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Laser photocoagulation combined with intravitreal triamcinolone acetonide injection in proliferative diabetic retinopathy with macular edema.

Choi KS, Chung JK, Lim SH - Korean J Ophthalmol (2007)

Bottom Line: Average BCVA (log MAR) significantly improved from preoperative 0.56-/+0.20 to 0.43-/+0.08 at 1 month (P=0.042) and it was maintained until 3 months after a combination of IVTA and PRP in 10 eyes (P=0.007).The thickness of fovea decreased from average 433.3-/+114.9 micrometer to average 279.5-/+34.1 micrometer at 2 weeks after combined treatment of IVTA and PRP (P=0.005), which was significantly maintained until 3 months, but there was a transient visual disturbance and no significant difference in thickness of the fovea before and after treatment in the groups with PRP and focal or grid laser photocoagulation.In combination with PRP, IVTA might be more effective than focal or grid laser photocoagulation and PRP for reducing diabetic macular edema and preventing aggravation of macular edema without transient visual disturbance in patients requiring immediate PRP.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Soonchunhyang University, College of Medicine, Yongsan-gu, Seoul, Korea. ckseek@naver.com

ABSTRACT

Purpose: To evaluate therapeutic effects and usefulness of a combination treatment of intravitreal injection of triamcinolone acetonide (IVTA) and panretinal photocoagulation (PRP) in patients with clinically significant macular edema secondary to proliferative diabetic retinopathy (PDR).

Methods: Visual acuity test, fundoscopy, fluorescein angiography, and optical coherence tomography (OCT) were taken in 20 patients (20 eyes) of macular edema and PDR. A combination of intravitreal injection of triamcinolone acetonide and PRP was performed in 10 patients (10 eyes) and a combination of focal or grid laser photocoaqulation and PRP in the remaining 10 eyes. The postoperative outcomes were compared between the two combination treatments by best corrected visual acuity (BCVA), tonometry, fluorescein angiography, and OCT at 2 weeks, 1, 2, and 3 months.

Results: Average BCVA (log MAR) significantly improved from preoperative 0.56-/+0.20 to 0.43-/+0.08 at 1 month (P=0.042) and it was maintained until 3 months after a combination of IVTA and PRP in 10 eyes (P=0.007). The thickness of fovea decreased from average 433.3-/+114.9 micrometer to average 279.5-/+34.1 micrometer at 2 weeks after combined treatment of IVTA and PRP (P=0.005), which was significantly maintained until 3 months, but there was a transient visual disturbance and no significant difference in thickness of the fovea before and after treatment in the groups with PRP and focal or grid laser photocoagulation.

Conclusions: A combination of IVTA and PRP might be an effective treatment modality in the treatment of macular edema and PDR and prevent the subsequent PRP-induced macular edema result in visual dysfunction. In combination with PRP, IVTA might be more effective than focal or grid laser photocoagulation and PRP for reducing diabetic macular edema and preventing aggravation of macular edema without transient visual disturbance in patients requiring immediate PRP.

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Evaluation of mean foveal thickness and best corrected visual acuity after combined intravitreal injection of triamcinolone acetonid and panretinal photocoagulation. ⋆: statistically significant difference between initial foveal thickness and each value, *: statistically significant difference between best corrected visual acuity before and after combination treatment.
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Figure 1: Evaluation of mean foveal thickness and best corrected visual acuity after combined intravitreal injection of triamcinolone acetonid and panretinal photocoagulation. ⋆: statistically significant difference between initial foveal thickness and each value, *: statistically significant difference between best corrected visual acuity before and after combination treatment.

Mentions: In the group with a combination treatment of IVTA and PRP, postoperative thickness of the fovea decreased significantly to 279.5±34.1 (P=0.005), 257.0±47.2 (P=0.005), 263.4±52.0 (P=0.007), and 259.7±43.1 µm (P=0.005) at 2 weeks, 1, 2, and 3 months, respectively, as compared with preoperative thickness of the fovea (Table 2, Fig. 1). However, there was no significant difference in thickness of the fovea between the experimental time points (P>0.750). In the group with focal or grid laser photocoagulation and PRP, postoperative thickness of the fovea increased to 339.9±32.5 and 333.8±28.1 µm at 2 weeks and 1 month, respectively, as compared with baseline thickness of the fovea without significant difference (P=0.139, and 0.798, respectively), and the macular edema began to decrease 2 months after treatment without significant difference (Table 2, Fig. 2). In the group with a combination treatment, BCVA did not change significantly at 2 weeks after surgery. However, it improved significantly at 1 month (P=0.042) and visual improvement was continued until 3 months (Fig. 1). In the group with laser photocoagulation, visual acuity decreased to 0.50±0.13 (P=0.046), 0.47±0.11 (P=0.792), and 0.47±0.08 (P=0.792) at 2 weeks, 1, and 2 months after treatment, respectively. A transient visual disturbance occurred at 2 weeks then returned to initial visual acuity at 3 months after treatment (Fig. 2). The changes in intraocular pressure in the group with a combination treatment were 16.1±4.2, 17.3±3.8, 16.9±5.7, and 16.6±5.4 mmHg at 2 weeks, 1, 2, and 3 months after surgery, and the intraocular pressure did not exceed 21 mmHg. Complications such as endophthalmitis, retinal detachment, or vitreous hemorrhage did not occur in all patients.


