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Oliver G Fischer, David Scott Ketner; Effect of Tobacco Use on the Efficacy of Intravitreal Injection of Bevacizumab in Patients with Diabetic Macular Edema (DME). Invest. Ophthalmol. Vis. Sci. 2018;59(9):399. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
The etiology of DME is multifactorial. Little is known about the contribution of tobacco smoking to the development and clinical course of DME. We sought to examine the effect of tobacco smoking on the response to intravitreal injection of bevacizumab in patients with DME.
In a retrospective case-series, the electronic medical records of Bronx-Lebanon Hospital Center were searched for patients with decreased vision from DME (study eye BCVA 20/40 to 20/320) who were treated with intravitreal injection of bevacizumab from 2014 to November of 2017. Key exclusion criteria were history of recent cataract surgery, vein occlusion, or initial central macular thickness (CMT) of ≤ 275 µm. The medical records were reviewed for demographics, clinical history, Snellen visual acuity (VA), and OCT data (CMT) from the start of treatment until one-year post treatment. In patients treated bilaterally, one eye was selected at random. Snellen VA were converted to LogMar units for analysis. These results were compared in patients with a history of tobacco use versus patients that never smoked tobacco.
Twenty-five patients receiving intravitreal injection of bevacizumab for DME were identified: 14 (56%) males and 11 (44%) females, ranging in age from 50 to 82 (mean age of 66.2 years old). Nineteen (76%) patients were of Hispanic or Latino descent, and 6 (24%) patients were of African American or black descent. Nine (36%) patients smoked tobacco and 16 (64%) patients never smoked tobacco. Mean VA in tobacco smokers at baseline and 12 months were 20/60 ± 1.6 lines and 20/40 ± 1.2 lines, respectively, with mean CMT of 454.0 ± 76.6 µm, and 366.7 ± 80.1 µm, respectively. Mean VA in patients that never smoked tobacco at baseline and 12 months were 20/63 ± 1.3 lines and 20/50 ± 1.1 lines, with mean CMT of 444.9 ± 52.7 µm and 357.2 ± 43.2 µm, respectively. Mean CMT at two months in patients that smoked tobacco was 418.17 ± 82.3 µm compared to 294.2 ± 62.3 µm in patients that never smoked tobacco (p=0.027).
Intravitreal injection of bevacizumab for the treatment of DME was found to have significant anatomical improvement in CMT at 12 months for both tobacco smokers and non-smokers. The difference in VA improvement was not statistically significant between groups. Patients that never smoked tobacco had thinner CMT than tobacco smokers at 2 months post treatment.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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