Systemic Associations with Residual Subretinal Fluid after Ranibizumab in Diabetic Macular Edema

Abstract

Purpose To investigate the impact of systemic diseases on the occurrence of subretinal fluid (SRF) in diabetic macular edema (DME) and prognostic factors for residual SRF following three consecutive monthly intravitreal ranibizumab. Methods Ninety-seven eyes from 68 patients with DME who completed 3 consecutive monthly injections of ranibizumab were enrolled. Systemic parameters mainly included chronic kidney disease (CKD), hypertension, HbA1c, and insulin dependence. Renal parameters for CKD were serum creatinine, estimated glomerular filtration rate (eGFR), and serum albumin. Ocular factors were baseline central macular thickness (CMT), severity of diabetic retinopathy (DR), and status of panretinal photocoagulation (PRP). Results Chronic kidney disease had significant correlation with baseline SRF (R = 0.397, p < 0.001 after partial correlation with adjustment for age and DR severity). As for CKD, lower serum albumin, but not eGFR or serum creatinine, was associated with baseline presence of SRF (p = 0.026, p = 0.08 and p = 0.53, resp., after adjustment for age and DR severity). Overall, lower eGFR and lower HbA1c values, contrary to popular belief, predicted the presence of residual SRF following intravitreal injections (p = 0.016 and p < 0.001, resp.). Conclusions Tight sugar control and poorer baseline kidney function may slow the resorption of SRF after anti-VEGF injections in patients with DME in the short term.

Association of Body Fluid Expansion With Optical Coherence Tomography Measurements in Diabetic Retinopathy and Diabetic Macular Edema

“…Also, as stated previously, increased capillary hydrostatic pressure creates an excessive flow of water into the interstitial tissue and subsequently causes macular edema. In line with the present result, one recent study 12 has observed that tight glycemic control may slow the resolution of subretinal fluid in DME after ranibizumab treatment at 3 months. Similarly, another report 33 has shown that glycosylated hemoglobin is inversely correlated with central macular thickness in the presence of macular edema.…”

“…It is worth mentioning that unlike normal vasculature, these diabetic retinal capillaries may lose their autoregulation in response to such volume fluctuations. 12,28 Patients with DME have significantly higher levels of OH than those without DME or without any DR. This finding sheds light on some clinical situations that have previously remained largely unexplained.…”

“…4,10,11 The application of this rule to the flow of extracellular fluid possibly sheds light on previous observations that tight glycemic control does not seem to have a positive impact on the resolution of edema. 12,13 At a cellular level, previous research has suggested that intracellular edema may precede the development of macular edema. 9 Retinal ischemia may alter the expression of water channel proteins, particularly aquaporin-4, and potassium channels, in Müller cells, causing osmotic and water imbalance.…”

Impact of metabolic control on macular thickness in diabetic macular oedema

“…This shed light on an observation in a recent study that resorption of subretinal fluid in DME was slower in patients with lower HbA1c levels after ranibizumab than in others. 10 Other supportive evidence includes a prospective study showing that retinal thickness may decrease after meal consumption, indicating that macular thickness during fasting may be improved in patients with clinically significant macular oedema. 11 Data from a post hoc analysis of the RISE/RIDE study was also consistent with our observation.…”

Amelioration of diabetic nephropathy in db/db mice treated with tibetan medicine formula Siwei Jianghuang Decoction Powder extract

“…A lot of evidence from animal models of diabetes and human patients suggested that persistent hyperglycemia increases the expression of renal TGF-β1 12 . In addition, vascular endothelial growth factor (VEGF) is the main factor that linked to DN, the clinical study shown that, at the early stage of DN diabetic urine VEGF level is raised, and the level of urinary VEGF and DN lesions in diabetic patients have clinical relevance, urinary VEGF high expression levels leading to pathological GBM structure change, and produces a large of albumin 13 , 14 . Hypoxia inducible factor-1α (HIF-1α) is a transcription factor induced by hypoxia reaction, which can activate expression of many hypoxia responsive genes and involve in the development of DN, it is also closely related to renal function decline and proteinuria appear.…”