Systemic Factors Associated with Treatment Response in Diabetic Macular Edema.

Wendy Meihua Wong,Xinyi Su,Hazel Lin,Mayuri Bhargava,Gopal Lingam,Charmaine Chai,Tien Yin Wong,Yew Sen Yuen,Erlangga Ariadarma Mangunkusumo,Thet Naing,Paul Zhao,Caroline Chee

doi:10.1155/2020/1875860

Abstract

Purpose To identify systemic factors that may influence the response to anti-VEGF therapy in patients with diabetic macular edema (DME). Methods 35 patients undergoing anti-VEGF injections for centre-involving DME were studied in this prospective observational study. The primary outcome was change in macular thickness one month after treatment, measured using spectral-domain optical coherence tomography (OCT). At baseline, information on various systemic factors was collected including glycosylated hemoglobin (HbA1c), serum VEGF levels, lipid profile and markers of renal function, and blood pressure. Thirty-three of the 35 patients were included in this study. Nonparametric statistical tests were used for the analysis of the data in view of the nonnormal distribution of the outcome variables. Multivariate analysis was performed using logistic regression. Stata 12.1 software was used for the analysis. Main Outcome Measures. Reduction in macular central subfield thickness (on spectral-domain OCT) and change in logMAR visual acuity at one month after injection. Results Lower HbA1c levels (7% or less) were significantly associated with greater reduction in central macular subfield thickness at one month after injection of bevacizumab or ranibizumab on both univariate analysis (p=0.012) and multivariate analysis (p=0.012) and multivariate analysis (Conclusions Better glycemic control is associated with a greater reduction in central macular thickness after the first injection of bevacizumab or ranibizumab in diabetic macular edema. Patients with high levels of HbA1c and poor response to anti-VEGF may benefit from strict control of their blood glucose.

Highlights

Diabetic macular edema (DME) is a vision-threatening complication of diabetes
We explored whether systemic factors, such as blood pressure, glucose control, cholesterol, triglyceride, and creatinine levels at the time of intravitreal anti-VEGF injection, affect the visual or anatomic response at one month after initiating the treatment
E baseline demographic and study eye characteristics are summarized in Table 1. e mean duration of diabetes for study participants was 11.8 ± 9.5 years. e mean baseline central subfield thickness (CST) was 440.5 ± 136.3 microns. ere was no statistically significant difference in the mean baseline CST of patients with HbA1c ≤7.0% and patients with HbA1c >7.0% (p 0.27)

Summary

Introduction

Diabetic macular edema (DME) is a vision-threatening complication of diabetes. In DME, accumulation of fluid in the macula results in loss of central vision, which is important for facial recognition, reading, and driving. DME affects 1 in 15 people with diabetes [1] and is the leading cause of blindness in young adults in developed countries [2]. Intravitreal injections of antivascular endothelial growth factor (anti-VEGF) have revolutionized the treatment of patients with DME, causing visual impairment. Several landmark studies have demonstrated that anti-VEGF therapy, compared to laser photocoagulation, provides superior visual outcomes [3, 4]. In the Diabetic Retinopathy Clinical Research Network Protocol T, three commonly used anti-VEGF agents, bevacizumab, ranibizumab, and aflibercept, were shown in the randomized controlled trial to improve vision in centre-involving DME [5]

Methods

Results

Discussion

Conclusion