Evaluating the Effect of Nephropathy and Neuropathy on Response to Short-Term Intravitreal Anti-Vegf Treatment in Diabetic Macular Edema: An Optical Coherence Tomography-Angiography Study.

Purpose: To evaluate the effects of nephropathy and neuropathy on short-term anatomical and functional responses to intravitreal anti-VEGF treatment in patients with diabetic macular edema (DME), using optical coherence tomography angiography (OCTA).

Materials and methods: This prospective study included 34 eyes from 34 DME patients who received three monthly intravitreal anti-VEGF injections. Patients were stratified based on renal function (eGFR ≥90 vs. <90 mL/min/1.73 m²; UACR <30 vs. ≥30 mg/g) and the presence of diabetic neuropathy confirmed by EMG. Functional (BCVA) and anatomical (central macular thickness, vessel densities in the superficial and deep capillary plexus, and FAZ area) changes were compared across subgroups using OCTA at baseline and 3 months.

Results: Of all patients, BCVA improved significantly (p < 0.05) and central macular thickness (CMT) decreased significantly (p < 0.01) after treatment. However, eyes with nephropathy (eGFR <90) showed smaller reductions in CMT compared to those without nephropathy, though the difference was not statistically significant (p = 0.68). Patients with neuropathy showed less improvement in BCVA and reduced changes in superficial and deep vessel densities. OCTA parameters showed modest, variable responses across all subgroups.

Conclusions: Nephropathy and neuropathy do not seem to affect the functional recovery response to short-term intravitreal anti-VEGF therapy for DME. Nephropathy affects peripapillary vascular density.