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S. Yoshida, H. Oh, K. Nishijima, A. Sakamoto, N. Unoki, H. Hayashi, S. Nakagawa, Y. Makiyama, M. Kita, N. Yoshimura; Changes in the Photoreceptor Layer Integrity and Its Relation to Visual Acuity in Patients Treated With Intravitreal Triamcinolone Acetonide Injection for Diabetic Macular Edema. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1318.
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To study the correlation between visual acuity and the integrity of photoreceptor layer reported on spectral domain optical coherence tomography (SD-OCT) before and after intravitreal triamcinolone acetonide (IVTA) injection for diabetic macular edema.
We retrospectively reviewed the medical records of 22 eyes of 20 patients who received a single IVTA (4mg) injection for diabetic macular edema and followed for at least 3 months. The status of the photoreceptor inner segment/ outer segment junction (IS/OS) and the external limiting membrane (ELM) documented with SD-OCT were classified into 3 groups as continuous, discontinuous, and defective.
The mean foveal thickness significantly decreased from 418 µm to 247 µm (p<0.01) and logMAR visual acuity (VA) improved from 0.42 to 0.29 (p<0.01) 3 months after IVTA. In eyes with preoperative continuous or defective IS/OS junction, the postoperative status remained the same. A similar trend was observed with ELM. Eyes with preoperative defective integrity of either IS/OS or ELM had significantly worse preoperative and postoperative VA compared to the remaining groups (0.73 vs 0.22 for IS/OS, 0.66 vs 0.22 for ELM, p<0.05 for both IS/OS and ELM). Five out of 17 eyes and 4 out of 18 eyes with preoperative discontinuous integrity of IS/OS junction and ELM, respectively, improved to be continuous postoperatively. In regard to IS/OS, these eyes had significantly better postoperative VA compared to those that remained unchanged (0.19 vs 0.39, p<0.05). However, a similar trend was not observed with ELM.
The overall integrity of both IS/OS and ELM reflect well both the preoperative and postoperative VA. The preoperative status of the photoreceptor layer integrity can partly predict its postoperative one. About 20% of the eyes showed an improvement in the integrity of photoreceptor layer in terms of the IS/OS junction or the ELM after IVTA. In the preoperative discontinuous IS/OS group, improvement of this structure after treatment may have a role in postoperative VA.
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