Macular function after intravitreal triamcinolone acetonide injection for diabetic macular oedema

Purpose: We aimed to evaluate the effect of intravitreal triamcinolone acetonide (IVTA) on macular function in patients with diabetic macular oedema (DMO). Methods: Eleven eyes in 11 patients with DMO were enrolled. In each eye, at baseline and at 30 days after IVTA injection, logMAR visual acuity (VA), macular sensitivity, fixation stability and fixation location by MP‐1 microperimetry and optical coherence tomography (OCT) foveal thickness were assessed. Results: Thirty days after IVTA injection, eyes with DMO showed a significant (p < 0.001) reduction in foveal thickness and significant (p < 0.01) increases in logMAR VA and MP‐1 retinal sensitivity (p < 0.001). There was also significant (p = 0.046) improvement in fixation location and some improvement in fixation stability, although the latter was not significant (p = 0.08). Conclusions: In eyes with DMO, short‐term improvement in retinal sensitivity and fixation properties can be achieved by IVTA injection.     

Intravitreal triamcinolone for diffuse diabetic macular oedema

AIM: To evaluate the efficacy of intravitreal triamcinolone (IVTA) for the treatment of diffuse diabetic macular oedema (DME) refractory to conventional argon macular laser therapy. METHODS: A prospective, consecutive, and noncomparative case series was undertaken involving 38 eyes of 38 patients with refractory DME. Triamcinolone acetonide (4 mg) in 0.1 ml was injected intravitreally. LogMar visual acuity (VA) and macular thickness measured by ocular coherence tomography (OCT) were assessed preoperatively and postoperatively at 1, 3, and 6 months. RESULTS: All patients completed 6 months of follow up. VA (mean+/-SD) improved from 0.905+/-0.23 to 0.605+/-0.28, 0.555+/-0.29, and 0.730+/-0.30 at 1, 3, and 6 months, respectively. Macular thickness baseline (mean+/-SD) on OCT was 418.7+/-104.2 microm and this decreased to 276.9+/-72.6 microm, 250.6+/-53.1 microm, and 308.8+/-87.3 microm at 1, 3, and 6 months, respectively. CONCLUSIONS: IVTA may be a potential temporary treatment for refractory DME. It is effective in decreasing macular thickness and improving VA but the effect lasts approximately for 6 months in the majority of patients. Further investigations are required to establish the safety of IVTA for the treatment of DME.     

Structural and functional outcomes after treatment of uveitic macular oedema: an optical coherence tomography and multifocal electroretinogram study

Background: The aim was to evaluate the correlation between the anatomical and functional outcomes before and after treatment of uveitic macular oedema. Methods: Thirty‐three eyes of 33 patients with uveitic macular oedema were included in the present study. Visual acuity (VA), optical coherence tomography (OCT) and multifocal electroretinogram (mfERG) were measured before and after treatment of the macular oedema. Correlation analyses between VA, OCT and mfERG parameters were performed. Results: The VA and mfERG measurements showed statistically significant improvement after treatment of the macular oedema (p < 0.01) and OCT‐measured central foveal thickness decreased significantly from 434 ± 135 µm before treatment to 267 ± 92 µm after treatment (p < 0.001). Correlation analyses showed that uveitic central foveal thickness before treatment was correlated with mfERG N1 response amplitude of area 1 (Spearman's r = ‐0.62, p < 0.001). VA (logMAR) after treatment had a negative correlation with the mfERG N1 response amplitude of area 1 (Spearman's r = ‐0.56, p = 0.001). Also, there was no correlation between the final VA and pre‐treatment OCT and mfERG measurements. Conclusion: This study deals with cystoid macular oedema associated with recurrent uveitis. In cystoid macular oedema, the value of mfERG before treatment is related to the central foveal thickness and VA. In contrast, after treatment the decrease of macular thickness is not always followed by an improvement of mfERG and VA. This supports the view that in uveitic macular oedema, the decrease in macular thickness after treatment may not be used as a predictor of improvement of macular function.     

