Diabetic Macular Edema Treatment with Bevacizumab Does Not Depend on the Retinal Nonperfusion Presence.

Bogumiła Sędziak-Marcinek,Edward Wylęgała,Sławomir Teper,Mateusz Bas,Elżbieta Chełmecka,Adam Wylęgała,Mateusz Marcinek,Irini Chatziralli

doi:10.1155/2021/6620122

Abstract

This study evaluated the relationship between the retinal nonperfusion area (NPA) presence and the effectiveness of bevacizumab treatment (IVB) in patients with diabetic macular edema (DME). It also tested the prognostic usefulness of ultra-wide-field fluorescein angiography (UWFFA) and OptosAdvance software for diabetic retinopathy monitoring. Eighty-nine patients with DME with a macular central subfield thickness (CST) ≥ 250 μm, with (N = 49 eyes) and without (N = 49 eyes) retinal NPA, underwent nine bevacizumab injections over 12 months. NPA distribution, leakage area distribution, microaneurysm (MA) count, macular CST, diabetic retinopathy severity, and best-corrected visual acuity (BCVA) were assessed. The results show that bevacizumab reduced the macular CST from 420 to 280 μm (p < 0.001) and improved BCVA (p < 0.001) by about 10 ETDRS letters in both groups of patients. Additionally, the therapy reduced total retinal NPA from 29 (14-36) mm2 to 12 (4-18) mm2 (Me (Q1-Q3); p < 0.001) in patients with diagnosed nonperfusion. The effect of the therapy measured with vascular leakage, MA count, BCVArelative, and CSTrelative strongly depended on the zone of the retina and the NPA distribution. We conclude that the bevacizumab treatment had a positive effect on DME and BCVA in both study groups and on the size of retinal NPA in patients with retinal nonperfusion.

Highlights

Diabetic retinopathy (DR) is considered the most common microvascular complication of diabetes [1]
Some authors suggested that almost all T1DM patients would have some degree of retinopathy 20 years from T1DM diagnosis, as would more than 80% of insulintreated type 2 diabetes mellitus (T2DM) patients and 50% of those not requiring insulin [2, 3]
We evaluated the relation between the retinal nonperfusion area presence and the effectiveness of bevacizumab treatment in patients with diabetic macular edema that were not subjected to the previous treatment

Summary

Introduction

Diabetic retinopathy (DR) is considered the most common microvascular complication of diabetes [1]. Some authors suggested that almost all T1DM (type 1 diabetes mellitus) patients would have some degree of retinopathy 20 years from T1DM diagnosis, as would more than 80% of insulintreated T2DM (type 2 diabetes mellitus) patients and 50% of those not requiring insulin [2, 3]. It was shown that the extent of capillary nonperfusion can increase from the peripapillary retina in ascending order and that the areas of nonperfusion occur in the midperiphery [4]. Silva et al reported that the extent of capillary nonperfusion in the midperiphery increased as DR progressed [4]

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