ARVO 2012 Annual Meeting Abstracts by Scientific Section/Group

301 Pages·2012·10.71 MB·English

by  Michele Appley

ARVO 2012 Annual Meeting Abstracts by Scientific Section/Group – Retina+ (RE)

111 Diabetic Retinopathy-Clinical Research I Purpose: To compare the effect of an intravitreal injection of bevacizumab alone
Sunday, May 6, 2012, 8:30 AM - 10:15 AM (IVB) or combined with triamcinolone (IVB/IVT) versus triamcinolone (IVT) in
Hall B/C Poster Session patients with diabetic macular edema (DME).
Program #/Board # Range: 344-377/D895-D928 Methods: In this randomized three-arm clinical trial, eligible eyes were assigned
Organizing Section: Retina+ randomly to one of the three study arms; the IVB group, two injections of 1.25 mg
Contributing Section(s): Visual Neurophysiology of bevacizumab with 6-week intervals; the IVB/IVT group, 1.25 mg of intravitreal
bevacizumab with 2 mg of intravitreal triamcinolone; and the IVT group, 2 mg of
intravitreal triamcinolone. The clinical course of best-corrected visual acuity and
Program Number: 344 Poster Board Number: D895
central macular thickness by optical coherence tomography was monitored for up
Presentation Time: 8:30 AM - 10:15 AM
to12 months after initial injection.
Intraocular Pressure in Diabetic Patients
Nahoko Ogata1, Kayako Matsuyama2, Masato Matsuoka2, Tadanobu Yoshikawa2, Results: One hundred eleven eyes of 105 patients with DME completed 12 months
Kanji Takahashi3. 1Ophthalmology, Nara Medical University, Kashikhara, Japan; of follow-up. The IVB/IVT group and the IVT group showed better visual acuity
2Ophthalmology, Kansai Medical University, Moriguchi, Japan; 3Ophthalmology, and reduced central macular thickness at 6 weeks and 3 months, compared with the
IVB group (P=0.041, P=0.02 at 6 weeks; P=0.045, P=0.043 at 3 months,
Kansai Medical University, Hirakata, Japan.
respectively). However, no significant difference in visual acuity and central
Purpose: Several cross sectional studies have found a positive and significant
macular thickness was observed between the three groups at 12 months (P=0.088,
correlation between diabetes and primary open-angle glaucoma (OAG). However,
P=0.132, respectively). The frequency of retreatment was lower in the IVB/IVT
there have been other studies that failed to confirm this significant association.
and IVT groups during the12-month period (P < 0.001). No significant differences
Thus, the relationship between DM and OAG has not been clearly established. The
in visual acuity or central macular thickness were observed between the IVB/IVT
purpose of this study is to determine whether the intraocular pressure (IOP) in
and IVT groups during follow-up.
diabetic patients is significantly different from that of non-diabetic patients.
Conclusions: IVB/IVT and IVT showed more pronounced effects during the
Methods: Seven hundred and sixteen patients who were >20 years and did not
earlier post-injection period. However, levels of visual acuity or central macular
have any type of glaucoma were studied. The medical records of the first visiting of
thickness at 12 months were comparable in the three study groups. No beneficial
all patients were initially examined. At the initial examination, each patient had a
effect of the combination injection was observed.
detailed interview and comprehensive ophthalmic examinations. The data were
Commercial Relationships: Minchul Shin, None; Hyokyoung Lee, None; Jiwon
analyzed statistically using the Mann-Whitney test, one way analysis of variance
Lim, None
(ANOVA) with Dunnet’s correction, and Pearson's product moment correlation
Support: None
coefficient (r).
Clinical Trial: http://www.clinicaltrials.gov, NCT01342159
Results: The mean IOP of the diabetic patients was 15.9 ± 0.4 mmHg (mean ±
SEM, n=219) which was significantly higher than the 14.0 ± 0.1 mmHg (n = 497)
in the non-diabetic patients (P < 0.0001). The IOP was negatively correlated with Program Number: 347 Poster Board Number: D898
the age (r = -0.213; P = 0.016) in the diabetic patients and it was weakly but Presentation Time: 8:30 AM - 10:15 AM
significantly correlated with the level of HbA1c (r = 0.240; P = 0.015) in the A Prospective Randomized Trial Of Intravitreal Bevacizumab Versus
diabetic retinopathy group. Ranibizumab For The Management Of Refractory Diabetic Macular Edema
Conclusions: he significantly higher IOP in diabetic patients and the positive Rodrigo Jorge1, Antonio B. Nepomuceno1, Erika Takaki1, Jefferson A. RIbeiro1,
correlation of the IOP with the level of HbA1c in patients with diabetic retinopathy Renato Peroni2, Ingrid U. Scott3, Jose A. Cardillo2, Andre Messias1.
indicate that the IOP in diabetic patients should be carefully monitored especially 1Ophthalmology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao
those with poor control of the level of the HbA1c. Preto, Brazil; 2Ophthalmology, Hospital de Olhos de Araraquara, Araraquara,
Commercial Relationships: Nahoko Ogata, None; Kayako Matsuyama, Brazil; 3Ophthalmology & Public Health Sciences, Penn State College of Medicine,
None; Masato Matsuoka, None; Tadanobu Yoshikawa, None; Kanji Takahashi, Hershey, PA.
None Purpose: To compare anatomic and visual acuity outcomes associated with
Support: None intravitreal bevacizumab (IVB) versus ranibizumab (IVR) for the management of
refractory diabetic macular edema (DME).
Methods: Forty-seven patients (63 eyes) with refractory center-involving DME
Program Number: 345 Poster Board Number: D896
were randomly assigned to receive either 1.5 mg/0.06 cc IVB or 0.5 mg/0.05 cc
Presentation Time: 8:30 AM - 10:15 AM
IVR. Intravitreal injections were performed at baseline and monthly if central
Retinal Vascular Caliber Changes on OCT after Intravitreal Bevacizumab
subfield thickness (CSFT) measured by spectral domain optical coherence
Injection in Diabetic Macular Edema
tomography (SDOCT) > 275 um. Comprehensive ophthalmological examination
Sung Soo Kim, Hyeong Eun Kim. Ophthalmology, Yonsei Univ Gangnam Sev
was performed monthly, including SDOCT and Early Treatment Diabetic
Hosp, Seoul, Republic of Korea.
Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA) measurement.
Purpose: To investigate retinal vascular caliber changes with Spectral Domain
Results: To date, 73% and 56% of the patients completed 24 and 48 weeks of
OCT after intravitreal Bevacizumab injection in diabetic macular edema patients
follow-up, respectively. A statistically significant reduction in mean CSFT was
Methods: 34 eyes of 29 diabetic macular edema patients who were injected
observed for the IVB and IVR groups at all study visits compared to baseline
Bevacizumab(1.25g/0.05ml) intravitreously were studied. 24 fellow eyes of 24
(p<0.05). Mean ± SE CSFT (µm) was 451.7 ± 22.3 and 322.1 ± 17.6, (56% < 275
patients with Bevacizumab injection were also recruited as a control group. We
µm) for IVB, and 421.9 ± 23.1 and 284.9 ± 16.5, (76% < 275 µm) for IVR, at
measured retinal vascular caliber at 0.5~1 disc size apart from disc margin with
baseline and week 48, respectively. There was no significant difference in CSFT
Spectral Domain OCT at the baseline, 1 month and 3 months follow-up visits.
reduction between the IVB and IVR groups at any study visit. A significant
Central macular thicknesses were also measured.
improvement in mean BCVA was observed within each of the two study groups at
Results: Over the 3 months of studies, there was a significant reduction of
all study visits compared to baseline (p<0.05); mean ± SE BCVA (logMAR) was
arteriolar caliber at 3 months compared to baseline (p=0.024), There were
0.60 ± 0.05 and 0.39 ± 0.07 for IVB, and 0.63 ± 0.05 and 0.42 ± 0.06 for IVR, at
significant reduction of venular caliber at 1 month(p=0.001) and 3
baseline and week 48, respectively. There was no significant difference in BCVA
months(p=0.000) compared to baseline. Venymliular caliber reduction at 3 months
improvement between the IVB and IVR groups at any study visit. No significant
follow-up was significantly correlated with central macular thickness(R=0.487,
change in intraocular pressure change was observed in either group during follow-
p=0.003).
up. One patient developed endophthalmitis after his first ranibizumab injection.
Conclusions: Retinal venular caliber reduction was significant at 1 and 3 months
Conclusions: These data indicate that IVB and IVR are associated with similar
follow-up and arteriolar caliber reduction was significant at 3 months follow-up
effects on CSFT and BCVA at 1 year in patients with refractory DME.
compared to baseline. After 3 months of treatment, venular caliber reduction was
Commercial Relationships: Rodrigo Jorge, None; Antonio B. Nepomuceno,
correlated with reduction of central macular thickness.
None; Erika Takaki, None; Jefferson A. RIbeiro, None; Renato Peroni,
Commercial Relationships: Sung Soo Kim, None; Hyeong Eun Kim, None
None; Ingrid U. Scott, None; Jose A. Cardillo, None; Andre Messias, None
Support: None
Support: FAPESP 2010/16980-6
Clinical Trial: Comitê de Ética em Pesquisa - Hospital das Clínicas da Faculdade
Program Number: 346 Poster Board Number: D897 de Medicina de Ribeirão Preto
Presentation Time: 8:30 AM - 10:15 AM http://www.hcrp.fmrp.usp.br/sitehc/informacao.aspx?id=64&ref=4&refV=27,
Comparison Of Intravitreal Bevacizumab Alone Or Combined With 13368/2010
Triamcinolone Versus Triamcinolone In Diabetic Macular Edema: A
Randomized Clinical Trial

Minchul Shin, Hyokyoung Lee, Jiwon Lim. Ophthalmology, Chunchon Sacred
Heart Hospital, Hallym University, Chuncheon-Si, Gangwon-Do, Republic of
Korea.

Copyright 2012 by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. For permission to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2012 Annual Meeting Abstracts by Scientific Section/Group – Retina+ (RE)

