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Two-year analysis of changes in the optic nerve and retina following anti-VEGF treatments in diabetic macular edema patients

Authors Filek R, Hooper P, Sheidow TG, Gonder J, Chakrabarti S, Hutnik CML

Received 28 December 2018

Accepted for publication 10 May 2019

Published 1 July 2019 Volume 2019:13 Pages 1087—1096


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Richard Filek,1 Phil Hooper2,3 Tom G Sheidow2,3 John Gonder2,3 Subrata Chakrabarti,1 Cindy ML Hutnik1–3

1Department of Pathology and Laboratory Medicine, Western University, London, ON, Canada; 2Department of Ophthalmology, Western University, London, ON, Canada; 3Ivey Eye Institute, St. Joseph’s Health Care London, London, ON, Canada

Purpose: To evaluate long-term structural and functional changes that happen to the optic nerve and retina following ranibizumab (Lucentis) injections in diabetic macular edema (DME) patients.
Methods: Patients with clinically significant DME requiring anti-VEGF injections underwent pre-injection baseline, 6, 12, and 24 month follow-up tests. The tests performed were optical coherence tomography (OCT), best-corrected visual acuity (BCVA), and visual field (VF). Wide-field fluorescein angiogram (IVFA) was performed to monitor the progression of diabetic ischemia.
Results: A total of 30 patients requiring anti-VEGF injections and 21 control patients not requiring anti-VEGF injections were enrolled in the study. From baseline, the average macular thickness significantly decreased (p<0.0002) over the 24-month time period. Mean perfused ratio significantly increased (p<0.0005) at 6, 12, and 24 months. Cup volume and vertical cup-to-disk ratio significantly increased (p<0.0014) over the study period. This was verified by masked independent grading of patient optic nerve stereo-photographs by glaucoma specialists. BCVA significantly (p<0.0006) improved over the study period. VFs showed a non-significant trend of deteriorating peripheral vision at 12 and 24 months.
Conclusion: Clinically, anti-VEGF therapy appears to affect the optic nerve by increasing cup volume and increasing vertical cup/disk ratio over time. The results provide a cautionary note to monitor both the retina and optic nerve status in patients undergoing frequent injections.

Keywords: diabetic macular edema, retina, optic nerve, anti-VEGF, lucentis, ranibizumab

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