Retinal Vascular Caliber Changes in Diabetic Retinopathy after Panretinal Photocoagulation and Additive Bevacizumab Injections

Ji Hyoung Chey; Jung Min Park

doi:10.3341/jkos.2016.57.6.917

Journal List > J Korean Ophthalmol Soc > v.57(6) > 1010608

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Chey and Park: Retinal Vascular Caliber Changes in Diabetic Retinopathy after Panretinal Photocoagulation and Additive Bevacizumab Injections

Original Article

J Korean Ophthalmol Soc 2016;57(6):917-923.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.6.917

Retinal Vascular Caliber Changes in Diabetic Retinopathy after Panretinal Photocoagulation and Additive Bevacizumab Injections

Ji Hyoung Chey, MD, Jung Min Park, MD, PhD

Department of Ophthalmology, Maryknoll Medical Center, Busan, Korea

Address reprint requests to Jung Min Park, MD, PhD Department of Ophthalmology, Maryknoll Medical Center, #121 Junggu-ro, Jung-gu, Busan 48972, Korea Tel: 82-51-461-2540, Fax: 82-51-466-5198 E-mail: pjm1438@hanmail.net

Received 18 February 2016 Revised 8 April 2016 Accepted 18 May 2016

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 panretinal photocoagulation and additive intravitreal bevacizumab injections on central retinal vessel diameters and characteristic retinal vascular caliber changes in diabetic retinopathy.

Methods

Changes in central retinal vessel diameters were retrospectively analyzed before and 6 months after panretinal photo-coagulation with or without additive intravitreal bevacizumab injections in 64 eyes first diagnosed with diabetic retinopathy. Vessel diameters and arteriovenous ratio (AVR) were measured using Interactive Vessel Analysis (IVAN) software and the Big six formula.

Results

There were significant decreases in central retinal artery equivalent (CRAE) and central retinal vein equivalent (CRVE) in both groups, with and without additive intravitreal bevacizumab injections, 6 months after completion of panretinal photo-coagulation (p < 0.001, p = 0.008), but no significant change in AVR (p = 0.338). Additive intravitreal bevacizumab injections did not produce significant changes in central retinal vessel diameters after 6 months compared to vessel diameters treated with panretinal photocoagulation only. Retinal vascular caliber of progressed diabetic retinopathy showed smaller CRAE, larger CRVE, and smaller AVR compared to those of normal or diabetic Korean subjects in a previous study and showed no significant association with age.

Conclusions

CRAE and CRVE decreased significantly 6 months after panretinal photocoagulation in diabetic retinopathy, but additive intravitreal bevacizumab injections did not cause significant additive changes to central retinal vascular calibers in this study. We established the standard retinal vascular caliber of Korean subjects in diabetic retinopathy and analyzed the effects of retinopathy on retinal vessel caliber.

Keywords: Bevacizumab, Diabetic retinopathy, Panretinal photocoagulation, Retinal vascular caliber

References

1. Lundberg K, Kawasaki R, Siølie AK, et al. Localized changes in retinal vessel caliber after focal/grid laser treatment in patients with diabetic macular edema: a measure of treatment response? Retina. 2013; 33:2089–95.

2. Falck A, Laatikainen L. Retinal vasodilation and hyperglycaemia in diabetic children and adolescents. Acta Ophthalmol Scand. 1995; 73:119–24.

3. Nguyen TT, Wang JJ, Sharrett AR, et al. Relationship of retinal vascular caliber with diabetes and retinopathy: the Multi-Ethnic Study of Atherosclerosis (MESA). Diabetes Care. 2008; 31:544–9.

4. Kang JY, Lee SU, Nam KY, et al. The effect of bevacizumab on abdominal vessel diameter, intraocular pressure, retinal nerve fiber layer and the optic disc. J Korean Ophthalmol Soc. 2014; 55:216–21.

5. Islam FM, Nguyen TT, Wang JJ, et al. Quantitative retinal vascular calibre changes in diabetes and retinopathy: the Singapore Malay eye study. Eye (Lond). 2009; 23:1719–24.

6. Im JC, Shin JP, Kim IT, et al. Analysis of factors associated with retinal vascular caliber in normal Korean subjects. J Korean Ophthalmol Soc. 2014; 55:548–54.

7. Myers CE, Klein R, Knudtson MD, et al. Determinants of retinal venular diameter: the Beaver Dam Eye Study. Ophthalmology. 2012; 119:2563–71.

8. Chang M, Yoo C, Kim SW, Kim YY. Retinal vessel diameter, abdominall nerve fiber layer thickness, and intraocular pressure in Korean patients with normal-tension glaucoma. Am J Ophthalmol. 2011; 151:100–5.e1.

