Skip to main content

Advertisement

SpringerLink
Log in

Retinal function in eyes with proliferative diabetic retinopathy treated with intravitreal ranibizumab and multispot laser panretinal photocoagulation

  • Original Research Article
  • Published:
Documenta Ophthalmologica Aims and scope Submit manuscript

Abstract

Purpose

To compare retinal function changes in eyes with proliferative diabetic retinopathy (PDR) after intravitreal ranibizumab (IVR), combined or not with conventional (ETDRS) or multispot laser panretinal (PASCAL) photocoagulation (PRP).

Methods

This study included laser-naive PDR patients that required PRP. Eyes were randomly and prospectively assigned to receive IVR or IVR combined with PASCAL or EDTRS. PRP was performed at baseline in 1 (PASCAL) or 2 (ETDRS) sessions. In eyes with macular edema, macular short pulse grid laser was associated with IVR at baseline and IVR was repeated monthly or quarterly if neovascularization was detected on angiography. Comprehensive ophthalmological evaluations, including SD-OCT, were performed at baseline and every 4 weeks after treatment. Full-field electroretinography (ERG: extended ISCEV standard) was performed at baseline and at 12, 24 and 48 weeks.

Results

IVR = 13, PASCAL = 15 and ETDRS = 15 eyes finished 48-week follow-up. There was a statistically significant BCVA improvement of 0.1–0.3 logMAR in all groups, and fluorescein angiography leakage area (FLA) reduced in 56%, 73%, and 73% from baseline for ETDRS, IVR and PASCAL, respectively, up to 48 weeks without significant differences between groups (p > 0.05). A significant a- and b-wave amplitudes reduction was observed for dark- and light-adapted ERG for ETDRS and PASCAL, but only minor dark-adapted b-wave reduction was found for IVR, up to 48 weeks. As an example, at week 48, combined response b-wave amplitude reduced in 181.5 ± 31.4 µV, 128.0 ± 27.9 µV and 82.4 ± 15.2 µV for ETDRS, PASCAL and IVR (p < 0.05 each group), respectively. No significant difference was observed between ETDRS and PASCAL for any ERG parameter.

Conclusions

IVR combined with single or multiple spot PRP causes similar retinal function impairment during 48 weeks of observation, while IVR alone seems to be similarly effective controlling FLA without changing retinal function.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Yau JW, Rogers SL, Kawasaki R, Lamoureux EL, Kowalski JW, Bek T, Chen SJ, Dekker JM, Fletcher A, Grauslund J, Haffner S, Hamman RF, Ikram MK, Kayama T, Klein BE, Klein R, Krishnaiah S, Mayurasakorn K, O’Hare JP, Orchard TJ, Porta M, Rema M, Roy MS, Sharma T, Shaw J, Taylor H, Tielsch JM, Varma R, Wang JJ, Wang N, West S, Xu L, Yasuda M, Zhang X, Mitchell P, Wong TY, Meta-Analysis for Eye Disease Study G (2012) Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care 35:556–564

    Article  PubMed  PubMed Central  Google Scholar 

  2. Engerman RL (1989) Pathogenesis of diabetic retinopathy. Diabetes 38:1203–1206

    Article  CAS  PubMed  Google Scholar 

  3. Group TDRSR (1976) Preliminary report on effects of photocoagulation therapy. The Diabetic Retinopathy Study Research Group. Am J Ophthalmol 81:383–396

    Article  Google Scholar 

  4. Landers MB 3rd, Stefansson E, Wolbarsht ML (1982) Panretinal photocoagulation and retinal oxygenation. Retina 2:167–175

    Article  PubMed  Google Scholar 

  5. Vander JF, Duker JS, Benson WE, Brown GC, McNamara JA, Rosenstein RB (1991) Long-term stability and visual outcome after favorable initial response of proliferative diabetic retinopathy to panretinal photocoagulation. Ophthalmology 98:1575–1579

    Article  CAS  PubMed  Google Scholar 

  6. ETDRS (1991) Early photocoagulation for diabetic retinopathy. ETDRS report number 9. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology 98:766–785

    Article  Google Scholar 

  7. McDonald HR, Schatz H (1985) Macular edema following panretinal photocoagulation. Retina 5:5–10

    Article  CAS  PubMed  Google Scholar 

  8. Pender PM, Benson WE, Compton H, Cox GB (1981) The effects of panretinal photocoagulation on dark adaptation in diabetics with proliferative retinopathy. Ophthalmology 88:635–638

    Article  CAS  PubMed  Google Scholar 

  9. Henricsson M, Heijl A (1994) The effect of panretinal laser photocoagulation on visual acuity, visual fields and on subjective visual impairment in preproliferative and early proliferative diabetic retinopathy. Acta Ophthalmol (Copenh) 72:570–575

    Article  CAS  Google Scholar 

  10. Khosla PK, Rao V, Tewari HK, Kumar A (1994) Contrast sensitivity in diabetic retinopathy after panretinal photocoagulation. Ophthalmic surgery 25:516–520

    CAS  PubMed  Google Scholar 

  11. Blumenkranz MS, Yellachich D, Andersen DE, Wiltberger MW, Mordaunt D, Marcellino GR, Palanker D (2006) Semiautomated patterned scanning laser for retinal photocoagulation. Retina 26:370–376

    Article  PubMed  Google Scholar 

  12. Muqit MM, Marcellino GR, Gray JC, McLauchlan R, Henson DB, Young LB, Patton N, Charles SJ, Turner GS, Stanga PE (2010) Pain responses of Pascal 20 ms multi-spot and 100 ms single-spot panretinal photocoagulation: Manchester Pascal Study, MAPASS report 2. Br J Ophthalmol 94:1493–1498

