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Alex Wright, Dalbert Jonathan Chen, Alice Chuang, Eric L Crowell; Factors affecting DME resolution in nonproliferative diabetic retinopathy. Invest. Ophthalmol. Vis. Sci. 2020;61(7):301.
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© ARVO (1962-2015); The Authors (2016-present)
Risk factors for the development of diabetic macular edema (DME) are well defined and studied, but the studies assessing factors affecting the resolution of DME have not come to a consensus. In this retrospective cohort study, our objective is to identify risk factors for prolonged DME after treatment.
A retrospective chart review was performed on diabetic patients who received an eye exam between January 2010 and June 2017 at Lyndon B. Johnson Hospital. Patients with DME were included. Patients whose initial diagnosis was proliferative diabetic retinopathy (PDR) or followed less than 1 year were excluded. If both eyes were eligible, the right eye was included. Demographics and baseline systemic and ocular characteristics were recorded. Time from the initial diagnosis to resolution of DME by optical coherence tomography (OCT), number of intravitreal anti-vascular endothelial growth factor (VEGF) injections before resolution, and mean HbA1C were recorded. Stepwise Cox regression was used to identify risk factors and estimate their effects on time to resolution of DME. The risk factors studied were age of DME onset, sex, race, hypertension (HTN), number of injections, and mean HbA1c.
120 eyes of 120 patients were included. 72 patients (60%) were female. 77 (64%) were Hispanic, 31 (26%) Black, and 10 (8%) White. The majority of patients (102 [84%]) had HTN. Mean age at DME diagnosis was 59.1 years (+8.0, 34-82) with HbA1c 8.8 (+1.8,5.4-15.0). During a mean of 3.8 years (+1.9, 1.1 - 9.4) follow-up, 49 (41%) DME eyes resolved at a mean of 2.5 years (+1.5, range 0.3 - 7.0) with a mean of 4.6 anti-VEGF injections (+4.9, 0 - 25). If the number of injections increased by 1, the time to resolution of DME was reduced by a factor of 0.83 (P<0.001). When HbA1c increased by 1 unit, the time to resolution of DME increased 1.28 times (P=0.010). Other risk factors did not affect the time to resolution (P>0.05).
After adjusting for number of anti-VEGF injections, higher HbA1c prolonged resolution of DME. Glycemic control appears to be the primary driver in prolonged resolution of DME when compared to HTN, sex, race, and age of onset. If confirmed by prospective clinical trials, this could help guide the clinical approach to DME in non-PDR.
This is a 2020 ARVO Annual Meeting abstract.
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