Histological observation of trabecular meshwork in a patient with Axenfeld-Rieger syndrome—a new theory for the mechanism of ectropion uvea in congenital glaucoma

AIM: To analyze the clinical efficacy of intravitreal injection of ranibizumab on diabetic macular edema (DME) with multifocal electroretinography (mfERG) and optical coherence tomography (OCT). METHODS: A total of 41 patients (41 eyes) with DME were treated with intravitreal injection of ranibizumab (IVR). The best corrected visual acuity (BCVA), mfERG results, and OCT were analyzed to compare to the baselines, 1wk, 1 and 3mo after operation. RESULTS: The BCVA was significantly improved in all eyes at each time point (P<0.001). The macular area leakage and edema were reduced 1wk and 1mo after IVR, and the central fovea thickness (CFT) was significantly reduced compared to baseline (P<0.001). The mfERG, two-dimensional and three-dimensional images all showed that the macular fovea (1 ring) response density decreased, and the fovea and macular area spikes significantly decreased or disappeared. The amplitude density of the P1 wave was increased, and the latency of the P1 wave was shortened than preoperation (P<0.001). At 1wk and 1mo after the operation, there was a negative correlation between the amplitude density of P1 waves and CFT. CONCLUSION: OCT and mfERG fully demonstrate the importance of IVR for DME patients from the macular morphology and function, especially the significance of mfERG in this disease.     

曲安奈德治疗视网膜分支静脉阻塞继发黄斑水肿的疗效评估

目的 应用光学相干断层扫描(optical coherence to mo graphy,OCT)和多焦视网膜电流图(multifocal electmretinogram.mfERG),随访观察曲安奈德玻璃体腔注射治疗视网膜分支静脉阻塞继发黄斑水肿患者的疗效.方法 对28例视网膜分支静脉阻塞继发黄斑水肿患者,于曲安奈德玻璃体腔注射前后进行视力及OCT、nfERG检查,对比分析视力与视网膜神经上皮层厚度及黄斑区视功能变化.结果 :与治疗前相比,视力均有不同幅度的提高;视网膜神经上皮层厚度平均厚度明显降低;中心凹处(1环)P1波振幅密度增加,均与治疗前比较差异具有统计学意义(P<0.05).结论 应用OCT、mfERG随访检查,司以对病情的发展进行有效的跟踪观察,为曲安奈德玻璃体腔注射治疗的疗效提供可靠的依据.     

Arteriovenous crossing sheathotomy versus intravitreal triamcinolone acetonide injection for treatment of macular edema associated with branch retinal vein occlusion

PURPOSE: To compare the functional and anatomical outcomes of arteriovenous (AV) sheathotomy and intravitreal triamcinolone acetonide (IVTA) injection in the treatment of macular edema associated with branch retinal vein occlusion (BRVO). METHODS: Forty eyes of 40 patients with macular edema secondary to BRVO were randomized into two treatment groups. A total of 20 patients received AV sheathotomy (sheathotomy group), and the second group of 20 patients was treated with IVTA (IVTA group). Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity (VA) score, total macular volume measured, and foveal thickness by 3rd generation optical coherence tomography (OCT3) were evaluated as main outcome measurements. RESULTS: The average changes in ETDRS scores, total macular volumes, and foveal thicknesses compared to baseline values, were significant 3 months and 6 months after treatment in both groups (P < 0.05, paired t-test), but only the IVTA group showed significant improvements 1 month after treatment. The between-group differences in average ETDRS score, total macular volume, and foveal thickness changes were significantly better at 1 month after treatment in the ITVA group (P = 0.026, P < 0.001, P = 0.001, respectively, Student's t-test), at which time IVTA patients had better vision and anatomical outcomes than did those in the sheathotomy group. CONCLUSIONS: After either AV sheathotomy or IVTA treatment, patients with macular edema secondary to BRVO showed similar functional and anatomical outcomes 6 months later. When the cost and the risks of vitreoretinal surgery are considered, IVTA treatment may be a better treatment option, as the drug yields better short-term outcomes.     

Correlation between optical coherence tomography, multifocal electroretinogram findings and visual acuity in diabetic macular edema

