Predictive factors for treatment in diabetic macular edema

##plugins.themes.academic_pro.article.sidebar##

Published Feb 15, 2026
https://doi.org/10.62438/tunismed.v103i12.5986
Download
PDF
Vol. 103 No. 12 (2025): Tunis Med Dec 2025

##plugins.themes.academic_pro.article.main##

Lotfi Chaabani
Ophtalmology department , Kasserine hospital center, University of medicine of Sousse, Tunisia
Dhouha Nefzi
Ophtalmology department , Kasserine hospital center, University of medicine of Sousse, Tunisia
Mariem Kalou
Ophtalmology department , Kasserine hospital center, University of medicine of Sousse, Tunisia
Ahmed Jaklouti
Ophtalmology department , Kasserine hospital center, University of medicine of Sousse, Tunisia

Abstract

Background: Diabetic macular edema represents the primary cause of blindness in individuals under the age of 50 and in those with diabetes. Treatment success is influenced by numerous factors.Our objective was to identify factors affecting anatomical and functional responses to DME treatment.


Methods: This retrospective study included 95 eyes of 54 patients treated for diabetic macular edema in our Ophthalmology Department at the Regional Hospital of Kasserine, Tunisia, between January 2016 and January 2018.Statistical analysis was done in 3 steps: a univariate analysis, then a bivariate analysis and finally, we performed a multivariate analysis with a logistic regression. Analysis was performed using the statistical software "SPSS 20.0”.


Results: The multivariate analysis selected one principal factor: poor initial acuity as the only predictive factor of poor functional response to treatment with OR=35,763. The independent variables associated with a poor anatomical response to treatment were dyslipidemia (OR = 0.923), diabetic nephropathy (OR = 4.46), and proliferative diabetic retinopathy (OR = 0.063).


Conclusion: The treatment of diabetic macular edema is associated with high costs and a variable response from one patient to another, justifying better definition of the predictive factors for treatment. The results of other future studies will probably give answer for this question.  

Keywords:

