Avaliação do tratamento do edema macular diabético com medicamentos antiangiogênicos no Sistema Único de Saúde Brasileiro

Abstract

Objective: To evaluate the anatomical and functional response of DME to anti-angiogenic agents and correlate with biomarkers. Methods: A retrospective longitudinal study in which patients diagnosed with diabetic macular edema who underwent intravitreal anti-angiogenic therapy, followed by OCT examination, at the Instituto de Olhos Ciências Médicas-MG were included. Subsequently, the markers in the OCT examination that correlated with anatomical and functional improvement of diabetic macular edema were compared. Results: In the sample, 107 eyes of 78 patients were evaluated, and in 29 patients both eyes were evaluated. Of these, 53% had initial VA ≤ 20/80 and 47% > 20/80. The mean initial AV was 20/80 and the final AV was 20/50, with a gain of 2 lines of vision or 10 ETDRS letters. There was no difference in results between genders. Functional response to treatment was three times more likely to improve in non-insulin dependent patients compared to insulin dependent patients. A one year reduction in patient age implied a 5% increase in the chances of achieving an improvement in VA. The rates of functional improvement were similar between the patients who had never been treated and those previously treated with anti-VEGF( 65.9% and 63%) . Eyes with intraretinal hyperreflective focus measurements less than or equal to 10 had a 2.9 times greater chance of treatment success, than an eye with a value greater than 10.Eyes with an absence of DRIL had almost three times the chance of CME improvement than eyes with its presence. Eyes with the absence of pre-treatment ERM are 14.3 times more likely to show anatomical improvement than eyes with its presence. Eyes with absent SRF are 5.3 times more likely to show anatomical improvement than eyes with its presence. When post-treatment reduction of the SFCT occurs, there is a 2.9 times greater chance of final visual acuity improvement.

Conclusions: Most eyes showed improvement of VA after three monthly injections of anti-VEGF. Young patients and non-insulin dependent patients showed better functional response. Patients with better initial VA had better final VA after treatment. The presence of DRIL, MER, FSR biomarkers and hyperreflective foci was associated with worse visual prognosis.