Abstract
Abstract: :
Purpose:To determine, in eyes of diabetic patients with diffuse macular edema, the evolution of macular thickness and visual acuity during the first 4 weeks after intravitreal triamcinolone acetonide injection (TA). Methods: 33 eyes of 21 patients with mean age of 60.3 years (range: 37 to 70) and mean duration of diabetes of 15.4 years (range 4 to 30), were diagnosed with diabetic macular diffuse edema refractory to laser photocoagulation (mean duration of edema: 24.7 months, range 6 to 72; mean number of laser sessions: 2.3, range: 1 to 4). The central macular thickness (CMT) measured on optical coherence tomography (OCT) exceeded 300 µm. After informed consent, patients were injected with 4 mg TA through the inferior pars plana. During the first 4 weeks after injection, repeated central macular thickness measurements were performed (4 measurements in the 2 weeks after injection and then every week).Visual acuity (VA) was measured on Early Treatment of Diabetic Retinopathy Study (ETDRS) charts at inclusion, day 14 and day 28. Results: Mean CMT (±SD) at inclusion was 552.5µm (+/-147.5) (range 323 to 958) and mean VA (±SD) was 42.2 (+/-12.9) (range 20 to 69). These values were 223.9 µm (+/-52.7) (range 138 to 323) and 47.8 (+/-12.6) (range 19 to 72) respectively15 days after injection, and 202.6 µm (+/- 40.9) (range 137 to 304) and 50.4 (+/-11.9) (range 24 to 70) respectively 28 days after injection. Differences between CMT at inclusion, day 14 and day 28 were significant (p<0.0001). Difference between VA at inclusion and day 14 was significant (p<0.001) but not between day 14 and day 28 (p=0.58). 16 (48%) patients had CMT inferior to 205 µm at day 14 and 21 (64%) at day 28. No correlation was found between initial VA and CMT, final VA and CMT, neither between visual gain and amplitude of CMT decrease. 10 patients required a topical anti-hypertensive treatment for an intraocular pressure superior over 25 mmHg. Conclusions: Intravitreal TA is rapidly effective in reducing CMT in diabetic diffuse macular edema. The visual gain is not correlated with the amplitude of the CMT decrease.
Keywords: diabetic retinopathy • imaging methods (CT, FA, ICG, MRI, OCT, RTA, S • clinical (human) or epidemiologic studies: tre