Program Number: 348 Poster Board Number: D899 Clinical Trial: http://www.clinicaltrials.gov, NCT01486238
Presentation Time: 8:30 AM - 10:15 AM
Visual Acuity after 3 Intial Injections of Intravitreal Ranibizumab in the
Program Number: 350 Poster Board Number: D901
Management of Diabetic Macular Edema
Presentation Time: 8:30 AM - 10:15 AM
Claus Zehetner1, Martina T. Kralinger2, Gerhard F. Kieselbach3. 1Ophthalmology,
Maculopexy: A New Treatment for Diffuse Diabetic Macular Edema
Medical University Innsbruck, Innsbruck, Austria; 2Ophthalmology, Medical
Robert E. Morris, Matthew H. Oltmanns, Gregory M. Lewis. Retina Spec of
University of Innsbruck, Innsbruck, Austria; 3Ophthalmology, University of
Alabama, LLC, Birmingham, AL.
Innsbruck, Innsbruck, Austria.
Purpose: To determine the safety and efficacy of maculopexy (the production of
Purpose: To determine change of best corrected visual acuity (BCVA) and
microscopic chorioretinal adhesions by grid laser treatment together with gas
anatomic effects of 3 initial intravitreal injections of ranibizumab followed by a pro
tamponade) combined with intravitreal triamcinolone acetate (combined assisted
re nata (PRN) dosing regimen in patients with clinically significant diabetic
maculopexy, CAMP) to permanently increase retinal resistance to expansion as a
macular edema (CSME).
new treatment for diffuse diabetic macular edema (DDME).
Methods: 15 eyes of 9 patients (mean age, 67,1 years [range, 41-78]) with center-
Methods: Retrospective, consecutive case series of 10 eyes of 10 patients with
involving CSME were treated with 3 monthly intravitreal injections of 0,5 mg
DDME that did not have foveal ischemia, all treated by CAMP.
ranibizumab followed by a PRN reinjection regimen. Follow-up in all patients was
Results: Visual acuity improved significantly (0.43 (20/54) to 0.26 (20/36)
6 months.
logMAR (Snellen), p=0.04) as did optical coherence tomography (OCT) central
Analysis included the mean change from baseline BCVA and change from baseline
thickness (433 to 220 uM, p=0.0002). Mean length of follow-up was 43.6 months
mean foveal thickness (FTH) defined as center subfield thickness.
(range 8-72). Five patients (50%) had 2 or more Snellen lines of improvement, 2
Reinjections after week 12 were performed upon signs of disease activity as
had 1 line of improvement and 3 remained unchanged. Eight of 8 eyes (100%) with
defined by increase of mean foveal thickness (FTH) determined by SD OCT or loss
foveal cysts had resolution of the cysts with concave fovea at final follow-up.
of best-corrected visual acuity (BCVA).
Conclusions: CAMP appears to be a safe and effective new treatment for DDME,
Results: The baseline mean BCVA was 0,32±0,22 and the mean FTH was
a common and visually debilitating condition that has heretofore had no
505±210 μm. Mean HbA1c was 6,4±0,4. At month 3 after 3 intravitreal injections
satisfactory treatment. A larger prospective clinical trial is justified based on
of ranibizumab mean BCVA was 0,38±0,21 (p=1,0) and mean FTH was 333±135
encouraging results of this pilot study.
μm (p=0,139). At month 6 mean BCVA was 0,31±0,21 (p=1,0) and mean FTH was
Commercial Relationships: Robert E. Morris, None; Matthew H. Oltmanns,
385±143 μm (p=0,019). The mean number of reinjections between month 4 and 6
None; Gregory M. Lewis, None
was 0,43±0,51 resulting in a mean total of 3,43±0,51 injections per study eye. None
Support: None
of the study eyes received more than 1 reinjection and 60% of all study eyes only
received the initial 3 injections of ranibizumab.
Conclusions: In this series a regimen with 3 initial intravitreal injections of Program Number: 351 Poster Board Number: D902
ranibizumab followed by PRN reinjections resulted in overall stabilization of Presentation Time: 8:30 AM - 10:15 AM
BCVA. Despite a favorable morphological response as shown by reduction of Reversal Of Diabetic Macular Edema Following Gastric Bypass Surgery
mean FTH no statistically significant gain in BCVA could be achieved. Bernard J. Fowler. Ophthalmology, Englewood Hospital & Medical Center,
This may indicate that a PRN regimen does not prove an equivalent alternative to a Englewood, NJ.
fixed-dosing schedule in the treatment of diabetic macular edema. Purpose: To demonstrate connection between complete reversal of diabetic
Commercial Relationships: Claus Zehetner, None; Martina T. Kralinger, macular edema{which had been previously resistant to standard laser therapy} and
None; Gerhard F. Kieselbach, None gastric bypass surgery in an obese Type 2 diabetic.
Support: None Methods: The patient was followed at regular intervals using visual acuity OCT
and dilated retinal exam following gastric bypass surgery.
Results: Complete resolution of diabetic macular edema in both eyes. HgbA1c and
Program Number: 349 Poster Board Number: D900
serum lipemic studies normalized. Hypertension normalized. Patient is off all
Presentation Time: 8:30 AM - 10:15 AM
diabetic and antihypertensive medications.Weight loss was 55 lbs.
Pegaptanib for Retinal Edema Secondary to Diabetic Vascular Disease
Conclusions: Gastric bypass can relieve severe sight threatening ocular
(PRESerVe) Study
complications in obese Type 2 diabetics who have previously failed on standard
Roberto Diaz-Rohena1, Alex Kartvelishvili1, Victor H. Gonzalez2. 1Valley Retina
laser therapy. Decrease in belly fat generated cytokines may play a role following
Institute,PA, MCALLEN, TX; 2Valley Retina Institute PA, McAllen, TX.
weight loss.
Purpose: To analyze the effect that the administration of intravitreal pegaptanib
Commercial Relationships: Bernard J. Fowler, None
sodium injections every 4 weeks, as compared to every 6 weeks, have on best-
Support: None
corrected visual acuity (BCVA) and on area and volume of diabetic macular edema
(DME) as measured by optical coherence tomography (OCT) in patients with
DME. Program Number: 352 Poster Board Number: D903
Methods: A total of 72 patients in 10 study sites across the United States were Presentation Time: 8:30 AM - 10:15 AM
enrolled. A total of 64 patients completed the study. Only 1 eye from each patient Gas-Assisted Posterior Vitreous Detachment For The Treatment Of Diabetic
was included in the study. All study eyes had foveal thickness of 250 microns or Macular Edema
more on OCT, and BCVA between 70 and 20 letters on Early Treatment Diabetic Alessandro J. Dare1, Jose A. Cardillo2, Rogerio A. Costa3, Eduardo Moreira4,
Retinopathy Study (ETDRS) chart. Eyes that had any confounding factors, that Francyne Tognin4. 1Ophthalmology, CBEO, Ribeirao Preto, Brazil; 2Retina
could cause macular edema or decrease in vision or could interfere with treatment Department, Hospital de Olhos de Araraquara, Araraquara, Brazil; 3Division of
results, were excluded. The study was conducted in compliance with the Macula: Imaging & Treatment, Centro Brasileiro de Ciencias Visuais, Belo
Declaration of Helsinki, and all patients signed informed consent. Horizonte, Brazil; 4Ophthalmology, Hospital de Olhos de Araraquara, Ribeirao
Results: There was a total of 49 patients in the 4-week arm, and 23 patients in the Preto, Brazil.
6-week arm. Mean baseline visual acuity (VA), central subfield thickness (CST), Purpose: To assess the functional and anatomic outcomes of a single intravitreous
macular volume, and center point thickness (CPT) were comparable between the 2 perfluoropropone (C3F8) gas injection to treat patients with tractional DME, as
study arms. Mean change in visual acuity by week 24 was +7.2 letters in 4-week assessed by optical coherence tomography (OCT).
arm, and +0.2 letters in 6-week arm (P= 0.018). Mean change in CST on OCT at Methods: Five patients previously treated with focal grid photocoagulation, with
week 24 was -9 microns in 6-week arm, and -71 microns in 4-week arm (P= 0.042). tractional diabetic macular edema received an intravitreous gas injection and were
Mean change in macular volume on OCT at week 24 was -0.9 mm3 in 6-week arm, prospectively followed with optical coherence tomography. After informed consent
and -0.42 mm3 in 4-week arm (P= 0.446). Mean change in CPT on OCT at week was obtained, the compromised eye was injected with 0.4 ml C3F8 gas using a 30-
24 was -2 microns in 6-week arm, and -47 microns in 4-week arm (P= 0.240). gauge needle via the pars plana. Patients maintained a head-prone posture for 14
Conclusions: The results demonstrate that the administration of pegaptanib sodium days. Changes in vitreous-macular relationship and central macular thickness were
injections every 4 weeks as opposed to every 6 weeks resulted in higher gain of assessed using optical coherence tomography. Patients were followed 1 week, 2
letters on ETDRS chart. CST also improved more in 4-week arm than in 6-week weeks, 1, 2, 3, and 6-months after treatment. ETDRS best correct visual acuity and
arm, although macular volume and CPT failed to show statistically significant fluorescein angiography were assessed during follow up.
difference between the 2 groups. Results: A complete posterior vitreous detachment was achieved within 4 weeks
Commercial Relationships: Roberto Diaz-Rohena, None; Alex Kartvelishvili, after gas injection in 3 of the 5 patients. By 6 months of follow-up after induced
None; Victor H. Gonzalez, Eyetech, Alimera Sciences, Genentech, Regeneron, separation of the hyaloid at the fovea, there was resolution of the macular edema
Iconic, Thrombogenics, Ophthotec, Steba, Alcon, DRCR.net, Pfizer, Ista and restoration of the foveal depression. No complication was related to the
Pharmaceuticals (F), Eyetech, Genetech, Ista Pharmaceuticals, Pfizer (C), Eyetech, procedure. Vitrectomy were performed in those patients whom completed vitreous
Ista Pharmaceuticals, Pfizer (R) detachment were not obtained with gas injection.
Support: Eyetech Conclusions: The pneumatically-assisted vitreofoveal separation is a relative

Copyright 2012 by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. For permission to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2012 Annual Meeting Abstracts by Scientific Section/Group – Retina+ (RE)

simple outpatient procedure with minimal surgical manipulation and low morbidity Yufei Tu, Catherine Fay, Suqin Guo, Edward Marcus, Neelakshi Bhagat. Institute
that may have broad therapeutic use. of Ophthalmology & Visual Science, UMDNJ-New Jersey Medical School,
Commercial Relationships: Alessandro J. Dare, None; Jose A. Cardillo, Newark, NJ.
None; Rogerio A. Costa, None; Eduardo Moreira, None; Francyne Tognin, Purpose: To evaluate the safety of ranibizumab as a surgical adjunct during
None cataract surgery in patients with proliferative diabetic retinopathy (PDR) with
Support: None rubeosis, and to evaluate the efficacy and adverse effects of ranibizumab in treating
PDR with rubeosis.
Methods: Three intravitreal injections of 0.5 mg ranibizumab were administered
Program Number: 353 Poster Board Number: D904
on day 0, month 1 and 2 with cataract surgery 6-16 days after 1st injection.
Presentation Time: 8:30 AM - 10:15 AM
Retreatments with ranibizumab injections and pan-retinal photocoagulation (PRP)
Does Preoperative Intravitreal Bevacizumab Reduce The Incidence Or
were given if recurrence or persistence of PDR was noted between months 3 to 11.
Severity Of Postoperative Diabetic Vitreous Hemorrhage?
Safety observation visits occurred at months 12, 18 and 24. Primary end points
Rocky L. McAdams, Richard Winslow, Georges Bounajem. Ophthalmology, UT
were incidence and severity of adverse events (AE) that were related to both
Southwestern, Dallas, TX.
cataract surgery and treatment of PDR with rubeosis through month 12. Secondary
Purpose: To examine the impact of preoperative intravitreal bevacizumab
end points and results are summarized in Table 1.
injections prior to vitrectomy on the rate of postoperative vitreous hemorrhage in
Results: Of 6 patients screened, 4 (mean age 61.3) were enrolled. No AEs were
diabetics with non-clearing vitreous hemorrhage or tractional retinal detachments.
noted with either cataract surgery or treatment of PDR. Neovascularization of iris
Methods: A retrospective chart review was conducted using ICD-9 and CPT codes
(NVI) promptly regressed by 4 days after 1st ranibizumab injection, prior to
to identify 121 eyes with proliferative diabetic retinopathy being treated with pars
cataract surgery in 3 of 4 patients (one had significantly regressed NVI by post-
plana vitrectomy at Parkland Hospital between 2006 and 2010. Chart review was
injection day 3 visit); NVI was not noted in any patient at 2 weeks after 1st
done to pull pertinent data from all preoperative and up to 3 months postoperative
ranibizumab injection. Recurrence of rubeosis or NVA after 3 monthly injections
visits including the use of bevacizumab.
was not observed in any patient. At month 12, PDR was not present assessed
Results: At 1 week and at 3 months post op the rate of any significant hemorrhage
clinically nor by fluorescein angiogram. Only 1 patient developed
was 12.5 % and 26.9% in the bevacizumab group compared to 26.2% and 45.8%
neovascularization of disc and neovascularization elsewhere and required
respectively in the observation group. These results trend to have decreased rate of
retreatments at months 5 and 9.
hemorrhage in the injection group. The timing of the injection did not show a
Conclusions: Multiple intravitreal injections of ranibizumab may be a safe,
statistical difference in the measured outcome.
effective treatment adjunct for PDR with diabetes related rubeosis in absence of
Conclusions: The results suggest a trend toward decreased rates of postoperative
retinal traction membranes. It might serve as a more timely treatment alternative for
vitreous hemorrhage with a preoperative bevacizumab injection in patients with
patients with dense cataracts, which prevents them from undergoing immediate
non clearing vitreous hemorrhage and tractional retinal detachments from
PRP, the standard therapy of PDR. Ranibizumab treatment may have further
proliferative diabetic retinopathy. Further research is still needed to establish the
benefits of reducing bleeding complications during anterior segment surgery in a
value of implementing preoperative therapy in this important postoperative
rubeotic eye.
complication.
Commercial Relationships: Rocky L. McAdams, None; Richard Winslow,
None; Georges Bounajem, None
Support: None
Program Number: 354 Poster Board Number: D905
Presentation Time: 8:30 AM - 10:15 AM
Intravitreal Pegaptanib Sodium Prior to Pars Plana Vitrectomy in
Proliferative Diabetic Retinopathy: An Update
Karl E. Waite1A, Michael D. Bennett1. AOphthalmology, 1Retina Institute of
Hawaii, Honolulu, HI.
Purpose: To explore the efficacy and safety of pegaptanib sodium used as adjuvant
therapy prior to pars plana vitrectomy in eyes with proliferative diabetic
retinopathy (PDR) and tractional retinal detachment (TRD).
Methods: Consecutive patients with PDR who required pars plana vitrectomy due
to vitreoretinal traction to the macula received intravitreal pegaptanib 0.3 mg
injection 5 to 14 days prior to the surgical procedure. Eyes with vitreous
hemorrhage precluding preoperative fundus assessment and those treated during the
previous month with anti-VEGF agents were excluded from this analysis. Best
corrected visual acuity (BCVA) was evaluated at baseline and after vitrectomy. The
effects of pegaptanib on regression of retinal neovascularization and progression of

