Purchase this article with an account.
Sonja G. Prager, Katharina Kriechbaum, Matthias Bolz, Georgios Mylonas, Bianca Gerendas, Georg Rainer, Christoph D. Scholda, Ursula Schmidt-Erfurth, DRRG - Diabetic Retinopathy Research Group Vienna; Predictive Morphological Factors Associated With Positive Response To Intravitreal Bevacizumab And Triamcinolone In Diabetic Macular Edema. Invest. Ophthalmol. Vis. Sci. 2011;52(14):575.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Intravitreal triamcinolone as well as anti-VEGF have been shown to be effective agents in the treatment of diabetic macular edema (DME). The aim of this study was to identify morphologic factors associated with functional improvement following three months of treatment, respectively.
32 patients with untreated clinically significant cystoid DME were included in this prospective, comparative interventional case series. They were randomized into two equal groups: 16 received three injections of 2,5mg bevacizumab at 1-month intervals and 16 patients received one initial injection of 8 mg triamcinolone followed by two sham injections. Study population was classified in two groups regarding BCVA improvement or worsening at month 3. Baseline characteristics in SD-OCT were evaluated regarding subretinal fluid (SRF), size of intraretinal cysts (IC), and photoreceptor inner segment (IS) and outer segment (OS) junction integrity. Baseline FA images were graded in regard to ischemic areas (IA), irregularly shaped foveal avascular zone (FAZ) and type of CME (focal or diffuse). Grading was performed by two readers of the Vienna Reading Center using a standardized protocol.
23 subjects showed a statistically significant BCVA improvement from initially 0,32 logarithm of the minimum angle of resolution (logMAR) to 0,2 logMAR (p<0,001) at month 3 whereas nine subjects developed a statistically significant BCVA worsening from 0,26 logMAR to 0,38 logMAR (p=0,005) at month 3. Baseline characteristics were well balanced regarding sex, age, BCVA, central retinal thickness (CRT), size of IC and CME type. Patients treated with bevacizumab were more likely to gain vision than patients treated with triamcinolone though retinal thinning was comparable in both groups. Furthermore IS/OS integrity, regular FAZ as well as SRF at baseline were seen more often in patients with BCVA improvement after 3 months.
Evaluation of retinal morphology by SD-OCT and FA may help to predict the individual treatment response secondary to intravitreal bevacizumab or triamcinolone injection in patients with diabetic macular edema.
Clinical Trial: :
This PDF is available to Subscribers Only