Effects of Diabetic Retinopathy and Intravitreal Bevacizumab Injection on Choroidal Thickness in Diabetic Patients

Byeong Park; Hye Won Chung; Hyung Chan Kim

doi:10.3341/jkos.2013.54.10.1520

Journal List > J Korean Ophthalmol Soc > v.54(10) > 1009501

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Park, Chung, and Kim: Effects of Diabetic Retinopathy and Intravitreal Bevacizumab Injection on Choroidal Thickness in Diabetic Patients

Original Article

J Korean Ophthalmol Soc 2013;54(10):1520-1525.

Published online: 3 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.10.1520

Effects of Diabetic Retinopathy and Intravitreal Bevacizumab Injection on Choroidal Thickness in Diabetic Patients

Byeong Park, MD, Hye Won Chung, MD, PhD, Hyung Chan Kim, MD, PhD

Department of Ophthalmology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea

Address reprint requests to Hyung Chan Kim, MD, PhD, Department of Ophthalmology, Konkuk University Medical Center, #120-1 Neungdong-ro, Gwangjin-gu, Seoul 143-729, Korea, Tel: 82-2-2030-8180, Fax: 82-2-2030-5273, E-mail: eyekim@kuh.ac.kr

Received 18 March 2013 Revised 9 May 2013 Accepted 24 August 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 evaluate the effect of diabetic retinopathy on choroidal thickness and the changes of choroidal thickness after intravitreal bevacizumab injection (IVB) in diabetic patients.

Methods

The present study included 105 patients (105 eyes). Patients were classified into 6 groups: control group (A); no change (B), mild (C), moderate (D), and severe (E) non proliferative diabetic retinopathy (NPDR); and proliferative diabetic retinopathy (PDR) (F), with 15 diabetic patients in each group. All patients underwent enhanced depth imaging spectral- domain optical coherence tomography (EDI OCT) to evaluate choroidal thickness. An additional 15 patients (15 eyes) with diabetic retinopathy treated with IVB were also included. These patients underwent EDI OCT before and 1 month after IVB.

Results

Mean choroidal thickness was significantly thinner in the moderate and severe NPDR, and PDR groups compared with the control group. Moreover, when comparing sequential stages of diabetic retinopathy progression, the choroidal thickness in the moderate NPDR stage and PDR stage was found to be significantly thinner than in the mild and severe NPDR, respectively. Additionally, choroidal thickness was 187.3 μm before IVB and significantly decreased to 168.9 μm 1 month after IVB (p < 0.05).

Conclusions

Choroidal thickness is related to the severity of diabetic retinopathy and is significantly decreased after IVB. J Korean Ophthalmol Soc 2013;54(10):1520-1525

Keywords: Bevacizumab, Choroidal Thickness, Diabetic Retinopathy, Enhanced Depth Imaging Optical Coherence Tomography

References

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Figure 1.

The choroid is seen in cross-section using EDI- OCT. Subfoveal choroidal thickness was measured vertically from the outer border of the retinal pigment epithelium to the inner border of the sclera.

Figure 2.

Mean subfoveal choroidal thickness according to severity of diabetic retinopathy.

Figure 3.

Representative case of a 51-year-old man with diabetic macular edema was treated with IVB. (A) The VA was 20/30, and the subfoveal choroidal thickness was 176 μm, at initial visit. (B) At one month after first IVB, the VA was improved to 20/25. The subfoveal choroidal thickness was 164 μm.

Table 1.

Characteristics of control subjects and diabetic patients

	Control	No change	Mild NPDR	Moderate NPDR	Severe NPDR	PDR
Age (years)	50.6 ± 16.9	62.2 ± 14.1	61.0 ± 11.4	61.2 ± 13.0	57.9 ± 10.1	60.0 ± 9.5
Sex (M/F)	7/8	8/7	6/9	7/8	10/5	8/7
Spherical equivalent (D)	−0.32 ± 1.06	0.98 ± 2.80	−0.22 ± 2.07	0.40 ± 1.55	−0.15 ± 1.39	0.43 ± 1.39
Choroidal thickness (μm)	277.9 ± 22.4	279.3 ± 36.7	257.6 ± 25.9	229.6 ± 37.6	224.1 ± 30.8	192.6 ± 47.2

Values are presented as mean ± SD.

NPDR = non proliferative diabetic retinopathy; PDR = proliferative diabetic retinopathy.

Table 2.

Comparison of choroidal thickness among stages of diabetic retinopathy progression (p-value)

	No change	Mild NPDR	Moderate NPDR	Severe NPDR	PDR
Control	0.512	0.056	0.002^*	<0.001^*	<0.001^*
No change	−	0.233	−	−	−
Mild	−	−	0.045^*	−	−
Moderate	−	−	−	0.902	−
Severe	−	−	−	−	0.026^*

Dashes (-) indicate that the comparisons were not performed.

NPDR = non proliferative diabetic retinopathy; PDR = proliferative diabetic retinopathy.

^* p < 0.05.

Table 3.

Baseline characteristics of diabetic patient with intra- vitreal bevacizumab injection

Patients no. (M/F)		15 (9/6)
Age (years)		58.3 ± 8.6
Spherical equivalent (D)		0.27 ± 1.36
Injection no.		1.8 ± 0.8
BCVA (Snellen)	Pre-IVB	0.6 ± 0.3
BCVA (Snellen)	1 month after IVB	0.7 ± 0.3
Choroidal thickness (μm)	Pre-IVB	187.3 ± 47.2 μm
Choroidal thickness (μm)	1 month after IVB	168.9 ± 41.3 μm

Values are presented as mean ± SD.

NPDR = non proliferative diabetic retinopathy; PDR = proliferative diabetic retinopathy; BCVA = best corrected visual acuity; IVB = intravitreal Bevacizumab injection.

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