RESUMO
ABSTRACT: No studies have evaluated the retinal sensitivity (RS) for diabetic macular edema (DME) patients with good vision. Therefore, this study aimed to determine the effectiveness of microperimetry in evaluating the effectiveness of anti-vascular endothelial growth factor (anti-VEGF) treatment for DME patients with relatively good vision.Twenty-seven eyes of 27 patients (mean age, 61.3â±â11.2âyears) with DME and decimal best-corrected visual acuity (BCVA) ≥0.6 were studied. All patients received 3 consecutive monthly injections of intravitreal anti-VEGF agents. The BCVA, central subfield macular thickness (CMT), and RS were evaluated by microperimetry (MAIA) within the 10 degree of the foveal center. To determine significant differences between the values, we used paired t tests.Patients were evaluated at baseline and 4âweeks after the third injection. The BCVA improved significantly from 0.18â±â0.06 logarithm of the minimum angle of resolution (logMAR) units to 0.13â±â0.13 logMAR units (Pâ=â.002; paired t test). The CMT decreased significantly from 464.3â±â91.8âµm to 393.4â±â129.0âµm (Pâ=â.005), and the RS also improved significantly from 21.8â±â3.1âdB to 24.1â±â2.8âdB at 4âweeks after treatment (Pâ=â.006). Among the patients with a decimal BCVA of 0.7 or better at baseline, there was no significant improvement in the BCVA (Pâ=â.28). However, the CMT decreased significantly from 479.5â±â79.1âµm to 394.0â±â99.8âµm at 4âweeks after treatment (Pâ=â.007). The RS also improved significantly from 22.0â±â2.4âdB to 24.0â±â3.1âdB at 4âweeks after treatment (Pâ=â.004).Measuring RS by microperimetry is a good option for evaluating the effectiveness of anti-VEGF treatment for DME patients with a relatively good BCVA.
Assuntos
Diabetes Mellitus , Retinopatia Diabética/tratamento farmacológico , Edema Macular/tratamento farmacológico , Acuidade Visual/efeitos dos fármacos , Idoso , Retinopatia Diabética/complicações , Feminino , Hemoglobinas Glicadas/análise , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Retina/diagnóstico por imagem , Retina/patologia , Estudos Retrospectivos , Tomografia de Coerência Óptica , Resultado do Tratamento , Fatores de Crescimento do Endotélio Vascular/administração & dosagem , Fatores de Crescimento do Endotélio Vascular/uso terapêutico , Testes de Campo VisualRESUMO
AIM: To determine whether the area of the foveal avascular zone (FAZ), as a morphological indicator of the microcirculation of the perifoveal capillary network, changes in the carbohydrate metabolism disorders during pregnancy (the gestational age of patients with gestational diabetes mellitus (GDM) and preexisting diabetes (PexD)). METHODS: Ten normal individuals and 41 eyes of 41 patients, 28 with GDM and 13 with PexD, were studied. A 3 × 3 mm area of the FAZ of the superficial capillary plexus layer (SCP) and the deep capillary plexus layer (DCP) was determined by optical coherence tomography angiography (OCTA; RS-3000 Advance, NIDEK). The significance of the correlation between the size of the FAZ and the weeks of pregnancy was determined. RESULTS: The area of the FAZ of the SCP was 0.38 ± 0.11 mm2 (normal eyes), 0.41 ± 0.16 mm2 (GDM), and 0.43 ± 0.10 mm2 (PexD). The area of the FAZ of the DCP was 0.78 ± 0.23 mm2 (normal eyes), 0.69 ± 0.16 mm2 (GDM), and 0.79 ± 0.25 mm2 (PexD). No significant difference in the FAZ sizes was observed between the groups. The average number of weeks of pregnancy was 24.1 ± 8.2 weeks in the eyes with GDM and 23.3 ± 11.4 weeks in the eyes with PexD (P > 0.05). Significant correlations were found between the size of the FAZ of the SCP and the number of weeks (r = 0.37, P=0.04 for GDM, and r = 0.49, P=0.04 for PexD, Spearman's rank-order correlation coefficient). CONCLUSIONS: For GDM and PexD under established glycemic control, the area of the FAZ is not affected, but vascular changes occurred at the early phase of pregnancy.
Assuntos
Erros Inatos do Metabolismo dos Carboidratos/metabolismo , Fóvea Central/metabolismo , Macula Lutea/metabolismo , Complicações na Gravidez/metabolismo , Adulto , Metabolismo dos Carboidratos/genética , Erros Inatos do Metabolismo dos Carboidratos/diagnóstico por imagem , Erros Inatos do Metabolismo dos Carboidratos/patologia , Diabetes Mellitus/diagnóstico por imagem , Diabetes Mellitus/metabolismo , Diabetes Mellitus/patologia , Diabetes Gestacional/diagnóstico por imagem , Diabetes Gestacional/metabolismo , Diabetes Gestacional/patologia , Feminino , Fóvea Central/irrigação sanguínea , Fóvea Central/diagnóstico por imagem , Fóvea Central/patologia , Humanos , Macula Lutea/irrigação sanguínea , Macula Lutea/diagnóstico por imagem , Macula Lutea/patologia , Masculino , Gravidez , Complicações na Gravidez/patologia , Tomografia de Coerência ÓpticaRESUMO
To determine whether an intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) in eyes with diabetic macular edema (DME) affects the vascular infarction-related molecules (VIRMs). Nineteen eyes with DME were treated with 0.5 mg of intravitreal ranibizumab (IVR), and 22 eyes with DME were treated with 2 mg of intravitreal aflibercept (IVA). Blood was collected before, 1 week and 1 month after the injections. Aqueous humor was collected before and 1 month after the injections. The concentration of the VIRMs (cardiac myoglobin, cardiac troponin, intercellular adhesion molecule, monocyte chemotactic protein-1, matrix metalloproteinase-8, placental growth factor [PlGF], tenascin-C, tissue inhibitor of metalloproteinase-1, thrombospondin-2, vascular cell adhesion molecule-1, and VEGF) were determined by the multiplex assay. After the single injection of both types of anti-VEGF agents, the concentration of aqueous VEGF decreased significantly (P < 0.01). The plasma VEGF was reduced significantly at 1 week after the IVA (93.7 ± 17.6 to 39.5 ± 11.6 pg/ml; P < 0.01) but no significant change was seen after IVR (120.2 ± 11.3 to 137.4 ± 17.7 pg/ml). No significant changes were detected for the other VIRMs in the plasma and aqueous. A single intravitreal injection of anti-VEGF for DME does not significantly affect the concentration of several VIRMs.