Grid Laser Photocoagulation Research Articles

Intravitreal triamcinolone injection combined with or without macular grid laser photocoagulation to treat macular edema

Objective To compare the efficacy of intravitreal triamcinolone(IVTA) injection and IVTA combined with macular laser grid photocoagulation (MLGP) to treat macular edema.Methods Consecutive 89 patients (109 eyes)diagnosed with macular edema by examinations of ocular fundus and optical coherence tomography (OCT).The visual acuity was hand moving- 0.8 (0.19±0.13);the intraocular pressure(IOP)ranged from 7 mm Hg to 21 mm Hg(1 mm Hg=0.133 kPa)and the average IOP was 13.78 mm Hg.All the patients received OCT and microperimetry examinations,the central macular thickness was (570±182) μm;the average light sensitivity was (5.07±3.94) dB and the fixation percentage was 70.67% within 4 ° area around the macular fovea.All the patients received IVTA treatment,39 patients (48 eyes)further received MLGP 1 month later (IVTA-MLGP group).The remaining 50 patients (61 eyes) without MLGP treatment was the IVTA group.Best corrected visual acuity (BCVA),lOP,lens,OCT and microprimetry examinations before and after IVTA (1,3,6,12 months) were followed and analyzed.Results On the 12th months,the BCVA in IVTA-MLGP and IVTA group was (0.41±0.20),(0.24±0.19) respectively (P<0.05);the central macular thickness was (309±187) and (487±206) μm respectively(P<0.05);the mean light sensitivity of 4° central macular was (8.24±4.64)and(6.30±3.22) dB respectively (P<0.05);the fixation percentage was (87.01±19.70)% and (78.85±20.41) % respectively (P<0.05).During the follow-up recurrent macular edema was noticed in 28 eyes of IVTA group and 8 eyes of IVTA-MLGP group.Conclusions IVTA combined with MLG was more effective than IVTA to cure macular edema. Key words: Macular edema,cystoid/therapy; Triameinolone acetonide/therapeutic use; Laser coagulation/methods; Treatment outcome

Effects of repeated injection of intravitreal triamcinolone on macular oedema in central retinal vein occlusion

To investigate the effectiveness of repeated injections of intravitreal triamcinolone acetonide (IVTA) in the treatment of macular oedema caused by central retinal vein occlusion (CRVO). Seventeen pseudophakic or aphakic eyes of 17 patients (10 male, seven female) with macular oedema caused by CRVO received a repeat injection of 4 mg IVTA, 16 weeks after the first injection of the same dose. The examination included measurements of best-corrected visual acuity (BCVA) for distance and central foveal thickness (CFT) by optical coherence tomography (OCT), preoperatively and 1, 2, 3 and 4 months postoperatively. The values were compared by paired-t test. Side-effects were monitored. BCVA and CFT were not significantly different before initial and repeat injections. Transient improvements of BCVA and CFT were achieved after both injections. At the end of follow-up, BCVA and CFT were significantly different compared to pre-injection values in the same group (P = 0.032, 0.049 in the initial-injection group and P = 0.001, 0.008 in the repeat-injection group, respectively). However, compared to the initial injection, BCVA measurements were significantly worse at each time-point (P = 0.043, 0.011, 0.010 and 0.012, respectively) after the repeat injection, as were CFT at 1, 2 and 3 months post-injection (P = 0.040, 0.015 and 0.025, respectively). The achieved maximum mean intraocular pressures were 20.00 [standard deviation (SD) 2.06] mmHg and 18.56 (SD 3.65) mmHg after the first and repeat injections, respectively. These values were not significantly different (P = 0.467). No other significant adverse events were noted during the study. A repeat injection of 4 mg IVTA may not be as effective as an initial injection for the treatment of macular oedema caused by CRVO.

