Injection For Diabetic Macular Edema Research Articles

Glucose regulation influences treatment outcome in ranibizumab treatment for diabetic macular edema

Purpose To evaluate the effect of glucose regulation on intravitreal ranibizumab injection for clinically significant diabetic macular edema (DME). Methods This retrospective study enrolled 65 eyes of 65 patients with persistent DME treated with intravitreal ranibizumab injection. The main outcome measures were the change in best corrected visual acuity (BCVA), the central subfield macular thickness (CSMT) recorded with optical coherence tomography (OCT), and its correlation with the serum hemoglobin A 1c values (HbA 1c). Results The study included 24 (36.9%) female and 41 (63.1%) male patients with a mean age of 58.90±9.45 years. The mean HbA 1c of the enrolled patients was 8.25±1.74% (range 5.7–12.7%). The median value of BCVA at baseline examination was 20/80 (52 letters), and the median CSMT was 468 μm (range 255–964 μm). In the final control after 4–6 weeks following injection, the median value of BCVA increased to 20/50 (59.50 letters) and the median CSMT decreased to 310 μm (range 129–652 μm). This change in BCVA and macular thickness was found to be significant ( P<.001 for both). There was no correlation between BCVA and the change in macular thickness (coefficient=0.04, P=.78). The serum HbA 1c values were found to be negatively correlated with the change in CSMT (coefficient=−0.50, P<.001). Conclusions The results of intravitreal ranibizumab injection for DME demonstrated a beneficial effect on visual acuity and a decrease in CSMT which is inversely correlated with the serum HbA 1c level.

Fluorescein angiography patterns associated with the effect of intravitreal bevacizumab injection for diabetic macular edema

Abstract Purpose To analyze the fluorescein angiography (FAG) findings associated with the effect of intravitreal bevacizumab injection (IVB) for treatment of diabetic macular edema (DME). Methods Seventy eyes of 65 patients with DME were included in this prospective, non‐randomized pilot study. The changes in best‐corrected visual acuity (BCVA) and central macular thickness (CMT) on optical coherence tomography were evaluated considering the FAG pattern at baseline and 3 month after IVB. Results On baseline FAG, 20 eyes (28.6%) showed honeycomb type hyperfluorescence; 9 eyes (12.9%), petaloid type; and 41 eyes (58.6%), diffuse type. Three months after IVB, the mean decrease in CMT was 250.5 (198.78) μm in the case of the honeycomb and petaloid type, which was significantly larger than that in the case of the diffuse type 102.5 (147.72) μm (p = 0.03). The improvement in BCVA was 0.27 (0.30) logMAR in the case of the honeycomb and petaloid type and 0.11 (0.27) logMAR in the case of the diffuse type; this difference was statistically significant (p &lt; 0.02). There was no statistical relationship between the leakage starting time and CMT or BCVA. Conclusion The effect of IVB for treatment of DME was better in eyes showing honeycomb and petaloid type hyperfluorescence on baseline FAG than those exhibiting diffuse type hyperfluorescence.

Features of Optical Coherence Tomography Are Predictive of Visual Outcomes after Intravitreal Bevacizumab Injection for Diabetic Macular Edema

Purpose: To identify optical coherence tomography (OCT) patterns of diabetic macular edema (DME) predictive of visual outcomes after intravitreal bevacizumab (IVB; Avastin®) injection. Methods: We retrospectively examined 56 consecutive eyes that were given IVB injections for DME alongside the preoperative macular OCT data. Using this information, we categorized the eyes into 2 groups: group 1 showing diffuse patterns; group 2 demonstrating cystoid macular edema (CME). Result: The mean follow-up period was 11.66 ± 3.98 months. Group 1 eyes gained 0.04 ± 9.27 ETDRS letters (p = 0.984), while group 2 eyes gained 5.79 ± 9.98 ETDRS letters (p = 0.005). Mean macular thickness decreased by 72.79 ± 145.74 µm in group 1 (p = 0.014) and by 223.71 ± 224.52 µm in group 2 (p< 0.001). Conclusion: Patients showing CME upon OCT achieved greater improvements in visual acuity and macular thickness after IVB injection than patients with diffuse macular edema. The type of macular edema shown by OCT may provide an objective guideline in predicting the response of DME to IVB injection.

