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Jay Berdia, Jonathan Levine, Brandon B. Johnson; Retinal Vasculature Changes in Patients with Diabetic Macular Edema treated with Intravitreal Anti-VEGF. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2117. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Recent studies have shown that intravitreal anti-vascular endothelial growth factor (VEGF) therapy, a common treatment for diabetic macular edema (DME), can reverse clinical signs of diabetic retinopathy. In this retrospective study we used fluorescein angiography (FA) to characterize microvascular retinal changes after intravitreal anti-VEGF therapy for macular edema.
Retrospective case series of 20 patients (20 eyes), with an average age of 71 (range 57 to 83), who underwent FA before and after anti-VEGF treatment for DME. To assess changes in the retinal vasculature, FAs were graded by a single grader using the protocol described in Early Treatment Diabetic Retinopathy Study (ETDRS) Report 11. For each patient, early and late phase angiograms were graded and a separate averaged score was given for macular capillary loss and fluorescein leakage. The primary outcome measure was degree of capillary loss and fluorescein leakage before and after anti-VEGF treatment. Secondary outcome measures were changes in central retinal thickness (CRT) measured by spectral domain optical coherence tomography (SD-OCT, Heidelberg) and hemoglobin A1c (HbA1c) before and after treatment. Patients with prior treatment for diabetic retinopathy or macular edema were not excluded.
The average number of anti-VEGF injections per subject was 9. The average score for capillary loss before and after treatment was 2.1 and 1.5 respectively (p=0.01). The average score for fluorescein leakage before and after treatment was 1.5 and 1.2 respectively (p=.19). The average CRT before and after treatment was 534µm and 312µm respectively (p<0.01). There was no significant changes in HbA1c between dates of FA (p=0.27).
The study showed a statistically significant improvement in capillary dropout for our diabetic patients treated with intravitreal anti-VEGF therapy for DME. No statistically significant changes were found in degree of fluorescein leakage. We found a statistically significant decrease in CRT as demonstrated in previous studies. This study may provide a clinical-angiographic correlation of the reversal of diabetic retinopathy seen following anti-VEGF treatment.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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