AIM: To compare the effects of yellow (577 nm) subthreshold micropulse laser (SML) and intravitreal (IV) anti-vascular endothelial growth factor (VEGF) treatment in patients with diabetic macular edema (DME) with relatively better visual acuity [best corrected visual acuity (BCVA) ≤0.15 logMAR]. METHODS: The medical records of 76 eyes of 47 patients underwent IV (0.5 mg) anti-VEGF injection or SML for the DME with relatively better BCVA were reviewed. The IV group received three consecutive monthly IV anti-VEGF injections, then were retreated as needed. The laser treatment group was treated at baseline and 3mo, and then retreated at 6 and 9mo if needed. All participants were followed up for one year. The mean BCVA and mean central macular thickness (CMT) values changes over the follow-up were evaluated. RESULTS: Twenty-four and 23 patients were assigned to the SML and IV subgroups, respectively. The mean number of treatments was 3.64±0.76 in SML group and 5.85±1.38 in IV group (P<0.05). The subgroups were similar with regard to the mean BCVA score at baseline and at the 1st and 3rd months, but the score of SML group was better than that of IV group at the 6th, 9th and 12th months (P<0.05). The decrease in the mean CMT values from baseline values was higher in SML group at the 6th, 9th, and 12th months (P<0.05). CONCLUSION: Yellow SML treatment is superior to IV anti-VEGF injection in DME patients with relatively better BCVA for increasing visual acuity and decreasing CMT at 6, 9, and 12mo. SML can be a good alternative first-line therapy for DME with BCVA ≤0.15 logMAR.     

The role of macular hydration in the evaluation of the effect of intravitreal triamcinolone on visual acuity in eyes with diabetic macular edema

To evaluate the efficacy of intravitreal triamcinolone (IVTA) in eyes with clinically definite diabetic macular edema (DME) by using the parameters visual acuity (VA), central macular thickness (CMT) and macular hydration (MH). Medical records of patients who received IVTA (4 mg/0.1 mL) for DME were reviewed. Optically non-reflective areas which appear dark spaces within the 1000 μm from the center of the macula on OCT scan defined as MH. Best corrected logarithm of minimum angle of resolution (logMAR) visual acuity, CMT as determined by optical coherence tomography (OCT) and MH quantified from the OCT scans by using metamorph analysis were evaluated before the injection and at 1, 3 and 6 months in all, and up to 12 months in some eyes, after the IVTA injection. The correlations between these variables were also studied. 28 eyes of 27 patients were included in the study. Eyes with DME treated by a single IVTA injection responded with a trend towards significant improvement in logMAR VA at 1 (p < 0.0001) and 3 months (p < 0.0001), but no significant improvement in relation to baseline at 6 months was observed (p = 0.07). CMT was significantly reduced at 1 month (p < 0.0001), 3 months (p < 0.0001) and 6 months (p = 0.01) compared to baseline. Like the trend observed in VA improvement, MH also significantly reduced at 1 month (p < 0.0001) and 3 months (p < 0.0001), but not at 6 months (p = 0.14) compared to baseline. There was no correlation between the VA ratio and the CMT ratio (r = 0.18, p = 0.36), but there was a significant correlation between the VA ratio and the MH ratio (r = 0.85, p < 0.0001). There was also an inverse relationship between MH ratio and the age of the patients (r = ?0.7089, p = 0.0001). Macular hydration seems to be a better parameter than macular thickness for determining the effectiveness of IVTA treatment in a subset of eyes with DME. Although the treatment effect is temporary, younger patients with DME were more prone to respond with a greater reduction in MH after IVTA injection.     

Long-term outcomes of pars plana vitrectomy with internal limiting membrane removal in diabetic macular edema

PURPOSE: To report the long-term visual results and anatomical outcome as assessed by optical coherence tomography (OCT) after pars plana vitrectomy (PPV) with removal of the internal limiting membrane (ILM) in diabetic macular edema (DME). METHODS: Medical records of 27 eyes of 27 patients who underwent PPV with ILM removal for DME attributable to diffuse leakage were reviewed. This retrospective study included eyes that underwent PPV with ILM removal at our institution with preoperative and postoperative OCT assessment of DME. None of the eyes had OCT evidence of anteroposterior vitreomacular traction. Main outcome measures were foveal thickness and visual acuity changes. RESULTS: Foveal thickness decreased by at least 20% in 22 eyes (81.4%) and increased by at least 20% in 3 eyes (11.1%) with PPV and ILM removal (mean follow-up +/- SD, 27.6 +/- 7.2 months; range, 12-38 months). Mean foveal thickness decrease +/- SD was 178 +/- 164 microm (43.6%), with a mean preoperative foveal thickness +/- SD of 408 +/- 121 microm compared with a mean postoperative foveal thickness +/- SD of 230 +/- 74 microm (P < 0.001). Recurrence of DME was observed at postoperative month 24 in 2 eyes and postoperative month 30 in 1 eye. Visual acuity improved by > or =2 lines in 10 eyes (37%) and decreased by > or =2 lines in 3 eyes (11.1%). Mean best-corrected logMAR (logarithm of the minimum angle of resolution) visual acuity +/- SD was 0.75 +/- 0.35 preoperatively and 0.63 +/- 0.33 postoperatively (P = 0.033). CONCLUSION: PPV with ILM removal appears to be effective in reducing DME and improving visual acuity, and its effectiveness is maintained in the long term. Recurrence of DME may be observed in the late postoperative period.     

