الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 176 |  |  |
| | | from | 176 | | |
Abstract
Diabetic macular edema (DME) is a major cause of vision loss in patients with DM and the prevalence increases from 0%–3% in individuals with recent diagnosis of DM to 29% in those with DM for more than 20 years. Based on the results of ETDRS group, focal/grid laser photocoagulation was considered to be the gold standard treatment for management of DME. However, 12% of the treated eyes still lost 15 or more ETDRS letters at the 3-year follow-up interval. With the demonstration of role of VEGF in the pathogenesis of DME, its inhibition seemed to be a good therapeutic option. More recently, the standard of care for DME is shifting toward intravitreal VEGF inhibitors. Thus, the aim of the current study was to study the effect of glycosylated hemoglobin, dyslipidemia, blood pressure, and BMI on response to intravitreal injection of anti-VEGF in DME. This was a prospective, analytical, observational study conducted on 30 eyes diagnosed with primary diabetic macular edema with no previous intravitreal injection or laser therapy over one year from April 2017 to April 2018. This study revealed the following results: • The mean duration of DM was 14.93 ± 4.525. About 76.7% of the included cases were hypertensive. In addition, the mean UCVA was 0.18 ± 0.084. • The BCVA in the included patients showed a steady rise in the first four follow up visits to reach a mean of 0.618 ± 0.188 from a mean BCVA of 0.251 ± 0.105. However, the following follow-up visits showed a mild decrease in the CVA to reach a mean of 0.595 ± 0.181 and 0.572 ± 0.186 in the ninth and tenth visits respectively. • The CMT showed a decline in the first follow-up visits to decrease from mean basal CMT of 484.67 ± 111.343 to a mean CMT of 276.10 ± 79.331 in the fourth visits. In the following visits, the CMT increased mildly to reach a mean of 282.17 ± 66.626in the sixth visit (P˂ 0.001). • Significant decreases were recorded in HbA1c at third and six months form the basal value. • No significant changes were detected at all follow up visits concerning basal and follow-up values of cholesterol. • No significant changes were detected concerning basal and follow-up values of Triglycerides at all follow up visits. • No significant changes were detected concerning basal and follow-up values of LDL at all follow up visits. • No significant changes were recorded at basal and follow-up values of LDL at the 3rd and 6th follow up visits respectively. • No significant change was recorded among the 3rd and 6th follow up visits concerning Basal and follow-up values of BMI. • No significant differences at all follow up visits was recorded concerning MAP values. • The poor control group showed a statistically significant decline in the mean values of BCVA in either basal or follow-up visit values. In contrast, the mean values of CMA in Poor control group demonstrates significant increase compared to their corresponding values in the good control group as regards basal and 3rd follow up visit, while such increase did not reach the statistical significance in terms of 6th follow up. • The ”≥ 250 mg/dl of cholesterol level” group showed a statistically significant decline in the mean values of BCVA in either basal or follow-up visit values. In contrast, the mean values of CMA in ”≥ 250 mg/dl” group demonstrated non-significant increase in ”≥ 250 mg/dl” group compared to ”˂ 250 mg/dl” group as regards the basal level, while demonstrated significant increase in terms of the 3rd and the 6th follow up visits. • The ”≥ 150 mg/dl of triglyceride value” group showed a statistically significant decrease in the mean values of BCVA in the follow-up visits, despite not showing a statistically significant difference in the basal triglycerides values. Moreover, as regards the CMT, the ”≥ 150 mg/dl” group showed statistically significant higher values than the ”˂ 150 mg/dl” group only in the sixth follow-up visit, with no significance at the basal and 3rd follow up visit. • The ”≥ 150 mg/dl of LDL value” group showed a statistically significant decrease in the mean values of BCVA in the basal and follow-up visits. Moreover, as regards the CMT, the ”≥ 150 mg/dl” group showed statistically significant higher values than the ”˂ 150 mg/dl” group only in the third and sixth follow-up visits with no significance at the basal level. • Concerning HDL level, no statistically significant differences in the mean BCVA and CMT values were recorded between the ”≥ 60 mg/dl” and ”˂ 60 mg/dl” groups either at basal or follow up visits. • In addition, the patients were divided into ”≥ 30 Kg/m2” and ”˂ 150 Kg/M2” groups according to their BMI values. The ”≥ 30 Kg/m2” group showed a statistically significant decline in the mean values of BCVA in the follow-up visits (P<0.05). Moreover, as regards the CMT, the ”≥ 30 Kg/m2” group showed statistically significant higher values than the ”< 30 Kg/m2” group only in the third follow-up visit. • As regards the effect of MAP level on BCVA and CMT values of the studied patients, the ”≥ 100 mmHg” group showed an insignificant decline in the mean BCVA values compared to ”˂ 100 mmHg” either at basal or follow up visits (P>0.05). Similarly, there were no statistically significant differences in the mean CMT values between the ”≥ 100 mmHg” and ”˂ 100 mmHg” groups visit. • Regarding HbA1c there were highly statistically significant differences among both groups at basal, 3rd follow up and 6th follow up. • As regards Cholesterol, there were highly statistically significant differences among both groups in basal, 3rd and 6th follow up visits. • As regards LDL, there were highly statistically significant differences among both groups in basal, 3rd and 6th follow up visits. • As regards Triglyceride, there were highly statistically significant differences among both groups in basal, 3rd and 6th follow up visits. • While in terms of HDL, there were no statistically significant differences among both groups at basal, 3rd and 6th follow up visits. • Stable group demonstrated statistically significant increase in BCVA compared to recurrence group in terms of basal and throughout the follow up visits. • While, Stable group demonstrated statistically significant decrease in CMT compared to recurrence group in terms of basal and throughout the follow up visits. • BCVA change demonstrated an insignificant correlation as regards HbA1c change, Triglyceride change, LDL change, HDL change and MAP change, while BCVA change demonstrated a significant positive correlation as regards cholesterol change only. CMT change demonstrated an insignificant correlation as regards cholesterol change, Triglyceride change, LDL change, HDL change and MAP change (P>0.05), while BCVA change demonstrated a significant positive correlation as regards HbA1c change only. Conclusion In conclusion, intravitreal bevacizumab treatment resulted in an improvement in visual acuity and decrease in macular thickness in DME. Maximum benefit from the treatment may be attained by strict glucose regulation. Glycaemic control influences the treatment outcome and may be responsible in part for the different response among patients with the same DME treatment. In addition, HTN, dyslipidemia, elevated BMI were demonstrated to be risk factors which were interfered with the net outcomes of the study in which proper management of such factors were associated with promising outcomes.