Abstract
Purpose :
Most studies evaluating bevacizumab use for diabetic macular edema exclude poorly controlled diabetics with systemic comorbidities. As such, the anatomic response to bevacizumab is poorly characterized in the most advanced of diabetics. This retrospective study aims to explore real-world outcomes of bevacizumab therapy for diabetic macular edema in patients with and without renal dysfunction.
Methods :
This is a retrospective study of ninety-one patients at a single Veterans Affairs Medical Center who were treated for DME (diabetic macular edema) with intravitreal bevacizumab between the years of 2014-2017. We chose to use central macular thickness (CMT) as measured on macular optical coherence tomography (OCT) to assess treatment response to bevacizumab. Exclusion criteria included having had any intravitreal injections in the preceding 3 months, and having any history of previous vitrectomy or macular laser treatment. Anatomic response to bevacizumab was measured by comparing baseline CMT against follow up within 6 weeks of the first injection. Baseline serum creatinine values were recorded within 3 months of the first injection.
Results :
Of those patients with lower creatinine levels (≤ 1.2, 39 patients), the average decrease in CMT from the time of injection to the next follow-up visit was 8.6%, while the average decrease in CMT for those with higher creatinine (>1.2, 52 patients) was 18.8% (p=0.019). There was no significant difference in initial CMT between the two groups (p=0.75). Among those patients who began with CMT > 300 um, the group with higher creatinine levels had a greater proportion achieving anatomic improvement (CMT ≤ 300um) than those who began with lower creatinine levels, although this difference was not statistically significant. (p=0.11)
Conclusions :
These results demonstrate that patients in a VA population with DME who have a higher creatinine level have a more robust decrease in CMT after one intravitreal injection of bevacizumab than those with lower creatinine levels. This suggests that patients with advanced systemic diabetic microvasculopathy are not disadvantaged with intravitreal bevacizumab as initial treatment when compared against patients with milder systemic disease.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.