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C. J. Patel, N. Sun, R. M. Lieberman, R. M. Fischer; A Two-Year Analysis Evaluating the Treatment of Diabetic Macular Edema With Intravitreal Triamcinolone, Focal-Grid Laser, or Combination Therapy in an Underserved Population. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4226.
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To compare the long-term (2 yr) outcomes of a single intravitreal injection of preservative-free Triamcinolone Acetonide (IVT) (4mg/0.1ml), Focal-Grid laser (FGL), or Combination Therapy (CT) to treat diabetic macular edema (DME) in an indigent population.
A retrospective chart review was performed on 113 eyes (98 patients) in a clinic population with DME treated with either IVT, FGL, or CT with 2 yr follow up. Data included demographics, A1c levels, best-corrected visual acuity (BCVA in logmar), and central retinal thickness (CRT) (um) on OCT. Data was collected at months 0, 1, 3, 6, 12, 15, 18, and 24. Each arm was divided according to baseline BCVA (<0.4, 0.4-1.0, >1.0).
Patients included were 36% Asian, 52% Hispanic, 7% African-American, and 5% Caucasian. FGL group (68 eyes) had a mean initial BCVA of 0.39, ranging from 0.32 to 0.47. BCVA improved by 0.125 at one month. The initial CRT was 267um. Those with baseline BCVA >1.0 had the most improvement, followed those in groups <0.4 and 0.4-1.0. A statistically significant improvement in BCVA was observed in the 0.4-1.0 group at one month. The IVT group (18 eyes) had an initial BCVA of 0.89, ranging from 0.61-0.89 during the study. The improvement in BCVA in the IVT group was greatest in those with baseline BCVA >1.0, followed by 0.4-1.0 and <0.40 respectively. Statistically significant differences were seen in those with baseline BCVA >1.0 at months 3, 12, 15, 18, and 24. Patients in the CT group (27 eyes) had an average baseline BCVA of 0.63. The patients in the group with an initial BCVA >1.0 had the greatest improvements in BCVA, followed by groups 0.4-1.0, and <0.40, respectively. Statistically significant improvements were seen in the >1.0 group at months 1, 3, 6, and 12. Patients with baseline BCVA >1.0, however, experienced an average increase of 97um in CRT at 2 years. Subgroup analysis showed improvements in the IVT group to be most dramatic in patients with baseline BCVA <0.4, followed by 0.4-1.0, and >1.0, respectively. There was no correlation with A1c and BCVA in any group.
We found a statistically significant improvement in BCVA in all groups with an initial BCVA of >1.0. However, those who received IVT appeared to have the greatest sustained improvement in BCVA versus FGL and CT. As A1c levels were uniformly elevated in all groups, it may be important to assess baseline visual acuity and CRT when determining a therapeutic strategy for treating diabetic macular edema in a clinic population.
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