Two Cases of Long-Term Changes in the Retinal Nerve Fiber Layer Thickness after Intravitreal Bevacizumab for Diabetic Papillopathy

Jong Jin Kim; Jong Chan Im; Jae Pil Shin; In Taek Kim; Dong Ho Park

doi:10.3341/jkos.2013.54.9.1445

Journal List > J Korean Ophthalmol Soc > v.54(9) > 1009488

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim, Im, Shin, Kim, and Park: Two Cases of Long-Term Changes in the Retinal Nerve Fiber Layer Thickness after Intravitreal Bevacizumab for Diabetic Papillopathy

Original Article

J Korean Ophthalmol Soc 2013;54(9):1445-1451.

Published online: 7 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.9.1445

Two Cases of Long-Term Changes in the Retinal Nerve Fiber Layer Thickness after Intravitreal Bevacizumab for Diabetic Papillopathy

Jong Jin Kim, MD, Jong Chan Im, MD, Jae Pil Shin, MD, PhD, In Taek Kim, MD, PhD, Dong Ho Park, MD, PhD

Department of Ophthalmology, Kyungpook National University School of Medicine, Daegu, Korea

Address reprint requests to Dong Ho Park, MD, PhD Department of Ophthalmology, Kyungpook National University Hopital, #130 Dongdeok-ro, Jung-gu, Daegu 700-721, Korea Tel: 82-53-420-5813, Fax: 82-53-426-6552 E-mail: sarasate2222@gmail.com

∗ This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (2012004585) and by the Korea Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (A111345).

Received 8 February 201329 April 2013 Accepted 17 July 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report long-term changes in the average retinal nerve fiber layer (RNFL) thickness in 2 patients who had intra-vitreal bevacizumab (IVB) injection for diabetic papillopathy.

Case summary

A 36-year-old patient with diabetes complained of decreased visual acuity (20/200) in the right eye. The fundus examination showed optic disc swelling in both eyes. The average RNFL thickness based on optical coherence to-mography (OCT) increased to 278 μ m and Goldmann perimetry showed nasal visual field defect in the right eye. The IVB was injected into the right eye. Three weeks after the IVB injection, RNFL thickness decreased to 135 μ m and visual acuity improved to 20/25 in the right eye. However, RNFL thickness increased from 126 to 207 μ m and visual acuity decreased to 20/32 in the left eye. Thus, IVB was injected into the left eye. In week 3, RNFL thickness decreased to 147 μ m and visual acuity improved to 20/20 in the left eye. At 12 months after IVB injection, RNFL thickness was 87 μ m in the right eye and 109 μ m in the left eye. A 57-year-old patient with diabetes complained of decreased visual acuity (20/200) and showed op-tic disc swelling in the right eye. The average RNFL thickness increased to 252 μ m and Goldmann perimetry showed an enlarged blind spot in the right eye. IVB was injected into the right eye. After 3 weeks, RNFL thickness decreased to 136 μ m and visual acuity improved to 20/70 in the right eye. Six months after IVB injection, RNFL thickness was 83 μ m in the right eye.

Conclusions

Visual acuity progressively improved within 3 weeks and RNFL thickness measured by spectral domain OCT showed progressive thickness reduction in 2 cases of diabetic papillopathy patients who had IVB injections.

Keywords: Bevacizumab, Diabetic papillopathy, Diabetic retinopathy, Retinal nerve fiber layer thickness

References

1. Appen RE, Chandra SR, Klein R, Myers FL. Diabetic papillopathy. Am J Ophthalmol. 1980; 90:203–9.

2. Regillo CD, Brown GC, Savino PJ. . Diabetic papillopathy. Patient characteristics and fundus findings. Arch Ophthalmol. 1995; 113:889–95.

3. Barr CC, Glaser JS, Blankenship G. Acute disc swelling in juvenile diabetes. Clinical profile and natural history of 12 cases. Arch Ophthalmol. 1980; 98:2185–92.

4. Pavan PR, Aiello LM, Wafai MZ. . Optic disc edema in juve-nile-onset diabetes. Arch Ophthalmol. 1980; 98:2193–5.

5. Ostri C, Lund-Andersen H, Sander B. . Bilateral diabetic pap-illopathy and metabolic control. Ophthalmology. 2010; 117:2214–7.

