Anti-vascular endothelial growth factor (VEGF) reduces choroidal thickness by choroidal hypoperfusion in diabetic macula oedema (DME) patients. Indirect effect of anti-VEGF towards outer retinal layers (ORL) which supplied by choroidal circulation has not been well described. We evaluate the ORL thickness between retinal pigment epithelium (RPE) with inner-segment-outer-segment photoreceptor junction (IS/OS) and RPE with external limiting membrane (ELM) in pre- and postintravitreal Ranibizumab (IVR) treated eyes with central foveal diabetic macula edema. A total of 60 eyes (40 patients) were analysed. ORL thickness measured with optical coherence tomography at pre- and post-injection day 1, week 4 and week 6. Mean thickness of RPE-IS/OS was statistically significant over time (p=0.023) but not for RPE-ELM (p=0.216). Thickness ratio between RPE-IS/OS and RPE-ELM and central subfoveal thickness (CST) both showed statistically significant result over time with p=0.038 and p=0.000, respectively. We observed an initial reduction of ORL thickness at day 1 followed by increased in thickness at week 4 with subsequent reduction at week 6 was observed. ORL is an aspect that can be explore and emphasized further in patients considered for IVR injections. The long-term effects of IVR to the ORL however could not be concluded due to short follow up period.
Evaluation of Outer Retinal Layers in Diabetic Macula Edema Treated with Intravitreal Ranibizumab
Author
Abstrak
Anti-vaskular faktor pertumbuhan endothelial (VEGF) mengurangkan ketebalan choroidal oleh hipoperfusi choroidal di kalangan pesakit diabetes macula edema (DME). Kesan tidak langsung anti-VEGF terhadap lapisan retina luar (ORL) yang dibekalkan oleh sirkulasi choroidal belum dikaji. Kajian ini melihat ketebalan ORL di antara epitelium retina pigmen (RPE) dengan inner-segmen-outer-segmen fotoreseptor (IS/OS) dan RPE dengan external limiting membrane (ELM) sebelum dan selepas suntikan intravitreal ranibizumab (IVR) kepada pesakit diabetes macula edema melibatkan pertengahan fovea. 60 mata (40 pesakit) telah dianalisis. Ketebalan ORL diukur dengan optikal koherens tomografi pada sebelum dan selepas suntikan satu hari, minggu ke-empat dan minggu ke-enam. Min ketebalan RPE-IS /OS menunjukkan keputusan yang signifikan dari masa ke masa (p=0.023) tetapi tidak untuk RPE-ELM (p=0.216). Nisbah ketebalan antara RPE-IS/OS dan RPE-ELM dan ketebalan subfoveal pusat (CST) kedua-duanya menunjukkan keputusan statistik yang signifikan dari masa ke masa dengan p=0.038 dan p=0.000 masing-masing. Kajian mendapati pengurangan awal ketebalan ORL pada hari 1 diikuti oleh peningkatan dalam ketebalan pada minggu 4 dengan pengurangan berikutnya pada minggu 6 diperhatikan. ORL adalah satu aspek yang boleh diterokai dan diberikan penekanan pada pesakit di mana pemberian suntikan IVR harus dipertimbangkan. Kesan jangka panjang IVR kepada ORL bagaimanapun tidak dapat dirumuskan kerana susulan tempoh kajian yang singkat.
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