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S. Ahmad, S.S. Stinnett, G.J. Jaffe; Association Between Pre–Treatment Variables and Response to Intravitreal Triamcinolone Acetonide Injection in Diabetic Macular Edema . Invest. Ophthalmol. Vis. Sci. 2005;46(13):1464.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To determine whether pre–treatment clinical variables, optical coherence tomographic (OCT) findings, and FAZ size determined by fluorescein angiography (FA) in eyes with diabetic macular edema (DME) correlate with subsequent response to intravitreal triamcinolone (IVTA) injection. Methods: A consecutive series of 41 eyes of 36 patients who were treated with IVTA for DME was reviewed. Pre– and post–treatment clinical data were recorded. Pre–treatment OCT scans were assessed for central foveal thickness (CFT), morphologic edema pattern, cyst size, subfoveal fluid, ERM and vitreomacular traction. FAZ size on FA was measured. Statistical analyses were conducted to determine correlations between and among pre– and post–treatment variables. Results: After a median follow–up of 182 days, 36 eyes (88%) had a median 1.8 lines of maximal visual acuity (VA) improvement, attained a median 63 days after IVTA. Likewise, 38 eyes (93%) had a median 56% peak reduction in CFT, observed a median 55 days after treatment. Pre–treatment VA was highly correlated with post–treatment VA (p<0.0001). Non–hypertensive patients had a significantly greater VA improvement than those with hypertension (median 3 ETDRS lines vs 1 ETDRS line, p=0.036). Eyes with large cysts on OCT had a greater likelihood of VA improvement than those without (93% vs 67%, p=0.05). Eyes with cystic edema had better initial and final VA than those with diffuse macular edema. Greater CFT (p<0.0001), a predominantly–cystic pattern of edema (p=0.02), and the presence of large cysts (p=0.0009) on pre–treatment OCT were associated with a greater percentage–reduction in CFT. Although FAZ size correlated with initial CFT, it did not correlate with post–treatment VA or CFT reduction. Conclusions: We have identified pre–treatment variables that predict post–treatment VA and retinal morphology improvement following IVTA injection. These data will provide a more accurate prognosis to patients when they are counseled prior to IVTA injection.
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