Laser photocoagulation combined with intravitreal triamcinolone acetonide injection in proliferative diabetic retinopathy with macular edema.

Choi KS, Chung JK, Lim SH - Korean J Ophthalmol (2007)

Evaluation of mean foveal thickness and best corrected visual acuity after combined intravitreal injection of triamcinolone acetonid and panretinal photocoagulation. ⋆: statistically significant difference between initial foveal thickness and each value, *: statistically significant difference between best corrected visual acuity before and after combination treatment.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2629684&req=5

Figure 1: Evaluation of mean foveal thickness and best corrected visual acuity after combined intravitreal injection of triamcinolone acetonid and panretinal photocoagulation. ⋆: statistically significant difference between initial foveal thickness and each value, *: statistically significant difference between best corrected visual acuity before and after combination treatment.
Mentions: In the group with a combination treatment of IVTA and PRP, postoperative thickness of the fovea decreased significantly to 279.5±34.1 (P=0.005), 257.0±47.2 (P=0.005), 263.4±52.0 (P=0.007), and 259.7±43.1 µm (P=0.005) at 2 weeks, 1, 2, and 3 months, respectively, as compared with preoperative thickness of the fovea (Table 2, Fig. 1). However, there was no significant difference in thickness of the fovea between the experimental time points (P>0.750). In the group with focal or grid laser photocoagulation and PRP, postoperative thickness of the fovea increased to 339.9±32.5 and 333.8±28.1 µm at 2 weeks and 1 month, respectively, as compared with baseline thickness of the fovea without significant difference (P=0.139, and 0.798, respectively), and the macular edema began to decrease 2 months after treatment without significant difference (Table 2, Fig. 2). In the group with a combination treatment, BCVA did not change significantly at 2 weeks after surgery. However, it improved significantly at 1 month (P=0.042) and visual improvement was continued until 3 months (Fig. 1). In the group with laser photocoagulation, visual acuity decreased to 0.50±0.13 (P=0.046), 0.47±0.11 (P=0.792), and 0.47±0.08 (P=0.792) at 2 weeks, 1, and 2 months after treatment, respectively. A transient visual disturbance occurred at 2 weeks then returned to initial visual acuity at 3 months after treatment (Fig. 2). The changes in intraocular pressure in the group with a combination treatment were 16.1±4.2, 17.3±3.8, 16.9±5.7, and 16.6±5.4 mmHg at 2 weeks, 1, 2, and 3 months after surgery, and the intraocular pressure did not exceed 21 mmHg. Complications such as endophthalmitis, retinal detachment, or vitreous hemorrhage did not occur in all patients.

Bottom Line: Average BCVA (log MAR) significantly improved from preoperative 0.56-/+0.20 to 0.43-/+0.08 at 1 month (P=0.042) and it was maintained until 3 months after a combination of IVTA and PRP in 10 eyes (P=0.007).The thickness of fovea decreased from average 433.3-/+114.9 micrometer to average 279.5-/+34.1 micrometer at 2 weeks after combined treatment of IVTA and PRP (P=0.005), which was significantly maintained until 3 months, but there was a transient visual disturbance and no significant difference in thickness of the fovea before and after treatment in the groups with PRP and focal or grid laser photocoagulation.In combination with PRP, IVTA might be more effective than focal or grid laser photocoagulation and PRP for reducing diabetic macular edema and preventing aggravation of macular edema without transient visual disturbance in patients requiring immediate PRP.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Soonchunhyang University, College of Medicine, Yongsan-gu, Seoul, Korea. ckseek@naver.com

ABSTRACT

Purpose: To evaluate therapeutic effects and usefulness of a combination treatment of intravitreal injection of triamcinolone acetonide (IVTA) and panretinal photocoagulation (PRP) in patients with clinically significant macular edema secondary to proliferative diabetic retinopathy (PDR).

Methods: Visual acuity test, fundoscopy, fluorescein angiography, and optical coherence tomography (OCT) were taken in 20 patients (20 eyes) of macular edema and PDR. A combination of intravitreal injection of triamcinolone acetonide and PRP was performed in 10 patients (10 eyes) and a combination of focal or grid laser photocoaqulation and PRP in the remaining 10 eyes. The postoperative outcomes were compared between the two combination treatments by best corrected visual acuity (BCVA), tonometry, fluorescein angiography, and OCT at 2 weeks, 1, 2, and 3 months.

Results: Average BCVA (log MAR) significantly improved from preoperative 0.56-/+0.20 to 0.43-/+0.08 at 1 month (P=0.042) and it was maintained until 3 months after a combination of IVTA and PRP in 10 eyes (P=0.007). The thickness of fovea decreased from average 433.3-/+114.9 micrometer to average 279.5-/+34.1 micrometer at 2 weeks after combined treatment of IVTA and PRP (P=0.005), which was significantly maintained until 3 months, but there was a transient visual disturbance and no significant difference in thickness of the fovea before and after treatment in the groups with PRP and focal or grid laser photocoagulation.

Conclusions: A combination of IVTA and PRP might be an effective treatment modality in the treatment of macular edema and PDR and prevent the subsequent PRP-induced macular edema result in visual dysfunction. In combination with PRP, IVTA might be more effective than focal or grid laser photocoagulation and PRP for reducing diabetic macular edema and preventing aggravation of macular edema without transient visual disturbance in patients requiring immediate PRP.

Show MeSH
Related in: MedlinePlus