    Article  CAS  PubMed  Google Scholar 

  13. Muqit MM, Marcellino GR, Henson DB, Young LB, Patton N, Charles SJ, Turner GS, Stanga PE (2010) Single-session vs multiple-session pattern scanning laser panretinal photocoagulation in proliferative diabetic retinopathy: The Manchester Pascal Study. Arch Ophthalmol 128:525–533

    Article  PubMed  Google Scholar 

  14. Chappelow AV, Tan K, Waheed NK, Kaiser PK (2012) Panretinal photocoagulation for proliferative diabetic retinopathy: pattern scan laser versus argon laser. Am J Ophthalmol 153(137–142):e132

    Google Scholar 

  15. Jorge R, Costa RA, Calucci D, Cintra LP, Scott IU (2006) Intravitreal bevacizumab (Avastin) for persistent new vessels in diabetic retinopathy (IBEPE study). Retina 26:1006–1013

    Article  PubMed  Google Scholar 

  16. Witmer AN, Vrensen GF, Van Noorden CJ, Schlingemann RO (2003) Vascular endothelial growth factors and angiogenesis in eye disease. Prog Retin Eye Res 22:1–29

    Article  CAS  PubMed  Google Scholar 

  17. Aiello LP, Avery RL, Arrigg PG, Keyt BA, Jampel HD, Shah ST, Pasquale LR, Thieme H, Iwamoto MA, Park JE et al (1994) Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders. N Engl J Med 331:1480–1487

    Article  CAS  PubMed  Google Scholar 

  18. Tonello PS, Rosa AH, Abreu CH Jr, Menegario AA (2007) Use of diffusive gradients in thin films and tangential flow ultrafiltration for fractionation of Al(III) and Cu(II) in organic-rich river waters. Anal Chim Acta 598:162–168

    Article  CAS  PubMed  Google Scholar 

  19. Messias A, Filho JA, Messias K, Almeida FP, Costa RA, Scott IU, Gekeler F, Jorge R (2012) Electroretinographic findings associated with panretinal photocoagulation (PRP) versus PRP plus intravitreal ranibizumab treatment for high-risk proliferative diabetic retinopathy. Doc Ophthalmol 124:225–236

    Article  PubMed  Google Scholar 

  20. McCulloch DL, Marmor MF, Brigell MG, Hamilton R, Holder GE, Tzekov R, Bach M (2015) ISCEV Standard for full-field clinical electroretinography (2015 update). Doc Ophthalmol 130:1–12

    Article  PubMed  Google Scholar 

  21. Messias A, Jaegle H, Gekeler F, Zrenner E (2008) Software for evaluation of electroretinograms XLVI annual symposium of the international society for clinical electrophysiology of vision (ISCEV), Morgantown—USA

  22. Tzekov R, Arden GB (1999) The electroretinogram in diabetic retinopathy. Surv Ophthalmol 44:53–60

    Article  CAS  PubMed  Google Scholar 

  23. Arden GB, Sidman RL, Arap W, Schlingemann RO (2005) Spare the rod and spoil the eye. Br J Ophthalmol 89:764–769

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Moschos M (1982) ERG and VER findings after laser photocoagulation of the retina. Metab Pediatr Syst Ophthalmol 6:101–105

    CAS  PubMed  Google Scholar 

  25. Schuele G, Rumohr M, Huettmann G, Brinkmann R (2005) RPE damage thresholds and mechanisms for laser exposure in the microsecond-to-millisecond time regimen. Invest Ophthalmol Vis Sci 46:714–719

    Article  PubMed  Google Scholar 

  26. Subash M, Comyn O, Samy A, Qatarneh D, Antonakis S, Mehat M, Tee J, Mansour T, Xing W, Bunce C, Viswanathan A, Rubin G, Weleber R, Peto T, Wickham L, Michaelides M (2016) The effect of multispot laser panretinal photocoagulation on retinal sensitivity and driving eligibility in patients with diabetic retinopathy. JAMA Ophthalmol 134:666–672

    Article  PubMed  Google Scholar 

  27. Willmann G, Nepomuceno AB, Messias K, Barroso L, Scott IU, Messias A, Jorge R (2017) Foveal thickness reduction after anti-vascular endothelial growth factor treatment in chronic diabetic macular edema. Int J Ophthalmol 10:760–764

    PubMed  PubMed Central  Google Scholar 

Download references

Funding

FAPESP Grant Numbers: 2012/16265-0, and 2013/02169-2. Rodrigo Jorge received travel support from Novartis to attend the 2015 American Society of Retina Specialists (ASRS) meeting. The sponsor had no role in the design or conduct of this research.

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Otolaryngology and Head and Neck Surgery, Ribeirão Preto School of Medicine, Av. Bandeirantes 3900, Ribeirão Prêto, SP, 14049-900, Brazil

    Katharina Messias, Rafael de Montier Barroso, Rodrigo Jorge & Andre Messias

Authors
  1. Katharina Messias
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rafael de Montier Barroso
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rodrigo Jorge
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andre Messias
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andre Messias.

Ethics declarations

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Informed consent

All participants gave written informed consent before entering the study.

Statement of human rights

All procedures were in accordance with the ethical standards of the institutional research committee (Comitê de Ética em Pesquisa do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto—USP, Protocol Number 11685/2012) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Statement on the welfare of animals

No animals were used in this research.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Messias, K., Barroso, R.M., Jorge, R. et al. Retinal function in eyes with proliferative diabetic retinopathy treated with intravitreal ranibizumab and multispot laser panretinal photocoagulation. Doc Ophthalmol 137, 121–129 (2018). https://doi.org/10.1007/s10633-018-9655-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10633-018-9655-9

Keywords

Search

Navigation