BEVACIZUMAB COMPARED WITH MACULAR LASER GRID PHOTOCOAGULATION FOR CYSTOID MACULAR EDEMA IN BRANCH RETINAL VEIN OCCLUSION

To evaluate the outcome of cystoid macular edema treated with intravitreal injections of bevacizumab and macular grid laser photocoagulation (GLP), in patients with perfused branch retinal vein occlusion. Thirty eyes of 30 consecutive patients with cystoid macular edema secondary to nonischemic branch retinal vein occlusion were assigned to either GLP group or to intravitreal bevacizumab (IB) group. Complete ophthalmologic examinations were performed just before GLP and IB injection at 1, 3, 6, and 12 months after treatment. Changes in logarithm of minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA), central macular thickness (CMT) shown by optical coherence tomography-3 were evaluated. Baseline BCVA (logMAR) and CMT were, respectively, 0.89 +/- 0.13 and 650 +/- 140 microm for the GLP group, 0.87 +/- 0.16 and 690 +/- 120 microm for the IB group. After the treatment, at 1, 3, 6, and 12 months in the GLP group, BCVA had improved by 0.19, 0.22, 0.21, and 0.20 logMAR, CMT had decreased by 40%, 41.3%, 40.5%, and 42%. In the IB group, BCVA had improved by 0.31, 0.32, 0.30, and 0.31 logMAR and CMT had decreased by 59.5%, 59%, 60%, and 60.3%. The group receiving bevacizumab had better BCVA and lower CMT values at all time points (P < 0.05). Intravitreal bevacizumab injection improves BCVA and reduces CMT more than GLP. Intravitreal bevacizumab injection was well tolerated and could be used as primary treatment in patients with cystoid macular edema secondary to perfused branch retinal vein occlusion.

Grid Laser Photocoagulation After Intravitreal Triamcinolone for Macular Edema Associated With Branch Retinal Vein Occlusion

Purpose: To evaluate the clinical outcomes of macular laser photocoagulation after intravitreal injection of triamcinolone acetonide (IVTA) for macular edema in branch retinal vein occlusion (BRVO). Methods: In this retrospective study we reviewed the medical records of patients who had been treated with an intravitreal injection of 4 mg triamcinolone acetonide for macular edema due to BRVO and followed up for more than six months. We divided the eyes into two groups, namely, the IVTA-only group and the additional grid laser group after IVTA. Visual acuity, macular thickness, intraocular pressure, and abundance of IVTA were compared. Results: A total of 41 eyes underwent IVTA, 21 of which were treated with additional macular grid photocoagulation. The difference in best corrected visual acuity before IVTA between the two groups was not statistically significant. Laser photocoagulation was performed at an average of 2.8 months after IVTA. Final VA and foveal thickness improved significantly after IVTA in both groups and showed no significant difference between the two groups. After six months a second injection was required in six eyes in the IVTA group and one eye in the photocoagulation group due to recurrence of macular edema, the difference of which was significant (p=0.04). Conclusions: IVTA in BRVO patients improved macular edema and visual acuity. Combined grid photocoagulation after IVTA lowered the recurrence rate of macular edema. Grid photocoagulation can be considered as a useful adjuvant for avoiding repeated administration of intravitreal triamcinolone.

Comparison of Photocoagulation With Combined Intravitreal Triamcinolone for Diabetic Macular Edema

