Abstract
Aims To investigate the correlations between renal biomarkers and the treatment outcomes of ranibizumab for diabetic macular edema (DME). Methods This hospital-based study retrospectively enrolled 88 eyes from 67 patients who had received one-year intravitreal ranibizumab treatment for DME. Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) at baseline and during the follow-up period were recorded. BCVA and OCT characteristics at baseline and their changes after ranibizumab treatment were compared between different proteinuria and estimated glomerular filtration rate (eGFR) groups. Results Of the 88 eyes studied, those with moderately increased proteinuria had a thicker central subfield foveal thickness (CFT) and a higher proportion of intraretinal cysts than those with no proteinuria (P = 0.012 and 0.045, respectively) at baseline. After one year of ranibizumab treatment, the reduction in CFT was greater in patients with severely increased proteinuria than those with normal to mildly increased proteinuria (P = 0.030). On the other hand, patients with an eGFR <30 tended to have poorer visual improvements than those with normal eGFR (P = 0.044). Conclusions After ranibizumab treatment for DME, patients with severe proteinuria tended to gain better anatomical improvement, while those with poor eGFR tended to have poorer visual improvement.
Highlights
Diabetic macular edema (DME) is the main reason for the visual deterioration in patients with diabetes [1]
Inclusion criteria included the following: (1) diabetic retinopathy documented by fundus photography or fluorescein angiography (FA); (2) macular edema with the presence of retinal thickening, intraretinal cysts, or subretinal fluid and a central subfield foveal thickness (CFT) greater than 300 μm as documented by optical coherence tomography (OCT); (3) best-corrected visual acuity (BCVA) between 20/400 and 20/40 at baseline; (4) available record of estimated glomerular filtration rate at baseline or during the first year of treatment; and (5) available record of urinary albumin/creatinine ratio (UACR), urinary protein-creatinine ratio (UPCR), hemodialysis, or peritoneal dialysis at baseline or during the first year of treatment
We found that the severity of proteinuria was correlated with baseline CFT and the presence of intraretinal cysts at baseline
Summary
Diabetic macular edema (DME) is the main reason for the visual deterioration in patients with diabetes [1]. The disorganization of the blood-retinal barrier was regarded as a key event in the development of DME. This process encompasses a wide variety of cytokines under chronic hyperglycemia, among which hypoxia-induced release of vascular endothelial growth factor (VEGF) played an essential role [3]. Intravitreal ranibizumab (IVR) have shown anatomical and visual improvements in several large randomized clinical trials (RCTs) [4, 5]. In light of these discoveries, anti-VEGF drugs have been the treatment of choice for DME in recent years [3]
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