Electroretinographic findings associated with panretinal photocoagulation (PRP) versus PRP plus intravitreal ranibizumab treatment for high-risk proliferative diabetic retinopathy

André Messias, José Afonso Ramos Filho, Katharina Messias, Felipe P.P. Almeida, Rogério A. Costa, Ingrid Scott, Florian Gekeler, Rodrigo Jorge

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

To evaluate changes in electroretinographic (ERG) findings after panretinal photocoagulation (PRP) compared to PRP plus intravitreal injection of ranibizumab (IVR) in eyes with high-risk proliferative diabetic retinopathy (PDR). Patients with high-risk PDR and no prior laser treatment were assigned randomly to receive PRP (PRP group; n = 9) or PRP plus IVR (PRPplus group; n = 11). PRP was administered in two sessions (weeks 0 and 2), and IVR was administered at the end of the first laser session (week 0) in the PRPplus group. Standardized ophthalmic evaluations including (ETDRS) best-corrected visual acuity (BCVA), and fluorescein angiography to measure area of fluorescein leakage (FLA), were performed at baseline and at weeks 16 (±2), 32 (±2) and 48 (±2). ERG was measured according to ISCEV standards at baseline and at week 48 (±2). At 48 weeks, 2,400 3,000 laser spots had been placed in eyes in the PRP group, while only 1,400 1,800 spots had been placed in the PRPplus group. Compared to baseline, there was a statistically significant (P <0.05) FLA reduction observed at all study visits in both groups, with the reduction observed in the PRPplus group significantly larger than that in the PRP group at week 48. ROD b-wave amplitude was significantly reduced to 46 ± 5 % (P <0.05) of baseline in the PRP group and 64 ± 6 %(P <0.05) in the PRPplus group. This reduction was significantly larger in the PRP group than in the PRPplus group (P = 0.024; t Test). Similar results were observed for the dark-adapted Combined Response (CR) b-wave amplitude, with a reduction at 48 weeks compared to baseline of 45 ± 4 % in the PRP group and 62 ± 5 % in the PRPplus group; the reduction in CR b-wave amplitude was significantly larger in the PRP group than in the PRPplus group (P = 0.0094). CR a-wave, oscillatory potentials, cone single flash, and 30 Hz flicker responses showed statistically significant within-group reductions, but no differences in between-group analyses. These results suggest that treating high-risk PDR with PRP plus IVR is effective for PDR control, and permits the use of less extensive PRP which, in turn, induces less retinal functional loss, in particular for rod-driven post-receptoral responses, than treatment with PRP alone.

Original languageEnglish (US)
Pages (from-to)225-236
Number of pages12
JournalDocumenta Ophthalmologica
Volume124
Issue number3
DOIs
StatePublished - Mar 28 2012

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Light Coagulation
Diabetic Retinopathy
Intravitreal Injections
Therapeutics
Lasers
Ranibizumab
Fluorescein
Fluorescein Angiography
Visual Acuity

All Science Journal Classification (ASJC) codes

  • Ophthalmology
  • Sensory Systems
  • Physiology (medical)

Cite this

Messias, André ; Filho, José Afonso Ramos ; Messias, Katharina ; Almeida, Felipe P.P. ; Costa, Rogério A. ; Scott, Ingrid ; Gekeler, Florian ; Jorge, Rodrigo. / Electroretinographic findings associated with panretinal photocoagulation (PRP) versus PRP plus intravitreal ranibizumab treatment for high-risk proliferative diabetic retinopathy. In: Documenta Ophthalmologica. 2012 ; Vol. 124, No. 3. pp. 225-236.
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abstract = "To evaluate changes in electroretinographic (ERG) findings after panretinal photocoagulation (PRP) compared to PRP plus intravitreal injection of ranibizumab (IVR) in eyes with high-risk proliferative diabetic retinopathy (PDR). Patients with high-risk PDR and no prior laser treatment were assigned randomly to receive PRP (PRP group; n = 9) or PRP plus IVR (PRPplus group; n = 11). PRP was administered in two sessions (weeks 0 and 2), and IVR was administered at the end of the first laser session (week 0) in the PRPplus group. Standardized ophthalmic evaluations including (ETDRS) best-corrected visual acuity (BCVA), and fluorescein angiography to measure area of fluorescein leakage (FLA), were performed at baseline and at weeks 16 (±2), 32 (±2) and 48 (±2). ERG was measured according to ISCEV standards at baseline and at week 48 (±2). At 48 weeks, 2,400 3,000 laser spots had been placed in eyes in the PRP group, while only 1,400 1,800 spots had been placed in the PRPplus group. Compared to baseline, there was a statistically significant (P <0.05) FLA reduction observed at all study visits in both groups, with the reduction observed in the PRPplus group significantly larger than that in the PRP group at week 48. ROD b-wave amplitude was significantly reduced to 46 ± 5 {\%} (P <0.05) of baseline in the PRP group and 64 ± 6 {\%}(P <0.05) in the PRPplus group. This reduction was significantly larger in the PRP group than in the PRPplus group (P = 0.024; t Test). Similar results were observed for the dark-adapted Combined Response (CR) b-wave amplitude, with a reduction at 48 weeks compared to baseline of 45 ± 4 {\%} in the PRP group and 62 ± 5 {\%} in the PRPplus group; the reduction in CR b-wave amplitude was significantly larger in the PRP group than in the PRPplus group (P = 0.0094). CR a-wave, oscillatory potentials, cone single flash, and 30 Hz flicker responses showed statistically significant within-group reductions, but no differences in between-group analyses. These results suggest that treating high-risk PDR with PRP plus IVR is effective for PDR control, and permits the use of less extensive PRP which, in turn, induces less retinal functional loss, in particular for rod-driven post-receptoral responses, than treatment with PRP alone.",
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Electroretinographic findings associated with panretinal photocoagulation (PRP) versus PRP plus intravitreal ranibizumab treatment for high-risk proliferative diabetic retinopathy. / Messias, André; Filho, José Afonso Ramos; Messias, Katharina; Almeida, Felipe P.P.; Costa, Rogério A.; Scott, Ingrid; Gekeler, Florian; Jorge, Rodrigo.

