The association between peripheral blood inflammatory markers and anti-VEGF treatment response in patients with type 2 diabetic macular edema

Wenting Gu¹Min Wang²Zhizhe Li^1*Tianqi Xu^1*

• ¹Suzhou Municipal Hospital, Suzhou, China
• ²Affiliated Hospital 2 of Nantong University, Nantong, China

AIM: To investigate the correlation between serum inflammatory markers of patients with diabetic macular edema (DME) and the efficacy of intravitreal anti-vascular endothelial growth factor (VEGF) . METHODS: This was a single-center, prospective cohort study. Peripheral blood cell analysis was performed on 40 patients with confirmed type 2 diabetes complicated by DME, 40 healthy people, and 40 patients with confirmed type 2 diabetes without diabetic retinopathy. 2 Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and systemic immune-inflammation index [SII; (neutrophil count × platelet count)/lymphocyte count] were calculated. All patients with DME received three monthly intravitreal injections of anti-VEGF agents (ranibizumab). Correlation analyses and linear regression models were used to investigate the relationships between systemic inflammatory markers and best corrected visual acuity (BCVA) and central macular thickness (CMT) before and after anti-VEGF treatment in DME patients. RESULTS: The NLR, PLR, and SII values of the DME group significantly differed from those of the healthy and nondiabetic retinopathy (NDR) groups. There were significant differences in MLR values between the healthy and NDR groups. After the 3-month follow-up (post-three injections), the differences in BCVA and CMT were significant before and after anti-VEGF treatment in DME patients, but no significant differences were found in NLR, PLR, and SII before and after anti-VEGF treatment. MLR was significantly different before and after treatment. BCVA in the DME group before anti-VEGF treatment positively correlated with NLR, PLR, and SII. CMT before anti-VEGF treatment positively correlated with NLR, PLR, MLR, and SII. NLR, PLR, MLR, and SII were significantly correlated with BCVA and CMT. In multivariate linear regression analysis, only NLR was significantly correlated with CMT. CONCLUSIONS: The efficacy of anti-VEGF in DME is correlated with serum inflammatory markers. Additionally, NLR, PLR, MLR, and SII may be potential markers for DME treatment decisions. The finding that NLR remained significant in the multivariate analysis highlights its potential value as a simple, accessible prognostic biomarker for stratifying patients who may respond suboptimally to anti-VEGF treatment.