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

Richard Filek,1 Phil Hooper2,3 Tom G Sheidow2,3 John Gonder2,3 Subrata Chakrabarti,1 Cindy ML Hutnik1–31Department of Pathology and Laboratory Medicine, Western University, London, ON, Canada; 2Department of Ophthalmology, Western University, London, ON, Canada; 3Ivey Eye Institut...

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Autores principales:	Filek R, Hooper P, Sheidow TG, Gonder J, Chakrabarti S, Hutnik CML
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2019
Materias:	Diabetic macular edema retina optic nerve anti-VEGF lucentis ranibizumab Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/58906c1907be48fd9ea19b685f7d19a7
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spelling	oai:doaj.org-article:58906c1907be48fd9ea19b685f7d19a72021-12-02T00:44:31ZTwo-year analysis of changes in the optic nerve and retina following anti-VEGF treatments in diabetic macular edema patients1177-5483https://doaj.org/article/58906c1907be48fd9ea19b685f7d19a72019-07-01T00:00:00Zhttps://www.dovepress.com/two-year-analysis-of-changes-in-the-optic-nerve-and-retina-following-a-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Richard Filek,1 Phil Hooper2,3 Tom G Sheidow2,3 John Gonder2,3 Subrata Chakrabarti,1 Cindy ML Hutnik1–31Department 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, CanadaPurpose: 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, ranibizumabFilek RHooper PSheidow TGGonder JChakrabarti SHutnik CMLDove Medical PressarticleDiabetic macular edemaretinaoptic nerveanti-VEGFlucentisranibizumabOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 13, Pp 1087-1096 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diabetic macular edema retina optic nerve anti-VEGF lucentis ranibizumab Ophthalmology RE1-994
spellingShingle	Diabetic macular edema retina optic nerve anti-VEGF lucentis ranibizumab Ophthalmology RE1-994 Filek R Hooper P Sheidow TG Gonder J Chakrabarti S Hutnik CML Two-year analysis of changes in the optic nerve and retina following anti-VEGF treatments in diabetic macular edema patients
description	Richard Filek,1 Phil Hooper2,3 Tom G Sheidow2,3 John Gonder2,3 Subrata Chakrabarti,1 Cindy ML Hutnik1–31Department 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, CanadaPurpose: 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
format	article
author	Filek R Hooper P Sheidow TG Gonder J Chakrabarti S Hutnik CML
author_facet	Filek R Hooper P Sheidow TG Gonder J Chakrabarti S Hutnik CML
author_sort	Filek R
title	Two-year analysis of changes in the optic nerve and retina following anti-VEGF treatments in diabetic macular edema patients
title_short	Two-year analysis of changes in the optic nerve and retina following anti-VEGF treatments in diabetic macular edema patients
title_full	Two-year analysis of changes in the optic nerve and retina following anti-VEGF treatments in diabetic macular edema patients
title_fullStr	Two-year analysis of changes in the optic nerve and retina following anti-VEGF treatments in diabetic macular edema patients
title_full_unstemmed	Two-year analysis of changes in the optic nerve and retina following anti-VEGF treatments in diabetic macular edema patients
title_sort	two-year analysis of changes in the optic nerve and retina following anti-vegf treatments in diabetic macular edema patients
publisher	Dove Medical Press
publishDate	2019
url	https://doaj.org/article/58906c1907be48fd9ea19b685f7d19a7
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Two-year analysis of changes in the optic nerve and retina following anti-VEGF treatments in diabetic macular edema patients

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