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Intravitreal bevacizumab injections for diabetic macular edema - predictors of response: a retrospective study
Lavnish Joshi1, Asaf Bar2, Oren Tomkins-Netzer3
1Department of Clinical Ophthalmology, UCL Institute of Ophthalmology and Moorfields Eye Hospital, London, UK; Ophthalmology Department, Ashford & St Peter's NHS Foundation Trust, Ashford, Middlesex, UK; Ophthalmology Department, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, UK.
Background:
Outcomes of intravitreal antivascular endothelial growth factor injections are variable among patients with diabetic macular edema (DME). The aim of this study was to determine the ocular and systemic predictors of DME response to intravitreal bevacizumab (IVB).
Methods:
Retrospective review over 2 years of 78 eyes from 54 patients. An anatomical response to IVB was defined as a 20% reduction in central macula thickness after the first course (three injections) of IVB.
Results:
Twenty-eight percent of patients had an anatomical response after the first course of IVB. Systemic hypertension (odds ratio, 95% confidence interval: 12.1, 0.7-21) was a statistically significant predictor (P=0.025) of a good response to IVB, whereas previous macular laser was a statistically significant (P=0.0005) predictor of a poor response (0.07, 0.01-0.32). Sixty-eight percent of eyes underwent subsequent treatment for DME after the first course of IVB. The visual acuity gain at 24 months in hypertensive (0.7±3.6 letters) and nonhypertensive (5.2±3.7 letters) patients was not significantly different (P=0.41).
Conclusion:
Hypertension and previous macular laser were positive and negative predictors of response to IVB, respectively. However, long-term visual acuity changes were not significantly different between eyes with and without systemic hypertension.
