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O. O. Maia, Jr., B. S. Takahashi, M. L. Monteiro, W. Y. Takahashi; OCT and Visual Acuity in PDR Treated With Laser-Triamcinolone. Invest. Ophthalmol. Vis. Sci. 2009;50(13):191.
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To evaluate the correlation between ETDRS best-corrected visual acuity (BCVA) and central macular thickness (CMT) in eyes with moderate proliferative diabetic retinopathy (PDR) treated with laser (pan-retinal and macular) photocoagulation and intravitreal triamcinolone acetonide (IVTA) injection.
Prospective, interventional case-series. Twenty-eight eyes from 28 patients with treatment-naive moderate PDR were submitted to pan-retinal and macular laser photocoagulation according to the EDTRS guidelines. After completion of pan-retinal photocoagulation treatment at week 3, all eyes were assigned to receive a single 4 mg IVTA injection (Kenalog®40; triamcinolone acetonide injectable suspension, USP, Bristol-Myers Squibb Company). BCVA, digital color fundus photography, CMT measured using optical coherence tomography (Stratus® Tomographer, Model 3000, Carl Zeiss Meditec, Dublin, California, USA) was performed in all patients at baseline and at months 1, 3, and 6 after treatment. BCVA and CMT measurements before and after treatment were compared. Spearman’s rank correlation coefficients were used to evaluate the relationship between BCVA and CMT measurements.
At baseline, average CMT was 326.0 ± 101.1 µm (mean ± standard deviation), and BCVA was 0.37±0.20. After treatment, CMT decreased significantly to 242.2±35.1 (P< 0.001), 231.4±31.2 (P< 0.001), and 231.4±33.2 µm (P< 0.001) at 1, 3, and 6 months, respectively, as compared to baseline measurements (Wilcoxon signed ranks test). BCVA improved to 0.20±0.13 (P< 0.001), 0.15±0.09 (P< 0.001), and 0.14±0.08 (P< 0.001) at 1, 3, and 6 months after treatment, respectively (Wilcoxon signed ranks test). Improvement in BCVA was followed by a significant reduction in CMT at 1, 3 and 6 months follow up when compared to baseline measurements (P < 0.001, ANOVA). There was a strong correlation between BCVA improvement and reduction of CMT (ρ = 0.527, P= 0.004) (ρ = 0.423, P= 0.025) (ρ = 0.564, P= 0.002), at 1, 3, and 6 months, respectively (Spearman's correlation coefficient).
A single injection of IVTA as an adjuvant to laser treatment was effective in reducing CMT and improving BCVA in eyes with moderate PDR. A strong correlation between CMT reduction and improvement in BCVA in these patients with no previous treatment of the diabetic retinopathy was observed. A larger sample with longer follow-up is warranted to confirm our findings.
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