Résumé
Back ground: compared to laser photocoagulation, intra vitreal injection of anti-vascular endothelial growth factors [Anti VEGFs] have more desirable results and less complication. Study of this issue by multifocal electroretinogram [mf-ERG] revealed significant improvement in macular function associated with decreased retinal thickness using optical coherence tomography [OCT] and improvement of best corrected visual acuity [BCVA]
Aim of the Work: to study the role of multifocal Electroretinogram in the follow up of diabetic macular edema after intravitreal injection of Anti vascular endothelial growth factors [Anti-VEGFs] and study its correlation to visual acuity and optical coherence tomography changes
Patients and Methods: a non-randomized prospective study was carried out from February 2018 to August 2018 on thirty eyes of patients with diffuse or focal DME without macular ischemia. The patients were selected from the outpatient ophthalmology clinic of Al-Hussein University hospital. The patients were injected intravitreally by anti VEGF Ranibizumab 0.5 mg / 0.05 mL at baseline, 1 and 2 months. In this study we assessed pre and post-injection BCVA, IOP measurement by applanation tonometer, OCT and multifocal ERG changes over 3 months
Results: log MAR BCVA improved from [0.88 +/- 0.12] preoperatively to [0.53 +/- 0.18] at the end of the 3rd month, with P-value <0.001. Central subfield thickness 1 mm improved from [408.73 +/- 79.40 Mm] preoperatively to [224.33 +/- 32.49 Mum] at the end of the 3rd month, while para and peri-foveal thickness improved from [402 +/- 46.52 Mum] preoperatively to [286.30 +/- 32.67 Mum] at the end of the 3rd month, with P-value <0.001. P1 amplitude in ring 1 using MF-ERG improved from [33.08 +/- 10.59 nv/deg2] preoperatively to [58.30 +/- 32.67 nv/deg2] at the end of the 3rd month, with P-value<0.001. P1 amplitude in ring 2 using MF-ERG improved from [18.82 +/- 5.01 nv/deg2] preoperatively to [26.36 +/- 3.006 nv/deg2] at the end of the 3rd month, with P-value in the 1st month <0.05, while in the 3rd month <0.001. P1 implicit time in ring 1 using MF-ERG improved from [78.65 +/- 12.37 ms] preoperatively to [63.78 +/- 15.73 ms] at the end of the 3rd month, with P-value in the 1st month <0.05, while in the 3rd month <0.001. P1 implicit time in ring 2 using MF-ERG improved from [48.81 +/- 6.44 ms] to [44.39 +/- 4.06 ms] at the end of the 3rd month, with P-value in the 1st and 3rd months <0.05. Complications during follow up of patients especially 1 week after injection were relatively uncommon, including mild subconjunctival haemorrhage in 1 eye [3.3%] and transient increase of IOP in 4 eyes [13.33%]
Conclusion: intravitreal injection of Anti-VEGFs especially Ranibizumab resulted in improvement of macular function in study patients with diabetic macular edema. Postoperative improvement in visual acuity was accompanied by decreased retinal thickness measured by OCT and improvement of P1 amplitude in the central ring measured by MF-ERG
Résumé
Background: to date, fundus fluorescein angiography [FFA], remains the gold standard for the diagnosis of choroidal neovascular membrane [CNV]. Optical coherence tomography angiography [OCTA] is a new imaging modality that allows a clear, depth-resolved visualization of the retinal vascular structures
Aim of the Work: to evaluate the role of OCTA in diagnosis of CNV in patients with age-related macular degeneration [AMD]
Patients and Methods: this study enrolled 32 patients [40 eyes], including 20 patients [20 eyes] with wet AMD and 12 patients [20 eyes] with dry AMD. All patients underwent swept-source optical coherence tomography [SS-OCT], swept-source OCTA, and fundus fluorescein angiography [FFA]. OCTA was used to evaluate neovascular networks in terms of their type, location and extent of visualization. Sensitivity and specificity of the method were assessed separately in a group of 20 CNV eyes and 20 dry AMD based on FFA diagnosis as the gold standard
Results: sensitivity and specificity of en face OCTA were 95% and 100% respectively. Both Sensitivity and specificity of structural OCT were 100%
Conclusion: OCTA enables diagnosis of both classic and occult choroidal neovascularization in patients with AMD. The method has high sensitivity and specificity