9. Klein R, Klein BE, Moss SE, et al. The relation of retinal vessel caliber to the incidence and progression of diabetic retinopathy: XIX: the Wisconsin Epidemiologic Study of Diabetic Retinopathy. Arch Ophthalmol. 2004; 122:76–83.

10. Klein R, Myers CE, Lee KE, et al. Changes in retinal vessel abdominal and incidence and progression of diabetic retinopathy. Arch Ophthalmol. 2012; 130:749–55.

11. Sharrett AR, Hubbard LD, Cooper LS, et al. Retinal arteriolar abdominals and elevated blood pressure: the Atherosclerosis Risk in Communities Study. Am J Epidemiol. 1999; 150:263–70.

12. Ikram MK, Witteman JC, Vingerling JR, et al. Retinal vessel abdominal and risk of hypertension: the Rotterdam Study. Hypertension. 2006; 47:189–94.

13. Grunwald JE, Riva CE, Brucker AJ, et al. Effect of panretinal abdominal on retinal blood flow in proliferative diabetic retinopathy. Ophthalmology. 1986; 93:590–5.

14. Grauslund J, Hodgson L, Kawasaki R, et al. Retinal vessel calibre and micro- and macrovascular complications in type 1 diabetes. Diabetologia. 2009; 52:2213–7.

15. Wilson CA, Stefánsson E, Klombers L, et al. Optic disk abdominal and retinal vessel diameter in diabetic retinopathy. Am J Ophthalmol. 1988; 106:131–4.

16. Stefánsson E. Ocular oxygenation and the treatment of diabetic retinopathy. Surv Ophthalmol. 2006; 51:364–80.

17. Tatlipinar S, Dinç UA, Yenerel NM, Görgün E. abdominal effects of a single intravitreal bevacizumab injection on retinal vessel calibre. Clin Exp Optom. 2012; 95:94–8.

18. Harris A, Ciulla TA, Chung HS, Martin B. Regulation of retinal and optic nerve blood flow. Arch Ophthalmol. 1998; 116:1491–5.

19. Tilton RG, Chang KC, LeJeune WS, et al. Role for nitric oxide in the hyperpermeability and hemodynamic changes induced by abdominal VEGF. Invest Ophthalmol Vis Sci. 1999; 40:689–96.

20. Vinten M, Larsen M, Lund-Andersen H, et al. abdominal effects of intravitreal triamcinolone on retinal vascular leakage and trunk vessel diameters in diabetic macular oedema. Acta Ophthalmol Scand. 2007; 85:21–6.

21. Kelkar A, Shah R, Kelkar J, et al. Changes in the retinal vascular network morphology (diameter and tortuosity) after administration of intravitreal bevacizumab in a patient with ischaemic branch abdominall vein occlusion. Case Rep Ophthalmol. 2014; 5:411–5.

22. Terai N, Haustein M, Siegel A, et al. Diameter of retinal vessels in patients with diabetic macular edema is not altered by intravitreal ranibizumab (lucentis). Retina. 2014; 34:1466–72.

23. Soliman W, Vinten M, Sander B, et al. Optical coherence abdominal and vessel diameter changes after intravitreal bevacizumab in diabetic macular oedema. Acta Ophthalmol. 2008; 86:365–71.

24. Bakri SJ, Snyder MR, Reid JM, et al. Pharmacokinetics of abdominal bevacizumab (Avastin). Ophthalmology. 2007; 114:855–9.

25. Ho AC, Scott IU, Kim SJ, et al. Anti-vascular endothelial growth factor pharmacotherapy for diabetic macular edema: a report by the American Academy of Ophthalmology. Ophthalmology. 2012; 119:2179–88.

26. Jeganathan VS, Sabanayagam C, Tai ES, et al. Retinal vascular abdominal and diabetes in a multiethnic Asian population. Microcirculation. 2009; 16:534–43.

27. Ikram MK, Janssen JA, Roos AM, et al. Retinal vessel diameters and risk of impaired fasting glucose or diabetes: the Rotterdam study. Diabetes. 2006; 55:506–10.

28. Kim YJ, Kim HE, Song WK, Kim SS. Retinal vascular caliber changes on OCT after intravitreal bevacizumab injection in abdominal macular edema. J Korean Ophthalmol Soc. 2012; 53:262–7.

29. Rand LI, Prud'homme GJ, Ederer F, Canner PL. Factors abdominal the development of visual loss in advanced diabetic retinopathy. Diabetic Retinopathy Study (DRS) Report No. 10. Invest Ophthalmol Vis Sci. 1985; 26:983–91.

30. Chang MW, Kim YY. Comparison of the central retinal vessel abdominal between glaucomatous and normal eye. J Korean Ophthalmol Soc. 2009; 50:738–42.

