CHANGES IN RETINAL NERVE FIBER LAYER ON OPTICAL COHERENCE TOMOGRAPHY AFTER PANRETINAL PHOTOCOAGULATION IN PATIENTS WITH PROLIFERATIVE DIABETIC RETINOPATHY
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Abstract
ABSTRACT
OBJECTIVE: To study changes in retinal nerve fiber layer (RNFL) measured on optical coherence tomography (OCT) after panretinal photocoagulation (PRP) in patients with proliferative diabetic retinopathy (PDR).
METHODS: This quasi experimental study was conducted at Department of Ophthalmology, Lahore General Hospital, Lahore from 1-4-2017 to 30-3-2018. All patients (n=38) diagnosed with PDR requiring PRP were included. Patients having any coexisting ocular pathology hindering the OCT measurement were excluded. Pre-operatively, RNFL thickness in four quadrants and signal strength was measured on OCT and visual acuity (VA) on Snellen’s chart. Post-operatively, patients were followed-up after one-month and three-months and VA was measured and OCT performed.
RESULTS: The mean age of patients was 60.66±5.51years with 23(60.5%)males. PRP was performed in right-eye of 22 patients. Pre-laser VA in 28 patients was 6/60. Pre-laser total RNFL was 84.32±4.78µm reduced to 83.74±4.61µm one-month and 81.89±4.40µm three-months post-laser (p<0.001). Pre-laser, superior RNFL thickness was 84.97±4.13µm, reduced to 84.39±3.95µm one-month and to 82.21±3.84µm at three-months post-laser (p 0.024). Pre-laser inferior RNFL thickness was 84.89±4.68µm, reduced to 84.00±4.44µm one-month and to 81.71±4.50µm three months post-laser (p=0.032). Pre-laser temporal RNFL thickness was 83.26±3.47µm, reduced to 82.34±3.44µm one-month and to 80.21±3.49µm three-months post-laser (p<0.001). Pre-laser nasal RNFL thickness was 85.16±3.78µm, reduced to 84.26±3.88µm one-month post-laser and to 82.08±3.74µm at three-months post-laser (p=0.043). Pre-laser, signal strength on OCT was 8.26±0.69 and 8.66±0.48 one-month post-laser and 8.55±0.50 three-months post-laser (p=0.009).
CONCLUSION: PRP leads to a decrease in thickness of RNFL after one month and three months as compared to pre-laser RNFL thickness.
KEY WORDS: Retina (MeSH); Panretinal photocoagulation (Non-MeSH); Retinal nerve fiber layer thickness (Non-MeSH); Diabetic Retinopathy (MeSH); Tomography, Optical Coherence (MeSH); Neovascularization, Pathologic (MeSH); Laser Coagulation (MeSH).Article Details
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References
REFERENCES
Ajlan RS, Silva PS, Sun JK. Vascular endothelial growth factor and diabetic retinal disease. Semin Ophthalmol 2016;31(1-2):40-8. DOI: 10.3109/08820538.2015.1114833.
Lee R, Wong TY, Sabanayagam C. Epidemiology of diabetic retinopathy, diabetic macular edema and related vision loss. Eye Vis (Lond) 2015 Sep 30;2:17. DOI: 10.1186/s40662-015-0026-2.
Nentwich MM, Ulbig MW. Diabetic retinopathy-ocular complications of diabetes mellitus. World J Diabetes 2015;6(3):489-99. DOI: 10.4239/wjd.v6.i3.489.
Klein BE, Myers CE, Howard KP, Klein R. Serum Lipids and Proliferative Diabetic Retinopathy and Macular Edema in Persons With Long-term Type 1 Diabetes Mellitus: The Wisconsin Epidemiologic Study of Diabetic Retinopathy. JAMA Ophthalmol 2015 May;133(5):502-10. DOI: 10.1001/jamaophthalmol.2014.5108.
Sayin N, Kara N, Pekel G. Ocular complications of diabetes mellitus. World J Diabetes 2015 Feb 15;6(1):92-108. DOI: 10.4239/wjd.v6.i1.92
Emdin CA, Rahimi K, Neal B, Callender T, Perkovic V, Patel A. Blood pressure lowering in type 2 diabetes: a systematic review and meta-analysis. JAMA 2015 Feb 10;313(6):603-15. DOI: 10.1001/jama.2014.18574.
Lipska KJ, Krumholz H, Soones T, Lee SJ. Polypharmacy in the aging patient: a review of glycemic control in older adults with type 2 diabetes. JAMA 2016 Mar 8;315(10):1034-45. DOI: 10.1001/jama.2016.0299.
Ferraz DA, Vasquez LM, Preti RC, Motta A, Sophie R, Bittencourt MG, et al. A randomized controlled trial of panretinal photocoagulation with and without intravitreal ranibizumab in treatment-naïve eyes with non-high-risk proliferative diabetic retinopathy. Retina 2015 Feb;35(2):280-7. DOI: 10.1097/IAE.0000000000000363.