macular traction were assessed by comparing color fundus photographs and optical Commercial Relationships: Yufei Tu, None; Catherine Fay, None; Suqin Guo,
coherence tomography (OCT) exams obtained pre- and post-injection. The ability None; Edward Marcus, None; Neelakshi Bhagat, None
to dissect vitreoretinal tractional membranes from the underlying retina was Support: Genentech Inc.
assessed by the surgeon. Clinical Trial: http://www.clinicaltrials.gov, NCT01069341
Results: Five patients have been treated with preoperative pegaptanib. Regression
of neovascularization has been observed in follow-up images. There was no
Program Number: 356 Poster Board Number: D907
evidence of increased traction, postoperative hemorrhage, or endophthalmitis in
Presentation Time: 8:30 AM - 10:15 AM
any patient. Adverse events were consistent with the safety profile of pegaptanib.
Panretinal Photocoagulation Versus Intravitreal Injection Retreatment Pain
Conclusions: This supports the potential use of intravitreal pegaptanib sodium as
in High-Risk Proliferative Diabetic Retinopathy
an adjuvant therapy prior to pars plana vitrectomy in diabetic retinopathy with
Felipe P. Almeida1A, Célia R. Lucena1A, José A. Ramos1A, Andre Messias1A, José A.
tractional retinal detachment. Larger scale, randomized clinical studies are still
Silva1B, Ingrid U. Scott2, Rodrigo Jorge1C. AOphthalmology, BPsychology, Faculty
required to appropriately evaluate the benefit of selective VEGF inhibition in this
of Philosophy, Sciences and Literature, COphthalmology, Ribeirao Preto Med Sch,
condition.
1University of Sao Paulo, Ribeirao Preto, Brazil; 2Ophthalmology & Public Health
Commercial Relationships: Karl E. Waite, None; Michael D. Bennett, Eyetech
Sciences, Penn State College of Medicine, Hershey, PA.
(C), Genentech (C), Heidelberg (C), Optimedica (C), Optos (C), Optovue (C)
Purpose: Compare pain score between panretinal photocoagulation (PRP) or
Support: None
intravitreal injection of ranibizumab (IVR) in patients with proliferative diabetic
Clinical Trial: http://www.clinicaltrials.gov, RIH1005
retinopahty (PDR) already treated with PRP.
Methods: PRP patients (n = 16) received full scatter PRP in two sessions (Weeks 0
Program Number: 355 Poster Board Number: D906 and 2) while the PRP plus group (n = 17) received the same LASER treatment and
Presentation Time: 8:30 AM - 10:15 AM an additional IVR at week 0 (immediately after the 1st PRP session). After week
Multiple Intravitreal Injection of Ranibizumab in Patients with Dense 16, the patients of both groups underwent a fluorescein angiography (FA). If
Cataract and Proliferative Diabetic Retinopathy with Rubeosis: a 12- month leakage were shown, PRP group patients would receive an additional PRP session
Interventional Study (500 additional spots per quadrant of active new vessels) and PRP plus patients
received an additional IVR. Fifteen minutes after the end of, a masked examiner
used a 100-degree Visual Analog Scale (VAS) for pain score estimation.

Copyright 2012 by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. For permission to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2012 Annual Meeting Abstracts by Scientific Section/Group – Retina+ (RE)

Results: Sixteen and 17 patients from the PRP and PRP plus groups respectively ischaemia (r=0.59 p=0.0003) and maculopapillar ischaemia (r=0.52 p=0.002). The
completed the 16-week visit, and 14 patients from PRP and 17 from PRP plus were ratio of inner:outer retinal volume in ETDRS areas 1-9 was negatively correlated to
evaluated for pain scores. At week 16, all patients from both groups showed FAZ size (r=-0.29, p= 0.04). A negative correlation was also observed with inner
leakage confirmed by FA, and were retreated according to study protocol. Mean retinal (r=-0.31 p=0.03) but not outer retinal intensity (r=0.09 p=0.51).
IVR pain (±SEM) was 4.7 ± 2.1, significantly lower (p<0.0001) than mean PRP Conclusions: The extent and location of diabetic macular ischaemia is associated
pain (60.8 ± 7.8). Twelve out of 17 patients from the PRP plus group referred no with a reduction of visual acuity and disruption of Inner retinal architecture. The
pain (score zero) with the intravitreal injection treatment while the minimal score prognostic significance of macular ischaemia is not well understood. Its
found in one patient of PRP group was 10.5 while all others scored above 30. characterization is an important first step to determine the time point in which
Conclusions: PRP plus ranibizumab is superior to PRP alone for high-risk PDR patients may be amenable to future regenerative therapies.
treatment of BCVA and new vessels regression. In addition, the patient comfort is
higher when treatment is performed with an additional intravitreal injection.
Further larger studies are necessary to confirm the findings here reported.
Commercial Relationships: Felipe P. Almeida, None; Célia R. Lucena,
None; José A. Ramos, None; Andre Messias, None; José A. Silva, None; Ingrid
U. Scott, None; Rodrigo Jorge, None
Support: None
Clinical Trial: http://www.clinicaltrials.gov, NCT01102946
Program Number: 357 Poster Board Number: D908
Presentation Time: 8:30 AM - 10:15 AM
Structural and Functional Macular Evaluation in Proliferative Diabetic
Retinopathy patients treated using Panretinal Photocoagulation Combined
with Intravitreal Bevacizumab Injections
Rony C. Preti, Lisa M. Ramirez, Andre C. Barros, Augusto A. Motta, Celso Morita,
Otacilio O. Maia Junior, Daniel A. Ferraz, Walter Y. Takahashi. ophthalmology,
MD, University of Sao Paulo, Sao Paulo, Brazil.
Purpose: To investigate the effects of panretinal photocoagulation (PRP) combined
with intravitreal injections of Avastin® (Bevacizumab) as an adjuvant to
proliferative diabetic retinopathy (PDR)
Methods: Prospective randomized masked study conducted in patients with high-
risk PDR, which were divided into two groups. One eye was treated with only PRP Commercial Relationships: Dawn A. Sim, None; Pearse A. Keane, None; Elise
(PRP only group) and the fellow eye of same patient was treated with both PRP and Platteau, None; Javier Zarranz-Ventura, None; Marcus Fruttiger,
intravitreal bevacizumab injections (Adjuvant group). Best corrected visual acuity None; Praveen J. Patel, None; Catherine A. Egan, None; Adnan Tufail, None
(BCVA), central macular thickness (CMT) and macular volume (MV) were Support: Fight For Sight, NIHR - National Institute for Health Research
immediately recorded and also at the 1, 3 and 6 month’s follow-up visits.
Results: Of 30 patients with high-risk PDR, sixteen were male and fourteen were
Program Number: 359 Poster Board Number: D910
female. The average age and duration of the diabetes were 55(±7.87) and
Presentation Time: 8:30 AM - 10:15 AM
17.77(±9.12) years, respectively. There were no statistically significant BCVA
Effects of Macular Ischemia on Post-operative Visual Acuity, Foveal
changes after treatment in either group throughout the follow-up period. CMT
Thickness and Outer Retinal Layer Integrity after Pars Plana Vitrectomy
demonstrated improvement just in the first month follow-up in the adjuvant group
(PPV) for Proliferative Diabetic Retinopathy (PDR)
(P<0.035). MV improved in the first (P<0.07) and third month follow-ups in the
Hemang K. Pandya, Wendewessen Amde, Tamer H. Mahmoud. Ophthalmology,
adjuvant group (P<0.02).
Kresge Eye Institute, Detroit, MI.
Conclusions: Intravitreal bevacizumab injection with PRP resulted in reduced
Purpose: Proliferative Diabetic Retinopathy (PDR) is the primary cause of
CMT and MV one and three months after treatment. There was no difference in the
irreversible blindness in Western World. Pars Plana Vitrectomy (PPV) is a surgical
BCVA between the two groups during the six-months of follow-up.
approach for managing complications from PDR, such as vitreous hemorrhage. Our
Commercial Relationships: Rony C. Preti, None; Lisa M. Ramirez,
study attempts to correlate foveal avascular zone (FAZ) area to visual acuity (VA),
None; Andre C. Barros, None; Augusto A. Motta, None; Celso Morita,
central foveal thickness (CFT) and outer retinal layer integrity after PPV for PDR-
None; Otacilio O. Maia Junior, None; Daniel A. Ferraz, None; Walter Y.
related complications.
Takahashi, None
Methods: Retrospective review of 27 eyes treated with PPV for complications of
Support: Fundacao de Amparo a Pesquisa do Estado de Sao Paulo processo
PDR by single surgeon. Measured outcomes were visual acuity, foveal avascular
numero 2009/08895-1
zone, central foveal thickness, and outer retinal layer integrity.
Clinical Trial: http://www.clinicaltrials.gov, NCT01389505
Results: VA improved after PPV (p<0.0001). There was a significant negative
correlation between FAZ area & CFT (p= 0.02). Wider FAZ correlated
Program Number: 358 Poster Board Number: D909 significantly with disrupted external limiting membrane (p = 0.027) but not with
Presentation Time: 8:30 AM - 10:15 AM disrupted photoreceptor inner/outer segment (IS-OS). Neither FAZ area nor CFT
The Diabetic Retinopathy Repair Project - Prevalence And Prognostic correlated with VA.
Significance Of Ischaemia In Diabetic Macula Disease Conclusions: Wider FAZ correlated with thin CFT. IS-OS integrity was not
Dawn A. Sim1A,2A, Pearse A. Keane1A, Elise Platteau1A, Javier Zarranz-Ventura1A, affected by macular ischemia. Post-PPV VA may improve despite wider FAZ and
Marcus Fruttiger2, Praveen J. Patel1B, Catherine A. Egan1A, Adnan Tufail1C. thinner CFT.
AMedical Retina, BResearch & Development, COphthalmology, 1Moorfields Eye Commercial Relationships: Hemang K. Pandya, None; Wendewessen Amde,
Hospital, London, United Kingdom; ACell Biology, 2UCL Institute of None; Tamer H. Mahmoud, None
Ophthalmology, London, United Kingdom. Support: None
Purpose: To investigate the relationship between Fundus Fluorescein Angiography
(FFA) and Optical Coherence Tomography (OCT) derived measurements of retinal
Program Number: 360 Poster Board Number: D911
vascular morphology and visual acuity in Diabetic Macular Ischaemia (DMI).
Presentation Time: 8:30 AM - 10:15 AM
Methods: Data were retrospectively collected over a period of 6 months. FFAs
Angiofibrotic Response To VEGF Inhibition In Membranes Extracted During
were analysed by 3 independent graders using the Early Treatment Diabetic
Diabetic Vitrectomy: Results Of A Randomized, Controlled, Translational
Retinopathy Study (EDTRS) protocol for DMI. The Foveal Avascular Zone (FAZ),
Study
capillary non-perfusion areas, and OCT images were quantified using custom Elliott H. Sohn1, Christine Spee2, Shikun He3, Dean Eliott4, David R. Hinton5.
software. 1Retina Service, University of Iowa Hospitals and Clinics, Iowa City, IA;
Results: 1298 unique patient attendances were identified. 1534 eyes from 767 2Ophthalmology, Keck Sch of Med, Univ of So CA, Los Angeles, CA;
Type 2 diabetic patients included in the analysis. 45.4% of eyes had no DMI, 3Ophthalmology-USC, Doheny Eye Institute, Los Angeles, CA; 4Retina Service,
16.5% questionable, 16.4% mild, 7.9% moderate, and 3.7% severe ischaemia. Massachusetts Eye and Ear Infirmary, Boston, MA; 5Pathology, Keck School of
Mean FAZ area (mm2) ranged from 0.21 in no DMI to 0.63 in severe DMI. Visual
Medicine USC, Los Angeles, CA.
acuity (VA) was reduced in all grades of DMI compared to those with no DMI
Purpose: Connective tissue growth factor (CTGF) is a fibrosis inducer that is
(p<0.003). VA reduction was correlated FAZ size in the moderate (r=0.47 p=0.006)
elevated in proliferative diabetic retinopathy. The goal of this study was to
and severe DMI (r=0.30 p=0.02) subgroups, and in cases with concurrent temporal
determine the expression of vascular endothelial growth factor (VEGF) and CTGF

