Short-term Visual Acuity Outcome To Focal Retinal Photocoagulation In Black Patients With Clinically Significant Macular Edema

Abstract

Abstract: : Purpose: The purpose of this study was to evaluate the short-term outcome of visual acuity to focal retinal photocoagulation among black patients with diabetic clinically significant macular edema. Methods: We conducted a six-year retrospective review of consecutive charts consisting of 421 eyes from 240 black patients with CSME treated with focal retinal photocoagulation. These patients were treated in the Retina Clinic at Howard University Hospital by the same Surgeon. Eighty two patients with 138 eyes met the study eligibility criteria. These patients were observed for at least 8 months after the initial focal retinal laser surgery. On the basis of baseline visual acuity (VA), converted to decimals, eyes were classified into one of four groups. Preoperative patient characteristics were tested for their significance in predicting outcome using multiple regression analysis. Only the patients with hemoglobin A₁C of less than or equal to 7.20 were included in the data analysis. Primary objective measures were VA at 2-4 and 6-8 months versus initial VA. Statistical analyses were performed with using ANOVA, F test, and student T test. Results: There was no significant difference in the follow-up compliance of patients evaluated with increasing time points. The results showed an overall increase in the percent of eyes with improved or stable VA with time. Specifically, the VA of 81% of the eyes improved or remained the same after 2-4 months of treatment compared to 94% that improved or remained the same after 6-8 months follow up period. A significant number of the patients with poor initial visual acuity (less than 20/60) showed better visual acuity outcome after focal retinal photocoagulation. Most of the patients with better initial visual acuity (greater than 20/60) remained with better VA outcome both after 2-4 and 6-8 month follow-up periods, respectively. These were mostly patients without history of hypertension. Conclusion: There was an overall increase in the number of eyes with improved or stable VA with time after focal retinal laser treatment. The patients with history of hypertension had the worse response to focal retinal laser treatment compared to those without history of hypertension, who remained mostly in the groups with better VA. Thus, co-morbid history of hypertension, despite maintenance of average BP at less than or equal to 150/85, appears to represent a poor prognostic factor in patients with diabetic macular edema.

Keywords: 388 diabetic retinopathy • 454 laser • 620 visual acuity