Session Title: Vascular Diseases and Diabetic Retinopathy III
Session Date/Time: Friday 12/09/2014 | 16:30-18:00
Paper Time: 16:54
Venue: Boulevard D
First Author: : A.Awadein EGYPT
Co Author(s): : M. El-Shazly
The frequency of serous macular detachment in diabetic macular edema (DME) is approximately 15-30%. Treatments targeting vascular endothelial growth factor, such as ranibizumab, are being used in the treatment of DME. However, the effects of intravitreal ranibizumab on patients with serous macular detachment in patients with DME are not exactly known. The purpose of the study was to describe the characteristics of diabetic patients with serous macular neurosensory detachment, and to evaluate their response to intravitreal ranibizumab injections.
Institutional, single-centered, prospective, interventional study.
Consecutive patients with diabetic neurosensory detachment of the fovea were included if they fulfilled the following; (1) presence of severe non-proliferative diabetic retinopathy or proliferative diabetic retinopathy, (2) presence of DME with central foveal subfield (CSF) thickness on time domain optical coherence tomography (OCT) ≥250 μm, (3) presence of neurosensory detachment of the fovea in OCT (elevation of posterior surface of the retina over a non-reflective cavity) and minimal thickening of the neurosensory retina (central neuroretinal thickness < 300 μm), (4) absence of tractional membranes, (5) absence of ocular disorders that might cause macular edema e.g. uveitis. Serous retinal detachment (SRD) height and neuroretinal thickness (NRT) was measured manually using calipers as the distance between the RPE and the outer neurosensory retinal surface and the distance between the inner and outer retinal surfaces at the fixation point, respectively. All patents had intravitreal injection of 1 mg ranibizumab (Lucentis, Genentech, South San Francisco, CA) monthly for 3 months. Patients were then followed-up monthly for another 9 months. During each visit, patients had visual acuity measurement and OCT study. Additional injections were administered if visual acuity dropped >= 0.1 logMAR unit and/or there was evidence of submacular fluid (CSF ≥250 μm).
Thirty four eyes of 19 patients were identified; 71% had prior cataract extraction. Fourteen eyes (41%) showed normal foveal neurosensory retinal structure and thickness, 12 eyes (35%) showed diffuse macular thickening, 5 eyes (15%) showed focal macular thickening, and 3 eyes (9%) showed mixed focal and diffuse macular thickening. There was no correlation between the thickness of the NST and SRD height in the studied patients (r = 0.11, P = 0.27). The mean number of injections during the study was 4.3 ± 1.2 (range, 3 to 7 injections). The mean baseline logMAR visual acuity improved from 0.71 ±0.24 before injection to 0.38 ± 0.26 1 year after the first injection. Sixteen eyes (47%) showed improvement of visual acuity by 3 or more logMAR units, 17 eyes (50%) showed improvement of visual acuity by less than 3 logMAR units, and one eye (3%) showed no improvement of visual acuity at the end of the follow-up period. The mean CSF thickness and SRD height improved from 489 ± 162 µm and 221 ± 97 µm, respectively, before injection to 264 ± 131 µm and 22 ± 20 µ after 1 year. Eleven patients (34%) showed complete disappearance of SRD.
Cataract extraction may be one of the risk factors that predispose or accelerate the development of serous macular detachment in diabetic patients. The height of SRD did not correlate with the thickness of the retina above the SRD suggesting that SRD height is not related to DME severity and that the occurrence of SRD in DME is not a specific feature of a severe stage of DME. Intravitreal ranibizumab is an effective treatment that results in regression of serous macular detachment in patients with diabetic macular edema. However, the ideal regimen for injections need further study.