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Intravitreal bevacizumab injections for diabetic macular edema – predictors of response: a retrospective study
Authors Joshi L, Bar A, Tomkins-Netzer O, Yaganti S, Morarji J, Vouzounis P, Seguin-Greenstein S, Taylor SR, Lightman S
Received 4 April 2016
Accepted for publication 2 June 2016
Published 21 October 2016 Volume 2016:10 Pages 2093—2098
DOI https://doi.org/10.2147/OPTH.S109809
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Scott Fraser
Lavnish Joshi,1–3 Asaf Bar,4 Oren Tomkins-Netzer,1,3 Satish Yaganti,1 Jiten Morarji,1 Panayiotis Vouzounis,1 Sophie Seguin-Greenstein,1,4 Simon R Taylor,3,5 Sue Lightman1,3
1Department of Clinical Ophthalmology, UCL Institute of Ophthalmology and Moorfields Eye Hospital, London, UK; 2Ophthalmology Department, Ashford & St Peter’s NHS Foundation Trust, Ashford, Middlesex, UK; 3Ophthalmology Department, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, UK; 4Ophthalmology Department, Wolfson Medical Center, Holon Israel; 5Ophthalmology Department, University of Surrey, 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.
Keywords: diabetes, macular edema, intravitreal therapy
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