Multifocal electroretinogram analysis of the effectiveness of anti-VEGH treatment for clinically significant macular edema treatment
Keywords:MfERG, CSME, rings, anti-VEGF, retina
This study aimed to compare multifocal Electroretinogram (mfERG) between before and after the treatment of clinically significant macular edema (CSME). Cross-sectional comparative study was performed on the mfERG measurements of four patients (54 ± 11 years old) diagnosed with CSME by an ophthalmologist (retina subspecialty). The subjects were examined within 1 to 2 months before and after the anti-vascular endothelial growth factor (anti-VEGF) CSME treatment. The procedure of mfERG adhered to the standard recommended by the International Society for Clinical Electrophysiology of Vision (ISCEV). Parameters included in this investigation were N1 amplitude (µV), N1 implicit time (ms), P1 amplitude (µV), and P1 implicit time (ms). Further analysis was performed by dividing the retina area into five rings zone (1st Ring, 2nd Ring, 3rd Ring, 4th Ring, and 5th Ring with a subtended surface area of 0–2°, 2–5°, 5–10°, 10–15°, and >15°, respectively). The paired sample T-test was used to compare the mfERG between before and after Anti-VEGF intervention. Overall, mean differences were observed before and after the CSME treatment with the anti-VEGF, but not statistically different for the N1 amplitude (µV), N1 implicit time (ms), P1 amplitude (µV), and P1 implicit time (ms). Further analysis results based on rings was revealed to be not statistically different, except N1 amplitude (µV) at 5 to 10° surface area (3rd Ring), which the N1 amplitude became less negative after the treatment, -24.95 µV, (95% CI, -37.44 to -12.46), t (3) = -6.36, p < 0.05]. There was no statistically significant difference in mfERG before and after between treatment of CSME except for N1 amplitude (µV) for 3rd Ring after 1 to 2 months follow up. In the future, it is recommended that similar investigation should be conducted by involving more patients and performing a series of follow up.
Ali, F. A. 1997. A review of diabetic macular edema. Digital Journal of Ophthalmology, 93(7), 989-997.
Association Diabetes Association. 2011. Standards of medical care in diabetes-2011. Retrieved from https://care.diabetesjournals.org/
Chan, H., and Siu, A. 2003. Effect of optical defocus on multifocal ERG responses. Clinical and Experimental Optometry, 85(5), 317–322.
Greenstein, V. C., Chen, H., Hood, D. C., Holopigian, K., Seiple, W., and Carr, R. E. 2000. Retinal function in diabetic macular edema after focal laser photocoagulation. Investigative Ophthalmology & Visual Science, 41(11), 3655–3664.
Holm, K., Schroeder, M., and Adrian, M. L. 2015. Peripheral retinal function assessed with 30-Hz flicker seems to improve after treatment with Lucentis in patients with diabetic macular oedema. Documenta Ophthalmologica, 131(1), 43–51.
Hood, D. C., Frishman, L. J., Saszik, S., and Viswanathan, S. 2002. Retinal origins of the primate multifocal ERG: Implications for the human response. Investigative Ophthalmology & Visual Science, 43(5), 1673–1685.
Luttrull, J. K., and Dorin, G. 2012. Subthreshold diode micropulse laser photocoagulation (SDM) as invisible retinal phototherapy for diabetic macular edema: A review. Current Diabetes Reviews, 8(4), 274–284.
Kertes, P. J., and Johnson, T. M. 2007. Evidence-based eye care. Philadephia, United States: Lippincott Williams & Wilkins.
Lai, T. Y. Y., Chan, W.-M., Lai, R. Y. K., Ngai, J. W. S., Li, H., and Lam, D. S. C., 2007. The clinical applications of multifocal electroretinography: A systematic review. Survey of Ophthalmology, 52(1), 61–96.
Musat, O., Cernat, C., Labib, M., Gheorghe, A., Toma, O., Zamfir, M., and Boureanu, A. M. 2015. Diabetic macular edema. Romanian Journal of Ophthalmology, 59(3), 133–136.
Nicholson, B. P., and Schachat, A. P. 2010. A review of clinical trials of anti-VEGF agents for diabetic retinopathy. Graefe’s Archive For Clinical and Experimental Ophthalmology = Albrecht Von Graefes Archiv Fur Klinische Und Experimentelle Ophthalmologie, 248(7), 915–930.
Nowacka, B., Kirkiewicz, M., Mozolewska-Piotrowska, K., and Lubiński, W. 2016. The macular function and structure in patients with diabetic macular edema before and after ranibizumab treatment. Documenta Ophthalmologica, 132(2), 111–122.
Park, Y. G., and Roh, Y.-J., 2015. New diagnostic and therapeutic approaches for preventing the progression of diabetic retinopathy. Journal of Diabetes Research, 2016, 1-9.
Saxena, S., Jalali, S., Meredith, T. A., Holekamp, N. M., and Kumar, D. 2000. Management of diabetic retinopathy. Indian Journal of Ophthalmology, 48(4), 321.
Stewart, M. W. 2012. Aflibercept (VEGF Trap-eye): The newest anti-VEGF drug. The British Journal of Ophthalmology, 96(9), 1157-1158.
Tajunisah, I., Nabilah, H., and Reddy, S. 2006. Prevalence and risk factors for diabetic retinopathy--a study of 217 patients from University of Malaya Medical Centre. The Medical journal of Malaysia, 61(4), 451–456.
Tehrani, N. M., Riazi-Esfahani, H., Jafarzadehpur, E., Mirzajani, A., Talebi, H., Amini, A., Mazloumi, M., Roohipoor, R., and Riazi-Esfahani, M. 2015. Multifocal electroretinogram in diabetic macular edema; Correlation with visual acuity and optical coherence tomography. Journal of Ophthalmic & Vision Research, 10(2), 165.
Thibaut, M., Tran, T. H. C., Szaffarczyk, S., and Boucart, M. 2014. The contribution of central and peripheral vision in scene categorization: A study on people with central vision loss. Vision Research, 98, 46–53.
Tyrberg, M. 2010. Retinopathy in subjects with pre-diabetes and electrophysiological studies in diabetes patients with and without retinopathy (PhD thesis). Department of Ophthalmology, Lund University.
Weiner, A., Christopoulos, V. A., Gussler, C. H., Adams, D. H., Kaufman, S. R., Kohn, H. D., and Weidenthal, D. T. 1997. Foveal cone function in nonproliferative diabetic retinopathy and macular edema. Investigative Ophthalmology & Visual Science, 38(7), 1443–1449.
Yamamoto, S., Yamamoto, T., Hayashi, M., and Takeuchi, S. 2001. Morphological and functional analyses of diabetic macular edema by optical coherence tomography and multifocal electroretinograms. Graefe’s Archive For Clinical and Experimental Ophthalmology, 239(2), 96–101.