PurposeTo compare the efficacy between macular laser grid (MLG) photocoagulation and MLG plus intravitreal triamcinolone acetonide (IVTA; MLG+IVTA) therapy in diabetic macular edema (DME) patients.MethodsA prospective, randomized, clinical trial was conducted of DME patients. A total of 60 eyes (54 patients) affected by DME were observed for a minimum of 6 months. Thirty eyes of 28 patients who received MLG treatment and 30 eyes of 26 patients who received the combined MLG+IVTA treatment were included in the study. Main outcome measures were BCVA and central macular thickness (CMT) as measured by optical coherence tomography (OCT) at 1, 3, and 6 months after treatment. Additionally, the authors examined retrospectively 20 eyes of 20 patients who were treated with only IVTA and compared with the 2 groups (MLG group and MLG+IVTA group).ResultsBaseline BCVA was 0.53±0.32 and CMT was 513.9±55.1 µm in the MLG group. At 1 and 3 months after treatment, the MLG group showed no significant improvement of BCVA and CMT, although there was significant improvement after 6 months. In the MLG+IVTA group, the baseline BCVA was 0.59±0.29 and CMT was 498.2±19.8 µm. After treatment, significant improvement of BCVA and CMT was observed at all follow-up time periods. When comparing the MLG group with the MLG+IVTA group, the latter had better results after 1 and 3 months, although at 6 months, there was no significant difference of BCVA and CMT between the 2 groups. Additionally, the IVTA group showed more improvement than the MLG group at 1 and 3 months but showed no significant difference at 6 months. In addition, the IVTA group showed no significant difference with the MLG+IVTA group at all follow-up time periods.ConclusionsFor DME patients, the combined MLG+IVTA treatment had a better therapeutic effect than the MLG treatment for improving BCVA and CMT at the early follow-up time periods. IVTA treatment alone could be an additional alternative therapeutic option to combined therapy.

Posterior Juxtascleral Infusion of Modified Triamcinolone Acetonide Formulation for Refractory Diabetic Macular Edema: One-Year Follow-Up

To evaluate prospectively the efficacy and safety of posterior juxtascleral infusion of a new formulation of triamcinolone acetonide for refractory diffuse diabetic macular edema. This was an interventional case series. Twenty-two consecutive eyes of 18 patients with refractory diffuse diabetic macular edema were included in the study. Each patient underwent a complete ophthalmic examination, including optical coherence tomography (OCT) and digital fluorescein angiography (FA). All patients received a suspension of 40 mg triamcinolone acetonide, 20 mg sodium chondroitin sulfate, and 15 mg sodium hyaluronate (1.5 mL), delivered posteriorly through a conjunctival and Tenon's incision. All patients completed the 1-year follow-up. On average, studied eyes received 1.5 treatments. Mean preoperative foveal thickness (+/-SD) and visual acuity (+/-SD) were 474.2 +/- 136.6 microm and 0.6 +/- 0.37 logarithm of the minimum angle of resolution (logMAR), respectively. The central foveal thickness was significantly reduced from baseline at every follow-up visit (P < 0.001). Mean (+/-SD) reductions in macular thickness were 136 +/- 108 microm at 1 week and 128 +/- 122 microm after 1 year of follow-up. Mean (+/-SD) improvement in visual acuity at 12 months was 0.15 +/- 0.21 logMAR (P = 0.008). Visual acuity improvement of one or more lines and three or more lines were observed in 14 (63.6%) and 6 (27.3%) eyes, respectively. Seven eyes (31.8%) required topical treatment due to a significant intraocular pressure increase. Posterior juxtascleral infusion of a new formulation of triamcinolone acetonide is an effective treatment for diffuse diabetic macular edema unresponsive to conventional grid laser photocoagulation. A randomized, larger study is warranted.

