J Korean Ophthalmol Soc.  2013 Sep;54(9):1445-1451.

Two Cases of Long-Term Changes in the Retinal Nerve Fiber Layer Thickness after Intravitreal Bevacizumab for Diabetic Papillopathy

• Kim JJ
• Im JC
• Shin JP
• Kim IT
• Park DH

Abstract

PURPOSE
To report long-term changes in the average retinal nerve fiber layer (RNFL) thickness in 2 patients who had intravitreal bevacizumab (IVB) injection for diabetic papillopathy.
CASE SUMMARY
A 36-year-old patient with diabetes complained of decreased visual acuity (20/200) in the right eye. The fundus examination showed optic disc swelling in both eyes. The average RNFL thickness based on optical coherence tomography (OCT) increased to 278 microm and Goldmann perimetry showed nasal visual field defect in the right eye. The IVB was injected into the right eye. Three weeks after the IVB injection, RNFL thickness decreased to 135 microm and visual acuity improved to 20/25 in the right eye. However, RNFL thickness increased from 126 to 207 microm and visual acuity decreased to 20/32 in the left eye. Thus, IVB was injected into the left eye. In week 3, RNFL thickness decreased to 147 microm and visual acuity improved to 20/20 in the left eye. At 12 months after IVB injection, RNFL thickness was 87 microm in the right eye and 109 microm in the left eye. A 57-year-old patient with diabetes complained of decreased visual acuity (20/200) and showed optic disc swelling in the right eye. The average RNFL thickness increased to 252 microm and Goldmann perimetry showed an enlarged blind spot in the right eye. IVB was injected into the right eye. After 3 weeks, RNFL thickness decreased to 136 microm and visual acuity improved to 20/70 in the right eye. Six months after IVB injection, RNFL thickness was 83 microm in the right eye.
CONCLUSIONS
Visual acuity progressively improved within 3 weeks and RNFL thickness measured by spectral domain OCT showed progressive thickness reduction in 2 cases of diabetic papillopathy patients who had IVB injections.

Keyword

Bevacizumab; Diabetic papillopathy; Diabetic retinopathy; Retinal nerve fiber layer thickness

MeSH Terms

Adult
Antibodies, Monoclonal, Humanized
Diabetic Retinopathy
Eye
Humans
Middle Aged
Nerve Fibers
Optic Disk
Retinaldehyde
Tomography, Optical Coherence
Visual Acuity
Visual Field Tests
Visual Fields
Bevacizumab
Antibodies, Monoclonal, Humanized
Retinaldehyde

Figure

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  Figure 1. (Case 1) (A) The fundus examination showed hyperemic optic disc swelling with peripapillary flame-shap-ed hemorrhage and superficial, radially oriented, and dilated telangiectatic vessels in the right eye. Inferior focal swelling and peripapillary flame-shaped hemorrhage was shown in the left eye. (B) Fluorescein angiography showed late leakage from telangiectatic vessels on both discs, which was more in the right eye. (C) Goldmann perimetry showed nasal visual field defects in the right eye and normal findings in the left eye.

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  Figure 2. (Case 1) (A) At 3 weeks after intravitreal bevacizumab (IVB) injection, the fundus examination showed marked improvement in optic disc swelling in the right eye and aggravated hyperemic optic disc swelling with peri-papillary flame-shaped hemorrhage in the left eye. (B) 3 weeks after IVB injection, late leakage of fluorescein de-creased markedly in the right eye and increased markedly in the left eye.

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  Figure 3. (Case 2) (A) The fundus examination showed non-proliferative diabetic retinopathy findings in both eyes. Hyperemic optic disc swelling and superficial, radially oriented, and dilated telangiectatic vessels were noted in the right eye. (B) Fluorescein angiography showed late leakage from telangiectatic vessels on the disc in the right eye and multiple leakage involving the fovea in both eyes. (C) Goldmann perimetry showed enlarged blind spot in the right eye and normal findings in the left eye.

Reference

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