Copyright 2012 by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. For permission to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2012 Annual Meeting Abstracts by Scientific Section/Group – Retina+ (RE)

in membranes causing diabetic traction detachment with regard to vascular retinopathy were retrospectively analysed. The later four years saw the
endothelial cells, myofibroblasts, and cytokeratin. commencement of routine use of IVB (1.25mg 4-9 days prior to operating). All
Methods: In a randomized, controlled, prospective trial (www.clinicaltrials.gov patients with follow-up of at least six weeks were included. Surgery was performed
NCT01270542) of 20 eyes (n=10 controls, n=10 given preoperative bevacizumab by three different vitreoretinal surgeons at two hospitals in East Africa
3-7 days prior to diabetic traction detachment surgery), epiretinal membranes were (Kilimanjaro Christian Medical Centre, Tanzania and Kikuyu Eye Unit, Kenya).
excised at the time of vitrectomy. The membranes were snap frozen and sectioned Results: Initial data was compiled for 140 patients (158 eyes). Of the included eyes
at 9 µm. Sections were immunofluorescent stained with anti-CTGF or anti-VEGF 46 (43%) had received IVB the remaining 62 (57%) had not. The main indications
antibody followed by antibody specific for endothelial cells (CD31), for surgery were vitreous haemorrhage (39%) and tractional retinal detachment
myofibroblasts (smooth muscle actin [SMA]), or cytokeratin. Volocity software (54%). The majority of patients required delamination surgery (81%). The
(version 5.4) allowed quantitative and co-localization analysis of antibody content distribution of the above surgical indications and requirements was even to within
obtained through immunofluorescence confocal microscopy. Multiple sections for 4% between the two groups. Intraoperative complications were higher in the
each membrane were averaged for each eye. patients who had not received IVB. Significant haemorrhage occurred in 8 (11%)
Results: The bevacizumab group had a greater than 25% reduction in co- compared to 1 (1.8%) in those who had received IVB. Similarly iatrogenic breaks
localization in the CD31-CTGF and cytokeratin-CTGF studies compared to were more common, 33 (44.6%) to 19 (35%). The number needed to treat to restore
controls. There was no change in VEGF colocalization between the treated and sight to one blind person (both eyes < 20/200) was 5.1 for those who received IVB
controls. See figure for complete results. and 7.7 for those who did not.
Conclusions: Intravitreal bevacizumab 1.25 mg administered within one week of Conclusions: This is the first study to indicate that a relatively inexpensive
surgery may decrease VEGF and CTGF expression in diabetic traction membranes. preoperative dose of bevacizumab can improve surgical outcomes in PRD surgery
VEGF inhibition decreases co-expression of CTGF but not VEGF in vascular in East Africa. The improved outcomes are largely a result of Bevacizumab
endothelial cell and cytokeratin stains. Attenuation of fibrovascular activity in antiangeogentic actions improving intraoperative visualization of the retina. This
membranes might provide scientific rationale for performing surgery within 7 days audit shows that IVB should be considered a cost-effective intervention in the
of preoperative adjunctive bevacizumab for diabetic traction detachment. treatment of PDR in the developing world.
Commercial Relationships: Grant Guthire, None; Anthony Hall, None; Kazim
Dhalla, None
Support: None
Program Number: 362 Poster Board Number: D913
Presentation Time: 8:30 AM - 10:15 AM
A Comparison of Surgical Outcomes After Diabetic Tractional Retinal
Detachment Repair Using Small Versus Large Gauge Vitrectomy
John Au, Alex Yuan, Jonathan Sears, Rishi Singh, Peter Kaiser. Cole Eye Institute,
Cleveland Clinic, Cleveland, OH.
Purpose: To compare surgical outcomes between traditional 20-gauge versus small
(23 and 25) gauge vitrectomy surgery for diabetic tractional retinal detachment
(TRD) repair.
Methods: We reviewed medical records of patients who underwent TRD repair by
either large or small gauge vitrectomy between 11/2008 and 4/2011. To date, 27
consecutive patients who underwent large gauge and 28 consecutive patients who
underwent small gauge vitrectomy with an ICD-9 code for TRD were included
with 6 months of followup. Baseline characteristics such as age, prior glaucoma,
prior laser treatment (PRP or focal), preoperative lens status and preoperative visual
acuity (VA) were compared between each group. The primary outcome was change
in VA and secondary outcomes included operative times, surgical complications,
post operative lens status, postoperative complications including redetachments,
and the choice of posterior segment tamponade (silicone oil VS gas). Numerical
data was analyzed by student T-test. Categorical data was analyzed by Fisher Exact
test.
Results: Baseline characteristics between the two groups were well matched with
no significant differences. The numbers of combination
phacoemulsification/vitrectomy cases were similar between both groups: 15 small
gauge cases and 14 large gauge cases were combined with cataract extraction
(p=1.0). The average operative time was 90±8.4 minutes for small gauge surgery
and 140.2±10.2 minutes for large gauge. This difference was statistically
significant (p=0.0005). There was a trend favoring small gauge surgery for visual
outcomes. The average net gain in vision was 37±9 letters for small gauge and
11±10 letters for large gauge (p=0.052). The baseline VA was comparable for both
Commercial Relationships: Elliott H. Sohn, None; Christine Spee, groups. The median baseline VA was 20/400 for small gauge and 20/1100 for large
None; Shikun He, None; Dean Eliott, Genentech (C); David R. Hinton, None gauge (p=0.44). Median postoperative VA was 20/70 for small gauge and 20/200
Support: Research to Prevent Blindness. NEI Grant EY03040 for large gauge (p=0.01). There were no differences in rates of surgical and
Clinical Trial: http://www.clinicaltrials.gov, NCT01270542 postoperative complications. There were 2 small gauge and 6 large gauge cases
requiring reoperation (p=0.25). There was a statistically significant difference
Program Number: 361 Poster Board Number: D912 favoring the use of silicone oil in large gauge surgery (p=0.005). Oil was used in 9
Presentation Time: 8:30 AM - 10:15 AM of 27 large gauge cases and only 1 of 28 small gauge cases.
Bevacizumab As An Adjunct To Vitrectomy In The Management Of Conclusions: Though small in size, this preliminary study suggests that small
Proliferative Diabetic Retinopathy In East Africa gauge TRD repair is significantly faster while yielding similar or superior outcomes
Grant Guthire1, Anthony Hall2,3, Kazim Dhalla2. 1Newcastle Medical School, compared with traditional 20-gauge surgery.
Newcastle Upon Tyne, United Kingdom; 2Kilmanjaro Christian Medical Centre, Commercial Relationships: John Au, None; Alex Yuan, None; Jonathan Sears,
Moshi, Tanzania, United Republic of; 3Kikuyu Eye Unit, Kikuyu, Kenya. None; Rishi Singh, Buckeye Ocular, LLC (P), Oraya Therapeutics (E); Peter
Purpose: Diabetes mellitus is an important public health problem worldwide. In Kaiser, Alcon Laboratories (E), Ophthotech (E, P), Oraya Therapeutics, Inc. (E, P)
sub-Saharan Africa, its current incidence is 12 million. Although proliferative Support: None
diabetic retinopathy (PDR) can be treated with laser some patients will need a
vitrectomy. Preoperative intravitreal use of the antiangiogenic bevacizumab (IVB) Program Number: 363 Poster Board Number: D914
has been shown to reduce intraoperative complications by improving retinal Presentation Time: 8:30 AM - 10:15 AM
visualization. The following multi-centre retrospective audit is the first study to Rational For ILM Removal In Diabetic Retinopathy
assess surgical outcomes and the cost-effectiveness of IVB in vitrectomy for PDR Constantin J. Pournaras1A, Marie-Luce Bochaton-Piallat1B, Nicole Gilodi2,
in an East African context. Efstratios Mendrinos1A. AVitreo-retinal Unit, Ophthalmology, BDepartment of
Methods: Eight years of case notes from patients undergoing vitrectomy for PDR Pathology and Immunology, 1Geneva University Hospitals, Geneva, Switzerland;

Copyright 2012 by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. For permission to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2012 Annual Meeting Abstracts by Scientific Section/Group – Retina+ (RE)

