Clinical Ophthalmology (Jun 2020)
Prospective, Single-Center, Six-Month Study of Intravitreal Ranibizumab for Macular Edema with Nonproliferative Diabetic Retinopathy: Effects on Microaneurysm Turnover and Non-Perfused Retinal Area
Abstract
Seung Joon Lee,1,2 In Choel Shin,1,2 Il Won Jeong,1,2 Chang Wook Choi,1,2 Yun Sik Yang1,2 1Department of Ophthalmology, Wonkwang University College of Medicine, Iksan, Korea; 2Institute of Wonkwang Medical Science, Wonkwang University, Iksan, KoreaCorrespondence: Yun Sik YangDepartment of Ophthalmology, Wonkwang University Hospital, #895 Muwang-Ro, Iksan, 54538, KoreaTel +82 63 859 1370Fax +82 63 855 1801Email [email protected]: To analyze the effects on microaneurysm (MA) and perifoveal perfusion in nonproliferative diabetic retinopathy (NPDR) patients with macular edema (ME) after early intensive treatment using intravitreal ranibizumab (IVR) injections.Patients and Methods: Prospectively, 25 eyes of 25 type 2 diabetes mellitus patients with ME were included between August 2016 and February 2019. For 6 months, patients were administered 0.5-mg IVR injections monthly. Ocular evaluation, including best-corrected visual acuity (BCVA; using the Early Treatment Diabetic Retinopathy Study chart), central retinal thickness (CRT; using optical coherence tomography), fundus photography, and fluorescein angiography, was performed for all participants. Results obtained at baseline were compared to those observed after 6 months.Results: Mean BCVA increased significantly from 67.6± 3.29 letters at baseline to 76.36± 1.61 letters after 6 months (P=0.002) of IVR therapy. CRT decreased significantly from 479.12± 16.66 μm at baseline to 369.12± 13.02 μm at 6 months. Similarly, the total number of MAs decreased significantly from 5.68± 3.41 to 1.60± 1.73 (P< 0.0001). MA turnover, calculated by adding the MA formation rate to the MA disappearance rate (both calculated as MA number/month) also decreased significantly from 6.88± 3.83 to 1.92± 1.75 after treatment (P< 0.0001). Perifoveal non-perfused area decreased from 2.517± 0.456 mm2 at baseline to 2.495± 0.293 mm2 at 6 months, but the results were not statistically significant (P=0.954).Conclusion: Treatment with early intensive IVR therapy in NPDR patients with ME not only improved BCVA and CRT but also decreased MA turnover. However, in the study period of 6 months, IVR therapy did not show significant improvement in perifoveal non-perfused area.Keywords: nonproliferative diabetic retinopathy, macular edema, ranibizumab, early intensive treatment, microaneurysm
