Abstract
Purpose: Visual outcome and long-term stability of Kuwaiti diabetic patients at high risk of poor visual prognosis due to diabetic macular edema (DME), in response to early intravitreal treatment initiation and multidisciplinary management.
Methods: Longitudinal observational study of 152 eyes of 81 patients with type 2 diabetes and DME treated and monitored for 6 to 13 years.
Results: High risk of incomplete or unstable response to treatment and low final vision were associated with age over 65 years at presentation, female gender, poor metabolic control, nephropathy, baseline best-corrected visual acuity (BCVA) less than 20/40 , chronicity of the edema and atrophic changes in outer retinal layers of the macula.
Incomplete and unstable response to treatment had 80% of the eyes. Recurrences were associated with cardiac and renal complications and had severe impact on eyes with lower baseline vision .Eyes with higher baseline vision had small vision fluctuations during recurrences of the edema and recovered after treatment.
The cohort had improvement in vision after the first year of treatment, but only 25% of the eyes with lower baseline BCVA could retain it. 81% of the eyes with baseline BCVA over 20/30 maintained it for at least 6 years despite frequent recurrences.
Mean annual number of injections in the whole cohort was in the range of 1.6 ± 2.2 and was not associated with response of the edema and final BCVA.
Conclusions: Early initiation and long-term strategy of multidisciplinary management is more effective for Kuwaiti patients with high-risk diabetic maculopathy compared to observation and delay until the visual acuity deteriorates.