2Department of Ophthalmology, Geneva University Hospitals, Geneva, Program Number: 365 Poster Board Number: D916
Switzerland. Presentation Time: 8:30 AM - 10:15 AM
Purpose: Myofibroblasts play a major role in the production of retractile Anatomic And Functional Surgical Outcomes Of Epiretinal Membrane
phenomena causing contraction or shrinkage of the epiretinal membranes (ERM) in Secondary To Diabetes
proliferative vitreoretinopathy, diabetic retinopathy or idiopathic macular epiretinal Isabelle Fournier, Jr., Laurent BALLONZOLI, Sr., Maher SALEH, Sr., Tristan
membranes. To evaluate the expression of myofibroblasts on epiretinal macular BOURCIER, Sr., Claude SPEEG-SCHATZ, Sr., David GAUCHER, Sr.. Department
tissue, in eyes with diabetic retinopathy undergoing of ophtalmology, Nouvel Hospital Civil, Strasbourg, France.
vitrectomy. Purpose: To evaluate clinical features and surgical results of epiretinal membrane
Methods: Samples of ERMs and/or ILMs following macular surgery in eyes with (ERM) secondary to diabetes and to compare them with idiopathic ERM.
diabetic maculopathy or other diabetic-related complications were collected in 13 Methods: Data from 100 eyes of 97 consecutive patients operated on for ERM
eyes. Samples included ILMs only in 7 eyes, ERMs only in 2 eyes and ERM with were reviewed retrospectively. Two groups of patients were studied: diabetic (37
ILM in 4 eyes. Double immunofluorescence staining with antibodies recognizing a- eyes) and nondiabetic (63 eyes). They were compared for best corrected visual
SMA and ED-A FN or vimentine in myofibroblasts, followed by confocal acuity (BCVA), central macular thickness (CMT), intraretinal cysts before and after
microscopy analysis as well as electronic microscopy were performed in all surgery, and the status of posterior vitreous detachment (PVD) during surgery.
samples. Results: Complete PVD was less frequent in diabetic ERM (40.6%) than in
Results: a-SMA in association to either ED-A FN or vimentine were detected in all idiopathic ERM (63.2%) (p=0.034). Although both groups showed significant
ERM samples with or without ILM. In addition, ED-A FN or vimentine was improvement in BCVA, the diabetic group had poorer visual recovery (0.42±0.31
expressed in close relation with a-SMA-positive myofibroblasts in 2 out of 7 ILM vs 0.23±0.23 logMAR), CMT decreased after surgery in both groups, but final
samples. CMT remained thinner in the diabetic group (313.68 vs 341.12µm) (p=0.0181).
Conclusions: Scanning electron microscopy indicated that myofibroblats cellular Conversely, postoperative cystic spaces were more frequent in diabetic eyes
migration is always expressed in epiretinal macular membrane. Most (5/7) of the (37.037% vs 13.725%) (p=0.0234). Preoperative BCVA was significantly
ILM samples were negative for myofibroblasts, whereas 2 stained positive. These correlated with the visual improvement in the diabetic group.
results suggest that in some cases ILM may contain myofibroblasts with no Conclusions: Removal of ERM secondary to diabetes can be recommended,
macroscopic evidence of ERM. If during surgery, the ILM is colored especially to patients without DR. As complete PVD is less frequent in diabetic
inhomogeneously, this suggests the presence of cells and should be peeled. If the patients, surgeons should take care to fully remove the posterior hyaloid while
ILM is colored homogeneously, peeling is not considered necessary. operating diabetic patients for ERM.
Commercial Relationships: Constantin J. Pournaras, None; Marie-Luce Commercial Relationships: Isabelle Fournier, Jr., None; Laurent Ballonzoli,
Bochaton-Piallat, None; Nicole Gilodi, None; Efstratios Mendrinos, None Sr., None; Maher Saleh, Sr., None; Tristan Bourcier, Sr., None; Claude Speeg-
Support: None schatz, Sr., None; David Gaucher, Sr., None
Support: None
Program Number: 364 Poster Board Number: D915
Presentation Time: 8:30 AM - 10:15 AM Program Number: 366 Poster Board Number: D917
The Effect of Pan-Retinal Photocoagulation on Macular Inner Retinal Presentation Time: 8:30 AM - 10:15 AM
Thickness in Proliferative Diabetic Retinopathy Exploratory Analysis of Diabetic Retinopathy Worsening (Progression) at 1
Joshua A. Morrison-Reyes, Sam Mansour, Lindsay Smithen. Ophthalmology, Year and 3 Years in a Randomized Clinical Trial Evaluating Ranibizumab
George Washington University, Washington, DC. and Triamcinolone
Purpose: Panretinal photocoagulation (PRP) for patients with proliferative diabetic David G. Miller, Diabetic Retinopathy Clinical Research Network. Retina
retinopathy (PDR) improves visual outcomes and prevents vision loss. Studies Associates of Cleveland, Cleveland, OH.
using Time-Domain Ocular Coherence Tomography (TD-OCT) have shown an Purpose: Evaluate effect of intravitreal ranibizumab or intravitreal triamcinolone
increase in edema and overall macular thickness following the procedure, but the acetonide on worsening (progression) of diabetic retinopathy.
TD-OCT lacks the resolution to accurately measure the individual layers of the Methods: Exploratory analysis was performed on subjects with diabetic macular
retina. It has not yet been investigated using Spectral-Domain OCT (SD-OCT) edema randomly assigned to sham+prompt laser, intravitreal 0.5-mg
whether certain layers of the retina may thin even while overall thickness may ranibizumab+prompt laser, intravitreal 0.5-mg ranibizumab+deferred (>24 weeks)
increase. laser, or 4-mg intravitreal triamcinolone+prompt laser. Fundus photographs were
The purpose of this study is to conduct a retrospective analysis on patients with obtained at baseline, 1 year, and 1 additional time between 1.5 and 3 years.
PDR who have undergone PRP and had SD-OCT before and after the procedure to Progression of retinopathy was defined as worsening from non-proliferative
determine the change in thickness of the retinal layers after treatment at 1, 3, and 6 diabetic retinopathy (NPDR) to proliferative diabetic retinopathy (PDR) (NPDR
month intervals. eyes only), or occurrence of panretinal photocoagulation, or occurrence of vitreous
Methods: All 99 patients with PDR who underwent a total of 202 sessions of PRP hemorrhage, or worsening of diabetic retinopathy severity level by at least 2 levels
over a 2 year period were identified using the electronic medical record. Of these, (NPDR eyes only). Cumulative probabilities were calculated using the life-table
27 eyes from 18 patients met the criteria for inclusion, including no prior PRP, method. P values for the comparison of the
scans at the appropriate intervals using SD-OCT, and clarity of optical media to ranibizumab or triamcinolone groups with sham+prompt laser, adjusted for
permit adequate quality scans. Baseline scans were obtained before PRP, then at 1, baseline retinopathy severity level and baseline visual acuity, were computed using
3, and 6 months following. All patients were scanned using the Optovue RTVue proportional hazards regression. Results through 1 year are provided.
system and scans were analyzed to determine the total, inner or “ganglion cell Results: For eyes without PDR at baseline (N = 538), the cumulative probability
complex,” and outer retinal thickness; each measurement was taken at the fovea, with worsening was 10% (sham+prompt laser), 4% (ranibizumab+prompt laser, P
1.5mm (parafoveal) and 3mm (perifoveal) from the center. Additionally, charts = 0.04), 4% (ranibizumab+deferred laser, P = 0.06), and 4%
were reviewed to determine visual acuity, number of laser spots, years since (triamcinolone+prompt laser, P = 0.05). For eyes with PDR at baseline (N = 254),
diagnosis of diabetes, age, sex, race, and presence of CSME or glaucoma. the cumulative probability with worsening was 20% (laser), 9%
Results: Ages ranged from 35-75 years; the average age was 54. 89% were ranibizumab+prompt laser, P = 0.08), 2% (ranibizumab+deferred laser, P = 0.03),
African-American and 11% were Hispanic. The baseline average total central and 5% (triamcinolone+prompt laser, P<0.01).
foveal thickness was 282.96µ; this increased at the 1 month visit, then decreased at Conclusions: Intravitreal ranibizumab+prompt or deferred laser as well as
the 3 month (258.58µ) and 6 months visits (234.88µ; p=0.061). Total parafoveal intravitreal triamcinolone+prompt laser appear to reduce the risk of worsening of
thickness and perifoveal thickness did not change significantly. Average central diabetic retinopathy in eyes with NPDR or PDR. These results suggest that use of
inner retinal thickness decreased from a baseline 85.8µ to 71.3µ at 6 months these drugs to prevent worsening of diabetic retinopathy is worth further
(p=0.101). Average central outer retinal thickness decreased from 197.12 µ to investigation. Given the exploratory nature of these analyses, use of these
163.55 µ at 6 months (p=0.093). Patients with CSME showed a 12.7% decrease in treatments to reduce the probability of worsening of diabetic retinopathy is not
total thickness at 6 months, while patients without showed a 20.67% decrease in warranted at this time.
total thickness. Commercial Relationships: David G. Miller, Acuity, Allergan, Eli Lilly,
Conclusions: The inner and outer retinal layers both decrease in thickness over the Genentech (R)
6 months following PRP in a pattern that trends towards but does not meet Support: NEI and the NIDDK, NIH, Department of Health and Human Services
statistical significance. Interestingly, this trend is seen in patients both with and EY14231, EY14229, EY018817
without CSME, suggesting that the thinning effect is independent of resolution of Clinical Trial: http://www.clinicaltrials.gov, NCT00445003
concurrent macular edema.
Commercial Relationships: Joshua A. Morrison-Reyes, None; Sam Mansour,
Program Number: 367 Poster Board Number: D918
None; Lindsay Smithen, None
Presentation Time: 8:30 AM - 10:15 AM
Support: None
Navilas Panretinal Photocoagulation in Diabetic Retinopathy: A Case Series

Copyright 2012 by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. For permission to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2012 Annual Meeting Abstracts by Scientific Section/Group – Retina+ (RE)

