Abstract
Purpose To evaluate the effects of intravitreal ranibizumab (IVR) treatment on the blood flow of the optic nerve head (ONH) and of retinal vessels of the peripapillary region of eyes with diabetic macular edema (DME) assessed using laser speckle flowgraphy (LSFG). Methods Forty eyes of 30 patients treated with IVR for DME were included in this prospective clinical study. Mean blur rate (MBR) and relative flow volume (RFV) of the ONH and of a superior retinal artery and an inferior retinal vein of the peripapillary region were measured using LSFG at baseline, 2 weeks (T1), and 1 month (T2) after IVR injection. In addition, best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were measured in all cases. Results The BCVA improved and CRT decreased significantly during the follow-up period (p < 0.010). MBR-related parameters of the ONH such as MBR of all area (MA), MBR of vascular area (MV), and MBR of tissue area (MT) decreased significantly at 2 weeks after IVR compared to baseline values (MA, p < 0.010). MBR-related parameters of the ONH such as MBR of all area (MA), MBR of vascular area (MV), and MBR of tissue area (MT) decreased significantly at 2 weeks after IVR compared to baseline values (MA, p < 0.010). MBR-related parameters of the ONH such as MBR of all area (MA), MBR of vascular area (MV), and MBR of tissue area (MT) decreased significantly at 2 weeks after IVR compared to baseline values (MA, p < 0.010). MBR-related parameters of the ONH such as MBR of all area (MA), MBR of vascular area (MV), and MBR of tissue area (MT) decreased significantly at 2 weeks after IVR compared to baseline values (MA, p < 0.010). MBR-related parameters of the ONH such as MBR of all area (MA), MBR of vascular area (MV), and MBR of tissue area (MT) decreased significantly at 2 weeks after IVR compared to baseline values (MA, p < 0.010). MBR-related parameters of the ONH such as MBR of all area (MA), MBR of vascular area (MV), and MBR of tissue area (MT) decreased significantly at 2 weeks after IVR compared to baseline values (MA, p < 0.010). MBR-related parameters of the ONH such as MBR of all area (MA), MBR of vascular area (MV), and MBR of tissue area (MT) decreased significantly at 2 weeks after IVR compared to baseline values (MA, p < 0.010). MBR-related parameters of the ONH such as MBR of all area (MA), MBR of vascular area (MV), and MBR of tissue area (MT) decreased significantly at 2 weeks after IVR compared to baseline values (MA, p < 0.010). MBR-related parameters of the ONH such as MBR of all area (MA), MBR of vascular area (MV), and MBR of tissue area (MT) decreased significantly at 2 weeks after IVR compared to baseline values (MA, Conclusion IVR injection leads to a reduction of ocular blood flow both in the ONH and in the retinal peripapillary vessels associated with peripapillary vessel constriction. The reduction of CRT and related improvement of vision may be related to the changes in ocular blood flow.
Highlights
Diabetic retinopathy (DR) is a specific microvascular complication of diabetes, which represents the leading cause of blindness in the western countries. e prevalence of DR increases with the duration of diabetes, BioMed Research International hypertension, pregnancy, puberty, and cataract surgery [1]
We investigated the effect of intravitreal ranibizumab (IVR) on ocular blood flow in DR patients with Diabetic macular edema (DME) using laser speckle flowgraphy (LSFG) and we assessed central retinal thickness and visual acuity changes after treatment
Sugimoto et al have assessed the effects of unilateral IVR on the ocular circulation of patients treated for DME and ME in retinal vein occlusion (RVO) eyes [13]. ey showed a reduction of the Mean blur rate (MBR) of the optic head and of central macular thickness (CMT) after treatment in the affected treated eyes, but not the fellow untreated eyes
Summary
Diabetic retinopathy (DR) is a specific microvascular complication of diabetes, which represents the leading cause of blindness in the western countries. e prevalence of DR increases with the duration of diabetes (most persons with type 1 diabetes and more than 60% of those with type 2 have some retinopathy after 20 years), BioMed Research International hypertension, pregnancy, puberty, and cataract surgery [1].Reduction of retinopathy progression relies on optimum control of blood glucose, blood pressure, and possibly blood lipids [2,3,4]. E prevalence of DR increases with the duration of diabetes (most persons with type 1 diabetes and more than 60% of those with type 2 have some retinopathy after 20 years), BioMed Research International hypertension, pregnancy, puberty, and cataract surgery [1]. It has been demonstrated that hyperglycaemia instigates a cascade of events leading to retinal vascular endothelial dysfunction. E upregulation of vascular endothelial growth factor (VEGF) and inflammatory cytokines further leads to the breakdown of blood-retinal barrier and capillary leakage with consequent accumulation of intraretinal and subretinal fluid. Diabetic macular edema (DME), which can occur at any stage of DR, is characterized by increased vascular permeability and the deposition of hard exudates at the central retina [5]. Intravitreal injection of anti-VEGF drugs, such as ranibizumab or aflibercept, blocks VEGF and subsequently reduces macular edema [6]
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