title: The impact of metabolic parameters on clinical response to VEGF inhibitors for diabetic macular edema.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  This study suggests that glucose regulation can impact the response to anti-VEGF therapy in the management of DME.
authors.affiliation: 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.
authors.forename: Simone
authors.initials: S
authors.lastname: Matsuda
authors.affiliation: Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Tam
authors.affiliation: Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Rishi P
authors.initials: RP
authors.lastname: Singh
authors.affiliation: Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Peter K
authors.initials: PK
authors.lastname: Kaiser
authors.affiliation: Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Dan
authors.initials: D
authors.lastname: Petkovsek
authors.affiliation: Department of Medicine, Division of Endocrinology, Federal University of Sao Paulo, Sao Paulo, SP, Brazil.
authors.forename: Glaucia
authors.initials: G
authors.lastname: Carneiro
authors.affiliation: Department of Medicine, Division of Endocrinology, Federal University of Sao Paulo, Sao Paulo, SP, Brazil.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Zanella
authors.affiliation: Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH, USA. Electronic address: ehlersj1@yahoo.com.
authors.forename: Justis P
authors.initials: JP
authors.lastname: Ehlers
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000068258:Bevacizumab; D001786:Blood Glucose / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy / Q000378:metabolism; D003930:Diabetic Retinopathy / Q000188:drug therapy* / Q000378:metabolism*; D005260:Female; D006801:Humans; D058449:Intravitreal Injections; D008269:Macular Edema / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D001786:Blood Glucose; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab
keywords: Avastin; Bevacizumab; Diabetic macular edema; Diabetic retinopathy; HbA1c; Metabolic parameters; VEGF; VEGF-inhibitors