Assessment of Retinal Nerve Fiber Layer Thickness Using Optical Coherence Tomography Before and After Ranibizumab Intravitreal Injection in Patients with Diabetic Macular Edema

Background: Anti-Vascular Endothelial Growth Factor (Anti-VEGF) therapy serves to decrease central retinal thickness in eyes affected with diabetic macular edema (DME). The Retinal Nerve Fiber Layer (RNFL) forms the basis of the optic nerve. Objectives: Our study is concerned with studying the effects of Anti-VEGF injections in patients with DME on RNFL thickness. Patients and methods: This was a prospective cohort interventional study conducted at South Valley University Hospital, Ophthalmology department outpatient clinic. It included 50 diabetic patients with diabetic macular edema whose RNFL thickness was measured before the anti-VEGF injections and again after the completion of the three injections treatment course using spectral domain optical coherence tomography (SD-OCT). Results: This study included 50 eyes from 50 patients. 35 (70%) of them were females and 15 (30%) of them were males. 26 patients (52%) had their right eye injected, and 24 patient (48%) had their left eye injected. The superior quadrant of the RNFL showed a mean increase of 1.2 microns (SD = 38.4, 95% Confidence Interval CI = -9.7:12.1, p value = 0.829). The inferior quadrant showed a mean increase of 7.5 microns (SD = 35.6, 95% CI = -2.6:17.6, p value = 0.144). The nasal quadrant showed a mean increase of 8.3 microns (SD = 23, 95% CI = 1.8:14.9, p value = 0.014). The temporal quadrant showed a mean increase of 4.1 microns (SD = 33.2, 95% CI = -5.3:13.6, p value = 0.386). Conclusion: There is no statistically significant correlation between intra-vitreal injections of anti-VEGF and the RNFL thickness

Incidence of macular edema after phacoemulsification with and without diabetes mellitus: A hospital-based clinical prospective trial in Upper Egypt

Background: Diabetes mellitus, or DM, is a condition that increases the risk of developing cataracts. Cataracts are one of the leading causes of blindness; some studies report that DM patients with cataracts have an increased risk of progression, while other studies report that their progression is merely the natural course of the disease. Objectives: To estimate incidence of macular edema (ME), in patients with and without diabetes following phacoemulsification operation. Patients and methods: This study is a prospective cross- sectional observational which enrolled 100 eyes of one hundred subjects, fifty patients suffering diabetes (group 1) and fifty patients suffer no diabetes (group 2) having immature senile cataract . Participants belonged to the ophthalmology department of South Valley University. OCT was done preoperatively and postoperatively by one month. Results: Mean age of patients with and without diabetes was 66.48 and 66.16 respectively. Males represent 64% of group 1 and , and 80% of group 2 respectively. Both groups showed a considerable rise in the central macular thickness one month postoperatively, but there was no potential variation statistically in central macular thickness between the two groups neither before, nor after the surgery. Conclusion: There is an increase in central macular thickness as a result of the effects of phacoemulsification on the macula in patients with and without diabetes. OCT is the single most crucial diagnostic and prognostic tool for managing macular oedema. But long-term studies are needed to prove longer effect of uncomplicated phacoemulsification and macular thickness and its visual impact

Prostaglandin vs Dorzolamide/Timolol Effect on Anterior Scleral Thickness in Patients with Primary Open Angle Glaucoma By Using Anterior Segment Optical Coherence Tomography

Background: analogues of prostaglandin are usually the first-line prescribed drops therapy in patients with glaucoma, but the mechanism of their action is not completely understood. Objectives: Our study aims to compare anterior scleral thickness in glaucoma patients taking prostaglandins vs dorzolamide/timolol combinations Patients and methods: This was a interventional prospective randomized study that included 60 adults with primary OAG randomized to receive either PG analogues or Dorzolamide/Timolol fixed combination drugs. The AST was evaluated manually by the built-in calibers of a plateform provided in the OCT tools at three locations (scleral spur, 1000 μm, and 2000 μm behind the scleral spur) in the temporal and nasal meridians. Results: The AST at the nasal area showed a decrease of 15.5 microns (SD = 21.4, p = .000). 1000-micron posterior to it, a decrease of 11.5 microns (SD = 5.5, p = .000), and 2000-micron posterior to it, 9.3 (SD = 6.3, p = .000). The AST at the temporal area demonstrated a decrease of 22.3 microns (SD = 8.6, p = .000). 1000-micron posterior to it, 20.9 microns (SD = 14, p = .000), and 2000-micron posterior to it, 20 microns (SD = 13.2, p = .000) Conclusion: The use of prostaglandin analogues and dorzolamide/timolol showed a significant decrease in anterior scleral thickness in all measured points; over the nasal and temporal scleral spurs, and 1000 microns posterior to them, and 2000 microns posterior to them with no statistically significant difference between the two drugs

Imaging of choroidal neovascular membrane by optical coherence tomography Angiography

Background: Optical coherence tomography angiography (OCTA) is a new safe imaging technique that uses motion contrast imaging to high-resolution volumetric blood stream information to produce angiographic pictures in a matter of seconds. Objectives: We aimed to identify different patterns and types of CNV by OCTA and the relationship between these patterns and activity of CNV. Patients and Methods: Fifty eyes of 50 patients presented with CNV had a regular diagnostic evaluation that included FA and/or OCT. Suspected cases with CNV underwent scanning by OCTA in this study. Patients with media opacity or bad image quality had been excluded. Results: In 80% of patients, there is a statistically significant correlation between the patterns of CNV and its activity (P-value =0.0001). Conclusion: OCTA is a critical technique for better characterizing the various forms and patterns of CNV, as well as the link between these patterns and CNV activity

Evaluation Of Choroidal Thickness Before and After Intravitreal Injection Of Anti Vascular endothelial growth factors for Treatment Of Diabetic Macular Edema using Optical Coherence Tomography

Background: The choroid is the vascular tissue supplying the outer retina. Objectives: We are concerned with studying the changes in choroidal thickness related to anti-VEGF injection in diabetic patients. Patients and Methods: This was a prospective cohort interventional study conducted at South Valley University Hospital, Ophthalmology department and included 40 eyes from 40 patients with diabetic macular edema. Inclusion criteria included adult phakic patients with diabetic macular edema receiving anti vascular endothelial growth factors injections without prior anti-VEGF therapy. All the patients underwent full eye examination , Refraction was done, uncorrected visual acuity, corrected visual acuity were estimated ,Injections were done only one injection every month for three months and the follow up was 6 months after the date of the first injection. OCT Measurements were performed before and after 6 monthes. OCT Measurements were done 3 times and the average was estimated. Results: The mean decrease in nasal choroidal thickness was 14.4 (SD = 4.3, 95% CI = 13.02:15.78, p value = .000). The mean decrease in subfoveal choroidal thickness was 12.25(SD = 3.59, 95% CI = 11.1:13.4, p value = .000). The mean decrease in temporal choroidal thickness was 13.33 (SD = 4.2, 95% CI = 11.98:14.67, p value = .000). Conclusion: The temporal, nasal, and subfoveal choroid showed a decrease in thickness after receiving anti-VEGF injections in DME patients. . Further studies are recommended to ascertain the relationship between diabetic retinopathy, anti-VEGF injections & choroidal thickness