First Author: M.Abushaala UK
Co Author(s): C. Sanghvi 0 0 0 0 0 0 0 0 0
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To determine the effect of intravitreal Ranibizumab on diabetic macular oedema.
Ophthalmology department, Eye clinic, East Lancashire NHS Trust.
Retrospective review of clinical notes and Optical Coherence Topography ( OCT ) for 62 eyes of 50 diabetic patients who had intravitreal Ranibizumab to treat diabetic macular oedema according to NICE guidelines .It included patients who had 3 injections or more. Treatment took place between August 2013 till February 2014. Data includes Best Corrected Visual Acuity (BCVA) in logMAR and Central Retinal Thickness (CRT) in micrometres at baseline visit, injection and review visits. BCVA was checked in all visits, OCT test was done at baseline, 4th and 7th visits. Fundus Fluorescein Angiography was done to all patients to confirm Non ischemic maculopathy. Patients received treatment from baseline visit, then every 4 weeks for the first 8 weeks. On week 12 at 4th visit, patients either had their treatment stopped, or given single injection or to start new cycle of 3 injections. The same principles apply to the 7th visit at week 16.
Our data shows that 56% of patients gained >15 letters after 1st cycle, with improvement in CRT by 27%, and of those who had 2 full cycles 78% gained 15 letters or more with reduction in CRT by 34% compared to baseline visit. Interestingly, over half of patients who had macular grid laser previously gained > 15 letters by the 4th visit and had reduction in CRT by around one third of that of the initial visit. And patients who had focal laser and PRP treatment in the past, 30% and 16% respectively gained >15 letters by 4th visit and CRT diminished by 18% and 17% respectively. In 4th visit, treatment was stopped in the third of patients as their OCT shows dry macula and their BCVA improved by >15 letters. In 7th visit, patients had 2 full cycles, treatment was stopped in 15% of them, their OCT shows no oedema and vision improved >15 letters. Males and females responded to treatment similarly. Those with NIDDM, gained more number of letters and maintained dryer macula over the period of observation in comparison with patients with IDDM. Patients aged >60 maintained steady improvement in BCVA over the full period.
Intravitreal Ranibizumab is fairly safe procedure and shows promising results in treating non ischemic diabetic macular oedema. According to our data Macular grid laser is favoured over focal laser as initial treatment for diabetic maculopathy, as it was found to enhance the efficiency of intravitreal Ranibizumab. 4 weeks interval is the recommended period between injections, and midway 4th visit OCT helps in making the decisions of weather to stop the injections or to commence new cycle.