Observation On The Changes Of Retinal Vein Diameter And Therapeutic Effect Of Aflibercept Combined With PRP In The Treatment Of High-risk PDR

Diabetes mellitus is a metabolic disease characterized by hyperglycemia caused by lack of insulin secretion or insulin resistance.it has become one of the major diseases threatening human health all over the world.According to the statistics of the International Diabetes Federation(IDF)in 2021,the number of people with diabetes in China ranks first in the world,with more than 140 million patients,which is the country with the largest number of patients with diabetes in the world.Diabetic retinopathy(DR)is one of the most common microvascular complications of diabetes and the leading cause of blindness in the working age population.Due to the microvascular damage of retinal capillary network caused by long-term hyperglycemia,the pericytes of normal vascular system degenerate,resulting in the formation of microaneurysms(MA),vascular leakage and retinal ischemia.Vascular endothelial growth factor(VEGF)plays an important role in this process.Progressive ischemia can lead to neovascularization(NV),secondary vitreous hemorrhage,traction retinal detachment,neovascularization glaucoma and macular ischemia.Proliferative diabetic retinopathy(PDR)is the most common cause of severe vision loss in diabetic patients.Pan retinal photocoagulation(PRP)has become the standard for the treatment of proliferative diabetic retinopathy(PDR).A number of studies have shown that,compared with anti-VEGF drugs alone or PRP therapy alone,anti-VEGF drugs combined with PRP therapy can reverse neovascularization,have certain benefits in the improvement of vision,and can reduce the energy and number of PRP laser,reduce the damage of peripheral visual field caused by PRP,reduce vitreous hemorrhage to a certain extent,and reduce the medical expenses caused by injection times.At present,there are few studies on the changes of retinal vascular indexes in patients with PDR before and after combined treatment.The main damage to retinal vessels caused by diabetes is vein.The main observation index of this study was the changes of retinal vein diameter and vein beads in patients with high-risk PDR after vitreous injection of Aflibercept combined with PRP.The secondary observation indexes included BCVA,CFT,MA,HE,NV,FAZ,SCP-VD,and the correlation between them.Objective:To investigate the changes of retinal vein diameter and therapeutic effect of Aflibercept combined with PRP in the treatment of high-risk proliferative diabetic retinopathy(PDR)complicated with DME.Methods:A retrospective study was conducted on 59 patients(59 eyes)with PDR from September 2020 to August 2022.According to the 3+PRN regimen,all the patients were treated with a single dose of 2mg(0.05ml)intravitreal injection of Aflibercept,and pan retinal photocoagulation was performed one week after the first vitreous injection.OCT,OCTA and FFA imaging techniques were used to compare the changes of best corrected visual acuity(BCVA),central fovea thickness(CFT),number of microaneurysms(MA),hard exudation(HE)area,neovascularization area(NV),fovea avascular area(FAZ),Superficial capillary plexus vessels density(SCP-VD),Central retinal vein equivalent(CRVE)and venous beading before and after treatment.Results:The best corrected visual acuity(BCVA)of all observation nodes after treatment was better than that before treatment,the macular foveal thickness(CFT)of all observation nodes after treatment was lower than that before treatment,and the number of microaneurysms(MA)at each observation node after treatment was lower than that before treatment.The diameters of retinal veins at 12 months,18 months and 24 months after treatment were lower than those before treatment(P<0.05).The improvement of retinal vein beads was observed 18 months after treatment.The hard exudation at 6 months after treatment was lower than that before treatment,however the difference was not statistically significant,but it was significantly at 12 months,18 months and 24 months after treatment than that before treatment(P<0.05).The neovascularization area ratio of all observation nodes after treatment was significantly lower than that before treatment(P<0.05).The fovea avascular area at 6 months after treatment was lower than that before treatment,but the difference was not statistically significant,however at 12 months,18 months and 24 months after treatment,The fovea avascular area was lower than that before treatment(P<0.05).The density of superficial retinal capillaries in each observation node after treatment was significantly higher than that before treatment(P<0.05).Conclusion:1.Intravitreal injection of Aflibercept combined with PRP significantly improved the visual acuity and alleviated macular edema in patients with high-risk PDR complicated with DME.It reduced the number of microaneurysms,reduced the diameter of retinal veins,improved venous beads,reduced hard exudation,eliminated neovascularization,reduced fovea avascular area,and increased the Superficial capillary plexus vessels density.2.CFT detected by SD-OCT,MA,HE,NV,diameter of retinal vein and beaded retinal vein detected by FFA.FAZ and SCP-VD detected by OCTA can be used as imaging indicators to monitor the development and evolution of DR and to evaluate the therapeutic response to diabetic macular edema.3.The anatomical changes of retinal veins take long enough time for vein remodeling.With the rapid growth of artificial intelligence and deep learning systems used in DR,indicators related to the diameter of retinal veins play an important role in evaluating the progression and severity of the disease.