6. Mansour AM, El-Dairi MA, Shehab MA. . Periocular cortico-steroids in diabetic papillopathy. Eye (Lond). 2005; 19:45–51.

7. Al-Haddad CE, Jurdi FA, Bashshur ZF. Intravitreal triamcinolone acetonide for the management of diabetic papillopathy. Am J Ophthalmol. 2004; 137:1151–3.

8. Ornek K, Oğ urel T. Intravitreal bevacizumab for diabetic papillopathy. J Ocul Pharmacol Ther. 2010; 26:217–8.

9. Kupersmith MJ, Mandel G, Anderson S. . Baseline, one and three months changes in the peripapillary retinal nerve fiber layer in acute optic neuritis: relation to baseline vision and MRI. J Neurol Sci. 2011; 308((1-2)):117–23.

10. Pro MJ, Pons ME, Liebmann JM. . Imaging of the optic disc and retinal nerve fiber layer in acute optic neuritis. J Neurol Sci. 2006; 250((1-2)):114–9.

11. Sung KR, Kim DY, Park SB, Kook MS. Comparison of retinal nerve fiber layer thickness measured by Cirrus HD and Stratus op-tical coherence tomography. Ophthalmology. 2009; 116:1264–70.

Figure 1.

(Case 1) (A) The fundus examination showed hyperemic optic disc swelling with peripapillary flame-shap-ed hemorrhage and superficial, radially oriented, and dilated telangiectatic vessels in the right eye. Inferior focal swelling and peripapillary flame-shaped hemorrhage was shown in the left eye. (B) Fluorescein angiography showed late leakage from telangiectatic vessels on both discs, which was more in the right eye. (C) Goldmann perimetry showed nasal visual field defects in the right eye and normal findings in the left eye.

Figure 2.

(Case 1) (A) At 3 weeks after intravitreal bevacizumab (IVB) injection, the fundus examination showed marked improvement in optic disc swelling in the right eye and aggravated hyperemic optic disc swelling with peri-papillary flame-shaped hemorrhage in the left eye. (B) 3 weeks after IVB injection, late leakage of fluorescein de-creased markedly in the right eye and increased markedly in the left eye.

Figure 3.

(Case 2) (A) The fundus examination showed non-proliferative diabetic retinopathy findings in both eyes. Hyperemic optic disc swelling and superficial, radially oriented, and dilated telangiectatic vessels were noted in the right eye. (B) Fluorescein angiography showed late leakage from telangiectatic vessels on the disc in the right eye and multiple leakage involving the fovea in both eyes. (C) Goldmann perimetry showed enlarged blind spot in the right eye and normal findings in the left eye.

Table 1.

(Case 1) Longitudinal changes of the average retinal nerve fiber layer (RNFL) thickness after intravitreal bev-acizumab (IVB) injection

	RNFL thickness (right eye)	RNFL thickness (left eye)
Baseline	278 μ m	126 μ m
Period after IVB injection in the right eye
1 week	194 μ m	164 μ m
2 weeks	166 μ m	177 μ m
3 weeks*	135 μ m	207 μ m
4 weeks	121 μ m	169 μ m
5 weeks	120 μ m	160 μ m
6 weeks	109 μ m	147 μ m
3 months	99 μ m	128 μ m
6 months	87 μ m	117 μ m
12 months	87 μ m	109 μ m

RNFL = retinal nerve fiber layer; IVB = intravitreal bevacizumab.

^* At 3 weeks after IVB injection in the right eye, left eye had also IVB injection.

Table 2.

(Case 2) Longitudinal changes of the average retinal nerve fiber layer (RNFL) thickness after intravitreal bev-acizumab (IVB) injection in the right eye

	RNFL thickness (right eye)	RNFL thickness (left eye)
Baseline	252 μ m	124 μ m
1 week	187 μ m	121 μ m
2 weeks	156 μ m	122 μ m
3 weeks	136 μ m	116 μ m
6 months	83 μ m	108 μ m

RNFL = retinal nerve fiber layer; IVB = intravitreal bevacizumab.

TOOLS

Similar articles