POSTERIOR HYALOID CHANGES FOLLOWING INTRAVITREAL TRIAMCINOLONE AND MACULAR LASER FOR DIFFUSE DIABETIC MACULAR EDEMA

To compare the effects of intravitreal triamcinolone and macular grid laser photocoagulation on the vitreomacular relationship in diffuse diabetic macular edema. Review of optical coherence tomography images gathered in a prospective, interventional randomized clinical trial. Institutional Practice. Seventy-seven optical coherence tomography images of 88 consecutive patients entered into a randomized clinical trial of the treatment of persistent diffuse diabetic macular edema were reviewed by two independent observers. All patients in the trial had diabetic macular edema following at least two macular grid laser treatments and were randomized to intravitreal injections of 4 mg triamcinolone or to further macular grid laser. Optical coherence tomography images were recorded at baseline, 4, 8, and 12 months and the patterns of vitreomacular relationship were classified into six categories. The patterns of vitreomacular relationship in the two groups were compared and correlated with the response to treatment. Outcome measures were defined as changes in best-corrected visual acuity Early Treatment Diabetic Retinopathy Study letters and central macular thickness on optical coherence tomography. Six eyes had peri-foveal vitreous detachment with or without traction in each group at baseline. At 12 months, the prevalence of peri-foveal vitreous detachment was significantly higher after intravitreal triamcinolone (n = 11) than macular grid laser (n = 8). These patients had poorer visual outcome (P = 0.01) and increased central macular thickness (P = 0.002). The development of complete posterior vitreous detachment was associated with significantly decreased central macular thickness (P = 0.001) but not better visual outcome (P = 0.72). These results suggest that posterior hyaloid changes may play a more influential role in the response to intravitreal triamcinolone than laser treatment for diffuse diabetic macular edema.

Grid laser photocoagulation for early macular edema in central retinal vein occlusion

Grid laser photocoagulation for early macular edema in central retinal vein occlusion

Posterior sub‐tenon injection of triamcinolone acetonide as a pretreatment of focal laser photocoagulation for diabetic macular edema

Abstract Purpose To determine whether a posterior sub‐Tenon injection of triamcinolone acetonide (TA) before focal photocoagulation is a safe and effective treatment for diabetic macular edema. Methods Sixteen eyes of 11 diabetic patients with unresolved diffuse macular edema were treated with a 20 mg sub‐Tenon injection of TA 1 to 2 months before focal photocoagulation. Focal photocoagulation was applied only to microaneurysms, and grid laser photocoagulation was not performed. The main outcome measures were visual acuity (VA), the optical coherence tomographically (OCT)‐determined central macular thickness (CMT), and the fluorescein angiographic appearance of the retina. Patients were followed for at least 6 months. Results One month after the sub‐Tenon injection of TA, the macular edema was resolved with a significant reduction of the CMT by OCT. The VA was slightly improved. Subsequent focal photocoagulation of the microaneurysms maintained the significant reduction of CMT for up to 6 months. A significant improvement of VA was observed in 37.5% patients at 6 months, and no patient had a decrease of VA. Conclusion A 20 mg of sub‐Tenon's TA injection prior to focal laser photocoagulation is a safe and beneficial treatment for diabetic macular edema.

One-year results after intravitreal bevacizumab therapy for macular edema secondary to branch retinal vein occlusion

To investigate the long-term effectiveness of intravitreal bevacizumab treatment in eyes with perfused macular edema due to branch retinal vein occlusion (BRVO). In this prospective interventional case series, 23 consecutive, previously untreated eyes with perfused macular edema were treated with intravitreal bevacizumab (1.25 mg) injections and followed for 1 year. The main outcome measures were visual acuity (VA) and central retinal thickness (CRT). In addition, VA data were adapted to the non-logarithmic VA charts used in the previously published grid laser photocoagulation BRVO Study. The median VA gained 3.0 lines from baseline at 48 weeks. This was accompanied by a significant decrease of 39% of the median CRT. The mean number of re-injections was 1.6 during the first 6 months of follow-up and only 0.8 during the subsequent 6 months. In 65% of the cases, adapted VA data showed a gain of 1 or more lines and no eye lost more than 1 line. Repetitive intravitreal bevacizumab injections result in a significant long-term improvement of VA and CRT. The number of re-injections necessary to maintain this effect declined over time. However, the treatment seems to be only slightly better than grid laser photocoagulation.