macular edema, diabetes, Anti-vascular endothelial growth factor, prognosis

##plugins.themes.academic_pro.article.details##

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

References

  1. Wilkinson CP, Ferris FL, Klein RE, Lee PP, Agardh CD, Davis M, et al. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology. sept 2003;110(9):1677-82.
  2. Tan GS, Cheung N, Simó R, Cheung GCM, Wong TY. Diabetic macular oedema. Lancet Diabetes Endocrinol. févr 2017;5(2):143-55.
  3. Moss SE, Klein R, Klein BE. Ten-year incidence of visual loss in a diabetic population. Ophthalmology. juin 1994;101(6):1061-70.
  4. Lee CM, Olk RJ. Modified grid laser photocoagulation for diffuse diabetic macular edema. Longterm visual results. Ophthalmology. oct 1991;98(10):1594-602.
  5. Bressler SB, Qin H, Beck RW, Chalam KV, Kim JE, Melia M, et al. Factors associated with changes in visual acuity and central subfield thickness at 1 year after treatment for diabetic macular edema with ranibizumab. Arch Ophthalmol Chic Ill 1960. sept 2012;130(9):1153-61. 6.Kook D, Wolf A, Kreutzer T, Neubauer A, Strauss R, Ulbig M, et al. Long-term effect of intravitreal bevacizumab (avastin) in patients with chronic diffuse diabetic macular edema. Retina Phila Pa. oct 2008;28(8):1053-60.
  6. Nguyen QD, Brown DM, Marcus DM, Boyer DS, Patel S, Feiner L, et al. Ranibizumab for diabetic macular edema: results from 2 phase III randomized trials: RISE and RIDE. Ophthalmology. avr 2012;119(4):789-801.
  7. Stefanini FR, Arevalo JF, Maia M. Bevacizumab for the management of diabetic macular edema. World J Diabetes. 15 avr 2013;4(2):19-26.
  8. Diabetic Retinopathy Clinical Research Network (DRCR.net), Beck RW, Edwards AR, Aiello LP, Bressler NM, Ferris F, et al. Threeyear follow-up of a randomized trial comparing focal/grid photocoagulation and intravitreal triamcinolone for diabetic macular edema. Arch Ophthalmol Chic Ill 1960. mars 2009;127(3):245-51.
  9. Klein R, Klein BE, Moss SE, Cruickshanks KJ. The Wisconsin Epidemiologic Study of Diabetic Retinopathy. XV. The long-term incidence of macular edema. Ophthalmology. janv 1995;102(1):7-16.
  10. Jeppesen P, Bek T. Impaired retinal autoregulation in small retinal arterioles before and after focal laser treatment for diabetic maculopathy. Br J Ophthalmol. févr 2006;90(2):198201.
  11. Romero P, Baget M, Mendez I, Fernández J, Salvat M, Martinez I. Diabetic macular edema and its relationship to renal microangiopathy: a sample of Type I diabetes mellitus patients in a 15-year follow-up study. J Diabetes Complications. 2007;21(3):172-80.
  12. Turnbull CD, Stockley JA, Madathil S, Huq SSA, Cooper BG, Ali A, et al. Effect of obstructive sleep apnoea on retinal microvascular function: a randomised controlled trial. Graefes Arch Clin Exp Ophthalmol. 2022;260(7):2129-39.
  13. « Dupas B, Massin P, Averous K. Rétine. Médecine Sciences Publications ; 2012, 277 p. »,
  14. . [Internet]. [cité 6 avr 2024]. Disponible sur:
  15. https://www.emconsulte.com/revue/JFOO/presentation/journalfrancais-d-ophtalmologie
  16. Elman MJ, Ayala A, Bressler NM, Browning D, Flaxel CJ, Glassman AR, et al. Intravitreal Ranibizumab for diabetic macular edema with prompt versus deferred laser treatment: 5-year randomized trial results. Ophthalmology. févr 2015;122(2):375-81.
  17. Diabetic Retinopathy Clinical Research Network, Wells JA, Glassman AR, Ayala AR, Jampol LM, Aiello LP, et al. Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema. N Engl J Med. 26 mars 2015;372(13):1193-203.
  18. Korobelnik JF, Do DV, Schmidt-Erfurth U, Boyer DS, Holz FG, Heier JS, et al. Intravitreal aflibercept for diabetic macular edema. Ophthalmology. 1 nov 2014;121(11):2247-54.
  19. Gillies MC, Lim LL, Campain A, Quin GJ, Salem W, Li J, et al. A randomized clinical trial of intravitreal bevacizumab versus intravitreal dexamethasone for diabetic macular edema: the BEVORDEX study. Ophthalmology. déc 2014;121(12):2473-81.
  20. Nguyen QD, Tatlipinar S, Shah SM, Haller JA, Quinlan E, Sung J, et al. Vascular endothelial growth factor is a critical stimulus for diabetic macular edema. Am J Ophthalmol.
  21. déc 2006;142(6):961-9.
  22. Schmidt-Erfurth U, Lang GE, Holz FG, Schlingemann RO, Lanzetta P, Massin P, et al. Three-year outcomes of individualized ranibizumab treatment in patients with diabetic macular edema: the RESTORE extension study. Ophthalmology. mai 2014;121(5):1045-53.
  23. Sonnenreich P, Zoeller J. American Academy of Ophthalmology 2015 Annual Meeting. Pharm Ther. mars 2016;41(3):192-3.
  24. Real-World Outcomes of Ranibizumab Treatment for Diabetic Macular Edema in a United Kingdom National Health Service Setting - PubMed [Internet]. [cité 7 avr 2024]. Disponible sur: https://pubmed.ncbi.nlm.nih.gov/27637784/
  25. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ. 12 sept 1998;317(7160):703-13.
  26. Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1. Early Treatment Diabetic Retinopathy Study research group. Arch Ophthalmol Chic Ill 1960. déc 1985;103(12):1796-806.
  27. Klein R, Knudtson MD, Lee KE, Gangnon R, Klein BEK. The Wisconsin Epidemiologic Study of Diabetic Retinopathy XXIII: the twenty-five-year incidence of macular edema in persons with type 1 diabetes. Ophthalmology. mars 2009;116(3):497-503.
  28. Lattanzio R, Brancato R, Bandello FM, Azzolini C, Malegori A, Maestranzi G. Florid diabetic retinopathy (FDR): a long-term followup study. Graefes Arch Clin Exp Ophthalmol Albrecht Von Graefes Arch Klin Exp Ophthalmol. mars 2001;239(3):182-7.
  29. McDonald HR, Schatz H. Macular edema following panretinal photocoagulation. Retina Phila Pa. 1985;5(1):5-10.
  30. Korobelnik JF, Lu C, Katz TA, Dhoot DS, Loewenstein A, Arnold J, et al. Effect of Baseline Subretinal Fluid on Treatment Outcomes in VIVID-DME and VISTA-DME Studies. Ophthalmol Retina. août 2019;3(8):663-9.