Outcomes of eyes with persistent diabetic macular oedema: The Fight Retinal Blindness! Project

Aims: To compare 1-year and 2-year outcomes of eyes with persistent and non-persistent diabetic macular oedema (DME) treated with vascular endothelial growth factor (VEGF) inhibitors. Methods: This was a cohort study using the Fight Retinal Blindness! (FRB!) international outcomes registry. Participants had treatment-naïve eyes with centre-involving DME starting intravitreal VEGF inhibitor therapy from 2014 to 2023. Eyes were grouped as those with persistent DME and those with non-persistent DME. Main outcome measures were mean visual acuity (VA) change and central subfoveal thickness change after 1 and 2 years of treatment. Results: This study included 877 eyes, of which 40% had persistent DME. The mean VA change in eyes with persistent DME was less than that in eyes with non-persistent DME at 1 (+3.6 vs. +6.5 letters; p<0.001) and 2 (+3.6 vs. +6.3 letters; p<0.001) years. The persistent group had a lower mean reduction in central subfield thickness at 1 (−74 vs −111 µm; p<0.001) and 2 (−90 vs −114 µm; p<0.001) years and received more mean injections at 1 (7.6 vs 6.5; p<0.001) and 2 (11.8 vs 9.5; p<0.001) years. Conclusion: Eyes with persistent DME had significantly lower improvement in mean VA, lower reduction in CST and more injections 1 and 2 years after the initiation of VEGF inhibitor therapy. Eyes with persistent DME likely had a higher treatment burden because they had more aggressive disease that was more difficult to control. More effective agents would likely deliver better outcomes in this significant group of patients with DME.