Ken Y. Lin, Stephanie Lu. Ophthalmology, University of California, Irvine, Irvine, 5 injections of pegaptanib sodium. Fluorescein angiogram was carried out at
CA. baseline and at the final visit (week 30).The central retinal arteriolar (CRAE) and
Purpose: An interventional case-series to evaluate the comfort and clinical efficacy venular equivalence (CRVE) on baseline angiogram and at week 30 were measured
of the new panretinal Navilas photocoagulation in treating high-risk proliferative using a new software. In this software, the CRAE and CRVE can be calculated in
diabetic retinopathy (PDR). patients with only the temporal part of the optic disc included in the colour fundus
Methods: Thirty consecutive eyes of 30 patients with high-risk PDR were treated image and in fluorescein angiogram images. Student t-test was used.
with panretinal photocoagulation (PRP) using the Navilas photocoagulation system Results: Twenty seven patients have been recruited between January 2011 and
(532nm laser). Spot size, ablated area, uniformity of the laser spots, duration of November 2011. Sixteen patients have to be excluded from the study. 2 patients
treatment and patient comfort were assessed during the procedure. Regression of had received less than 3 injections, 3 patients had an early termination, 11 patients
neovascularization was evaluated at 3 months after the first laser procedure. had poor quality images in either eye on fluorescein angiogram examination. In
Results: In newly diagnosed PDR, eyes received an average of 1,590 laser spots many cases we managed to analyse the data in 3 out of 4 images but these were
(1,203-1,731) in 4 quadrants in one single session. The average power intensity excluded for this analysis. The mean CRAE unit were 5.07 (SD 1.22) and 5.04 (SD
used was 258mW at 30ms pulse duration using 300 microns spot size. Laser uptake 0.93) before and after treatment while the mean CRVE unit were 6.83 (SD 1.02)
was consistent across the quadrants. Average procedure time was 7 minutes when and 7.11 (SD 0.83) before and after treatment. There were no significant changes in
using the pattern scan mode. Visibility of the retina was superior under infrared CRAE (p=0.83) whilst CRVE is increased significantly (p=0.025). There were no
mode in eyes with vitreous hemorrhage. There were no complications during or significant changes in the untreated eye either on CRAE or CRVE. The mean
after the laser treatment. After 1 to 2 treatments, regression of neovascularization CRAE unit in the untreated group were 4.86 (SD 0.68) and 5.07 (SD 1.70) before
was observed in 100% of patients within 3 months after the initial treatment. and after treatment. The mean CRVE were 7.37 (SD 1.08) and 7.31 (SD 2.03)
Conclusions: Panretinal photocoagulation using Navilas is safe, well tolerated and before and after treatment. There was no significant change in the CRAE (p=0.72)
achieves a high rate of clinical efficacy measured by regression of PDR. Retina and CRVE (p=0.91) units in the untreated eyes.
visibility was better under infrared mode than the conventional color view. Laser Conclusions: This novel software appears to be able to measure retinal vascular
uptake was consistent across the retina and regression of neovascularization was changes reliably in an angiogram. We were able to demonstrate, pegaptanib, a
observed in 100% of the treated cases. selective anti-VEGF agent, has retinal venular dilatation effect. Our findings are in
Commercial Relationships: Ken Y. Lin, None; Stephanie Lu, None keeping with previous studies that showed retinal venular dilation after non-
Support: None selective anti-VEGF therapies.
Commercial Relationships: Rupal Morjaria, None; Magdalena SincZak,
None; Christine Kiire, None; Peter Bankhead, None; G. McGeown, None; T.
Program Number: 368 Poster Board Number: D919
Curtis, None; Victor Chong, None
Presentation Time: 8:30 AM - 10:15 AM
Support: University of Oxford, Pfizer
Combined Treatment of Proliferative Diabetic Retinopathy (PDR)
Clinical Trial: http://www.clinicaltrials.gov, NCT01175070
Evgeny Smirnov. Novosibirsk Affiliate, S N Fyodorov's Eye Microsurgery
Complex, Novosibirsk, Russian Federation.
Purpose: : To study the efficacy of the intravitreal injections of ranibizumab prior Program Number: 370 Poster Board Number: D921
to the vitrectomy in surgical treatment of PDR. Presentation Time: 8:30 AM - 10:15 AM
Methods: Study included 80 patients with PDR and clinically significant diabetic Pan-retinal Photocoagulation In High-risk Non-proliferative Diabetic
macular edema (DME) from type I or II diabetes mellitus, aged 54-68 years. Retinopathy
Baseline central retinal thickness (CRT) measured on Fourier-domain optical Cristos Ifantides, Barrett Eubanks, Daniel Taylor, Marc Peden. Ophthalmology,
coherent tomography (OCT) (RTVue, model RT-100, Optovue, Fremont, CA) was University of Florida, Gainesville, FL.
370-490µm. Visual acuity (VA) varied from 20/200 to 20/320. Subtotal 25-guage Purpose: The Early Treatment Diabetic Retinopathy Study has shown that PRP
vitrectomy (Constellation, Alcon, USA) was performed in all patients. When reduces the risk of severe visual loss in all stages of non-proliferative diabetic
required, surgery was concluded by silicon oil or air/gas or balanced salt solution retinopathy (NPDR). The absolute risk reduction in this group of all-comer NPDR
(BSS) tamponade of the vitreous cavity. Patients were randomly assigned to one of and the risk of deferring treatment, however, is small. Therefore, PRP treatment is
the two equal groups: group I received intravitreal injection of ranibizumab 0.5mg usually deferred until patients develop PDR. Our study’s aim was to examine
8-14 days prior the surgery, group II (control) was followed up without intravetreal whether PRP reduces the risk of adverse events in a subgroup of patients known as
injections. Morphological and functional outcomes of the treatments in groups I high-risk NPDR, as defined by capillary dropout on fluorescein angiography (FA).
and II were analyzed and compared to the baseline data at 6-month time point after Specifically, we investigated whether PRP treatment at this high-risk stage leads to
the surgery. improved outcomes measured as the lack of progression to PDR and vitreous
Results: At 6 months after the surgery, VA in the control group was 20/200-20/100 hemorrhage (VH).
(p=0.21), and CRT decreased by 50±20µm (p=0.041), whereas in the ranibizumab Methods: A retrospective chart review was performed at the University of Florida
group, VA improved to 20/50-20/30 (p <0.05), and CRT decreased by ophthalmology clinic. Included patients had a prior diagnosis of high risk NPDR
(Mean±St.D.) 110±70µm (p <0.05). Postoperative vitreous hemorrhages (in the confirmed with an FA identifying capillary-dropout, had no observation of
areas of new vessels) were observed in after BSS tamponade: in the control group neovascularization, had no prior history of having a PRP treatment, and went on to
hemorrhages developed in 27 patients (67.5%). In four of them (10%), additional have PRP treatment at our clinic. The patient’s fundus was examined for the
revisions of the vitreous cavity were performed to remove blood. In the rest 23 development of VH or PDR. Data was analyzed using the Kaplan-Meier estimator.
patients, hemorrhages resolved without treatment in 2-3 months. In the Incidence of conversion to PDR or VH was also calculated. Change in visual acuity
ranibizumab group, hemorrhages developed in 11 patients (27.5%) and resolved was measured using a paired t-test and LogMAR conversion of visual acuity on a
without treatment in 10-21 days. Snellen chart.
Conclusions: Intravitreal injections of ranibizumab performed prior to vitrectomy Results: A search of the University of Florida database for eyes treated for the first
for PDR and DME, significantly improve the efficacy of the vitrectomy, provide time with PRP for high-risk NPDR resulted in a total of 38 eyes in 23 patients.
regression of new vessels thus decreasing the incidence of postoperative Incidence of VH following PRP treatment was 10.4% at one year post-treatment.
hemorrhagic complications, and improve visual and morphological outcomes. Kaplan-Meier estimator resulted in 94.12% of patients without VH at six months
Commercial Relationships: Evgeny Smirnov, None and 90.35% at one year and two years. Incidence of conversion to PDR following
Support: None PRP treatment was 38.9% at one year post-treatment. Kaplan-Meier estimator
resulted in 82.35% of patients without PDR at six months, 67.65% at one year, and
30.07% at two years. Paired t-test used for visual acuity changes showed no
Program Number: 369 Poster Board Number: D920
significant difference in visual acuity at six months post-PRP treatment (p=0.206).
Presentation Time: 8:30 AM - 10:15 AM
Conclusions: Despite treatment with PRP at the high-risk stage of NPDR, there
Retinal Venular Calibre Dilatation After Intravitreal Pegaptanib For
was a significant amount of individuals who developed PDR within the year.
Ischaemic Diabetic Macula Edema Using A Novel Software
Rupal Morjaria1, Magdalena SincZak1, Christine Kiire1, Peter Bankhead2, G However, our incidence of VH at one year is substantially less than prior reports
McGeown2, T Curtis2, Victor Chong1. 1Ophthalmology, Oxford Hospitals NHS (8.28% vs. 37%, respectively). Earlier treatment at this threshold of disease is more
Trust, OXFORD, United Kingdom; 2Centre for Vision and Vascular Sciences, effective in mitigating VH than the convention of treating once retinopathy has
become proliferative. Furthermore, there was no significant adverse effect on
Queen's University of Belfasr, United Kingdom.
vision. Further investigation is warranted in this high-risk non-proliferative group
Purpose: To evaluate the retinal vascular changes in patients treated with
to determine whether PRP is beneficial in reducing adverse outcomes prior to
intravitreal pegaptanib compared to the untreated fellow eye using a novel
conversion to PDR.
software.
Commercial Relationships: Cristos Ifantides, None; Barrett Eubanks,
Methods: Patients with ischaemic diabetic macula edema resistant to treatment
None; Daniel Taylor, None; Marc Peden, None
with laser and / or intravitreal steroids have been recruited since January 2011.
Support: None
Patients were seen every 6 weeks for assessment and treatment, receiving a total of

Copyright 2012 by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. For permission to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2012 Annual Meeting Abstracts by Scientific Section/Group – Retina+ (RE)

Program Number: 371 Poster Board Number: D922 uniform across the retina, and not limited to the edematous areas. In other words,
Presentation Time: 8:30 AM - 10:15 AM regions which did and did not develop edema worsened at similar rates (0.67/0.50
Functional and Structural Cone Abnormalities in Adolescents with Type 1 IT Z-scores; 0.63/0.49 Amp Z-scores respectively).
Diabetes Conclusions: The early fundoscopic appearance of mild DME does not seem to
Wylie Tan1,2, Yaiza Garcia-Sanchez1, Laura Finkelberg1,2, Tom Wright1, Marsha result in significant changes in VA in this pilot group. CS was depressed before
Kisilak3, Melanie Campbell3, Carol Westall1,2. 1Ophthalmology and Vision DME developed and was not altered by DME onset. The mfERG neural function is
Sciences, The Hospital for Sick Children, Toronto, ON, Canada; 2Institute of locally abnormal in patients with DR before edema develops and continues to
Medical Science, University of Toronto, Toronto, ON, Canada; 3Department of worsen diffusely across the entire central retina (not only locally), as diabetic
Physics and Astronomy, School of Optometry and WIN, University of Waterloo, disease progresses.
Waterloo, ON, Canada. Commercial Relationships: Wendy W. Harrison, None; Marcus A. Bearse, Jr.,
Purpose: To identify biomarkers for Diabetic Retinopathy (DR) by examining the None; Glen Y. Ozawa, None; Marilyn E. Schneck, None; Kavita P. Dhamdhere,
structure and function of the cone photoreceptor system in adolescents with Type 1 None; Shirin Barez, None; Anthony J. Adams, None
Diabetes (T1D), no DR or mild nonproliferative DR (NPDR). Aims: 1) To identify Support: EY 02271
the retinal quadrants with greatest and least dysfunction using the multifocal
electroretinogram (mfERG). 2) To examine cone density in areas identified in Aim
Program Number: 373 Poster Board Number: D924
1 and other areas at similar eccentricities using Adaptive Optics Scanning Laser
Presentation Time: 8:30 AM - 10:15 AM
Ophthalmoscopy (AOSLO).
Electroretinogram Findings in Patients with Proliferative Diabetic
Methods: Patients with T1D, no DR or mild NPDR, and aged-matched controls
Retinopathy after Argon Laser Photocoagulation
were assessed for localized retinal function using the mfERG. The amplitude and
Sung E. Watanabe, Somaia Mitne, Luciana C. Noia, Adriana Berezovsky, Paula Y.
implicit time (IT) of the first order responses were averaged over 4 quadrants,
Sacai, Solange R. Salomao, Augusto Paranhos, Jr.. Ophthalmology, Federal
divided along the vertical and horizontal axes. Responses were compared between
University of Sao Paulo, Sao Paulo, Brazil.
patients and controls to identify the quadrants with greatest and least dysfunction.
Purpose: The Diabetic Retinopathy Study has shown that panretinal
A subset of these patients and controls underwent AOSLO imaging with a PSI
photocoagulation with argon laser reduce the risk of severe visual loss due to
multimodal AO instrument at 5° superior and 5° nasal and temporal. Images of the
proliferative diabetic retinopathy. Consequently some degree of functional retinal
cone mosaic (2°x2°) were used to compare cone densities between and within
impairment should be expected after panretinal laser photocoagulation. The
groups.
purpose of this study is to evaluate retinal function through full-field
Results: Fifty-three patients (16±2 years old) and 47 controls (17±3 years old)
electroretinogram (ERG) after panretinal argon photocoagulation in patients with
underwent mfERG testing. Quadrant (Q) amplitudes and IT were compared
proliferative diabetic retinopathy.
between patients and control using Student’s t-tests (p=0.0125 for multiple testing).
Methods: Nine patients (17 eyes, 7 males) aging from 39 to 63 (mean=55±7.6)
QIT in patients was delayed in the superior temporal (Q1, p=0.002), inferior
years with ischaemic diabetic retinopathy had retinal function evaluated by full-
temporal (Q3, p=0.005), and inferior nasal (Q4, p=0.003), but not in the superior
field ERG before and after 6 months panretinal laser photocoagulation treatment.
nasal (Q2, p=0.028). There were no significant differences in Q amplitudes
ERG was recorded according to the International Society for Clinical
between patients and controls. Ten patients and 7 controls underwent AOSLO
Electrophysiology of Vision standard protocol. Wilcoxon test was performed
imaging. Eleven images (5 controls, 6 patients) of the superior temporal and 8
between ERG responses before and after photocoagulation and random effects
images (3 controls, 5 patients) of the superior nasal cone mosaic were taken.
models were performed to account for the dependence between eyes of the same
Qualitative assessment identified that cone densities of patients were lower than
patient.
controls, with the greatest difference (significant at p=0.02) being a relative
Results: Statistically significant reduction in amplitude was found for rod response
reduction in the superior nasal location.
(p= 0.0000), maximal response (p=0.0000), oscillatory potentials (p= 0.0000), cone
Conclusions: Relative cone dysfunction was greatest in the superior temporal and
response (p=0.0000), and 30-Hz flicker response (p=0.0000) after panretinal
least in the superior nasal quadrant in patients with diabetes compared with
photocoagulation when compared to baseline ERG. No statistically significant
controls. Qualitative examination on the small number of patients and controls who
difference was found for rod latency (p=0.860) and b/a wave ratio (p=0.709), but
underwent structural assessments showed that patients had a reduction in cone
significantly delayed implicit time for cone response (p=0.0000). Greater amplitude
density at both the superior temporal and nasal quadrants, with a significant deficit
reductions were detected for rod response, maximal response and cone response.
in the nasal location.
Conclusions: Full-field ERG provided a sensitive measure of retinal function
Commercial Relationships: Wylie Tan, None; Yaiza Garcia-Sanchez,
impairment in patients with diabetic retinopathy treated with panretinal argon
None; Laura Finkelberg, None; Tom Wright, None; Marsha Kisilak, None;
photocoagulation. Despite the reduction in all ERG responses, the b/a-wave ratio
Melanie Campbell, . (P); Carol Westall, None
remained unchanged. These findings suggest that, the outer retina seems to be more
Support: CFI, NSERC, CIHR, CHRP, JDRF, VSRP, SickKids RESTRACOMP,
vulnerable to laser treatment in patients with diabetic retinopathy.
BBDC
Commercial Relationships: Sung E. Watanabe, None; Somaia Mitne,
None; Luciana C. Noia, None; Adriana Berezovsky, None; Paula Y. Sacai,
Program Number: 372 Poster Board Number: D923 None; Solange R. Salomao, None; Augusto Paranhos, Jr., None
Presentation Time: 8:30 AM - 10:15 AM Support: None
Retinal Function In Type 2 Diabetes Patients Who Develop Macular Edema:
A Longitudinal Pilot Study
Program Number: 374 Poster Board Number: D925
Wendy W. Harrison1,2, Marcus A. Bearse, Jr.2, Glen Y. Ozawa2, Marilyn E.
Presentation Time: 8:30 AM - 10:15 AM
Schneck2, Kavita P. Dhamdhere2, Shirin Barez2, Anthony J. Adams2. 1Arizona
Retinal Function In Patients With Isquemic Diabetic Retinopathy Using Full-
College of Optometry, Midwestern University, Glendale, AZ; 2School of
field Electroretinogram
Optometry, University of California Berkeley, Berkeley, CA.
Mariana A. Coelho, Sung E. Watanabe, Somaia Mitne, Luciana C. Noia, Adriana
Purpose: We have shown that the mfERG, along with other health factors, is a
Berezovsky, Augusto Paranhos, Jr.. Ophthalmology, Federal University of Sao
sensitive predictor of diabetic edema (DE) in an at-risk patient group. However, it
Paulo, Sao Paulo, Brazil.
is unclear how these factors change as diabetic macular edema (DME) develops. In
Purpose: Evaluate full-field electroretinogram findings in patients with isquemic
this pilot study, we examine changes in retinal and visual function in a group of
diabetic retinopathy and correlate with visual prognosis
type 2 diabetes patients before and after DME development.
Methods: A group of 30 patients with pre-proliferative and proliferative diabetic
Methods: A small high-risk group of type 2 diabetes patients (one eye each, n=7;
retinopathy without previous photocoagulation had retinal function evaluated by
aged 55.2 ± 9.3 years) was followed every 6-12 months until DME developed. All
full-field electroretinography according to the International Society for Clinical
had high HbA1c (10.4 ± 2.4%) and long disease duration (14.5 ± 6.6 years). All
Electrophysiology of Vision standard protocol. The responses analyzed were:
had diabetic retinopathy (DR) and no DME at the first visit (v1); all eyes had DME
scotopic rod response, scotopic maximal response, scotopic response for oscillatory
onset at the second visit (v2). mfERG, (VERIS 5.2) , blood pressure (BP), fundus
potentials, photopic single-flash response and photopic 30Hz flicker for cone
photos, visual acuity (VA), contrast sensitivity (CS), and HbA1c were obtained on
response.
all patients at both visits. mfERG implicit times (IT) and amplitudes (Amp) were
Results: 30 eyes of diabetic retinopathy group and 20 eyes of subjects without
normalized to Z-scores based on 52 controls, and grouped into 35 zones.
diabetes were randomly selected. Mean age of diabetic retinopathy group (± 1 SD)
Differences between v1 and v2 were evaluated.
was 53.56 ± 9.91 years. The mean time of the diagnosis of diabetes was 13.96
Results: VA, CS, and HbA1c remained unchanged from v1 to v2 (p =0.30; 0.33;
years. Mean values amplitude for rod response was 184.23 ± 62.29 µV, 322.47 ±
and 0.47 respectively). VA was good for all patients (95 ± 6 letters; 20/25) but CS,
93.76 µV for maximal response; 59.02 ± 38.04 µV for oscillatory potentials; 84.15
although unchanged, was reduced (1.46 ± 0.12 log CS) at both visits. BP improved
± 38.19 µV for single-flash cone response and 59.43 ± 23.55 µV for light adapted
v1 to v2 (141/83 to 128/75; p<0.02). Three eyes had retinopathy that clinically
30 Hz flicker response. Mean values b-wave implicit time was 97.48 ± 11.02 ms
worsened between visits. Overall, IT became more delayed from v1 to v2 (p <0.05)
for rod response; 35.81 ± 6.02 ms for single-flash cone response and 36.18 ± 6.39
and Amp trended toward decreasing (p = 0.08). These mfERG changes were

