Document Detail


Optical coherence tomographic pattern may predict visual outcome after intravitreal triamcinolone for diabetic macular edema.
MedLine Citation:
PMID:  17467527     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To identify an optical coherence tomography (OCT) pattern predictive of visual outcome in patients with diabetic macular edema (DME) who underwent a single dose of intravitreal triamcinolone. DESIGN: Retrospective case analysis with prospective data collection for controls. PARTICIPANTS: Ninety-three cases and 25 controls. METHODS: Two independent masked observers retrospectively examined preoperative macular OCTs of 93 eyes of 93 patients who were given a single dose (4 mg in 0.1 ml) of intravitreal triamcinolone for DME and categorized them as belonging to 2 groups: 1, comprised of eyes with high reflectivity (bright colors) from inner retinal layers, and 2, comprised of eyes that had low reflectivity (darker colors) from inner retinal layers. Logarithm of the minimum angle of resolution visual acuity (VA) and macular thickness measured by OCT were assessed preoperatively and postoperatively at 1 and 3 months. MAIN OUTCOME MEASURES: Optical coherence tomographic appearance of inner retinal layers. RESULTS: All patients completed 3 months of follow-up. In group 1, 45 of 51 eyes (88%) experienced visual improvement of > or =2 lines on an Early Treatment Diabetic Retinopathy Study (ETDRS) chart at 1 month of follow-up. Forty-four of 51 patients (86%) experienced visual improvement of > or =2 lines on an ETDRS chart at 3 months of follow-up. In group 2, 18 of 42 patients (43%) experienced visual improvement of > or =1 lines on an ETDRS chart at 1 and 3 months of follow-up. For the remaining patients, VA remained unchanged during the postoperative course of 3 months. CONCLUSIONS: Patients in whom OCT demonstrated the high reflectivity of inner retinal layers achieved greater VA though macular thickness decreased significantly after intravitreal triamcinolone in both groups. It may be hypothesized that a lower optical reflectivity of inner retinal layers is related to the atrophy of the inner retinal layers, thus resulting in a failure of VA recovery in these patients. The level of reflectivity from inner retinal layers on OCT may provide objective criteria in predicting the response of DME to intravitreal triamcinolone and help in preoperative counseling of patients with DME.
Authors:
S K Gibran; K Khan; S Jungkim; P E Cleary
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Ophthalmology     Volume:  114     ISSN:  1549-4713     ISO Abbreviation:  Ophthalmology     Publication Date:  2007 May 
Date Detail:
Created Date:  2007-04-30     Completed Date:  2007-05-10     Revised Date:  2008-02-11    
Medline Journal Info:
Nlm Unique ID:  7802443     Medline TA:  Ophthalmology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  890-4     Citation Subset:  IM    
Affiliation:
Eye, Ear, Nose and Throat Centre, Queens Medical Centre, Nottingham, United Kingdom.
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MeSH Terms
Descriptor/Qualifier:
Aged
Diabetes Mellitus, Type 2 / complications
Diabetic Retinopathy / diagnosis*,  drug therapy
Female
Glucocorticoids / administration & dosage*
Humans
Injections
Macular Edema / diagnosis*,  drug therapy
Male
Prospective Studies
Retina / pathology*
Retrospective Studies
Tomography, Optical Coherence*
Treatment Outcome
Triamcinolone / administration & dosage*
Visual Acuity / physiology*
Vitreous Body
Chemical
Reg. No./Substance:
0/Glucocorticoids; 124-94-7/Triamcinolone
Comments/Corrections
Comment In:
Ophthalmology. 2008 Feb;115(2):417-8; author reply 418   [PMID:  18243920 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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