Intravitreal Bevacizumab Treatment for Refractory Diabetic Macular Edema

The aim of this study was to report the short-term clinical and angiographic outcomes after an intravitreal injection of bevacizumab in eyes with refractory diabetic macular edema. Patients who had been treated with both grid-laser photocoagulation and intravitreal trimacinolone acetonide injections for diabetic macular edema received intravitreal bevacizumab (0.125 mg/0.05 mL). Snellen visual acuity testing and fluorescien angiography were performed before and 1 month after the injection for each patient. Seventeen (17) eyes of 16 patients were included in the study. All patients completed 6 weeks of follow-up. Visual acuity improved in 12 eyes (70%) and remained the same in 5 eyes (30%). Eight (8) eyes (47%) revealed a marked improvement of macular edema, 6 eyes (35%) revealed mild improvement, and 3 eyes (18%) had no change. None of the patients developed local or systemic adverse events. Intravitreal injection of bevacizumab may be effective in the treatment of refractory diabetic edema unresponsive to laser photocoagulation and an intravitreal triamcinolone injection.

Posterior sub-Tenon injection of triamcinolone acetonide as pretreatment for focal laser photocoagulation in diabetic macular edema patients

To determine whether a posterior sub-Tenon injection of triamcinolone acetonide (TA) before focal photocoagulation is safe and effective in patients with diabetic macular edema. Sixteen eyes of 11 diabetic patients with unresolved diffuse macular edema were treated with a 20-mg sub-Tenon injection of TA 1 to 2 months before focal photocoagulation. Focal photocoagulation was applied only to microaneurysms, and grid laser photocoagulation was not performed. The main outcome measures used were visual acuity (VA), central macular thickness (CMT) determined by optical coherence tomography (OCT), and the fluorescein angiographic appearance of the retina. Patients were followed for at least 6 months. One month after the sub-Tenon injection of TA, the macular edema was resolved with a significant reduction of the CMT on OCT. VA improved slightly. Subsequent focal photocoagulation of the microaneurysms maintained the significant reduction of CMT for up to 6 months. A significant improvement of VA was observed in 37.5% patients at 6 months, and there was no decrease in VA in any of the patients. A 20-mg sub-Tenon TA injection prior to focal laser photocoagulation is a safe and beneficial treatment in patients with diabetic macular edema.

Optical coherence tomography and vessel diameter changes after intravitreal bevacizumab in diabetic macular oedema

To assess the effect of intravitreal bevacizumab on diabetic macular oedema (DMO) and retinal vessel calibres. We performed a consecutive case series study in which 10 consecutive eyes with diffuse DMO, two of which had not previously been treated, received an intravitreal injection of bevacizumab 1 mg, which was followed by two more injections at 6-week intervals. Fundus photography and optical coherence tomography (OCT) were carried out at baseline immediately before injection and at 1, 2.5 and 4 months after the first injection. Outcome measures were best corrected visual acuity (BCVA) in Early Treatment Diabetic Retinopathy Study letters, macular volume, foveal subfield thickness and vessel diameter measurement. Intravitreal administration of bevacizumab was followed by a mean increase in BCVA of 7.3 +/- 17 (mean +/- standard deviation) letters between baseline and month 4, which was 1 month after the last injection (p < 0.0001). This was accompanied by a reduction in mean macular volume from 9.90 +/- 1.9 mm(3) to 8.96 +/- 2.4 mm(3) (p = 0.002) and in foveal subfield thickness from 447 +/- 117 microm to 388 +/- 117 microm (p = 0.03). Two eyes with early proliferative diabetic retinopathy lost all signs of proliferation without any evidence of fibrosis. Although there was a trend towards vasoconstriction, the changes in vessel diameters (arteries and veins) after 4 months of intravitreal Avastin injection were not statistically significant (p = 0.9 and p = 0.17, respectively). Foveal thickness in non-injected fellow eyes with DMO changed from 428 +/- 153 microm at baseline to 383 +/- 151 microm at 4 months (p = 0.1), which did not reach statistical significance. Intravitreal bevacizumab 1 mg every 6 weeks was followed by a moderate reduction in DMO without normalization of foveal and macular thickness. Our observations suggest that a larger study where patients are examined sooner after injection is needed to elucidate the potential relationship between changes in retinal vessel diameters and thickness changes in DMO.

