Effects of intravitreal injection of ranibizumab on choroidal structure and blood flow in eyes with diabetic macular edema

  • Masahiro Okamoto
  • Mariko Yamashita
  • Nahoko Ogata
Retinal Disorders



To determine the effects of an intravitreal injection of ranibizumab (IVR) on the choroidal structure and blood flow in eyes with diabetic macular edema (DME).


Twenty-eight consecutive patients with DME who received an IVR and 20 non-diabetic, age-matched controls were followed for 1 month. The eyes with DME were divided into those with prior panretinal photocoagulation (PRP, n = 16) and those without prior PRP (no-PRP, n = 12). The enhanced depth imaging optical coherence tomography (EDI-OCT) scans and Niblack’s image binarization were performed to determine the choroidal structure. The choroidal blood flow was determined by laser speckle flowgraphy.


The subfoveal choroidal thickness at the baseline was significantly thicker in the no-PRP group than in the PRP-treated group. After IVR, the best-corrected visual acuity (BCVA) and central retinal thickness in eyes with DME were significantly improved compared to the baseline values. There were significant differences in the choroidal thickness, total choroidal area, and choroidal vascularity index between the groups after IVR. Choroidal vascular index and choroidal blood flow were significantly reduced only in the no-PRP group and not in the PRP-treated group. In addition, the correlation between the central retinal thickness and the choroidal blood flow was significant in the no-PRP group (r = 0.47, P < 0.05).


A single IVR will reduce the central retinal thickness and improve the BCVA in eyes with DME in both the no-PRP and PRP-treated group. IVR affected the choroidal vasculature and blood flow significantly, and a significant correlation was found between the central retinal thickness and the choroidal blood flow in eyes without PRP.


Diabetic macular edema Intravitreal injection of ranibizumab Choroidal structure Choroidal thickness Choroidal blood flow 



The authors thank Professor Emeritus Duco Hamasaki of the Bascom Palmer Eye Institute for discussions and manuscript revision.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent is not required.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Masahiro Okamoto
    • 1
  • Mariko Yamashita
    • 1
  • Nahoko Ogata
    • 1
  1. 1.Department of OphthalmologyNara Medical UniversityKashiharaJapan

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