Chhablani J, Mathai A, Rani P, Gupta V, Arevalo JF, Kozak I. Comparison of conventional pattern and novel navigated panretinal photocoagulation in proliferative diabetic retinopathy. Invest Ophthalmol Vis Sci 2014 May 1;55(6):3432-8. DOI: 10.1167/iovs.14-13936.
Yun SH, Adelman RA. Recent developments in laser treatment of diabetic retinopathy. Middle East Afr J Ophthalmol. 2015 Apr-Jun;22(2):157-63. DOI: 10.4103/0974-9233.150633.
Oddone F, Lucenteforte E, Michelessi M, Rizzo S, Donati S, Parravano M, et al. Macular versus retinal nerve fiber layer parameters for diagnosing manifest glaucoma: A systematic review of diagnostic accuracy studies. Ophthalmology 2016 May;123(5):939-49. DOI: 10.1016/j.ophtha.2015.12.041.
Garcia-Martin E, Polo V, Larrosa JM, Marques ML, Herrero R, Martin J, Ara JR, et al. Retinal layer segmentation in patients with multiple sclerosis using spectral domain optical coherence tomography. Ophthalmology 2014 Feb;121(2):573-9. DOI: 10.1016/j.ophtha.2013.09.035.
Yang Z, Tatham AJ, Zangwill LM, Weinreb RN, Zhang C, Medeiros FA. Diagnostic ability of retinal nerve fiber layer imaging by swept-source optical coherence tomography in glaucoma. Am J Ophthalmol 2015 Jan;159(1):193-201. DOI: 10.1016/j.ajo.2014.10.019.
Kim HY, Cho HK. Peripapillary retinal nerve fiber layer thickness change after panretinal photocoagulation in patients with diabetic retinopathy. Korean J Ophthalmol. 2009 Mar;23(1):23-6. DOI: 10.3341/kjo.2009.23.1.23.
Lim MC, Tanimoto SA, Furlani BA, Lum B, Pinto LM, Eliason D, et al. Effect of diabetic retinopathy and panretinal photocoagulation on retinal nerve fiber layer and optic nerve appearance. Arch Ophthalmol 2009 Jul;127(7):857-62. DOI: 10.1001/archophthalmol.2009.135.
Lee SB, Kwag JY, Lee HJ, Jo YJ, Kim JY. The longitudinal changes of retinal nerve fiber layer thickness after panretinal photocoagulation in diabetic retinopathy patients. Retina 2013 Jan;33(1):188-93. DOI: 10.1097/IAE.0b013e318261a710.
Kim J, Woo, SJ, Ahn J, Park KH, Chung H, Park KH. Long-term temporal changes of peripapillary retinal nerve fiber layer thickness before and after panretinal photocoagulation in severe diabetic retinopathy. Retina 2012 Nov-Dec;32(10):2052-60. DOI: 10.1097/IAE.0b013e3182562000.
Muqit MM, Wakely L, Stanga PE, Henson DB, Ghanchi FD. Effects of conventional argon laser photocoagulation on retinal nerve fiber layer and driving visual fields in diabetic retinopathy. Eye (Lond)) 2010 Jul;24(7):1136-42. DOI: 10.1038/eye.2009.308.
Muqit MM, Marcellino GR, Henson DB, Fenerty CH, Stanga PE. Randomized clinical trial to evaluate the effects of pascal panretinal photocoagulation on macular nerve fiber layer. Retina 2011 Sep;31(8):1699-707. DOI: 10.1097/IAE.0b013e318207d188.
Park YR, Jee D. Changes in peripapillary retinal nerve fiber layer thickness after pattern scanning laser photocoagulation in patients with diabetic retinopathy. Korean J Ophthalmol 2014 Jun;28(3):220-5. DOI: 10.3341/kjo.2014.28.3.220.
Lee DE, Lee JH, Lim HW, Kang MH, Cho HY, Seong M. The effect of pattern scan laser photocoagulation on peripapillary retinal nerve fiber layer thickness and optic nerve morphology in diabetic retinopathy. Korean J Ophthalmol 2014;28(5):408-16. DOI: 10.3341/kjo.2014.28.5.408.
Shin HJ, Shin KC, Chung H, Kim HC. Change of retinal nerve fiber layer thickness in various retinal diseases treated with multiple intravitreal antivascular endothelial growth factor. Invest Ophthalmol Vis Sci 2014 Apr 15;55(4):2403-11. DOI: 10.1167/iovs.13-13769.
Hwang DJ, Lee EJ, Lee SY, Park KH, Woo SJ. Effect of diabetic macular edema on peripapillary retinal nerve fiber layer thickness profiles. Invest Ophthalmol Vis Sci 2014 May 15;55(7):4213-9. DOI: 10.1167/iovs.13-13776.