The predictive value of optical coherence tomography after grid laser photocoagulation for diffuse diabetic macular oedema

The predictive value of optical coherence tomography after grid laser photocoagulation for diffuse diabetic macular oedema

EFFICACY OF INTRAVITREAL TRIAMCINOLONE FOR THE TREATMENT OF MACULAR EDEMA SECONDARY TO BRANCH RETINAL VEIN OCCLUSION IN EYES WITH OR WITHOUT GRID LASER PHOTOCOAGULATION

To evaluate the efficacy of primary and secondary (following grid laser photocoagulation) intravitreal triamcinolone acetonide (IVTA) injection for the treatment of macular edema associated with branch retinal vein occlusion (BRVO). Eyes with macular edema secondary to BRVO and best-corrected visual acuity (BCVA) worse than 20/40 were included. Eyes eligible for Branch Retinal Vein Occlusion Study (BVOS) guidelines received grid laser treatment first. Those that were not improved at least two lines following grid laser or that did not meet those guidelines received 4 mg IVTA injection. The efficacy of IVTA treatment was assessed by analyzing the change in BCVA and reduction in central macular thickness (CMT) measured by optical coherence tomography. Intraocular pressure (IOP) spikes and other complications were recorded. The data from 37 eyes were included; in 12 of them IVTA injection was given after grid laser while 25 of them received IVTA as a primary treatment. Mean follow-up was 9.6 +/- 4.5 months. BCVA was 0.06 +/- 0.30 and 0.17 +/- 0.50 in the primary and secondary IVTA injection groups, respectively. In the primary injection group, there was a statistically significant gain in BCVA throughout the follow-up (P < 0.05), while a small increase in BCVA was noted only at the third month visit in the secondary IVTA injection group (P = 0.04). Average CMT were 434.8 +/- 122.1microm and 389.0 +/- 171.9 microm before IVTA injection in the two groups, respectively. In the primary IVTA injection group, CMT decreased at 1 month following IVTA injection and remained statistically significant until the sixth month visit (P < 0.05). In the secondary IVTA injection group, a slight reduction in CMT was noted only in the first month visit (P = 0.02). Pre-IVTA BCVA was found to be the single statistically significant predictor of BCVA gain following IVTA injection. In 8 patients (21.6%), the IOP increased above 25 mmHg postoperatively, and was successfully managed by medical treatment. Endophthalmitis did not develop in any of the patients. IVTA injection produced a significant reduction of macular edema in eyes with BRVO either with or without prior grid laser treatment. Reduction of CMT increased the BCVA in most of the eyes receiving IVTA primarily, while only a slight improvement of BCVA was found in eyes with prior grid laser. The IVTA effect was transient. Larger studies are necessary to find the best approach (either grid laser or IVTA) to patients with macular edema associated with BRVO.

Gas Tamponade and Macular Grid Laser Photocoagulation in the Management of Recurrent Retinal Detachment

To evaluate the efficacy of intraocular gas tamponade and macular grid laser photocoagulation to manage recurrent macular hole retinal detachment after an initially successful reattachment by gas tamponade in highly myopic eyes. Five patients with high myopia and macular hole retinal detachment were treated by gas tamponade at the initial operation. Gas tamponade and macular grid laser photocoagulation were performed to treat recurrent retinal detachment at the second surgery. Demographic information, anatomic reattachment of the retina, and final visual acuity were studied. Final successful retinal reattachment at the end of follow-up was obtained in all five eyes. Improvement of postoperative visual acuity with respect to preoperative visual acuity was observed in all patients. Intraocular gas tamponade and grid laser photocoagulation in the macula for the management of recurrent macular hole retinal detachment provides good long-term anatomic success and acceptable functional results.