中心性浆液性脉络膜视网膜病变OCT与mfERG图像的相关性

目的利用光学相干断层扫描（OCT）与多焦视网膜电图（mfERG）分析中心性浆液性脉络膜视网膜病变（csc）患者的OCT与mfERG图像的关系。方法横断面研究。应用德国CarlZeissCirrusHD-OCT及美国EDI VERIS Science^TM4．9视诱发反应图像系统对40只急性期CSC眼（40例）进行检查。将CSC患者OCT黄斑厚度图三个环的视网膜平均厚度与相对应的多焦视网膜电图（mfERG）的1＋2环、3环、4环的N1、P1波的平均反应密度和峰时间进行比较,并将黄斑区体积、总的黄斑中心凹的厚度、视网膜下液高度、视网膜下液范围和中心凹神经上皮厚度与mfERG6个环的N1、P1波反应密度和潜伏期比较分析。采用Spearman秩相关进行数据分析。结果CSC患者OCT内环、中环、外环的视网膜平均厚度与mfERG1＋2环、3环、4环的N1、P1波的峰时间呈正相关。黄斑区体积、总的黄斑中心凹的厚度、视网膜下液高度和视网膜下液范围与mfERG的N1、P1波反应密度和峰时间有显著的相关性。结论CSC患者的黄斑平均视网膜厚度及积液情况与mfERG之间有一定的相关性,可用OCT测量黄斑区视网膜下液的积液量,尤其是用积液范围来评估黄斑区视网膜功能的改变。OCT与mfERG的检测可以综合评价CSC患者的形态与功能的变化。     

Patterns of macular edema in patients with uveitis: qualitative and quantitative assessment using optical coherence tomography

PURPOSE: To describe the morphologic characteristics of uveitic macular edema by the use of optical coherence tomography (OCT) and to investigate the correlation between tomographic features and visual acuity (VA). DESIGN: Cross-sectional study. PARTICIPANTS: Seventy consecutive patients with uveitis in a university-based practice with a clinical diagnosis of macular edema in at least one eye. Inclusion criteria were: (1) verification of macular edema by OCT, (2) adequate media clarity for fundus visualization, and (3) absence of coexisting ocular disease limiting visual potential. METHODS: Complete ophthalmic examination: best-corrected Snellen VA, slit-lamp examination, fundus biomicroscopy, indirect ophthalmoscopy, and OCT. Fluorescein angiography was performed in selected cases. MAIN OUTCOME MEASURES: Best-corrected Snellen VA and tomographic features of the macula, including macular thickness measurement and correlation of macular thickness with VA. RESULTS: Eighty-four eyes of 60 patients met the inclusion criteria. The mean VA (Snellen test) was 20/36. There were 3 patterns of macular edema: diffuse macular edema (DME), cystoid macular edema (CME), and serous retinal detachment (RD). Serous retinal detachment was detected in 17 eyes (20.2%). Patients were classified into the following groups: DME (46 eyes, 54.8%), CME (21 eyes, 25%), DME and RD (5 eyes, 5.9%), CME and RD (12 eyes, 14.3%). Epiretinal membrane was detected by OCT in 34 eyes (40.5%). Eight eyes (9.5%) demonstrated vitreomacular traction. The mean retinal thickness at the central fovea was 333+/-171 microm (mean +/- standard deviation). Macular edema was located mainly in the outer retinal layers. Eyes with CME had significantly greater retinal thickness measurements than eyes with DME (P<0.001). Multivariate analysis revealed that VA was negatively correlated with increased macular thickness, presence of CME, and RD (P<0.05). CONCLUSIONS: Optical coherence tomography demonstrated 3 patterns of macular edema in patients with uveitis: DME, CME, and RD. Epiretinal membrane coexisted in a significant percentage of patients. In patients with uveitis with clear media, the morphologic features of macular edema and macular thickness correlated with VA.     

