Peripapillary perfusion changes influenced by intravitreal Ranibizumab in diabetic macular edema patients– an OCT angiography study

Background: Optical coherence tomography angiography (OCTA) is a method for noninvasively visualizing the vascular function of Optic Nerve Head (ONH) at the capillary level. A significant reduce in Optic Nerve Head vascular function has been found in a rat model of high intraocular pressure utilizing optical coherence tomography angiography. Aim: To assess the influence of intravitreal injection of antiVEGF Ranibizumab (lucentis) on peripapillary capillary perfusion in diabetic macular edema patients by OCTA. Patients and methods: A prospective cohort cross-sectional interventional research. This study was conducted in ophthalmology department and outpatient follow-up retina unit, Benha university hospital. Time of the study: from August 2023 till January 2024. Results: Superior RPC density significantly increased from 48.3 ± 6.17% to 50.8 ± 6.19% (P=0.01), and whole disc RPC density (all vessels) rose from 47.6 ± 3.77% to 55.1 ± 4.12% (P<0.001). Inferior RPC density showed no significant change (P=0.06). IOP changes were insignificant (17.3 ± 1.84 mmHg to 19.3 ± 4.74 mmHg, P=0.06). Conclusion: Intravitreal Ranibizumab significantly enhances peripapillary and whole disc perfusion in DME patients without significant IOP elevation. Long-term effects on ONH perfusion require further investigation.