GRID LASER TREATMENT FOR EXUDATIVE RETINAL DETACHMENT SECONDARY TO ISCHEMIC BRANCH RETINAL VEIN OCCLUSION

To evaluate the effectiveness of macular grid laser photocoagulation (MGLP) in obtaining the reabsorption of exudative retinal detachment (ERD) in patients with ischemic branch retinal vein occlusion (BRVO). Prospective, randomized clinical trial including 31 patients with ERD secondary to ischemic BRVO, who were randomized either to MGLP or to observation. A complete ophthalmologic examination was performed within 7 days of treatment, and was arranged to be repeated regularly every 6 months for 24 months. MGLP was performed using a krypton laser with a spot size of 100 microm at 0.1 second. The main outcome measure was the number of eyes that had gained at least 15 letters at the 24-month examination in the two groups. By the month 24 visit, 40% of the patients in the MGLP group had gained at least three lines of visual acuity as opposed to no patient in the control group. The mean best-corrected visual acuity passed from 20/160 to 20/125 Snellen equivalent in the MGLP group, and from 20/160 to 20/400 Snellen equivalent in the control group at month 24. The difference in the mean reabsorption time was statistically significant (P < 0.001) comparing the treated group with the controls (9.1 versus 15.8 months). Natural history of ERD secondary to ischemic BRVO is poor, and MGLP is able to prevent visual acuity deterioration through a 24-month follow-up.

Posterior Subtenon Triamcinolone, Intravitreal Triamcinolone and Grid Laser Photocoagulation for the Treatment of Macular Edema in Branch Retinal Vein Occlusion

Purpose: To evaluate the efficacy of posterior subtenon triamcinolone (PSTT), intravitreal triamcinolone (IVT) injections and grid laser photocoagulation (GLP) in eyes with macular edema secondary to branch retinal vein occlusion (BRVO). Material and Methods: Patients with macular edema due to BRVO treated with PSTT, IVT injections or GLP were evaluated retrospectively. Complete ophthalmic examination with fluorescein angiography and optic coherence tomography were noted before and in the 1st, 3rd, and 6th months of the treatment. The visual and anatomical responses were evaluated and compared between the groups using paired t test and one-way ANOVA test. Results: There were 20, 35 and 24 eyes in the PSTT, IVT and GLP groups. In the PSTT group, the mean visual acuity (VA) and central foveal thickness (CFT) were 0.23 ± 0.23 and 413.2 ± 143.5 µm before treatment and 0.23 ± 0.18 and 358.7 ± 109.2 µm at the 3rd month, respectively (p = 0.504 and p = 0.031). The mean VA increased from 0.14 ± 0.15 to 0.33 ± 0.26 and the mean CFT decreased from 518.2 ± 145 to 292.9 ± 121 µm in IVT group at the 3rd month (p = 0.001). The mean VA increased from 0.29 ± 0.25 to 0.47 ± 0.32 (p = 0.001); CFT decreased from 397.3 ± 105.9 to 307.1 ± 88.4 µm (p = 0.005) in the GLP group. VA and CFT changes were significantly different between the groups at the 3rd month (p = 0.031). VA increase was significantly greater in the IVT group than in the PSTT group. Decrease in CFT was the highest in the IVT group (Tukey, p = 0.001). Conclusions: IVT and GLP seemed to be more effective than PSTT for the treatment of BRVO-associated macular edema. Possible complications of IVT and GLP must be weighted with the advantages of each treatment modality for each patient.

