Characteristics of diabetic macular edema patients refractory to anti-VEGF treatments and a dexamethasone implant


Autoři: Moon Young Choi aff001;  Donghyun Jee aff001;  Jin-woo Kwon aff001
Působiště autorů: Department of Ophthalmology and Visual Science, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea aff001
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0222364

Souhrn

Purpose

To determine the characteristics of diabetic macular edema (DME) patients refractory to intravitreal bevacizumab (IVB) treatments and an additional dexamethasone implant.

Methods

We classified 119 DME patients according to whether or not they are responsive to 3 consecutive monthly anti-VEGF treatments and/or an additional dexamethasone implant. We compared their concentrations of IL (interleukin)-1β, IL-8, IL-10, IL-17, placental growth factor (PlGF), and vascular endothelial growth factor (VEGF) in the aqueous humor as well as their optical coherence tomography (OCT) findings, and baseline characteristics. We used logistic regression analyses to identify preoperative factors related to refractoriness to treatments.

Results

Of 119 treatment-naïve DME patients, 50 (42.02%) patients showed responsiveness [central subfield thickness (CST) < 300μm] after 3 IVBs, and 59 (49.58%) patients showed responsiveness after an additional dexamethasone implant, but 10 (8.40%) patients showed CST 300 ≥ μm even after both treatments. Refractory DME patients showed significantly higher number of hyperreflective foci (HF) in the OCT and higher average level of aqueous IL-1β at baseline (p<0.001 and p = 0.042, respectively). In the logistic regression analysis, higher number of HF in the OCT was associated with the refractoriness to both treatments (odds ratio [OR]: 7.03, p = 0.007)

Conclusions

Higher number of HF in the OCT at the initial visit was associated with poor responses to IVBs and an additional dexamethasone implant.

Klíčová slova:

Medicine and health sciences – Endocrinology – Endocrine physiology – Endocrine disorders – Diagnostic medicine – Diagnostic radiology – Tomography – Signs and symptoms – Diabetes diagnosis and management – HbA1c – Radiology and imaging – Immunology – Immune response – Inflammation – Pathology and laboratory medicine – Edema – Metabolic disorders – Ophthalmology – Retinal disorders – Retinopathy – Diabetic retinopathy – Biology and life sciences – Physiology – Placental growth factor – Bioengineering – Biotechnology – Medical devices and equipment – Medical implants – Biochemistry – Proteins – Hemoglobin – Engineering and technology – Research and analysis methods – Imaging techniques


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