Abstract
Purpose :
Recurrent macular edema is of increasing interest in the management of diabetic macular edema (DME). The risk factors for the development of DME are well studied, but those affecting the time to recurrence of DME after treatment have not been well defined. Our objective is to identify factors affecting the time to recurrence of DME after treatment.
Methods :
A retrospective chart review was performed on DME patients between 1/2010 to 6/2017 at Lyndon B. Johnson General Hospital. Patients over 18 years with DME and treated with anti-VEGF injection were included. If both eyes were eligible, the left eye was used for data analysis. Demographics and baseline systemic and ocular characteristics were recorded. Presence or recovery of DME, injections, and the last known HbA1C were recorded at each clinic visit. The time to recovery and recurrence were calculated. The cumulative number of anti-VEGF injections at the time of recovery and the Mixed Effect Cox regression was used to identify risk factors and estimate their effect on time to resolution and recurrence of DME.
Results :
114 patients were included in this study. 75 patients (65.8%) were female and 76 (66.7%) were Hispanics, 24 (21.1%) black, and 12 (10.5%) white, and 2 (1.8%) Asians. Mean age at anti-VEGF treatment for DME was 58.6 years (+8.0,27-75) with mean duration of DM 15.2 years (+6.9,1-36), and mean baseline HbA1c 8.8 (+2.1,5.7-15.1). During a mean follow-up period of 3.1 years (+1.7,0.1-7.8), 77 (67.5%) DME eyes were resolved for the first time at a mean of 1.2 years (+1.1,0.1-5.9) with a mean of 3.7 anti-VEGF injections (+2.1,1-10). After resolution, 46/77 eyes had a recurrence with mean of 2.0 years. No risk factors were associated with time to resolution, while males (Hazard ratio (HR) = 2.56 with 95% confidence interval (CI) = [1.30, 5.08], P=0.007) and longer duration of DM (HR=1.06 per year, 95% CI= [1.01, 1.18], P=0.013) significantly shorten the time to recurrence. HbA1c and number of anti-VEGF injections were not significant risk factors for resolution and recurrence of DME.
Conclusions :
In our review, the duration of diabetes and male gender were significant factors associated with decreased time to recurrence of DME after treatment with anti-VEGF. HbA1c was not associated with time to recurrence. If confirmed by prospective clinical trials, this could help guide monitoring and treatment approach of DME in patients with a long history of diabetes.
This is a 2021 ARVO Annual Meeting abstract.