June 2015
Volume 56, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2015
Reperfusion of retinal capillaries after anti vascular endothelial growth factor therapy in diabetic macular edema
Author Affiliations & Notes
  • Bilal Hajnajeeb
    Eye Department, General Hospital of Vienna, Vienna, Austria
  • Christian Simader
    Eye Department, General Hospital of Vienna, Vienna, Austria
  • Gabor Gyoergy Deak
    Eye Department, General Hospital of Vienna, Vienna, Austria
  • Ursula Schmidt-Erfurth
    Eye Department, General Hospital of Vienna, Vienna, Austria
  • Footnotes
    Commercial Relationships Bilal Hajnajeeb, None; Christian Simader, None; Gabor Deak, None; Ursula Schmidt-Erfurth, alcon (C), allergan (C), bayer (C), bohringer (C), novartis (C)
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2015, Vol.56, 4691. doi:
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      Bilal Hajnajeeb, Christian Simader, Gabor Gyoergy Deak, Ursula Schmidt-Erfurth, ; Reperfusion of retinal capillaries after anti vascular endothelial growth factor therapy in diabetic macular edema. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4691.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

In our previous work we presented the possibility of development foveal avascular zone (FAZ) enlargement or focal non perfusion patient as result of external pressure applied by intraretinal cysts on the capillaries in diabetic macular edema (DME)1. Now we report about the reperfusion phenomenon of occluded retinal capillaries in the same group of patients after resolution or decrease the size of cysts after treatment with anti vascular endothelial growth factor (VEGF).<br /> 1-The role of the macular intraretinal cysts in evolution of capillary drop out in diabetic macular retinopathy. A new mechanism. Poster:1614281 (ARVO), Seattle, Washington

 
Methods
 

We included patients with DME whose FA images showed reperfusion of FAZ enlargement or focal nonperfusion under the treatment with anti VEGF. Good quality FA images were evaluated for reperfusion. Spectral domain optical coherence tomography (SD- OCT) images done on the same day were also evaluated and the location and size of intraretinal cysts in the corresponding nonperfusion area were documented and followed in the next visits. Moreover, The presence of profundly leaking microaneurysms adjacent to nonperfusion area was determined using FA and SD-OCT.

 
Results
 

The reperfusion of retinal capillaries seen on FA was concomitant with absence or decrease of the size of the intraretinal cysts on SD-OCT. Interstingly, there were always adjacent microaneurysms near the nonperfusion areas which leak profoundly on FA before the treatment and stop or decreas its leakage after the therapy with anti VEGF.

 
Conclusions
 

Reperfusion phenomen seen in our study gets along with our previous findings that intraretinal cysts in DME can cause focal non perfusion. The non perfusion can be reversible process under anti VEGF therapy. Therfore, early and prompt intervention against microaneurysm is mandatory to prevent cystic formations which may close the retinal capillaries.  

 
Reperfusion of retinal capillary by enlaged FAZ in DME. upper images show the loss of capillary in the outlined red circle on FA, and the precence of intraretinal cyst (orange arrow) and nearby leaking microaneurysm (MA) (red arrow) on OCT in the correspondig place of non perfusion. Lower images show reperfusion of the capillary 24 weeks after starting anti VEGF therapy on FA, accompained with decrease of cyst. MA is no more identifieble on OCT image.
 
Reperfusion of retinal capillary by enlaged FAZ in DME. upper images show the loss of capillary in the outlined red circle on FA, and the precence of intraretinal cyst (orange arrow) and nearby leaking microaneurysm (MA) (red arrow) on OCT in the correspondig place of non perfusion. Lower images show reperfusion of the capillary 24 weeks after starting anti VEGF therapy on FA, accompained with decrease of cyst. MA is no more identifieble on OCT image.

 
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