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Simone Matsuda, Tiffany Tam, Rishi Singh, Gina Smith, Justis Ehlers; THE IMPACT OF SYSTEMIC FACTORS ON CLINICAL RESPONSE TO VEGF INHIBITORS FOR DIABETIC MACULAR EDEMA. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2417.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the effect of glucose regulation, renal function, blood pressure, obesity, and lipid profile on anti-vascular endothelial growth factor (VEGF) treatment for diabetic macular edema (DME).
A retrospective consecutive case series for eyes enrolled 125 eyes of 83 patients with DME treated with intravitreal bevacibizumab or ranibizumab. The main outcome measures were the change in best corrected visual acuity (BCVA), the change central subfield macular thickness (CST), the number of intravitreal injections; and their correlation with the serum hemoglobin A1c values (HbA1c), glomerular filtration rate (GFR) estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, fasting serum lipids and other clinical findings.
The study included 125 eyes of 83 patients. Fifty-two (62.6%) females and 72 (86.7%) males with a mean age of 60.4 years were identified. The mean HbA1c was 8.15 (range 6.0-15%) and the mean duration of DM was 11.2 years. The mean initial BCVA was 20/84 and improved to 20/61 at final follow-up (p = 0.02). The mean baseline CSMT was 448 µm and decreased to 366 µm at final follow-up (p < 0.001). The mean number of intravitreal injection was 6.3 and the mean follow-up was 11.9 months. The serum HbA1c values and duration of DM were found to be negatively correlated with the change in CSMT [(-0.33, p < 0.001), (-0.251, p = 0.05), respectively]. Improved glycemic control during the study period (e.g. reduction in HbA1c) was associated with reduced frequency of injections (-0.22; p = 0.05). GFR, blood pressure, and fasting lipid profile did not show significant correlation with change in CST, BCVA or number of intravitreal injections, respectively.
Intravitreal bevacizumab and ranibizumab for DME demonstrated a beneficial functional and structural effect with improved visual acuity and reduced macular edema. Systemic control of diabetes was associated with improved structural response and reduced injection burden. Enhancement of DM control may result in improved response to anti-VEGF therapy. In this study, renal function, blood pressure, and lipid profile did not have a significant impact on response to anti-VEGF therapy.
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