In: Documenta Ophthalmologica, Vol. 124, No. 3, 28.03.2012, p. 225-236.

Research output: Contribution to journalArticle

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T1 - Electroretinographic findings associated with panretinal photocoagulation (PRP) versus PRP plus intravitreal ranibizumab treatment for high-risk proliferative diabetic retinopathy

AU - Messias, André

AU - Filho, José Afonso Ramos

AU - Messias, Katharina

AU - Almeida, Felipe P.P.

AU - Costa, Rogério A.

AU - Scott, Ingrid

AU - Gekeler, Florian

AU - Jorge, Rodrigo

PY - 2012/3/28

Y1 - 2012/3/28

N2 - To evaluate changes in electroretinographic (ERG) findings after panretinal photocoagulation (PRP) compared to PRP plus intravitreal injection of ranibizumab (IVR) in eyes with high-risk proliferative diabetic retinopathy (PDR). Patients with high-risk PDR and no prior laser treatment were assigned randomly to receive PRP (PRP group; n = 9) or PRP plus IVR (PRPplus group; n = 11). PRP was administered in two sessions (weeks 0 and 2), and IVR was administered at the end of the first laser session (week 0) in the PRPplus group. Standardized ophthalmic evaluations including (ETDRS) best-corrected visual acuity (BCVA), and fluorescein angiography to measure area of fluorescein leakage (FLA), were performed at baseline and at weeks 16 (±2), 32 (±2) and 48 (±2). ERG was measured according to ISCEV standards at baseline and at week 48 (±2). At 48 weeks, 2,400 3,000 laser spots had been placed in eyes in the PRP group, while only 1,400 1,800 spots had been placed in the PRPplus group. Compared to baseline, there was a statistically significant (P <0.05) FLA reduction observed at all study visits in both groups, with the reduction observed in the PRPplus group significantly larger than that in the PRP group at week 48. ROD b-wave amplitude was significantly reduced to 46 ± 5 % (P <0.05) of baseline in the PRP group and 64 ± 6 %(P <0.05) in the PRPplus group. This reduction was significantly larger in the PRP group than in the PRPplus group (P = 0.024; t Test). Similar results were observed for the dark-adapted Combined Response (CR) b-wave amplitude, with a reduction at 48 weeks compared to baseline of 45 ± 4 % in the PRP group and 62 ± 5 % in the PRPplus group; the reduction in CR b-wave amplitude was significantly larger in the PRP group than in the PRPplus group (P = 0.0094). CR a-wave, oscillatory potentials, cone single flash, and 30 Hz flicker responses showed statistically significant within-group reductions, but no differences in between-group analyses. These results suggest that treating high-risk PDR with PRP plus IVR is effective for PDR control, and permits the use of less extensive PRP which, in turn, induces less retinal functional loss, in particular for rod-driven post-receptoral responses, than treatment with PRP alone.

AB - To evaluate changes in electroretinographic (ERG) findings after panretinal photocoagulation (PRP) compared to PRP plus intravitreal injection of ranibizumab (IVR) in eyes with high-risk proliferative diabetic retinopathy (PDR). Patients with high-risk PDR and no prior laser treatment were assigned randomly to receive PRP (PRP group; n = 9) or PRP plus IVR (PRPplus group; n = 11). PRP was administered in two sessions (weeks 0 and 2), and IVR was administered at the end of the first laser session (week 0) in the PRPplus group. Standardized ophthalmic evaluations including (ETDRS) best-corrected visual acuity (BCVA), and fluorescein angiography to measure area of fluorescein leakage (FLA), were performed at baseline and at weeks 16 (±2), 32 (±2) and 48 (±2). ERG was measured according to ISCEV standards at baseline and at week 48 (±2). At 48 weeks, 2,400 3,000 laser spots had been placed in eyes in the PRP group, while only 1,400 1,800 spots had been placed in the PRPplus group. Compared to baseline, there was a statistically significant (P <0.05) FLA reduction observed at all study visits in both groups, with the reduction observed in the PRPplus group significantly larger than that in the PRP group at week 48. ROD b-wave amplitude was significantly reduced to 46 ± 5 % (P <0.05) of baseline in the PRP group and 64 ± 6 %(P <0.05) in the PRPplus group. This reduction was significantly larger in the PRP group than in the PRPplus group (P = 0.024; t Test). Similar results were observed for the dark-adapted Combined Response (CR) b-wave amplitude, with a reduction at 48 weeks compared to baseline of 45 ± 4 % in the PRP group and 62 ± 5 % in the PRPplus group; the reduction in CR b-wave amplitude was significantly larger in the PRP group than in the PRPplus group (P = 0.0094). CR a-wave, oscillatory potentials, cone single flash, and 30 Hz flicker responses showed statistically significant within-group reductions, but no differences in between-group analyses. These results suggest that treating high-risk PDR with PRP plus IVR is effective for PDR control, and permits the use of less extensive PRP which, in turn, induces less retinal functional loss, in particular for rod-driven post-receptoral responses, than treatment with PRP alone.

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