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Millena Bittencourt, Daniel Ferraz, Jithin Yohanan, Owhofasa Agbedia, Mohammad Sadiq, Yasir Sepah, Mohamed Ibrahim, Raafay Sophie, Mostafa Hanout, Quan Dong Nguyen; Retinal Thickness, Retinal Point Sensitivity and Inner Segment/Outer Segment Photoreceptor (IS/OS) Status after Treatment with Ranibizumab in Patients with Diabetic Macular Edema. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3633.
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To evaluate the changes in retinal thickness, retinal sensitivity and inner segment/outer segment photoreceptor (IS/OS) status after treatment with ranibizumab (RBZ) in patients with diabetic macular edema (DME).
A retropective study of patients managed at a university-based retina practice was performed. Microperimetry (MP) and optical coherence tomography (OCT) data was acquired simultaneously with OPTOS/OTI automated system (OPTOS, UK) from DME patients before and after treatment with intravitreal RBZ. Demographic data including, age, gender, severity of diabetic retinopathy, number of injections and follow up time after first injection was also collected. A point-by-point analysis of presence or absence of the IS/OS layer and retinal thickness at every sentitivity point was done by a trained observer. Fixation stability and fixation location were also recorded. The number of standard deviation (SD) from the normal range of retinal thickness and sensitivity stratified by age and location was calculated for each point in the polar 3 pattern. Multivariate analysis was done to verify the effect of RBZ on the variables.
13 patients (15 eyes) were analyzed. The mean age of patients was 65.8 years (SD ±10.1), 10 patients were male (12 eyes), 9 eyes (60%) had moderate NPDR, 4 eyes (26.7%) had PDR, 1 eye (6.7%) had mild NPDR, and 1 eye (6.7%) had severe NPDR. The mean interval between the pre and post treatment was 5.1 months (SD ±2.7) with an average of 4.7 RBZ injections (SD ±2.4). Number of injections and DR scale have not shown statistically significant effect on the variables changes after treatment (p=0.213; p=0.083). The frequencies of fixation location and stability, as well as the changes in retinal thickness, sensitivity and IS/OS status are summarized on table 1.
In this pilot study, we have demonstrated that the disruption of the IS/OS junction has an impact on retinal sensitivity of - 3.38dB/- 3.33dB before and after treatment. However, treatment does not change the effect of IS/OS junction disruption on the relationship between retinal sensitivity and retinal thickness. The treatment with RBZ improves the fixation location/stability and the retinal thickness of eyes with DME. Further analyses with a larger sample size are necessary to confirm these results.
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