Perfil metabólico antes y después del tratamiento con anti-VEGF en la degeneración macular asociada a la edad neovascular: identificación de biomarcadores de respuesta terapéutica

Abstract

Introduction: Neovascular age-related macular degeneration (AMD) is one of the leading causes of irreversible vision loss in older adults worldwide. It is a multifactorial disease; known risk factors include age, smoking, sex, hypertension, obesity, and prolonged light exposure. Recent studies point to a genetic component, as well as oxidative stress accumulated throughout life. Treatment involves anti-VEGF drugs; however, not all patients respond favorably. Identifying serum metabolic and oxidative stress biomarkers could allow for predicting therapeutic response and optimizing clinical management. Objective: To evaluate metabolic profiles before and after treatment in patients with neovascular AMD. Methodology: A longitudinal study was conducted in the ophthalmology department of the INR (National Institute of Rehabilitation) using the registered protocol INR LGII 41/24 PA. Inclusion criteria were patients diagnosed with neovascular AMD who were treatment-naive and had no family members participating in the study. The exclusion criteria were prior treatment with ocular anti-angiogenic therapy. The elimination criteria were: dropout from the study (failure to attend more than two appointments) and incomplete data due to logistical or personal reasons. Two blood samples were obtained from each patient, pre- and post-treatment, for serum separation, which was used to determine metabolic markers. Statistical analysis was performed using STATA v16. Results: To date, 16 patients have been enrolled, of whom 44% did not respond to treatment. 69% were women, and the median age was 81.5 years (IQR 77.5-87). 25% were smokers, 50% had a diagnosis of neovascular AMD in the right eye, 19% in the left eye, and 31% had both eyes affected. Regarding metabolic data, statistically significant differences (P=0.009) were observed in serum glucose levels (91 mg/dL [IQR 87.5-103] vs. 108.5 mg/dL [IQR 97-120]) after treatment. Although no statistically significant differences were observed in triglycerides, VLDL, and ALT, a slight increase was observed post-treatment to determine whether the patient was a responder or non-responder. Oxidative stress data are pending. Conclusions: The increase in serum glucose levels, and although not statistically significant, the increase in triglyceride, VLDL, and ALT levels showed a trend toward higher levels, suggesting a metabolic imbalance.