Abstract
Purpose:
Bevacizumab is a less costly alternative than currently licenced therapies for Diabetic Macular Oedema (DMO) in the UK. Our purpose is to report improvement in best corrected visual acuity (BCVA) and central macular thickness (CMT) in patients with DMO treated with intravitreal bevacizumab (IVB, Avastin, Genentech/Roche). We also looked at the influence of blood pressure and glucose control on these outcomes.
Methods:
We performed a retrospective case review of 117 eyes that were treated with IVB (1.25 mg) four weekly for DMO in Frimley Park Hospital between 2010 and 2014. We included all patients that had at least 12 months follow-up. The primary outcomes were BCVA and CMT at 12 months, 18 months, 21 months and 24 months. We also recorded their initial blood pressure readings and their glycated haemoglobin value. Statistical analysis was carried out using the paired and unpaired student’s t-test.
Results:
The improvement in mean BCVA and the improvement in mean CMT are statistically significant at 12 months for 117 patients (+5.59 letters, p = 0.0001 and -29.83 µm, p =0.0123), 18 months for 84 patients (+5.52 letters, p = 0.0001 and -58.64 µm, p =0.0001), 21 months for 66 patients (+4.76 letters, p = 0.0014 and -60.70 µm, p =0.0001) and 24 months for 43 patients (+4.83 letters, p = 0.0109 and -53.47 µm, p =0.0006). These results are consistent with those of the BOLT study.<br /> <br /> The 36 patients with a systolic blood pressure < or = to 140 mmHg had a greater improvement in mean BCVA and CMT than the 80 patients with blood pressure > 140 mmHg (+6.42 letters vs. +3.41 letters and -45.03 µm vs. -30.31 µm), but the difference was not statistically significant. The 21 patients with glycated haemoglobin (Hba1c) <53 mmol/mol had a greater improvement in mean BCVA and CMT than the 75 patients with Hba1c > or = to 53 mmol/mol (+5.81 letters vs. +2.57 letters and -43.57 µm vs. -33.49 µm) but the difference was not statistically significant.
Conclusions:
This retrospective study demonstrated a statistically significant improvement in mean BCVA and CMT in patients treated with bevacizumab for DMO up to 24 months follow-up in an NHS clinic setting. Our results imply the outcomes may be influenced by blood pressure and glucose control, but these findings were not statistically significant, and further research with a larger sample is required to confirm this.