Top

Documenta Ophthalmologica

Published in:

01-10-2018 | Original Research Article

Retinal function in eyes with proliferative diabetic retinopathy treated with intravitreal ranibizumab and multispot laser panretinal photocoagulation

Authors: Katharina Messias, Rafael de Montier Barroso, Rodrigo Jorge, Andre Messias

Published in: Documenta Ophthalmologica | Issue 2/2018

Abstract

Purpose

To compare retinal function changes in eyes with proliferative diabetic retinopathy (PDR) after intravitreal ranibizumab (IVR), combined or not with conventional (ETDRS) or multispot laser panretinal (PASCAL) photocoagulation (PRP).

Methods

This study included laser-naive PDR patients that required PRP. Eyes were randomly and prospectively assigned to receive IVR or IVR combined with PASCAL or EDTRS. PRP was performed at baseline in 1 (PASCAL) or 2 (ETDRS) sessions. In eyes with macular edema, macular short pulse grid laser was associated with IVR at baseline and IVR was repeated monthly or quarterly if neovascularization was detected on angiography. Comprehensive ophthalmological evaluations, including SD-OCT, were performed at baseline and every 4 weeks after treatment. Full-field electroretinography (ERG: extended ISCEV standard) was performed at baseline and at 12, 24 and 48 weeks.

Results

IVR = 13, PASCAL = 15 and ETDRS = 15 eyes finished 48-week follow-up. There was a statistically significant BCVA improvement of 0.1–0.3 logMAR in all groups, and fluorescein angiography leakage area (FLA) reduced in 56%, 73%, and 73% from baseline for ETDRS, IVR and PASCAL, respectively, up to 48 weeks without significant differences between groups (p > 0.05). A significant a- and b-wave amplitudes reduction was observed for dark- and light-adapted ERG for ETDRS and PASCAL, but only minor dark-adapted b-wave reduction was found for IVR, up to 48 weeks. As an example, at week 48, combined response b-wave amplitude reduced in 181.5 ± 31.4 µV, 128.0 ± 27.9 µV and 82.4 ± 15.2 µV for ETDRS, PASCAL and IVR (p < 0.05 each group), respectively. No significant difference was observed between ETDRS and PASCAL for any ERG parameter.

Conclusions

IVR combined with single or multiple spot PRP causes similar retinal function impairment during 48 weeks of observation, while IVR alone seems to be similarly effective controlling FLA without changing retinal function.

Yau JW, Rogers SL, Kawasaki R, Lamoureux EL, Kowalski JW, Bek T, Chen SJ, Dekker JM, Fletcher A, Grauslund J, Haffner S, Hamman RF, Ikram MK, Kayama T, Klein BE, Klein R, Krishnaiah S, Mayurasakorn K, O’Hare JP, Orchard TJ, Porta M, Rema M, Roy MS, Sharma T, Shaw J, Taylor H, Tielsch JM, Varma R, Wang JJ, Wang N, West S, Xu L, Yasuda M, Zhang X, Mitchell P, Wong TY, Meta-Analysis for Eye Disease Study G (2012) Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care 35:556–564CrossRefPubMedPubMedCentral

Engerman RL (1989) Pathogenesis of diabetic retinopathy. Diabetes 38:1203–1206CrossRefPubMed

Group TDRSR (1976) Preliminary report on effects of photocoagulation therapy. The Diabetic Retinopathy Study Research Group. Am J Ophthalmol 81:383–396CrossRef

Landers MB 3rd, Stefansson E, Wolbarsht ML (1982) Panretinal photocoagulation and retinal oxygenation. Retina 2:167–175CrossRefPubMed

Vander JF, Duker JS, Benson WE, Brown GC, McNamara JA, Rosenstein RB (1991) Long-term stability and visual outcome after favorable initial response of proliferative diabetic retinopathy to panretinal photocoagulation. Ophthalmology 98:1575–1579CrossRefPubMed

ETDRS (1991) Early photocoagulation for diabetic retinopathy. ETDRS report number 9. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology 98:766–785CrossRef

McDonald HR, Schatz H (1985) Macular edema following panretinal photocoagulation. Retina 5:5–10CrossRefPubMed

Pender PM, Benson WE, Compton H, Cox GB (1981) The effects of panretinal photocoagulation on dark adaptation in diabetics with proliferative retinopathy. Ophthalmology 88:635–638CrossRefPubMed

Henricsson M, Heijl A (1994) The effect of panretinal laser photocoagulation on visual acuity, visual fields and on subjective visual impairment in preproliferative and early proliferative diabetic retinopathy. Acta Ophthalmol (Copenh) 72:570–575CrossRef

10.

Khosla PK, Rao V, Tewari HK, Kumar A (1994) Contrast sensitivity in diabetic retinopathy after panretinal photocoagulation. Ophthalmic surgery 25:516–520PubMed

11.

Blumenkranz MS, Yellachich D, Andersen DE, Wiltberger MW, Mordaunt D, Marcellino GR, Palanker D (2006) Semiautomated patterned scanning laser for retinal photocoagulation. Retina 26:370–376CrossRefPubMed

12.

Muqit MM, Marcellino GR, Gray JC, McLauchlan R, Henson DB, Young LB, Patton N, Charles SJ, Turner GS, Stanga PE (2010) Pain responses of Pascal 20 ms multi-spot and 100 ms single-spot panretinal photocoagulation: Manchester Pascal Study, MAPASS report 2. Br J Ophthalmol 94:1493–1498CrossRefPubMed

13.

