ArticleFrontiers in endocrinology2026
Systemic factors associated with poor anatomical response to anti-VEGF therapy in patients with diabetic macular edema: evidence from a large clinical cohort.
Article in Frontiers in endocrinology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Diabetic macular edema (DME) is a leading cause of vision impairment in the working-age population worldwide. Although intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy represents the established first-line treatment, a substantial proportion of patients exhibit inadequate anatomical responses. This retrospective cohort study aimed to identify independent systemic factors associated with poor anatomical response to intravitreal Conbercept in patients with DME. Methods: In this retrospective cohort study, 1,039 eyes from 691 patients with DME were analyzed. All patients underwent a standardized loading phase of intravitreal Conbercept (0.5 mg) administered monthly for three consecutive months. The primary outcome was the absolute and percentage change in central macular thickness (CMT) from baseline to one month after the third injection. Eyes achieving a percentage reduction in CMT exceeding 10% from baseline were classified as "responders." Generalized Estimating Equation (GEE) models were employed to identify independent factors while accounting for the intra-subject correlation between bilateral eyes. Results: Following the three-month Conbercept loading phase, the median CMT decreased significantly from 325.00 μm (IQR: 281.00-448.00 μm) at baseline to 291.00 μm (IQR: 268.00-334.00 μm) at the three-month follow-up, representing a median absolute reduction of 17.00 μm (P < 0.001). Concurrently, median best-corrected visual acuity (BCVA) improved from 0.30 (IQR: 0.15-0.50) to 0.40 (IQR: 0.25-0.50) (P < 0.001). Based on the responder criterion, 431 eyes (41.48%) were classified as responders and 608 eyes (58.52%) as non-responders. In the multivariable linear GEE model, baseline CMT, baseline BCVA, LDL-C, fasting blood glucose, and HbA1c were independently associated with degree of CMT reduction. In the multivariable logistic GEE model, lower baseline CMT (Estimate = -0.008, P < 0.001), higher baseline BCVA (Estimate = 5.274, P < 0.001), elevated fasting blood glucose (Estimate = 0.048, P = 0.030), and elevated HbA1c (Estimate = 0.192, P < 0.001) were independently associated with poor anatomical response. Conclusion: Systemic metabolic status-particularly HbA1c and fasting glucose levels-and baseline ocular morphology are independently associated with of anatomical response to intravitreal Conbercept in DME. These findings highlight the clinical imperative for integrating systemic metabolic optimization into the management strategy for DME patients prior to and during anti-VEGF loading therapy.
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