الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 162 |  |  |
| | | from | 162 | | |
Abstract
Patients with poorly controlled diabetes mellitus are vulnerable to developing DR with the retinopathic changes being presented by retinal microvascular pathological changes. Visual impairment due to retinopathic changes badly affects patients’ life quality, disease management, overall life expectancy, and incidence of other diabetic complications. DME is considered as the leading cause of visual loss in patients with DR. VEGF is considered responsible for the abnormal vascular permeability in DME. The advantages of anti- VEGF therapy are in decreasing DME and improving patient’s vision. Ranibizumab has been reported as the first line therapies among the other anti-VEGF. OCTA allows noninvasive and dye-free imaging of superficial and deep retinal vasculature providing high resolution 3D images of the different retinal vascular layers separately. OCTA has been previously shown to precisely and reliably delineate areas of capillary dropout and to image the FAZ without obscuration by dye leakage or macular xanthophyll pigment shadowing compared to FA. It also allows quantitative and automated measurements of the retinal VD. This prospective and interventional study was conducted to assess changes in FAZ area in patients with diabetic macular edema after intra vitreal injection of anti-VEGF (Ranibizumab) and its effect on visual function. The study was carried out in ophthalmic center, Mansoura University, Dakahlia governorate, Egypt, on 30 eyes with DME, collected from outpatient’s clinic in Mansoura ophthalmology center. Included diabetic patients with diabetic macular edema in need for intra vitreal injection of ranibizumab, patients aged 55 ± 15 years, both males and females. Excluded patients with history of previous IVI injection of anti-VEGF and steroid, patients with history of focal, grid laser or PRP, patients with history of pars plana vitrectomy, patients with media opacity as (corneal opacity, cataract or vitreous hemorrhage) interfering with imaging, patients with other retinal diseases as choroidal neovascular membrane, age related macular degeneration, inflammation and other vascular retinopathies, or patients with ocular trauma. The study included 30 eyes of diabetic patients with diabetic macular edema, the mean age was 57.4± 6.9 years, with the majority of study participants 19 (63.33%) were females, with only 11 (36.66%) were males. this study revealed that both BCVA and contrast sensitivity significantly improved after intravitreal Ranibizumab administration. Also color vision improved after injections where 70 % of patients before injections had defect color vision test and 30% had normal vision test. While postoperative, 86.7 % of patients had normal color vision test and only 13.3% remained with defect color vision test. Also, there was correlation between visual acuity and FAZ shape in which eyes with poor visual acuity had a more irregular shape of FAZ, according to FAZ shape pre-operative, all cases had more irregular shape with mean BCVA 0.9746±0.28. while postoperative, 27 (90%) patients had more regular FAZ shape with mean BCVA 0.413±0.162 and only 3 (10%) patients had irregular FAZ shape with mean BCVA 0.852±0.128. There was an increase in mean FAZ area in both SCP and DCP after injection than before injection, where the mean FAZ area in SCP (µm) was 384.6± 236.5 and increased to 498.25± 258.2 and the mean FAZ area in DCP (µm) was 412.4±268.4 and increased to 493.1±203.2, but it remained statistically insignificant. Conclusion & recommendations : Our study showed that the FAZ area, in the SCP and DCP as measured by OCTA showed non-significant change during the three months of intravitreal anti-VEGF therapy (Ranibizumab) in eyes with DME. While there were no significant changes in the FAZ, there is significant improvement in visual functions in patients with DME at three months’ treatment with intravitreal anti-VEGF (Ranibizumab). Also assessing both the size and shape of FAZ is probably important for detecting pathological alteration of the macula and prediction of visual outcomes in DR, as eyes with poor visual acuity had a more irregular shape of FAZ while after injections, better visual acuity was significantly associated with less FAZ irregularity in which FAZ regained its regular shape and contour. Future studies with a larger sample size, more injections, and longer follow-up period may be needed to confirm our findings. Furthermore, a randomized controlled trial may be necessary to control the effect of other confounding variables. Based on the current study results we propose that OCTA (SCP and DCP) markers in a routine clinical scenario could play a good role in measuring and establishing early progress to anti-VEGF therapy (Ranibizumab). This could help individualize the standard of care in individuals with retinopathy and macular oedema. More studies are needed to address the reliability and characterization of temporospatial changes in the OCTA in the long term.