Muqit MM, Marcellino GR, Henson DB, Young LB, Patton N, Charles SJ, Turner GS, Stanga PE (2010) Single-session vs multiple-session pattern scanning laser panretinal photocoagulation in proliferative diabetic retinopathy: The Manchester Pascal Study. Arch Ophthalmol 128:525–533CrossRefPubMed

14.

Chappelow AV, Tan K, Waheed NK, Kaiser PK (2012) Panretinal photocoagulation for proliferative diabetic retinopathy: pattern scan laser versus argon laser. Am J Ophthalmol 153(137–142):e132

15.

Jorge R, Costa RA, Calucci D, Cintra LP, Scott IU (2006) Intravitreal bevacizumab (Avastin) for persistent new vessels in diabetic retinopathy (IBEPE study). Retina 26:1006–1013CrossRefPubMed

16.

Witmer AN, Vrensen GF, Van Noorden CJ, Schlingemann RO (2003) Vascular endothelial growth factors and angiogenesis in eye disease. Prog Retin Eye Res 22:1–29CrossRefPubMed

17.

Aiello LP, Avery RL, Arrigg PG, Keyt BA, Jampel HD, Shah ST, Pasquale LR, Thieme H, Iwamoto MA, Park JE et al (1994) Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders. N Engl J Med 331:1480–1487CrossRefPubMed

18.

Tonello PS, Rosa AH, Abreu CH Jr, Menegario AA (2007) Use of diffusive gradients in thin films and tangential flow ultrafiltration for fractionation of Al(III) and Cu(II) in organic-rich river waters. Anal Chim Acta 598:162–168CrossRefPubMed

19.

Messias A, Filho JA, Messias K, Almeida FP, Costa RA, Scott IU, Gekeler F, Jorge R (2012) Electroretinographic findings associated with panretinal photocoagulation (PRP) versus PRP plus intravitreal ranibizumab treatment for high-risk proliferative diabetic retinopathy. Doc Ophthalmol 124:225–236CrossRefPubMed

20.

McCulloch DL, Marmor MF, Brigell MG, Hamilton R, Holder GE, Tzekov R, Bach M (2015) ISCEV Standard for full-field clinical electroretinography (2015 update). Doc Ophthalmol 130:1–12CrossRefPubMed

21.

Messias A, Jaegle H, Gekeler F, Zrenner E (2008) Software for evaluation of electroretinograms XLVI annual symposium of the international society for clinical electrophysiology of vision (ISCEV), Morgantown—USA

22.

Tzekov R, Arden GB (1999) The electroretinogram in diabetic retinopathy. Surv Ophthalmol 44:53–60CrossRefPubMed

23.

Arden GB, Sidman RL, Arap W, Schlingemann RO (2005) Spare the rod and spoil the eye. Br J Ophthalmol 89:764–769CrossRefPubMedPubMedCentral

24.

Moschos M (1982) ERG and VER findings after laser photocoagulation of the retina. Metab Pediatr Syst Ophthalmol 6:101–105PubMed

25.

Schuele G, Rumohr M, Huettmann G, Brinkmann R (2005) RPE damage thresholds and mechanisms for laser exposure in the microsecond-to-millisecond time regimen. Invest Ophthalmol Vis Sci 46:714–719CrossRefPubMed

26.

Subash M, Comyn O, Samy A, Qatarneh D, Antonakis S, Mehat M, Tee J, Mansour T, Xing W, Bunce C, Viswanathan A, Rubin G, Weleber R, Peto T, Wickham L, Michaelides M (2016) The effect of multispot laser panretinal photocoagulation on retinal sensitivity and driving eligibility in patients with diabetic retinopathy. JAMA Ophthalmol 134:666–672CrossRefPubMed

27.

Willmann G, Nepomuceno AB, Messias K, Barroso L, Scott IU, Messias A, Jorge R (2017) Foveal thickness reduction after anti-vascular endothelial growth factor treatment in chronic diabetic macular edema. Int J Ophthalmol 10:760–764PubMedPubMedCentral

Title: Retinal function in eyes with proliferative diabetic retinopathy treated with intravitreal ranibizumab and multispot laser panretinal photocoagulation
Authors: Katharina Messias
Rafael de Montier Barroso
Rodrigo Jorge
Andre Messias
Publication date: 01-10-2018
Publisher: Springer Berlin Heidelberg
Published in: Documenta Ophthalmologica / Issue 2/2018
Print ISSN: 0012-4486
Electronic ISSN: 1573-2622
DOI: https://doi.org/10.1007/s10633-018-9655-9

At a glance: The STEP trials

Springer Medicine

Retinal function in eyes with proliferative diabetic retinopathy treated with intravitreal ranibizumab and multispot laser panretinal photocoagulation

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2018

Transplantation of rat embryonic stem cell-derived retinal cells restores visual function in the Royal College of Surgeons rats

Phenotypic characterization of complete CSNB in the inbred research beagle: how common is CSNB in research and companion dogs?

A novel mutation in the PRPF31 in a North Indian adRP family with incomplete penetrance

Effect of varying skin surface electrode position on electroretinogram responses recorded using a handheld stimulating and recording system