Determinants of intravitreal anti-vascular endothelial growth factor treatment outcomes in diabetic patients having macular edema

Abstract

Background: With a growing number of patients diagnosed with microvascular complications of diabetes, cases of diabetic retinopathy (DR) are on the rise. This study helps to determine the treatment outcomes and factors associated with anti-vascular endothelial growth factor (VEGF) treatment for macular edema associated with diabetes in a Regional Hospital in Saudi Arabia. Materials and Methods: A retrospective study based on the data collected from the patient records of cases of diabetic macular edema presenting from May 2016 to December 2021 and treated with anti-VEGF agents. Information on demographics, disease, and treatment was extracted on a data driven form for 1293 patients. Student's paired t-tests and ordered logistic regression analysis were carried out to study the effect of various factors on treatment outcomes. All values were considered statistically significant at a value of P ≤ 0.05. Results: We found improvement in visual acuity (VA) and macular thickness following the treatment with anti-VEGF. VA improved from 0.24 ± 0.27 m to 0.28 ± 0.27 t (1716) = −2.958, P < 0.005, t (1716) = 27.30; and macular thickness decreased from 267.32 ± 200.17 to 194.40 ± 151.38 (P < 0.001). Younger patients, male gender, and patients having multimorbidity (presence of hypertension [HTN] or chronic kidney disease long with diabetes) significantly improved VA (P < 0.001). Intravitreal ranibizumab has significantly more effect on improvement in VA (P < 0.001), while all intravitreal anti-VEGF agents have a significant effect on reducing macular thickness (P < 0.001). Conclusion: Anti-VEGF agents provide successful treatment outcomes in patients having DR; however, treatment outcomes differ by gender, age, and co-existing HTN and kidney disease. Treatment with ranibizumab significantly increases VA.