الفهرس 
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Abstract
P
roliferative diabetic retinopathy (PDR) is a huge sight threatening problem which could expose half of the patients with high risk PDR to be legally blind within 5 years without treatment. PRP was established as an effective treatment to high risk PDR. DRS found reduction in the incidence of severe vision loss by 50% after PRP.
PRP has many complications such as decrease in the VA, worsening of the VF and color vision, macular edema, epiretinal membrane, vitreous hemorrhage and retinal detachment which make alternative treatment more desirable.
Anti VEGF showed promising results .The DRCR network found that ranibizumab 0.5 mg was non-inferior to PRP after 2 years follow up as VA and VF were worse in the PRP group, vitrectomy and diabetic macular edema development were more frequent in the PRP group. Eyes without active neovascularization after 2 years follow up were not significantly different between the two groups.
RPC form a vascular network in nerve fiber layer (RNFL). RPC density decreases with increased diabetic retinopathy severity and was correlated with VA,VF change, retinal nerve fiber layer (RNFL) thickness, and it could have a great role especially if macular edema present, which leads to automatic segmentation error, misidentification of retinal layers and macular vessel density measurement error in comparison to healthy eyes .
The primary aim of this study was to assess and compare RBC density between PRP and ranibizumab.
The secondary aim was to compare BCVA, CFT, OCTA macular and optic disc parameters, neovascularization on the disc (NVD) area (NVA) and flow (NVFA) and VF between PRP and ranibizumab.
This is prospective randomized control trial that was conducted at the Ophthalmology Department, Ain Shams university hospitals. Study subjects were selected from patients attending the ophthalmology outpatient clinics at Ain Shams university hospitals during the recruitment period, which took place between June 2019 and June 2022. A consecutive sample of 50 eyes with PDR were enrolled and they were randomized in 2 groups. One group had undergone PRP in 2 sessions 2 weeks apart and the other one had undergone ranibizumab intravitreal injection 0.5 mg 3 injections for 3 consecutive months.
Patients more than 18 years with high risk PDR and with clear media were included. Patients with media opacity, previous PRP or AntiVEGF, glaucoma, TRD, any retinal or optic nerve diseases rather than diabetic retinopathy and with Poor quality OCT images were excluded.
Included patients underwent full ophthalmic history taking, examination that include BCVA, IOP, slit lamp examination and fundus examination , HBA1C ,OCTA and VF at baseline.
The patients were followed up monthly after the last laser session and the 1st ranibizumab injection for 3 months. The patients had full examination and OCTA at every visit and VF in the last follow up point.
This clinical trial figured that the RPC density and whole image optic disc density increased in the ranibizumab group and decreased in the PRP group in the 1st, 2nd and 3rd months
The study showed also better visual acuity outcome in the ranibizumab group that could be correlated to increase optic disc perfusion or decrease CFT.
The study results revealed also decreased CFT in the ranibizumab group and increased CFT in the PRP group in 1st, 2nd and 3rd months.
The study showed that there was a non-significant statistical difference regarding NVA, NVFA, MD, PSD and FAZ area between the 2 groups.
Regarding macular vessel density, there was statistically significant difference between the PRP group and the ranibizumab group regarding change in parafoveal macular density and foveal density in the DCP and perifoveal macular density in the SCP at 1st month in comparison to baseline as they decreased more in the PRP group in comparison to ranibizumab that might be due to post PRP inflammation. The difference disappeared in the 2nd and 3rd month the change became non-significant between the 2 groups.
CONCLUSION
I
ntravitreal ranibizumab showed a significant improving effect on radial peripapillary capillary density (optic nerve perfusion) ,better BCVA and less CFT in comparison to PRP in PDR patients after 3 months follow up period.