Intravitreal triamcinolone for the treatment of ischemic macular edema associated with branch retinal vein occlusion

PURPOSE: To evaluate the safety and efficacy of intravitreal triamcinolone acetonide (IVTA) for ischemic macular edema associated with branch retinal vein occlusion (BRVO) and foveal ischemia. DESIGN: Prospective interventional case series. METHODS: setting: Clinical practice. study population: Eighteen eyes of 18 patients with macular edema associated with BRVO and foveal ischemia. intervention: Four mg IVTA. main outcome measures: Visual acuity (VA), optical coherence tomography, macular thickness measurements, and treatment-related complications. RESULTS: The mean duration of BRVO before treatment was 14 months. All patients were followed for a minimum of nine months, and 12 patients completed 12 months follow-up. The mean logarithm of the minimum angle of resolution (logMAR) VA improved significantly from 0.81 +/- 0.36 at baseline to 0.65 +/- 0.30 at one month (P = .03) but did not vary significantly from baseline at three, six, nine, and 12 months. Macular thickness improved significantly in all eyes from a mean of 400 +/- 134 mum preinjection, to 228 +/- 58 mum at one month (P < .01) and 256 +/- 121 mum at three months (P < .01) but did not vary significantly from baseline at six, nine, and 12 months. Eight eyes developed posterior subcapsular cataract, intraocular pressure (IOP) exceeded 21 mm Hg in four eyes, and two eyes developed vitreomacular traction during follow-up. CONCLUSIONS: IVTA is effective in reducing ischemic macular edema associated with BRVO and foveal capillary nonperfusion. This reduction is often associated with a temporary improvement in VA. Raised IOP and development of posterior subcapsular cataract are disadvantages of this treatment.     

Optical coherence tomography analysis of a randomized study combining photodynamic therapy with intravitreal triamcinolone

BACKGROUND: The objective of the study was to analyze optical coherence tomography (OCT) scan differences between patients with predominantly classic subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) treated with only photodynamic therapy (PDT) and patients treated with PDT combined with intravitreal triamcinolone acetonide (IVTA). METHODS: In this prospective study, 61 patients were randomized to receive PDT (n = 30) or PDT combined with IVTA (n = 31). They were evaluated every 3 months with a refraction protocol for best-corrected visual acuity (VA) measured with Early Treatment Diabetic Retinopathy Study (ETDRS) charts, fluorescein angiography (FA), and OCT. When measuring foveal thickness on OCT scans, neuroretinal foveal thickness (NFT) was differentiated from outer high reflectivity band thickness (OHRBT). The main outcome measures were mean change in OCT measurements and correlation of VA and angiographic area of the lesion with OCT measurements. RESULTS: At the 12-month follow-up, the mean change in NFT was not significantly reduced (P = 0.9), but the mean change in OHRBT was significantly lower (P = 0.004) in the group of patients who received combined therapy. There was no correlation between final VA and NFT in either patient group (P = 0.2). The final VA was significantly worse in eyes with a thicker OHRBT (P = 0.04) in the group of patients treated with only PDT. There was no correlation between angiographic area and NFT and OHRBT in either patient group (P > 0.3). There was a statistically significant difference between the pre-treatment angiographic area of the lesion and VA at the 12-month follow-up in the combined therapy group (P = 0.01), and more eyes treated with only PDT presented with intraretinal fluid at the last follow-up (P = 0.01). CONCLUSION: Combined PDT+IVTA therapy was more effective than PDT alone at reducing OHRBT. This OCT measurement seems to be have a greater effect on VA than NFT.     

Bevacizumab (Avastin) for diabetic macular edema in previously vitrectomized eyes

PURPOSE: To report the visual acuity (VA) and foveal thickness (FT) changes after intravitreal bevacizumab for diabetic macular edema (DME) in previously vitrectomized eyes. DESIGN: Retrospective, noncomparative, interventional case series. METHODS: Medical records of 11 eyes of 10 patients who underwent intravitreal bevacizumab injection for persistent DME were reviewed. This retrospective study included eyes that had persistent DME despite prior pars plana vitrectomy with internal limiting membrane removal at our institution with optical coherence tomography (OCT) assessment of DME. All eyes received three intravitreal injections of bevacizumab 1.25 mg/0.05 ml monthly. RESULTS: Mean FT was 408 +/- 77 microm at baseline, 453 +/- 97 microm at three months, and 454 +/- 101 microm at six months (P = .172). Mean Early Treatment Diabetic Retinopathy Study (ETDRS) letter scores were 59 +/- 15 (20/80) at baseline, 59 +/- 16 (20/80) at three months, 57 +/- 15 (20/80) at six months (P = .398). CONCLUSION: No change in VA and FT was observed in the short-term after intravitreal bevacizumab for DME in previously vitrectomized eyes.     

