A influência do controle metabólico nos resultados anatômicos e funcionais do tratamento do edema macular diabético com um anti-vegf
Matsuda, Simone Vicente [UNIFESP]
AdvisorZanella, Maria Teresa Zanella [UNIFESP]
TypeTese de doutorado
MetadataShow full item record
Artigo 1 The impact of metabolic parameters on clinical response to VEGF inhibitors for diabetic macular edema OBJECTIVES: 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 ?m, 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. xi Artigo 2 Impact of insulin treatment in diabetic macular edema therapy in type 2 diabetes OBJECTIVES: To evaluate the impact of insulin therapy on the outcomes of diabetic macular edema (DME) treatment with vascular endothelial growth factor (VEGF) inhibitors in type 2 diabetics. METHODS: A retrospective consecutive case series of 95 type 2 diabetic patients with DME treated with anti-VEGF therapy. Two cohorts were examined?patients taking only oral anti-diabetic agents (NIDDM) and patients on insulin therapy (IDDM). The main outcome measures were change in visual acuity (VA) and change central subfield macular thickness (CST) measured by spectral-domain optical coherence tomography (SD-OCT). Additional variables analyzed included HbA1c, creatinine, blood pressure and body mass index and theirs correlation with clinical findings. RESULTS: Both groups had a statistical significant improvement in VA (IDDM: 20/61 to 20/49, p=0.003; NIDDM: 20/76 to 20/56, p=0.005). There was no difference between groups at initial or 12 month examination (p=0.239 and p=0.489, respectively). From an anatomic standpoint, CST also improved significantly in both groups [454.7 ?m to 354.9 ?m (p<0.001) in the NIDDM and 471.5 ?m to 368.4 ?m (p<0.001) in the IDDM group]. Again, there was no significant difference between groups at initial or 12 month follow-up examination (p= 0.586 and p=0.591,respectively). Mean HBA1c levels remained relatively stable during the follow-up in both groups. CONCLUSION: This study suggests that insulin therapy in type 2 diabetic does not appear to impact the visual or anatomic effectiveness of DME treatment with anti-VEGF inhibitors over a 1 year follow up.