Simone Matsuda1, Tiffany Tam2, Rishi P Singh2, Peter K Kaiser2, Dan Petkovsek2, Glaucia Carneiro3, Maria Teresa Zanella3, Justis P Ehlers4. 1. Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH, USA; Department of Medicine, Division of Endocrinology, Federal University of Sao Paulo, Sao Paulo, SP, Brazil. 2. Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH, USA. 3. Department of Medicine, Division of Endocrinology, Federal University of Sao Paulo, Sao Paulo, SP, Brazil. 4. Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH, USA. Electronic address: ehlersj1@yahoo.com.
Abstract
AIMS: Evaluate the role of systemic factors on the functional and anatomic outcomes of anti-VEGF therapy for diabetic macular edema (DME). METHODS: A retrospective consecutive case series of 124 patients with DME treated with anti-VEGF therapy was collected. The main outcome measures were change in best corrected visual acuity (BCVA) and change central subfield macular thickness (CST) measured with spectral-domain ocular tomography coherence (SD-OCT); and their correlation with clinical findings. RESULTS: Patients with serum hemoglobin A1c values (HbA1c) ≤ 7.0% had a statistically significant improvement in BCVA (20/66 to 20/43, p < 0.001), and those patients with HBA1c > 7.0% also had a significant but less robust improvement in BCVA (20/78 to 20/62, p = 0.024). CST improved significantly in both groups, but showed a larger magnitude of improvement in the group with better DM control [-140.7 microns (p < 0.001) and -83.3 microns (p < 0.001)]. Mean HBA1c levels remained relatively stable during the follow-up in both groups, but patients with improved glucose control during the study duration had a significantly lower retinal thickness than patients that had a stable or worsening HbA1c (mean final CST of 324.3 versus 390.0 μm, respectively, p = 0.042). Other systemic parameters were not correlated with changes in OCT thickness or BCVA. There was not a significant difference related to number of intravitreal injection in the HbA1c ≤ 7.0% group compared to HbA1c > 7.0% group, mean of 5.48 and 6.0 intravitreal injections respectively (p = 0.362). CONCLUSION: This study suggests that glucose regulation can impact the response to anti-VEGF therapy in the management of DME.
AIMS: Evaluate the role of systemic factors on the functional and anatomic outcomes of anti-VEGF therapy for diabetic macular edema (DME). METHODS: A retrospective consecutive case series of 124 patients with DME treated with anti-VEGF therapy was collected. The main outcome measures were change in best corrected visual acuity (BCVA) and change central subfield macular thickness (CST) measured with spectral-domain ocular tomography coherence (SD-OCT); and their correlation with clinical findings. RESULTS:Patients with serum hemoglobin A1c values (HbA1c) ≤ 7.0% had a statistically significant improvement in BCVA (20/66 to 20/43, p < 0.001), and those patients with HBA1c > 7.0% also had a significant but less robust improvement in BCVA (20/78 to 20/62, p = 0.024). CST improved significantly in both groups, but showed a larger magnitude of improvement in the group with better DM control [-140.7 microns (p < 0.001) and -83.3 microns (p < 0.001)]. Mean HBA1c levels remained relatively stable during the follow-up in both groups, but patients with improved glucose control during the study duration had a significantly lower retinal thickness than patients that had a stable or worsening HbA1c (mean final CST of 324.3 versus 390.0 μm, respectively, p = 0.042). Other systemic parameters were not correlated with changes in OCT thickness or BCVA. There was not a significant difference related to number of intravitreal injection in the HbA1c ≤ 7.0% group compared to HbA1c > 7.0% group, mean of 5.48 and 6.0 intravitreal injections respectively (p = 0.362). CONCLUSION: This study suggests that glucose regulation can impact the response to anti-VEGF therapy in the management of DME.
Authors: Simone Matsuda; Tiffany Tam; Rishi P Singh; Peter K Kaiser; Daniel Petkovsek; Maria Teresa Zanella; Justis P Ehlers Journal: Can J Diabetes Date: 2014-10-22 Impact factor: 4.190
Authors: Yuji Itoh; Daniel Petkovsek; Peter K Kaiser; Rishi P Singh; Justis P Ehlers Journal: Ophthalmic Surg Lasers Imaging Retina Date: 2016-10-01 Impact factor: 1.300