ORIGINAL ARTICLE

QUANTITATIVE AND QUALITATIVE ASSESSMENT OF DIABETIC RETINOPATHY AFTER LASER TREATMENT Anukul Dixit1,*, Ishan Yadav2, Rajendra P Maurya3, M. K. Singh4, S. K. Singh5 1Ex- Resident, 2Senior Resident, 3Assistant professor, 4Professor, Dept. of Ophthalmology, 5Professor, Dept. of Endocrinology, Institute of Medical Sciences, BHU, Varanasi

*Corresponding Author: E-mail: [email protected] ABSTRACT Aim: To investigate the visual and tomographic changes in patients undergoing pan retinal photocoagulation (PRP) for proliferative diabetic retinopathy (PDR) with or without clinically significant macular edema (CSME). Methods: This was a prospective, interventional clinical trial including 78 eyes of 78 patients suffering from diabetic retinopathy (DR). All patients were divided into three groups based on the severity of diabetic retinopathy and presence of clinically significant macular edema (CSME). Laser was administered as per the ETDRS standards. Visual acuity (VA), Central macular thickness (CMT), HbA1c and other parameters recorded pre and post laser. Results: Mean BCVA decreases from 0.24 to 0.33 at one month (p0.05) after 4 months in group 1. In group 2 mean BCVA improved from 0.57 to 0.44 at one month (p0.05). Mean CMT in group one increased from 235µ to 277µ (p0.05). From group 2 mean CMT decreased from 379µ to 325µ at one month (p0.05). Conclusion: Laser photocoagulation still remains the gold standard treatment modality in cases of proliferative diabetic retinopathy (PDR) and in treatment of CSME. Keywords: Pan retinal photocoagulation, proliferative diabetic retinopathy, clinically significant macular edema, Central macular thickness.

INTRODUCTION According to the latest World Health Organization (WHO) report, India has 31.7 million diabetic subjects, which is expected to increase to 79.4 million by 20301. It is estimated that Diabetic Retinopathy (DR) develops in more than 75% of diabetic patients within 15 to 20 years of diagnosis of diabetes1-3. In last two decades since the completion of ETDRS, there have been drastic changes in both diagnosis and treatment for diabetic retinopathy patients. Traditional methods of evaluating macular thickening, including slit-lamp examination and stereo fundus photography, are relatively insensitive to small changes in retinal thickness. Optical coherence tomography (OCT) has emerged as a very sensitive tool for imaging macular edema both quantitatively and qualitatively5,6. Aim of this study was to investigate the visual and tomographic changes in patients undergoing PRP for PDR with or

without clinically significant macular edema (CSME). MATERIAL AND METHODS This prospective study was conducted at Department of Ophthalmology, Sir Sunderlal Hospital, Institute of Medical Sciences from June 2011 to August 2013. A total number of 120 patients were screened and examined out of which 78 eyes of 78 patients were selected for the study. Inclusion criteria were high risk PDR cases with or without CSME and non-proliferative diabetic retinopathy (NPDR) with CSME. Patients with corneal opacity, cataract, uveitis, glaucoma, aphakia, and poor visual acuity due to any other cause were excluded from the study. All patients were divided into three groups: Group (I) PDR with High risk without CSME: requiring Pan retinal photocoagulation; Group (II) NPDR/PDR without High risk, with CSME: requiring

Indian Journal of Clinical and Experimental Ophthalmology, January – March 2015;1(1):14-21

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Quantitative And Qualitative Assessment Of Diabetic Retinopathy After Laser…

Grid laser; Group (III) PDR with High risk with CSME: requiring Grid laser followed by PRP. All these patients underwent detailed history and physical examination. Data regarding patient’s age, gender, duration of diabetes mellitus, age at onset of diabetes mellitus, presence or absence of hypertension, use of insulin or oral hypoglycaemic agents, presence of other systemic diabetic complications and other general illnesses were collected. All patients underwent examination for measurement of Blood pressure, glycated haemoglobin (HbA1c), fasting and post

prandial blood sugar level. Ocular examination included assessment of best corrected visual acuity (BCVA) using a Snellen Visual Acuity chart which was converted to logarithm of minimum angle or resolution (LogMAR) unit, slit-lamp biomicroscopy, applanation tonometry, indirect ophthalmoscopy. Fundus fluorescein angiography (FF450) and OCT (Cirrus HD OCT) were carried out for all patients before and after PRP [Figure 1]. OCT and BCVA was done before and one month, and four months after PRP.

Fig. 1: FFA showing capillary leakage and multiple micro aneurysms around posterior pole. For quantitative estimation of central macular thickness, a macular cube scan was done using Cirrus HD OCT. A HD 5-line raster scan was done to study the morphological characteristics of macular edema and macular edema was divided into diffuse thickening (DT), cystoid macular edema (CME), and sub retinal fluid (SRF).

to compare pre and post visual acuity and central foveal thickness while Pearson coefficient test was used to find correlation between HbA1c and post laser visual acuity and central foveal thickness. P-value