravitreal treatment of diabetic macular edema (DME) patients to early treatment. METHODS: In this single-centre, retrospective, interventional, comparative study, DME patients were divided into two groups based on when they received treatment: Group 1 - received treatment within 24 weeks and Group 2 - at or after 24 weeks from the time of treatment advice. Visual acuity and central subfield thickness (CSFT) changes were compared at various time points. Reasons for delaying treatment were noted. RESULTS: The study included 109 (Group 1–94; Group 2–15) eyes. When treatment was advised, demographic profile, diabetes duration, glucose control and VA between two groups were comparable. At this point, CSFT was higher in Group 1 than in Group 2 (p = 0.036). At injection time, Group 2 had better VA and lower CSFT than Group 1 (p < 0.05). Group 2’s VA (53.4 ± 12.67) was significantly lower than Group 1’s (57.38 ± 20.01) after 1-year treatment. At 1-year, CSFT decreased in Group 1 and increased in Group 2. Group 1 had mean improvement of + 7.6 letters and Group 2 had a decline of -6.9 letters. Group 2 required more intravitreal anti-VEGF (median – 3; IQR: 2–4), steroid injections (median – 4; IQR: 2–4) and focal laser sessions (median – 4; IQR: 2–4). CONCLUSION: Late-treated DME eyes needed more injections and focal laser sessions than early treated eyes. Adherence to early treatment of DME in real-life will help prevent long-term vision loss.