Intravitreal triamcinolone as adjunctive treatment to laser panretinal photocoagulation for concomitant proliferative diabetic retinopathy and clinically significant macular oedema

Purpose: To evaluate the effect of intravitreal injections of triamcinolone acetonide (IVTA) combined with panretinal photocoagulation (PRP) on visual acuity (VA) and foveal thickness in patients with concomitant high‐risk proliferative diabetic retinopathy (PDR) and clinically significant macular oedema (CSMO). Methods: This retrospective interventional case series included seven eyes diagnosed with both high‐risk PDR and CSMO that underwent PRP and a single injection of 4 mg of IVTA. The main outcome measures were VA and foveal thickness, measured by optical coherence tomography (OCT) before treatment and throughout the follow‐up period. Results: Median follow‐up was 301 days (range 180–715 days). Foveal thickness data were available for four of seven eyes. Before the combined treatment, median LogMAR (logarithm of the minimum angle of resolution) VA and median foveal thickness were 1 (Snellen 20/200, range 20/40–20/800) and 559 µm (range 333–689 µm), respectively. After treatment, median vision improved to LogMAR 0.544 (Snellen 20/70, range 20/40–20/1000) (P = 0.13). Vision improved or remained stable in six of seven eyes. Median foveal thickness at final follow‐up was 436 µm (range 259–623 µm) (P = 0.15). Foveal thickness decreased or remained stable in all eyes. Conclusion: The addition of IVTA to PRP in the treatment of eyes with high‐risk PDR and CSMO may prevent PRP‐induced foveal thickening and loss of vision.     

The effect of intravitreal triamcinolone on foveal edema in exudative macular degeneration

PURPOSE: To evaluate the effect of a single intravitreal injection of triamcinolone (IVTA) on central macular thickness and visual acuity in eyes with minimally classic exudative age-related macular degeneration (AMD). DESIGN: Retrospective, nonrandomized clinical interventional study. METHODS: Optical coherence tomography (OCT) and best-corrected logarithm of the minimum angle of resolution visual acuity were performed at baseline and one month after treatment. RESULTS: We identified 11 eyes with foveal edema and minimally classic subfoveal neovascularization treated with an IVTA. Foveal edema decreased significantly from 401 +/- 98 microm at baseline to 295 +/- 141 microm (mean +/- standard deviation; P = .004) at one month. There was, however, no significant change in visual acuity at one or three months after the intervention. CONCLUSIONS: This biological effect of IVTA does not support its clinical use, yet it does warrant further research to determine whether locally delivered corticosteroids may be synergistic with other treatments. Reduction in foveal edema is not necessarily associated with improved visual function in exudative AMD.     

Optical Coherence Tomography for Classification and Clinical Evaluation of Macular Edema in Patients with Uveitis

Purpose: To study use of optical coherence tomography (OCT) for macular edema in uveitis. Methods: In total, 44 patients with uveitis and macular edema underwent OCT. Data obtained were correlated with anatomic type, duration of uveitis, and visual acuity (VA). Results: Both cystoid macular edema (CME) and diffuse macular edema (DME) correlate negatively with VA, although statistically CME showed stronger correlation (p = .02). Also CME had higher mean foveal thickness than DME (p < .01). Negative correlation between foveal thickness and VA (p < .05) was observed. CME correlates with uveitis duration (p < .01). Conclusions: CME and macular thickening correlate with VA reduction and uveitis duration.     

