Abstract
Purpose :
We evaluated the impact of the systemic metabolic and cardiovascular risk factors (e.g., HbA1c level, hypertension renal parameters or dyslipidemia) on the response to anti-VEGF treatment in patients with diabetic macular edema (DME).
Methods :
In prospective, monocentric interventional study (LIPSIA Trial) in total 148 eyes of 90 patients with DME received clinical examinations as 24-hour blood pressure measurement and laboratory examination of metabolic, renal and cardiovascular parameters. These investigations were conducted prior to the montly aflibercept treatment and after 6 months. We investigated the correlation with demographic parameters, baseline best corrected visual acuity (BCVA) and the blood pressure levels as well as laboratory blood parameters.
Results :
The mean age was 61.1±14.9 years. The mean body mass index (BMI) was 32.1±5.9 kg/m2. HbA1c values were >7.0% in 63% of all patients. The blood pressure (BP) of 77% patients was above the target values of systolic <140 mmHg and diastolic <80 mmHg. LDL cholesterol was above the target value of 1.4 mmol/l in 92% of patients. Worse baseline BCVA and lower age were associated with a more pronounced gain in BCVA 6 months after initiation of intravitreal therapy. Furthermore, patients with normal glomerular filtration rate (GFR≥ 90 ml/min/1.73m2) had a significant better functional outcome at 6 months compared to patient with reduced GFR (10.0 ± 11.7 letters vs. 2.9 ± 8.1 letters, EM mean [adjusted for baseline BCVA and age]: 7.7 ± 1.3 letters vs. 3.9 ± 1.1 letters, p=0.019). The better the baseline BCVA, the less likely a patient gained ≥ 5 letters at month 6 (OR: 0.913, 95% CI: 0.86 – 0.97, p=0.003). Patients with a GFR ≥ 60 ml /min /1.73m2 were more likely to gain ≥ 5 letters compared to patients with GFR <60 ml /min /1.73m2 (OR: 3.73, 95% CI: 1.28 – 10.92, p=0.016). HbA1c levels, fasting glucose or blood lipid levels did not show an association with visual outcome.
Conclusions :
The DME patients in the LIPSIA study presented several systemic comorbidities that were mainly poorly controlled. The response to aflibercept intravitreal treatment correlated with the age, baseline BCVA, and the renal parameters, but not with the HbA1c level.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.