Functional Recovery in Diabetic Macular Edema Following Bevacizumab: Insights from Microperimetry

Abstract

A BSTRACT To evaluate changes in retinal sensitivity using microperimetry following intravitreal bevacizumab (IVB) in patients with diabetic macular edema (DME), and to assess the role of microperimetry as a functional biomarker of recovery. This observational study included 52 eyes from 52 individuals who had never received therapy for center-involving DME. Each patient received one intravitreal injection of bevacizumab (1.25 mg/0.05 ml). We measured best-corrected visual acuity (BCVA, decimal notation), central macular thickness (CMT, OCT), and retinal sensitivity at baseline and 1 month later. Statistical analyses comprised Shapiro–Wilk tests for normality, paired t -tests or Wilcoxon signed-rank tests when appropriate, and correlation analyses of structural and functional characteristics. At 1 month, mean retinal sensitivity improved significantly from 12.9 ± 3.2 dB to 15.4 ± 3.5 dB ( P < 0.001). BCVA also improved from 0.34 ± 0.15 to 0.46 ± 0.18 (decimal; P < 0.001). Mean CMT decreased from 452.6 ± 85.4 µm to 379.2 ± 72.8 µm ( P < 0.001). Improvement in microperimetry correlated modestly but significantly with reduction in CMT ( r = –0.42, P = 0.002). Microperimetry revealed localized functional recovery in areas with edema resolution, even in cases where BCVA improved minimally. Microperimetry provides a sensitive assessment of retinal function recovery following anti-VEGF therapy in DME. It detects localized functional improvements not captured by visual acuity alone, supporting its integration into clinical trials and real-world monitoring of DME.