Copyright 2012 by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. For permission to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2012 Annual Meeting Abstracts by Scientific Section/Group – Retina+ (RE)

ms for 30 Hz flicker response. No statistically difference was found between the Purpose: In patients with diabetic retinopathy, panretinal photocoagulation (PRP)
groups for rod response, maximal response, cone response and amplitude of light is performed to treat retinal ischemia. PRP, however, causes a reduction of blood
adapted 30 Hz flicker response by gender. Statistically significant difference (p- flow, which is an undesirable side effect. A pattern scan laser (PSL) uses a shorter
value < 0,001) was found between the diabetic retinopathy group and the normal pulse duration of spots which reduces collateral damage and thus the adverse
group in oscillatory potentials and also b-waves implicit times for rod response, effects of PRP. This study compares retinal blood flow and visual function in
cone response and flicker response. Diabetic patients with more severe condition, severe diabetic retinopathy following PRP using either a PSL or a conventional
as vitreous hemorrhage and tractional retinal detachment (5 patients) had lower laser (CVL).
responses for oscillatory potentials (4 patients), maximal response (4 patients) and Methods: Ten patients with diabetic retinopathy in both eyes underwent PRP using
cone response (5 patients) when comparing to normal group. a PSL (2 sessions/ ≈3000 spots) in one eye, and PRP using a CVL (3 sessions/
Conclusions: The oscillatory potentials derive from the inner plexiform layers ≈2000 spots) in the other eye. Retinal blood flow was assessed with mean blur rate
involving bipolar cells, amacrine cells and ganglion cells which are also involved in (MBR) measured by laser speckle flowgraphy of the optic disc once a month for 6
the physiopathology of the diabetic retinopathy. These findings suggest that months. Central macular thickness (CMT) measured by optical coherence
changes in the oscillatory potentials and b-waves implicit times in the diabetic tomography and best-corrected visual acuity (VA) using a logMAR chart was also
retinopathy may be the first sign of injury of the retina in this disease. Furthermore, evaluated.
an increased degree of loss in amplitude of oscillatory potentials may be a Results: MBR was decreased during PRP in both the eyes treated with a PSL
distinctive feature of diabetic retinopathy with poor visual prognosis. (73.2±6.9%) and the eyes treated with a CVL (71.5±8.0%). There was no
Commercial Relationships: Mariana A. Coelho, None; Sung E. Watanabe, significant difference between the two groups. After completion of PRP, the MBR
None; Somaia Mitne, None; Luciana C. Noia, None; Adriana Berezovsky, in the eyes treated with a PSL improved and was 89.4±8.3% at 6 months. The MBR
None; Augusto Paranhos, Jr., None in the eyes treated with a CVL was unchanged (70.3±9.6% at 6 months: p<0.01).
Support: None Both CMT and VA in the eyes treated with a PSL were unchanged during the
clinical course, while those parameters in the eyes treated with a CVL worsened
over time.
Program Number: 375 Poster Board Number: D926
Conclusions: Compared to a CVL, PRP with a PSL resulted in rapid recovery of
Presentation Time: 8:30 AM - 10:15 AM
blood retinal flow after the completion of PRP, and had less influence on macular
Electroretinographic Findings in Intravitreal Ranibizumab Association to
function in patients with severe diabetic retinopathy.
Photocoagulation for High-Risk Proliferative Diabetic Retinopathy
Joaquim R. Valle1, Andre Messias2A, José A. Ramos1, Felipe P. Almeida2A, Ingrid Commercial Relationships: Sho Watarai, None; Shinji Onodera,
U. Scott3, Rogerio A. Costa4, Florian Gekeler5, Rodrigo Jorge2B, Katharina S. None; Kanako Yasuda, None; Masayuki Yasuda, None; Toru Nakazawa,
Messias2A. 1Ophthalmology, Ribeirao Preto Med Sch-U Sao Paulo, Ribeirao Preto, None; Masahiko Shimura, None
Brazil; AOphthalmology, BOphthalmology, Ribeirao Preto Med Sch, 2University of Support: None
Sao Paulo, Ribeirao Preto, Brazil; 3Ophthalmology & Public Health Sciences, Penn
State College of Medicine, Hershey, PA; 4Division of Macula: Imaging & Program Number: 377 Poster Board Number: D928
Treatment, Centro Brasileiro de Ciencias Visuais, Belo Horizonte, Brazil; 5Centre Presentation Time: 8:30 AM - 10:15 AM
for Ophthalmology, Tuebingen Univ Eye Hosp, Tuebingen, Germany. Are Proliferative Diabetic Retinopathy and Diabetic Macular Edema two
Purpose: To evaluate retinal function after panretinal photocoagulation (PRP) different disease processes? A Retrospective Cross-sectional Study
compared to PRP plus intravitreal injection of ranibizumab (IVR) in patients with Amar J. Patel1, Kenny Downes1, Alex Davis1, Arup Das1A. ADivision of
high-risk proliferative diabetic retinopathy (PDR) by means of electroretinography Ophthalmology, 1University of New Mexico School of Medicine, Albuquerque,
(ERG). NM.
Methods: In a prospective study, patients with high-risk PDR and no prior laser Purpose: To evaluate whether diabetic macular edema (DME) and proliferative
treatment were randomly assigned to receive PRP (PRP group; n=9) or PRP plus diabetic retinopathy (PDR) could represent two distinct clinical-pathological
IVR (PRPplus group; n=11).PRP was administered in two sessions (weeks 0 and entities, or occur concurrently along the same spectrum of disease.
2), and IVR was administered at the end of the first laser session in the PRPplus Methods: The study is a retrospective cross sectional review of patients presenting
group. Standardized ophthalmic evaluations including (ETDRS) best-corrected with PDR associated vitreous hemorrhage that were treated with either pan-retinal
visual acuity (BCVA), and fluorescein angiographyto measure area of fluorescein photocoagulation (PRP), or pars plana vitrectomy (PPV) with endolaser. The
leakage (FLA), were performed at baseline and at weeks 16 (±2), 32 (±2) and 48 presence or absence of macular edema was reviewed within 3-6 months of patient
(±2). ERG was measured according to ISCEV standard at baseline and at week 48 presentation with vitreous hemorrhage in order to allow for a clear assessment of
(±2). the macular status post intervention. The stereoscopic biomicroscopic fundus
Results: After 48 weeks, 2400 to 3000 laser spots were made in eyes from PRP examination was completed with the OCT exam (central retinal thickness > 250
group, while only 1400 to 1800 spots were necessary in PRPplus.There was a um) to grade diabetic macular edema. An analysis was done to examine the
statistically significant (p<0.05) FLA reduction at all study visitsin both groups, relationship of DME with risk factors like HbA1C, lipid panel, and systolic blood
with the reduction observed in the PRPplus group significantlylarger than that in pressure.
the PRP group at week 48. ROD b-wave amplitude was significantly reduced to 46 Results: A total of 263 patients were identified with active PDR associated
± 5 %(P<0.05) of baseline in the PRP group; and to 64 ± 6 %(P<0.05) in PRPplus. vitreous hemorrhage over the last six years with 124 undergoing PRP in clinic and
This reduction was significantly higher in PRP than in PRPplus (P=0.024; t-Test). 139 undergoing PPV with endolaser. Patients who had undergone recent PRP
The same was observed for SF amplitude: PRP: 45 ± 4 % and PRPplus: 62 ± 5 %; within the last 6 months were excluded. Of the 124 patients who underwent PRP in
also showing higher reduction in PRP than in PRPplus (P=0.0094). SF a-wave, OP, clinic, the incidence of concurrent macular edema was 28%. Of the 139 patients
CONE and 30 Hz showed statistically significant within group reductions, but no who underwent PPV with endolaser, the incidence of concurrent macular edema
differences in between group analyses. was 13%. The results show 53 of the patients (20%) had diabetic macular edema
Conclusions: These results suggest that treating high risk PDR with PRP plus IVR and active PDR concurrently. The majority (80%) of patients with active PDR did
is effective for proliferative retinopathy control, and allow the use of less extensive not have exudative changes like CSME, indicating that PDR may be a different
PRP, which induces less retinal functional loss, in particular for rod-driven post- disease process.
receptoral responses, than treatment with PRP alone. Conclusions: This data showed that the majority of diabetic patients with active
Commercial Relationships: Joaquim R. Valle, None; Andre Messias, retinal neovascularization (PDR) had little or no exudative changes in the macula.
None; José A. Ramos, None; Felipe P. Almeida, None; Ingrid U. Scott, In spite of the high VEGF levels expected in these patients, there was absence of
None; Rogerio A. Costa, None; Florian Gekeler, None; Rodrigo Jorge, macular edema in the majority of patients. It is possible that patients with diabetes
None; Katharina S. Messias, None go through phases of non-proliferative diabetic retinopathy, and then follow either
Support: None of two clinical pathways: predominantly exudative process (DME), or
Clinical Trial: http://www.clinicaltrials.gov, NCT00993525 predominatly proliferative process (PDR). These findings indicate that PDR and
DME could be two different disease processes driven by different molecular
mediators or genetic factors.
Program Number: 376 Poster Board Number: D927
Commercial Relationships: Amar J. Patel, None; Kenny Downes, None; Alex
Presentation Time: 8:30 AM - 10:15 AM
Davis, None; Arup Das, None
Comparison Of Blood Retinal Flow In Severe Diabetic Retinopathy Treated
Support: NEI RO1 12604
With Panretinal Photocoagulation Performed With A Pattern Scan Laser
Versus A Conventional Laser
Sho Watarai1, Shinji Onodera1, Kanako Yasuda1, Masayuki Yasuda2, Toru
Nakazawa2, Masahiko Shimura1. 1Department of Opthalmology, NTT East Japan
Tohoku Hospital, Sendai, Japan; 2Ophthalmology, Tohoku Univ Grad School of
Med, Aoba-ku, Japan.

