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B. Sander, C. Jorgensen, A. Bech Hansen, H. Lund-Andersen; Diabetic Macular Edema: Follow-up Study 5 years after Initial Photocoagulation . Invest. Ophthalmol. Vis. Sci. 2003;44(13):3959.
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Purpose: To evaluate the visual acuity at follow-up in relation to baseline parameters and maculopathy at follow-up. Methods: 43 eyes in 29 patients were reexaminded 5 years after initial macular photocoagulation. Clinically significant macular edema (CSME) and visual acuity were evaluated with ETDRS-criteria and blood-retinal barrier (BRB) permeability was measured with vitreous fluorometry (33 eyes). At follow-up, optical coherence tomography (OCT) was added to the examination. One eye with AMD at follow-up was omitted from the analysis. Results: Visual acuity decreased from logMAR 0.3 at baseline to 0.5 at follow-up (p< 0.01) and baseline acuity was correlated to follow-up acuity (r=0.44, p<0.01 , n=42). At follow-up, CSME was present in 10 eyes evaluated by biomicroscopy and in 15 eyes with OCT. Visual acuity had dropped more then 3 lines in 17 eyes. Severe maculopathy with persistent edema were found in 7 eyes, ischemic/atrofic retina in 4 eyes and persistent proliferations on the optic nerve in 1 eye. In 5 eyes, a high persistent BRB permeability was the most significant finding. A significantly higher baseline BRB permeability was found ind eyes with the worse visual outcome compared to eyes with stable visual acuity (14.5 nm/sec and 7.2 nm/sec respectively, p=0.04) and the ODDS ratio for worse visual outcome was 5.0 (95% conficende limits 0.4 – 9.3). No effects were found regarding other baseline parameters such as HbA1c, retinopathy and blood pressure. Conclusions: In 41%, the visual result at follow-up was decreased with 3 lines or more and baseline BRB permeability in these cases were significantly higher than in eyes with stable visual acuity. Persistent edema was found in 17% at follow-up. The low visual acuity in the remaining non-edematous eyes were related to retinal ischemia/atrophy and persistent excessive blood-retina barrier permeability.
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