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K. E. Burleigh, C. C. Zatezalo, R. M. Lieberman, R. M. Fischer; Treatment of Diabetic Macular Edema With Intravitreal Triamcinolone, Focal-grid Laser or Combination Therapy in a Diverse Clinic Population. Invest. Ophthalmol. Vis. Sci. 2009;50(13):190.
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To examine the efficacy and long-term outcomes in patients of a single intravitreal injection of 4mg/0.1mL of preservative free triamcinolone acetonide, focal-grid laser (FGL) and combination therapy (CT) for diabetic macular edema (DME) in a diverse clinic population.
A retrospective chart review of 109 consecutive patients (127 eyes) receiving FGL, IVK, or CT was conducted. Data collected include HA1c, demographics, best corrected visual acuity (BCVA), and central retina thickness (CRT) as measured by optical coherence topography (OCT). Main outcome measures included BCVA and CRT, both assessed initially and at 1, 3, 6, and 12 BCVA was converted to logMar. All interventions were subdivided with respect to initial BCVA (20/20-20/40, 20/50-20/100, <20/200).
Of the109 patients (127 eyes) included, there were 66 Hispanics, 39 Asians, 5 Blacks, and 2 Caucasians. Initial visual acuity ranged from 20/20-20/400. A1cs ranged from 5.4%-14.1%, with an initial mean of 8.3%, 8.2% and 7.8% for FGL, IVK and CT respectively. The FGL (n=79) mean BCVA at time of treatment was 20/24, 20/41.73 at 1 mo, 20/47.7 at 3 mo, 20/41 at 6 mo, and 20/42 at 12 mo. The mean CRT was 244.58um at presentation. Initial mean BCVA for IVK (n=18) was 20/138, 20/88 at 1 mo, 20/106 at 3 mo, 20/107 at 6 mo and 20/65 at 12 mo. There was statistically significant improvement in BCVA at12 mo (p= 0.1294). Initial mean CRT was 404 um. The CT (n=28) mean BCVA was 20/86 at time of treatment, 20/61 at 1 mo, 20/47 at 3 mo, 20/58 at 6 mo and 20/59 at 12 mo, demonstrating statistically significant change at 3 mo and 6 mo (p= 0.01017 and p= 0.0661). The mean initial CRT was 379um. Percent improvement from initial BCVA to data points at 1,3,6 and 12 mo was calculated at 14%, 0%, 17%, and 14% for FGL, and 23%, 14.3%, 13%, and 40%; 28%, 28.5%, 30%, and 17% for IVK and CT, respectively.
We found CT to show a statistically significant improvement in BCVA at 3 months and 6 months, which was not sustained. Despite elevated A1c levels, all groups did maintain their initial level of BCVA. It is therefore important to identify and to appropriately treat DME in a diverse population.
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