A Comparison of Visual Outcomes Between Patients Treated with Intravitreal Ranibizumab and Bevacizumab for Diabetic Macula Edema in A Real World Setting in Sub-Saharan Africa

Aims and Objectives: To report a comparison of visual outcomes between patients treated with intravitreal ranibizumab and bevacizumab for diabetic macula oedema (DME) in a real-world setting in sub-Saharan Africa. Methods: A retrospective review of cases files of patients who were treated with either intravitreal ranibizumab or bevacizumab for diabetic macular edema in Eye Foundation Hospital Ikeja, Lagos, Nigeria between January 2018, and January 2019. Results: A total of 508 injections were received by 138 eyes of 115 patients within the study year and diabetic macular edema accounted for 36 eyes, (26.1%) of the total eyes that received either intravitreal Ranibizumab or Bevacizumab. There were 18 males (50%) and 18 (50%) females. Overall, the mean baseline pre injection BCVA was 0.32 ± 0.24 (range:0.05-1.0). One hundred and forty-three total injections of either Bevacizumab or Ranibizumab were received by the 36 eyes of DME participants. Fifteen eyes (41.7%) received Bevacizumab while 21 eyes (58.3%) received Ranibizumab injections. At 4 months a larger percentage of eyes (47.6%) that received Ranibizumab had better visual acuities compared to (13.3%) eyes that received Bevacizumab. At 6 months, more of the eyes that received Ranibizumab had better visual acuities (26.7%) compared to 23.8% that received Bevacizumab. At 9 months, more of the eyes that received Ranibizumab had better visual acuities (33.3%) compared to (19%) those that received Bevacizumab. However, these differences were not statistically significant. Compliance to treatment regime was poor, only 7 eyes of the 36 eyes (19.4%) were compliant, 5 eyes (33.3%) form Bevacizumab group and 2 eyes (9.5%) from the Ranibizumab group. Conclusion: Despite poor compliance, improvements in best corrected visual acuities was achieved and maintained with the use of either intravitreal bevacizumab or ranibizumab for diabetic macula edema in a real life setting in sub-Saharan Africa. Neither bevacizumab nor ranibizumab showed statistically significant superiority.