31. Hwang CJ, Lee SH. Intraocular pressure dependent retinal vascular caliber change in glaucoma patients. J Korean Ophthalmol Soc. 1994; 35:326–31.

32. Liew G, Sharrett AR, Wang JJ, et al. Relative importance of abdominalic determinants of retinal arteriolar and venular caliber: the atherosclerosis risk in communities study. Arch Ophthalmol. 2008; 126:1404–10.

33. Klein R, Klein BE, Knudtson MD, et al. Are inflammatory factors related to retinal vessel caliber? The Beaver Dam Eye Study. Arch Ophthalmol. 2006; 124:87–94.

34. Jin KH, Shin JH, Kang JH. Analysis of retinal vascular calibers with cardiovascular risk factors. J Korean Ophthalmol Soc. 2015; 56:925–30.

Table 1.

Baseline characteristics of participants

Characteristics	All	Group 1	Group 2
Number of patients (eyes)	42 (64)	21 (34)	21 (30)
Male:female (n)	28:14	12:9	16:5
Age (years)	59.9 ± 11.1 (37–74)	59.5 ± 11.3 (37–74)	60.4 ± 11.1 (37–74)

Values are presented as mean ± SD unless otherwise indicated. ‘Group 1’ is ‘panretinal photocoagulation only’ and ‘Group 2’ is ‘panretinal photocoagulation + intravitreal bevacizumab injection’.

Table 2.

Mean changes of central retinal vascular caliber after panretinal photocoagulation in diabetic retinopathy

	CRAE (μ m)		CRVE (μ m)		AVR
	Before	6 months	Before	6 months	Before	6 months
All	137.82 ± 5.10	128.12 ± 5.58	212.66 ± 15.30	205.31 ± 15.88	0.62 ± 0.07	0.60 ± 0.06
p-value^*	<0.001		0.008		0.338
Group 1	138.80 ± 4.57	129.30 ± 6.24	213.79 ± 18.04	207.96 ± 17.89	0.62 ± 0.06	0.60 ± 0.06
p-value^*	<0.001		0.004		0.303
Group2	136.28 ± 5.85	127.39 ± 5.26	211.29 ± 11.66	202.32 ± 13.19	0.62 ± 0.08	0.60 ± 0.06
p-value^*	0.001		0.013		0.217
Control^†	148.30 ± 2.61	–	205.20 ± 3.52	–	0.72 ± 0.04	–
p-value^‡	0.069		0.256		0.837

CRAE = central retinal artery equivalent; CRVE = central retinal vein equivalent; AVR = arteriovenous ratio.

^* Comparison between before and after by Wilcoxon signed rank test

^† Retinal vascular calibers of diabetic mellitus diagnosed Korean patients.

Data obtained from previous study²¹

^‡ Comparison between group 1 and group 2 by Mann-Whitney U-test.

Table 3.

Comparison of central retinal vascular caliber with age group and sex in patients diagnosed with diabetic retinopathy

	Age (years)	CRAE (μ m)	CRVE (μ m)	AVR
All	40–49	138.28 ± 3.17	218.59 ± 25.95	0.64 ± 0.09
	50–59	136.15 ± 2.08	203.52 ± 7.74	0.62 ± 0.06
	60–69	143.37 ± 2.78	217.02 ± 9.66	0.60 ± 0.05
	70–79	130.61 ± 3.76	204.5 ± 15.88	0.60 ± 0.08
	Total	137.82 ± 5.10	212.66 ± 15.30	0.62 ± 0.07
	p-value^*	0.782	0.468	0.200
Control^†	40–49	149.50 ± 7.36	210.34 ± 10.32	0.71 ± 0.03
	50–59	148.61 ± 7.56	207.53 ± 12.01	0.72 ± 0.04
	60–69	146.28 ± 9.01	204.60 ± 8.86	0.72 ± 0.04
	70–79	142.18 ± 7.28	199.59 ± 8.86	0.71 ± 0.02
	Total	149.70 ± 9.01	209.33 ± 12.19	0.72 ± 0.04
	p-value^*	<0.001	<0.001	0.657
Male	Total	136.48 ± 4.60	215.50 ± 19.56	0.61 ± 0.07
Control^†	Total	151.05 ± 8.44	212.19 ± 10.14	0.71 ± 0.04
Female	Total	139.16 ± 5.47	210.32 ± 10.74	0.62 ± 0.07
Control^†	Total	148.07 ± 9.45	205.88 ± 13.55	0.72 ± 0.04

Values are presented as mean ± SD unless otherwise indicated.

CRAE = central retinal artery equivalent; CRVE = central retinal vein equivalent; AVR = arteriovenous ratio.

^* Comparison among age groups by Jonckheere-Terpstra test

^† Retinal vascular calibers of different age groups of Koreans. Data obtained from previous study.²¹

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