Impact of diabetes and diabetic retinopathy on neovascular exudative age‐related macular degeneration

Background: To evaluate the functional and morphological changes in patients with nAMD undergoing anti-VEGF therapy, focusing on the impact of concomitant diabetes with or without diabetic retinopathy. Methods: This retrospective cohort study included 1096 eyes from 916 patients with nAMD treated at the retina department of the University of Bari between August 2017 and May 2023. Patients were divided into two groups: 892 eyes without diabetes and 204 eyes with diabetes. Best-corrected visual acuity (BCVA), central retinal thickness (CRT) and presence of intraretinal fluid (IRF), subretinal fluid (SRF), subretinal hyperreflective material (SHRM) and atrophy were assessed at baseline, post-loading phase and at 12-month follow-up. Results: At baseline, no significant differences were observed between groups. Post-loading phase, both groups showed significant improvements in BCVA and reductions in CRT. However, SRF persistence was notably more frequent in the diabetic group (64.2% vs. 27.2%, p < 0.001). At 12 months, SRF was present in 53.7% of the diabetic group compared to 34.9% of the non-diabetic group (p < 0.001). Diabetic patients with moderate diabetic retinopathy (DR) exhibited significantly higher SRF persistence compared to those with mild DR or no DR. Conclusions: While anti-VEGF therapy improves visual and anatomical outcomes in both diabetic and non-diabetic patients with nAMD, diabetic patients, particularly those with more severe DR, experience a higher rate of persistence of SRF. This suggests a less than optimal anatomic treatment response and the potential need for more tailored management strategies in this patient population. Precis: This retrospective cohort study investigated the impact of diabetes mellitus and diabetic retinopathy on neovascular age-related macular degeneration treatment outcomes. The study analysed 1096 eyes from 916 patients undergoing anti-VEGF therapy over 12 months.