The predictive value of optical coherence tomography after grid laser photocoagulation for diffuse diabetic macular oedema

To assess the predictive value of optical coherence tomography (OCT) mapping of retinal thickness and intraretinal morphological changes after macular grid for diffuse diabetic macular oedema (DMO). We carried out a prospective, non-controlled, case series study, in which 28 consecutive eyes with previously untreated diffuse DMO underwent fundus photography and OCT at baseline and at 1, 3 and 6 months after treatment. Macular photocoagulation was followed by a significant reduction in retinal thickness in the foveal centre (- 80 microm) and in the foveal subfield (- 65 microm) from baseline to 6 months (p < 0.01). The bulk of the reduction in retinal thickness and macular volume was manifest after 1 month. No significant change in retinal thickness occurred from 1 to 3 months or from 1 to 6 months in any macular subfield (p > 0.05). The relative decrease in retinal thickness at 6 months was highest in the foveal centre (- 22%), followed by the foveal region (- 18%), the inner parafoveal region (- 8%), and the outer parafoveal region (- 2%). Thus, the effect of photocoagulation on retinal thickness decreased with increasing eccentricity (p < 0.025). Overall, there was no statistically significant change in best corrected visual acuity (BCVA) between baseline and follow-up (p < 0.05), but changes in foveal subfield thickness and changes in VA were highly correlated (r = 0.66, p < 0.0001). Visual outcome (final BCVA) and final foveal subfield thickness at 6 months were correlated with the pattern of intraretinal morphological changes at baseline (Spearman's correlation coefficient r = - 0.41, p = 0.03 and r = 0.45, p = 0.02, respectively). In addition, visual outcome (final BCVA) and final foveal subfield thickness at 6 months were correlated with baseline foveal thickness (Spearman's correlation coefficient (r = - 0.37, p = 0.05 and r = 0.5, p = 0.01, respectively). It seems that the 1-month time-point after macular laser treatment is a critical point for establishing the outcome of this modality of management of DMO. Baseline OCT mapping of intraretinal fluid accumulation patterns and foveal thickness can help to predict the final visual outcome and final foveal thickness, but not the absolute change in either of these parameters after macular laser therapy.

Intravitreal Triamcinolone plus Sequential Grid Laser versus Triamcinolone or Laser Alone for Treating Diabetic Macular Edema: Six-Month Outcomes

To evaluate the efficacy of sequential intravitreal triamcinolone acetonide (TA) injection followed by grid laser photocoagulation for treating diabetic macular edema (DME). Prospective, 3-armed, randomized clinical trial. One hundred eleven eyes of 111 patients with DME involving the fovea. Patients were randomized to grid laser photocoagulation (37 eyes), 4 mg of intravitreal TA (38 eyes), or 4 mg of intravitreal TA combined with sequential grid laser about 1 month later (36 eyes). Central foveal thickness (CFT) as measured by optical coherence tomography, logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA), and side effect profiles. The 6-month results are reported. All patients completed 6 months' follow-up. Baseline mean (+/- standard deviation) CFTs were 385+/-100 microm, 396+/-91 microm, and 424+/-108 microm for the laser, intravitreal TA, and combined groups, respectively (P = 0.24). After treatment, significant CFT reductions were noted in both the intravitreal TA and combined groups at all follow-up visits (P<0.01) but not in the laser group. Mean CFT improved significantly to minimums of 267+/-75 microm and 256+/-73 microm for the intravitreal TA and combined groups, respectively, but the difference between the 3 groups was not significant at 6 months. The standardized change in macular thickening at 17 weeks was significantly greater in the combined group versus the intravitreal TA group (P = 0.007), suggesting that combined treatment might prolong the effects of intravitreal TA. Mean baseline logMAR BCVAs were 0.64+/-0.37, 0.72+/-0.34, and 0.69+/-0.34 in the laser, intravitreal TA, and combined groups, respectively (P = 0.67). Best-corrected visual acuity improved significantly at 4 and 9 weeks for the intravitreal TA group but did not change significantly in the other 2 groups. No significant difference in BCVA was observed between the 3 groups at any time point. Contrary to the results of a recent study, combined treatment of intravitreal TA plus grid laser did not yield better CFT reduction or BCVA improvement at 6 months than intravitreal TA alone. Grid laser alone was significantly worse than the 2 other treatment modalities.