Department of ophthalmology, SSG eye clinic, South Korea

Hyun Seung Yang

Peripapillary RNFL and Retinal Edema change

after PRP or Anti-VEGF in Diabetic Retinopathy

Objective: To investigates the change for peripapillary retinal never fiber

layer (RNFL) and retinal edema in diabetic retinopathy (DR) patients after

panretinal photocoagulation (PRP) and intravitreal anti-VEGF injection and

its correction using the relationship between the peripapillary RNFL and

corresponding retinal edema after treatments.

Methods: A complete ophthalmic examination, including peripapillary

RNFL, retina and choroidal thickness using spectral-domain optical

coherence tomography was performed at baseline and at 6 and 12 months.

For each scan, we determined peripapillary quadrant RNFL thickness and

evaluated the relationship with peripapillary retinal and choroidal

thickness. Using the relationship, RNFL thickness was corrected (A new

RNFL index; peripapillary RNFL thickness divided by corresponding

peripapillary retinal thickness).

OphthalmologyAMC results

Consecutive observational case series

(AMCI 2012-0627)

RNFL change related with DMR treatment for 1year

Inclusion

• Treatment naïve severe NPDR

• Stable DM control (HbA1c < 8.0%)

Exclusion

• Vitrectomy hx., High myopia

• RD, glaucoma hx. or IIOP hx , macular disease (AMD, ERM)

• Severe medical disease hx.

OphthalmologyTotal 324 eyes

Control group (165 eyes)

Excluded (75eyes)

▪ Vitrectomy (3ME, 8VH)

▪ NTG (1), OAG (4), NVG (4), IIOP (4),

Poor OCT (5) f/u loss (29), other

treatments (11 PRP, 6ava)

Final control group (90 eyes)

▪ Group C: 90 eyes

• 90 eyes at 6 months

• 59 eyes at 1 year

Subject groups (159 eyes)

Excluded (37eyes)

▪ Vitrectomy (1ME, 2VH)

▪ NTG (3), OAG (5), NVG (1), IIOP (4),

Poor OCT (2) f/u loss (14), other

treatments (6 PRP or FRP in group

II)

Final subject groups (122 eyes)

▪ Group A: 72 eyes

• 72 eyes at 6 months

• 65 eyes at 1 year

▪ Group B: 50 eyes

• 50 eyes at 6 months

• 47 eyes at 1 year

OphthalmologyCharacteristics

OphthalmologyRNFL Thickness chage

2. VF change

1. RNFL change

• The RNFL changes were variable depending on the groups

• The RNFL thinning looked no relationship with VF defect Not a real RNFL loss

PRP (group I) IV injection (group II) Control (group III)

Ophthalmology

RNFL thickness change

Retinal thickness change

Similar profile changes were observed when comparing the

blue area (above) with corresponding the red area (below).

OphthalmologyCorrelation coefficient

• RNFL thickness has strong correlation with peripapillary retinal

thickness but not with peripapillary choroidal thickness

OphthalmologyThickness adjustment

New index (peripapillary RNFL divided by retinal thickness) for better

analysis of real RNFL change

Because they are closely related each other.

RNFL thickness Retinal thickness

OphthalmologyCorrection of RNFL thickness with

peripapillary retinal thickness

Index value: RNFL thickness/retinal thickness

VF change

• The RNFL index looked significant relationship with VF defect

PRP (group I) IV injection (group II) Control (group III)

OphthalmologyConclusions

RNFL thickness has strong correlation with peripapillary

retinal thickness but not with peripapillary choroidal

thickness

Because, peripapillary RNFL thickness looks strongly

affected by the peripapillary retina edema fluctuation after

treatments so that the thickness itself does not mean the

real RNFL gain or loss.

Thus, correction of edema component using the index is

necessary for better analysis of RNFL thickness in DR

patients with peripapillary retinal edema before and after

treatments.