The Effect of Vitamin D Supplementation on The Outcome of Treatment with Bevacizumab in Diabetic Macular Edema
Sahba Fekri1 *, Masoud Soheilian10 , Sepehr Roozdar10 , Seyed-Hossein Abtahi10 , Hosein Nouri10
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Abstract: Background: Vitamin D deficiency (VDD) has been linked to diabetic retinopathy (DR) incidence and severity. Given the protective properties of vitamin D against inflammatory processes and neovascularization, the backbone of diabetic macular edema (DME) pathogenesis, concomitant VDD is speculated to aggravate DME.
Objective: We aimed to determine the effect of hypovitaminosis D correction along with intravitreal bevacizumab (IVB; the standard treatment for DME) on the outcome of treatment in DME eyes.
Methods: 83 eyes of 83 patients with DME were recruited and divided into three groups: normal vitamin D levels + IVB administration (Group 1 ), vitamin D insufficient/deficient + IVB administration (Group 2), and vitamin D insufficient/deficient + IVB administration+ oral vitamin D supplementation (Group 3). Visual (corrected distance visual acuity, CDVA) and anatomical (central macular thickness, CMT) outcomes of intervention were evaluated 1, 3, and 6 months after the triple IVB injections were completed. Serum vitamin D levels were measured 1 and 6 months after the third IVB administration.
Results: The mean±SD baseline CDVA (LogMAR) in groups 1, 2, and 3 were 0.68±0.16, 0.72±0.14, and 0.71±0.1, respectively. The mean±SD baseline CMT in group 1 was less than the other two (466.83±57 µm in group 1, 527.46±42.3 µm in group 2, and 500.61±56.01 µm in group 3). In months 1, 3, and 6, after the basic triple IVB injection, visual acuity and CMT improved in all three groups, but improvements (both functional and anatomical) in groups 1 and 3 (sufficient vitamin D and corrected hypovitaminosis D) in month 6 were more significant than in group 2 (uncorrected hypovitaminosis D) (p <0.001). The mean number of IVB injections during follow-up was 5.33 (range: 4-7), which did not differ between the groups.
Conclusion: Correction of vitamin D deficiency in DME patients with type 2 diabetes and vitamin D deficiency, in addition to IVB injections, may play a role in improving CDVA and CMT. However, this beneficial effect seems to be delayed by several months
