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Serum pro‐inflammatory factors as predictors of persistent diabetic macular oedema with limited anatomic response to anti‐ VEGF : association with intravitreal injection treatment profiles in real‐world setting
Author(s) -
Brito Pedro,
Costa Jorge,
Gomes Nuno,
Costa Sandra,
CorreiaPinto Jorge,
Silva Rufino
Publication year - 2020
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/aos.14308
Subject(s) - medicine , diabetic retinopathy , triamcinolone acetonide , bevacizumab , creatinine , visual acuity , ophthalmology , gastroenterology , urology , diabetes mellitus , endocrinology , chemotherapy
Purpose To study the role of serum levels of pro‐inflammatory factors in the identification of persistent diabetic macular oedema ( DME ) cases with limited anatomic response to anti‐ VEGF . Additionally, possible predictive associations between serum factors and intravitreal treatment profiles were analysed. Methods Cases with DME were treated with monthly bevacizumab ( BVZ ). After the sixth month of follow‐up, if the change in central foveal thickness ( CFT ) was <20% of baseline, combination treatment with triamcinolone was initiated. All cases underwent a baseline laboratory workup including inflammatory, metabolic and prothrombotic factors. The following outcome parameters were evaluated: percentage of CFT change from baseline, occurrence of persistent DME with <20% change in CFT , achieving CFT <330 μ m with ≤6 BVZ injections, total number of intravitreal injections ( IVI ), number of IVI after the 6th month and number of triamcinolone acetonide ( TCA ) injections. Results A total of 58 cases were included receiving a mean of 7.23 ± 1.55 IVI in 12 months, resulting in a significant improvement of visual acuity ( VA ) and CFT . No significant differences were found for baseline CFT , baseline Log MAR VA , diabetic retinopathy grade, age or duration of DM 2 between cases initiating TCA and those treated only with anti‐ VEGF . Significant correlations were found between total number of IVI and the following serum factors: high‐sensitivity C‐reactive protein (hs CRP ) (p = 0.004, r = 0.395), creatinine (p = 0.023, r = 0.338) and homocysteine (p = 0.037, r = 0.309). Regression analysis revealed that hs CRP was a significant predictor of TCA treatment (p = 0.028, r 2 = 0.350). Cases requiring ≤6 IVI had significantly lower values of hs CRP (1.33 ± 1.07 versus 2.46 ± 2.18 mg/l, p = 0.016) and creatinine (0.71 ± 0.28 versus 0.94 ± 0.19 mg/dl, p = 0.003). Conclusions Serum markers of microvascular damage (hs CRP , homocysteine and creatinine) were associated with a higher frequency of IVI due to persistent DME , suggesting a role for such biomarkers in the identification of limited responders to anti‐ VEGF monotherapy.