Effect of Intravitreal Bevacizumab with Vitamin D Ssupplementation on Diabetic Macular Edema in Vitamin D Deficient Patients

To determine the effect of intravitreal injection of bevacizumab (IVB), which is the standard treatment for diabetic macular edema, along with vitamin D supplementation, on diabetic macular edema in patients with vitamin D deficiency.

Generally, 83 eyes of 83 patients with diabetes mellitus (DM) type 2 and diabetic macular edema (DME) were studied. The patients were divided into 3 groups: normal vitamin D levels + IVB administration (Group 1, n=29), vitamin D insufficient/deficient + IVB administration (Group 2, n=26), and vitamin D insufficient/deficient + IVB administration+ oral vitamin D supplementation (Group 3, n=28). All groups received 3 monthly IVB injections and group 3 received oral vitamin D supplementation simultaneously. The patients were followed up 1, 3, and 6 months after the third baseline IVB with clinical examination, CDVA, and CMT measurements.

The mean baseline CDVA (LogMAR) in groups 1, 2, and 3 was 0.68 ± 0.16, 0.72 ± 0.14, and 0.71 ± 0.1, respectively. In months 1, 3, and 6, after the basic triple IVB injection, visual acuity improved in all groups, but the increase in visual acuity in month 6 was statistically significant in the group treated with vitamin D supplement (group 3) and the group with normal vitamin D levels (group 1) compared to the vitamin D deficiency untreated group (group 2) (P<0.001). Mean CMT decreased in all groups following IVB injections (466.83 ± 57, 527.46 ± 42.3, and 500.61 ± 56.01 microns in groups 1, 2, and 3, respectively), but similar to visual acuity, only in month 6, these changes were significantly different in groups 1 and 3 compared to group 2 (P<0.001).

The 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.