Two-year analysis of changes in the optic nerve and retina following anti-VEGF treatments in diabetic macular edema patients

Abstract

Purpose: To evaluate long-term structural and functional changes that happen to the optic nerve and retina following ranibizumab (Lucentis) injections in diabetic macular edema (DME) patients.

Methods: Patients with clinically significant DME requiring anti-VEGF injections underwent pre-injection baseline, 6, 12, and 24 month follow-up tests. The tests performed were optical coherence tomography (OCT), best-corrected visual acuity (BCVA), and visual field (VF). Wide-field fluorescein angiogram (IVFA) was performed to monitor the progression of diabetic ischemia.

Results: A total of 30 patients requiring anti-VEGF injections and 21 control patients not requiring anti-VEGF injections were enrolled in the study. From baseline, the average macular thickness significantly decreased (p<0.0002) over the 24-month time period. Mean perfused ratio significantly increased (p<0.0005) at 6, 12, and 24 months. Cup volume and vertical cup-to-disk ratio significantly increased (p<0.0014) over the study period. This was verified by masked independent grading of patient optic nerve stereo-photographs by glaucoma specialists. BCVA significantly (p<0.0006) improved over the study period. VFs showed a non-significant trend of deteriorating peripheral vision at 12 and 24 months.

Conclusion: Clinically, anti-VEGF therapy appears to affect the optic nerve by increasing cup volume and increasing vertical cup/disk ratio over time. The results provide a cautionary note to monitor both the retina and optic nerve status in patients undergoing frequent injections.

Keywords:

• diabetic macular edema
• retina
• optic nerve
• anti-VEGF
• lucentis
• ranibizumab

Acknowledgments

We thank the Ivey Eye Institute, Western University – Department of Pathology and Laboratory Medicine, Lawson Health Research Institute, and the Schulich School of Medicine and Dentistry for their support. We would like to thank Dr. Devesh Varma and Dr. Lisa Heckler for grading our photos. We would like to thank Dr. William Hodge for his assistance in statistical analyses. We thank all of the secretaries, staff, and technicians at the Ivey Eye Institute for their assistance and support in this study.

This paper was presented at the ARVO 2017 Annual Meeting (Baltimore, Maryland) - Platform presentation 2017/05/07–2017/05/11. It was selected by the Annual Meeting Program Committee as a “Hot Topic”, representing the newest and most innovative research being conducted in various specialties. This distinction was awarded to just over 2% of all 2017 Annual Meeting abstracts. It was also presented at the 2017 COS Annual Meeting & Exhibition (Montreal, Canada) - Platform presentation 2017/06/15–2017/06/18.

Disclosure

The authors report no conflicts of interest in this work.