Systemic inflammatory and nutritional biomarkers associated with anatomical and visual outcomes after intravitreal bevacizumab for diabetic macular oedema.

CLINICAL RELEVANCE: Systemic inflammatory-nutritional biomarkers are readily accessible potential indicators of anti- vascular endothelial growth factor (antiVEGF) treatment outcomes in diabetic macular oedema; however, their independent clinical value remains uncertain. BACKGROUND: Systemic inflammatory indices have been associated with diabetic retinopathy and anti-VEGF treatment outcomes. This study evaluated whether composite inflammatory-nutritional biomarkers, particularly haemoglobin, albumin, lymphocyte, and platelet (HALP) score and prognostic nutritional index, are associated with anatomical and visual outcomes following bevacizumab treatment in diabetic macular oedema. METHODS: This retrospective study included 77 eyes of 77 patients with diabetic macular oedema treated with three consecutive intravitreal bevacizumab injections. Anatomical response was defined as a ≥ 50-µm reduction in central macular thickness from baseline. Systemic inflammatory-nutritional biomarkers were evaluated between responders and non-responders. Multivariable logistic regression was performed for anatomical response, while multivariable linear regression was used to evaluate visual improvement, adjusting for relevant ocular and systemic covariates. RESULTS: Anatomical response was observed in 24 eyes (31.2%). None of the evaluated inflammatory-nutritional indices differed significantly between responders and non-responders. In multivariable analysis, neither HALP nor prognostic nutritional index was independently associated with anatomical response, whereas higher baseline central macular thickness was independently associated with response (OR = 1.022, 95% CI: 1.010-1.034; p < 0.001). Neither HALP nor prognostic nutritional index was independently associated with best corrected visual acuity, whereas baseline best corrected visual acuity was significantly associated with visual improvement (β = 0.511; p < 0.001). CONCLUSION: HALP and prognostic nutritional index were not independently associated with anatomical or visual outcomes following bevacizumab treatment in diabetic macular oedema. Baseline ocular characteristics, particularly central macular thickness and best corrected visual acuity, showed stronger associations with treatment outcomes than systemic inflammatory-nutritional indices.