First Author: M.Dunaieva UKRAINE
Co Author(s): V. Serdiuk S. Ustimenko L. Bereznyuk 0 0 0 0 0 0 0 0 0
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To investigate the characteristics of retinal hemodynamic in the group of diabetic patients with clinical manifestation of macular edema treated with intravitreal injection of Ranibizumab.
Participants of this study were 10 men and 12 women (22 eyes) aged 58.5 ± 7.8 years, duration of diabetes 14,8 years with clinically significant diabetic macular edema
and 15 healthy volunteers. Treatment comprised 3 intravitreal injections of ranibizumab 0,5 mg given at 4-week intervals. In all subjects, best-corrected visual acuity (BCVA) according Snellen chart, fluorescein angiography (FA), fundus photography and optical coherence tomography were done. Ulrasound dopplerography were used to measure hemodynamic parameters including the peak systolic velocity (Vsyst, mm/s), end-diastolic velocity (V diast, mm/s), and resistance index (RI) of blood flow in the central retinal artery (CRA) and the ophthalmic artery (OA). All patients were examined before intravitreal Ranibizumab injections and during the 3-month follow up period
Retinal vessel analysis showed no statistically significant differences in venous circulation (P = 0.70). At the beginning of treatment the reduction of blood flow in the CRA and OA were established. The systolic velocity (Vs) in the CRA increased from 12,32 ± 1,05 mm/sec (baseline) to 14,9 ± 1,8 mm/sec ( Month 3), N = 15,2 ± 1,17 mm/sec ( P=0,005). In the OA Vs increased from 27,6 ± 1,2 mm/sec (baseline) to 34,02 ± 1,4 mm/sec ( Month 3) N = 40,2 ± 1,8 mm/sec ( P=0,005). The index of peripheral resistance (Ri) in CRA decreased from 1,021 ± 0,005 ( baseline) to 0,673 ±0,004 (Month 3) P=0,001, in OA decreased from 0,791 ± 0,008 ( baseline) to 0,573 ±0,001 (Month 3) P=0,001. Central retinal thickness, as measured by optical coherence tomography, decreased significantly from 376.2 ± 101.8 μm (baseline) to 272.3 ± 92.8 μm (Month 3), P = 0.001. After 3 monthly Ranibizumab injections the tendency to increasing of blood flow and decreasing of index of peripheral résistance in the CRA and OA were estimated and had positive correlation between BCVA and decreased macular thickness. (P=0,001)
Intravitreally applied ranibizumab significantly affected hemodinamics in the OA and CRA. The reduction of the index of peripheral résistance and increases blood flow in the OA and CRA during treatment of diabetic macular edema may play an important role in the regression of macular edema.