ArticleFrontiers in endocrinology2025
Predictors of response to anti-VEGF combined with laser therapy in severe non-proliferative diabetic retinopathy: development and validation of a nomogram model from retrospective data.
Article in Frontiers in endocrinology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Ginger-Derived Nanoparticles Deliver a VEGFA-Targeting DNAzyme and Modulate Retinal VEGFA Expression and Inflammatory Markers in Experimental Diabetic Retinopathy.International journal of nanomedicine · 2026Article
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3 authors.
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Abstract
Background: Anti-vascular endothelial growth factor (anti-VEGF) and laser combination therapy demonstrates variable efficacy in severe non-proliferative diabetic retinopathy, with 30-45% of patients experiencing suboptimal outcomes. This study aimed to develop and validate a clinically deployable nomogram integrating multimodal predictors to quantify individualized treatment response probabilities. Methods: A retrospective cohort study analyzed 280 severe non-proliferative diabetic retinopathy patients (Early Treatment Diabetic Retinopathy Study levels 43-53) receiving combined anti-VEGF (ranibizumab/aflibercept) and laser therapy (2018-2023). The primary outcome was a 12-month composite response (no proliferative diabetic retinopathy progression, ≥2-step Diabetic Retinopathy Severity Scale improvement or ≥30% retinal lesion reduction, and no rescue therapy). Least absolute shrinkage and selection operator regression with the "one standard error" rule selected key predictors from 15 candidate variables. A multivariable logistic regression model was translated into a nomogram, validated temporally (70%/30% split) using area under the curve, calibration curves, and decision curve analysis. Results: Four predictors were retained: glycated hemoglobin variability (adjusted odds ratio 0.63 per 5% increase; 95% confidence interval 0.51-0.78), fluorescein angiography non-perfusion area (adjusted odds ratio 0.68 per 10% increase; 95% confidence interval 0.55-0.84), Diabetic Retinopathy Severity Scale severity (adjusted odds ratio 0.72 per grade; 95% confidence interval 0.55-0.94), and serum albumin (adjusted odds ratio 1.85 per 0.5 g/dL; 95% confidence interval 1.22-2.81). The nomogram achieved robust discrimination (derivation area under the curve 0.821, validation area under the curve 0.754) and calibration (slopes 0.98-0.95; Hosmer-Lemeshow P > 0.60). Decision curve analysis confirmed clinical utility at 15-40% threshold probabilities (net benefit 0.28), outperforming "treat-all" strategies. Conclusions: This validated nomogram-integrating glycemic stability, retinal ischemia, baseline severity, and systemic nutrition-provides individualized response probabilities for anti-VEGF and laser therapy. It enables risk stratification to guide treatment intensification in severe non-proliferative diabetic retinopathy, addressing a critical unmet need in personalized retinopathy management.
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