后Tenon囊下注射曲安奈德治疗弥漫性糖尿病黄斑水肿的临床观察

目的 观察后Tenon囊下注射TA治疗格栅样光凝失败的弥漫性DME的有效性和安全性.方法 选择因患弥漫性DME并已行格栅样光凝无效的患者(时间至少3个月以上)39例(42只眼).随机分二组,一组给予后Tenon囊下注射TA(posterior subtenon TA,PSTT)20mg/0.5ml;另外一组给予玻璃体腔内注射TA(intravitreal TA,IVTA)4mg/0.1ml,分别于治疗前、治疗后1、2和3月进行最佳矫正视力、OCT、眼压等检查,同时观察治疗后并发症,对结果进行统计分析,评价两种给药方式的临床疗效及安全性.结果 PSTT组和IVTA组治疗后1、2和3月的最佳矫正视力(best-corrected visual acuity,BCVA)均提高,与治疗前视力相比差异具有统计学意义(P<0.01).两种注射方法之间在治疗前和治疗后各不同时间点,BCVA变化无统计学差异(P>0.05).PSTT组和IVTA组治疗后1月、2月和3月黄斑中心凹厚度与治疗前相比明显减低,差异具有统计学意义(P<0.01).两种注射方法之间在治疗前和治疗后各不同时间点,黄斑中心凹厚度差别无统计学差异(P>0.05).PSTT组治疗后眼压升高3例,占13.6%;IVTA组治疗后眼压升高6例,占30%,假性眼内炎1例.结论 后Tenon囊下注射TA和玻璃体腔内注射TA对于格栅样光凝失败的弥漫性DME患者,都能在短期内不同程度地提高患者中心视力,有效降低黄斑区视网膜水肿.虽然玻璃体腔注射给药方式效果更为明显,但后Tenon囊下注射仍不失为一种安全、有效的给药途径.     

Short-term effects of intravitreal triamcinolone on retinal vascular leakage and trunk vessel diameters in diabetic macular oedema

PURPOSE: To assess retinal vascular permeability and vessel diameter changes after intravitreal triamcinolone acetonide (IVTA) injection in eyes with persistent foveal thickening after photocoagulation for diabetic macular oedema (DMO). METHODS: We calculated the blood-retinal barrier permeability as measured by vitreous fluorophotometry, artery and venous vessel diameter at the temporal vascular arcades as measured on digital fundus photos, and retinal thickness as measured by optical coherence tomography. Seven patients with type 2 diabetes and DMO were examined immediately before and 1 week after IVTA 2 mg. The study was designed as an open-label interventional case series using the fellow eyes as untreated controls. RESULTS: One week after IVTA, we observed that, compared with baseline values, blood-retinal barrier permeability had decreased to 27.2 +/- 3.6% (p < 0.0001), retinal artery diameter had decreased to 94.9 +/- 0.02% (p = 0.05), retinal vein diameter had decreased to 89.2 +/- 0.03% (p = 0.02) and foveal thickness had decreased to 68.7 +/- 6.9% (p = 0.004). Visual acuity (VA) improved by 7.4 +/- 2.2 letters (p = 0.01). No significant change was observed in control eyes except that mean VA deteriorated by 2.6 +/- 0.9 letters (p = 0.03). Changes in permeability were closely correlated to changes in retinal thickness (R = 0.84) and venoule diameter (R = 0.93) in treated eyes. CONCLUSIONS: Intravitreal injection of triamcinolone acetonide in eyes with DMO is followed by a marked reduction in retinal vascular leakage and a concomitant reduction in retinal vessel calibre.     

A Three-year Follow-up of Intravitreal Triamcinolone Acetonide Injection and Macular Laser Photocoagulation for Diffuse Diabetic Macular Edema

Purpose

To report the three-year outcomes of macular laser photocoagulation following intravitreal injection of triamcinolone acetonide (IVTA) for diffuse diabetic macular edema (DME).

Methods

A prospective, randomized controlled study was completed. Eighty-six eyes of 74 patients with diffuse DME were randomized into two groups. Eyes assigned to the combination group (n = 48) were subjected to macular laser photocoagulation three weeks after IVTA. Eyes in the IVTA group (n = 38) underwent IVTA alone. Central macular thickness was measured by optical coherence tomography, and the number of additional treatments and mean time to recurrence were assessed.

Results

Thirty-seven eyes in the combination group and 26 eyes in the IVTA group completed the three-year follow-up. Recurrence of DME after initial treatment was not observed for nine of the 37 (24.3%) eyes in the combination group or for one of the 26 (3.9$) eyes in the IVTA group (p = 0.028). DME was absent for 19.9 months after treatment in the combination group compared to 10.3 months in the IVTA group (p = 0.027). The mean number of additional treatments was 0.92 in the combination group and 1.88 in the IVTA group (p = 0.001).

Conclusions

Results in the subset of subjects who completed the three-year follow-up demonstrated that laser photocoagulation following IVTA is more effective than IVTA monotherapy for diffuse DME. Combination therapy required fewer additional treatments and resulted in a lower recurrence rate than IVTA monotherapy.