The Effect of Serum HbA1c Level on Intravitreal Anti-VEGF Treatment for Diabetic Macular Edema

Yıl 2019, Cilt: 3 Sayı: 2, 79 - 83, 31.08.2019

Sait Alim , Ayşe Kevser Demir

Öz

Aim: To investigate the effect of serum glycosylated hemoglobin A1C (HbA1c) on treatment success in patients receiving intravitrealvascular endothelial growth factor inhibitor (anti-VEGF) treatment for diabetic macular edema (DME).

Material and Methods: The study included only one eye of patients who received anti-VEGF therapy for the first time and whohad checked blood HbA1c levels in the last two weeks. Patients with vitreomacular interface pathology and vitreous or premacularhemorrhage were excluded from the study. The affected eyes of the patients, the best corrected visual acuity (BCVA) with Snellen chart,dilated fundus examination findings, fundus fluorescein angiography, central macular thickness (SMK) measurements (pre-treatmentand 1 month after treatment) obtained by optical coherence tomography (OCT), and used type of anti -VEGF agents were recorded.Patients were divided into two groups as HbA1c level <9.0 mg / dl (group 1, 23 eyes) and ≥9.0 mg / dl (group 2, 34 eyes). 

Results: There were 54 patients, of them 54.4% were female included in the study. The mean age of the patients was 61.1 ± 11.9 years. Twenty-one eyes (54.4%) were received ranibizumab as intravitreal anti-VEGF injection and remained 26 (45.6%) eyes were received aflibercept. The mean HbA1c level of the patients was 9.35 ± 1.8 [6.5-13.6] mg / dl, while there was no difference between the male and female patients (p = 0,570). The two groups were not statistically different in terms of age, gender, eye laterality and anti-VEGF agents used (p> 0.05). While the decrease in SMC after the treatment was 164 μ in group 1, it was 138 μ in group 2 (p = 0.714). The increase in BCVA was 0.23 in group 1 and 0.12 in group 2 (p = 0.001).

Conclusion: Our study revealed that serum HbA1c level did not have a significant effect on anatomical success at the first month of intravitreal anti-VEGF treatment, whereas low HbA1c level was associated with increased functional success.

Anahtar Kelimeler

Diabetic macular edema, HbA1c, Anti-VEGF, Ranibizumab, Aflibercept

Diyabetik Maküla Ödemi Tedavisinde Serum HbA1c Düzeyinin İntravitreal Anti-VEGF Tedavisine Etkisi

Öz

Amaç: Diyabetik maküla ödemi (DMÖ) tedavisi için intravitreal vasküler endotelyal büyüme faktör inhibitörü (anti-VEGF) tedavisi alan hastalarda enjeksiyon esnasında serum glikolize hemoglobin A1c (HbA1c) düzeyinin tedavi başarısına etkisini incelemektir.

Gereç ve Yöntemler: Çalışmaya ilk kez DMÖ nedenli anti-VEGF tedavisi alan ve HbA1c düzeyi son 2 hafta içinde çalışılmış hastaların sadece tek gözleri alındı. Daha önce makülaya lazer yapılan, son 3 ay içinde göz cerrahisi geçiren, vitreomaküler ara yüzey patolojisi olan ve vitreus ya da premaküler hemorajisi olan olgular dahil edilmedi. Hastaların etkilenen gözleri, Snellen eşeli ile en iyi düzeltilmiş görme keskinlikleri (EİDGK), dilate fundus muayene bulguları, fundus floresein anjiyografileri, tedavi öncesi ve tedaviden 1 ay sonraki optik koherens tomografi (OKT) ile elde edilen santral maküla kalınlığı (SMK) ve uygulanan anti-VEGF türü kaydedildi. Hastalar HbA1c düzeyi <9,0 mg/dl (grup 1, 23 göz) ve ≥9,0 mg/dl (grup 2, 34 göz) olarak iki gruba ayrılarak analiz edildi.

Bulgular: Çalışmaya 31’i (%54,4) kadın olmak üzere 57 birey dahil edildi. Hastaların yaş ortalaması 61,1±11,9 idi. İntravitreal anti- VEGF olarak 31 göze (%54,4) ranibizumab, 26 (%45,6) göze ise aflibercept uygulandı. Hastaların ortalama HbA1c düzeyi 9,35±1,8 [6,5- 13,6] mg/dl iken kadın ve erkek hastalar arasında fark yoktu (p=0,570). İki grup yaş, cinsiyet, göz ve uygulanan anti-VEGF açısından istatistiksel olarak farklı değildi (p>0,05). Tedavi sonrası SMK azalması grup 1’de 164 μ iken grup 2’de 138 μ idi (p=0,714). Tedavi ile EİDGK artışı grup 1’de 0,23 ve grup 2’de 0,12 idi (p=0,001).

Sonuç: Çalışmamıza göre serum HbA1c düzeyi intravitreal anti-VEGF tedavisinin ilk bir ayında anatomik başarı üzerine bariz bir etki oluşturmazken HbA1c düzeyinin düşük olması fonksiyonel başarıda artış ile ilişkili bulunmuştur.

Anahtar Kelimeler

Diyabetik makula ödemi, HbA1c, Anti-VEGF, Ranibizumab, Aflibercept

Kaynakça

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