Copyright 2012 by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. For permission to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2012 Annual Meeting Abstracts by Scientific Section/Group – Retina+ (RE)

112 Diabetic Macular Edema-Clinical Research I Conclusions: A novel grading protocol for diabetic macular edema based on 2
Sunday, May 6, 2012, 8:30 AM - 10:15 AM imaging techniques was generated allowing for an exact description of the amount
Hall B/C Poster Session of alteration secondary to diabetic vasculopathy. As the main focus was to indicate
Program #/Board # Range: 378-419/D929-D970 a possible treatment decision, this grading protocol could be used in a clinical
Organizing Section: Retina+ setting, as well as for further specifying inclusion criteria or evaluating a treatment
response in a clinical trial.
Commercial Relationships: Matthias Bolz, None; Jan Lammer,
Program Number: 378 Poster Board Number: D929
None; Christoph Mitsch, None; Christoph D. Scholda, None; Ursula Schmidt-
Presentation Time: 8:30 AM - 10:15 AM
Erfurth, None
Observational Study of Worsening To Center- Involved Macular Edema
Support: None
Following Cataract Surgery in a Cohort with Diabetic Retinopathy
Timothy J. Murtha, Diabetic Retinopathy Clinical Research Network. Beetham Eye
Inst, Joslin Diabetes Center, Natick, MA. Program Number: 380 Poster Board Number: D931
Purpose: To estimate the incidence of center-involved macular edema (ME) at 16 Presentation Time: 8:30 AM - 10:15 AM
weeks following cataract surgery in eyes with diabetic retinopathy and no definite Evaluation Of Macular Ischemia In Diabetic Macular Edema
center involved diabetic macular edema pre-operatively. Secondary analyses Alexandros Deligiannidis1, Jose Lorenzo Carrero2. 1CHUVI Vigo, vigo, Spain;
included visual acuity (VA) and assessment of baseline risk factors. 2Povisa Hospital, Vigo, Spain.
Methods: Multi-center, prospective, observational study of eyes with OCT central Purpose: To evaluate the relationship between the macular ischemia and the visual
subfield (CSF) thickness<250 um time domain (TD) or <310 um SD who had acuity in patients with diabetic macular edema.
diabetic retinopathy and underwent cataract surgery < 28 days after enrollment. Methods: Sixty-two eyes from 37 patients diagnosed of diabetic macular edema
The primary outcome was worsening to central-involved ME at 16 weeks, defined and with transparent media were included in the study. A comprehensive
as CSF thickness of >250 um TD or > 310 um SD with > 1-step increase in the ophthalmologic examination was carried out. All patients underwent a digital high
logOCT thickness compared to baseline, or > 2-step increase in the logOCT CSF resolution fluorescein angiography with a non-flash blue laser (488nm) confocal
thickness from baseline or receiving treatment (other than eye drops) for ME prior ophthalmoscope (SPECTRALIS HRA2+OCT). Consecutively, a Spectral-Domain
to 16 weeks on the basis of the above criteria. Protocol refraction, best corrected E- OCT with active eye tracking was performed. The OCT data obtained included
ETDRS VA, fundus exam, and OCT were performed at all study visits. foveal thickness, macular volume and the disruption of the foveal photoreceptor
Results: Two hundred seventy six eyes were eligible for analysis (median age layer. The ischemia was quantified with a computer-assisted image analysis
65yrs, median VA letter score 70 [approximate Snellen equivalent 20/40], and 42% software. Data from one eye of each patient were assessed with Pearson and
had a history of treatment for DME). At 16 weeks post-op, preliminary results Spearman correlation analysis.
show 30 eyes (11%) worsened to central-involved ME (95% CI 7-15%). Twenty- Results: Visual acuity was correlated significantly only with the disruption of the
three eyes (8%) received post-op ME treatment other than eye drops; of these, 7 did foveal photoreceptor layer (P = ,022, r= - 0,397). The macular ischemia was
not worsen to central-involved ME. At 16 weeks, 216 eyes (78%) achieved 20/40 strongly correlated with the disruption of the foveal photoreceptor layer (P = ,013, r
or better VA. Of the 30 eyes that developed central-involved ME, 14 eyes (47%) = 0,428), but not with the macular volume, nor with the foveal thickness.
achieved 20/40 or better VA. Among baseline factors evaluated, history of DME Conclusions: The macular ischemia was positively correlated with the disruption
treatment (P<0.001), showed possible association with the primary outcome. of the foveal photoreceptor layer, independently of the macular volume or the
Conclusions: Sixteen weeks after cataract surgery for eyes with diabetic foveal thickness.
retinopathy but no definite center-involved edema, 7% to 15% will worsen to Commercial Relationships: Alexandros Deligiannidis, None; Jose Lorenzo
central-involved edema. To our knowledge, it is unknown at this time how many Carrero, None
similarly followed eyes without diabetes or diabetic retinopathy will worsen to Support: None
center-involved edema. Going forward, research may clarify which individuals
with diabetes are at highest risk for central-involved ME and whether treatments
Program Number: 381 Poster Board Number: D932
might mitigate vision loss associated with development of central-involved ME
Presentation Time: 8:30 AM - 10:15 AM
after cataract surgery.
Perifoveal Vascular Leakage In Patients With Diabetic Retinopathy Observed
Commercial Relationships: Timothy J. Murtha, None
With Spectral Domain Optical Coherence Tomography
Support: NEI, NIDDK, NIH, Department of Health and Human Services Christoph Mitsch1, Matthias Bolz1, Jan Lammer2, Christoph Scholda1, Ursula
EY14231, EY14229, EY018817 Schmidt-Erfurth1, Diabetic Retinopathy Research Group (DRRG) Vienna. 1Dpt. of
Ophthalmology and Optometrics, Medical University of Vienna, Vienna, Austria;
Program Number: 379 Poster Board Number: D930 2Dpt. of Ophthalmology and Optometrics, Medical University Vienna, Vienna,
Presentation Time: 8:30 AM - 10:15 AM Austria.
Evaluating A New Clinical Grading Protocol For Diabetic Macular Edema Purpose: Fluorescence Angiography (FA) remains the method of choice for the
Matthias Bolz, Jan Lammer, Christoph Mitsch, Christoph D. Scholda, Ursula diagnosis and follow-up of a broad spectrum of retinal vascular abnormalities
Schmidt-Erfurth, Diabetic Retinopathy Research Group Vienna. Department of secondary to diabetes mellitus. Recently, our group showed distinct leakage
Ophthalmology, Medical University of Vienna, Vienna, Austria. patterns observable in patients with diabetic macular edema as seen in spectral
Purpose: Apart from laser treatment, several new therapeutic agents have been domain optical coherence tomography (SD-OCT). We now want to describe
developed for the treatment of diabetic macular edema (DME) in the recent years. alterations to the retinal architecture associated with perifoveal vascular leakage.
However, it is not clear how the information originating from clinical trials can be Methods: 20 consecutive patients with diabetic retinopathy secondary to diabetes
used for a treatment decision in an individual case of diabetic macular edema in mellitus type 2 were examined using the FA+OCT mode of the (Heidelberg
daily clinical routine and if there are differences in the treatment response Engineering Spectralis HRA+OCT) during one same-day examination. FA images
according to specific morphologic alteration. For this reason, a new grading system were then analyzed for diffuse, hyperfluorescent areas surrounding retinal vessels
for DME was defined. and microaneurysms and the corresponding areas on the SD-OCT scans were
Methods: 110 eyes showing DME were examined using 2 different spectral observed using the Heidelberg Engineering Eye Explorer Software.
domain optical coherence tomography (SD OCT) devices (Cirrus©, Carl Zeiss Results: In all cases, structural alterations could be detected in the SD-OCT scans
Meditec, and Spectralis OCT©, Heidelberg Engineering) and by performing a corresponding to locations of diffuse hyper-fluorescence in FA representing
fluorescence angiography (FA) of the central and peripheral retina (Spectralis vascular leakage. SD-OCT images showed different stages of patho-morphological
HRA, Heidelberg Engineering). Results were evaluated for characteristic imaging changes including mild signal dispersals of the SD-OCT signal or very small cystic
findings that influence the treatment decision in a clinical setting, and based on spaces confined to the retinal inner nuclear layer (INL), cystic spaces and diffuse
these findings a grading protocol was generated. In the next step, all OCT and FA SD-OCT signal dispersal in the outer nuclear layer (ONL) and cystic spaces
images were evaluated by 3 blinded readers in order to evaluate the repeatability of throughout all retinal layers. Interestingly, all locations with significant retinal
the generated grading system. thickening showed alterations in the outer nuclear layer, whereas significantly less
Results: Giving respect to possible treatment decisions, the evaluation of the OCT retinal thickening was measured at locations with changes confined to the inner
and FA images revealed 4 types of diabetic macular edema: Edema secondary to retinal layers.
vitreoretinal traction, focal or generalized edema in OCT secondary to focal Conclusions: Perifoveal vascular leakage causes morphological alterations
leakage in FA, generalized edema in OCT secondary to generalized leakage in FA, observable in spectral domain optical coherence tomography. The detected changes
generalized or focal edema in combination with central or peripheral ischemia. ranged from mild signal dispersal and cystic spaces confined to the INL to signal
Each of these edema types was further specified by characteristic morphologic dispersal and cystic spaces in the INL and ONL, the latter case being more
details. The generated grading protocol allowed for precise description of the commonly associated with local edema in the affected retinal area.
individual amount of retinal alteration showing a significant inter-observer Commercial Relationships: Christoph Mitsch, None; Matthias Bolz, None; Jan
reproducibility between the 3 blinded readers. Lammer, None; Christoph Scholda, None; Ursula Schmidt-Erfurth, None

Copyright 2012 by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. For permission to reproduce any abstract, contact the ARVO Office at [email protected].