A Proposed Method of Logarithmic Transformation of Optical Coherence Tomography Data for Use in Clinical Research

To evaluate a logarithmic transformation of retinal thickness measurements from optical coherence tomography as a new approach to assess clinically meaningful changes in retinal thickness. Methodologic, evidence-based review. Standard published approaches for assessing change in retinal thickness over time, as measured by optical coherence tomography (OCT), were compared with a new approach based on a logarithmic transformation of the retinal thickness data. Comparative examples were derived using published data from a clinical trial comparing intravitreal corticosteroid injections for diabetic macular edema with standard laser treatment. Comparative examples using Diabetic Retinopathy Clinical Research Network data. Logarithmic transformation of retinal thickness data results in a more normalized distribution of OCT data and allows for data analyses assessing proportionate changes in retinal thickness during follow-up. For analysis of grouped data, a logarithmic transformation of the OCT retinal thickness measurements (logOCT) provides several analytic advantages. Distributions of retinal thickness in groups of eyes with diabetic macular edema, and many other causes of macular thickening, tend to be skewed to the right; the logOCT transformation tends to normalize these distributions, which has value for statistical comparisons. For assessing whether the observed OCT change in a patient is real (and not due to testing variability), a 1-step log scale change exceeds the measurement error for all degrees of retinal thickness in current instruments. In addition, this log scale is similar to the logarithm of the minimum angle of resolution (logMAR) scale used for visual acuity. Steps on the log scale for change in thickness seem to be better related to clinical importance than the actual change in microns because each step on the log scale is the same proportionate change in thickness, with a 3-step change equaling a halving or doubling of thickness, regardless of the baseline value. Transformation of OCT retinal thickness data to logOCT may assist in the assessment of clinically meaningful changes in retinal thickness just as use of the logMAR scale has helped to assess clinically meaningful changes in visual acuity.

Treatment of Diabetic Macular Edema: A Comparative Study

Purpose: To compare the effect and complications of treatments for diabetic macular edema. Methods: Literature review using the Korean medical database and the Korean Ophthalmological Society database was performed. Studies used consisted of patients with diabetic macular edema, comparing intravitreal triamcinolone acetonide (IVTA) injection with posterior subtenon triamcinolone acetonide (STTA) injection or intravitreal bevacizumab (IVB) injection, according to visual acuity (VA) outcomes, central macular thickness (CMT), and intraocular pressure (IOP) at 1, 3, and 6 months. Results: In the three studies comparing IVTA injection with STTA injection, IVTA injection demonstrated greater improvement in VA at 1 month and CMT at 6 months. The patients who received IVTA injection had significantly higher IOP at 3 months. In the three studies comparing IVTA injection with IVB injection, IVTA injection demonstrated greater improvement in VA at 3 months and CMT at 6 months. Conclusions: The functional and anatomical improvements are achieved by IVTA injection, STTA injection, and IVB injection for diabetic macular edema, and the effect of IVTA injection is more prominent than other injection types with longer duration.

The Results of a Combination of Cataract Surgery and Intravitreal Bevacizumab Injection for Diabetic Macular Edema

Purpose: To evaluate the efficacy and safety of the combination of cataract surgery and intravitreal bevacizumab injection in patients with cataract and diabetic macular edema. Methods: Patients received an intravitreal injection of bevacizumab(1.25 mg) combined with phacoemulsification and implantation of a posterior chamber intraocular lens. Best corrected visual acuity (BCVA, LogMAR) and, central macular thickness (CMT) were measured using OCT at baseline and at one week, one, three, and six months after surgery, and adverse events were recorded. Results: The mean baseline LogMAR BCVA was 0.840.50 and mean CMT was 337.157.50 . At one week, one, three, and six months after surgery, the mean BCVAs were 0.520.40, 0.510.42, 0.520.34, and 0.460.37, and the mean CMTs were 356.486.44 , 338.8138.4 , 349.0122.9 , and 334.2100.4 , respectively. No adverse events associated with cataract surgery or intravitreal bevacizumab injection were observed. Conclusions: The short-term results from the present study suggest the combination of cataract surgery and intravitreal bevacizumab injection are safe and effective for the prevention of macular edema aggravation for one month, but has little effect on prevention of macular edema aggravation three months after surgery for diabetic macular edema patients.

685 Trou maculaire lamellaire après injection intravitréenne de pegaptanib sodium pour œdème maculaire diabétique

The benefit of immediate focal photocoagulation for diabetic macular edema was demonstrated in the Early Treatment Diabetic Retinopathy Study (ETDRS). Anti-vascular endothelial growth factor (VEGF) therapy have been focused as alternative or adjunct treatments. We report a case of a patient who developed lamellar macular hole, one month after intravitreal pegaptanib sodium injection for diabetic macular edema. Interventional case report. A 66 – year-old patient with type 2 diabetes presented in the right eye a cystoid diabetic macular edema, without clinically detectable vitreomacular traction. One injection of pegaptanib 0.05 ml/0.3 mg was administered without complication. One month after intravitreal pegaptanib sodium injection (0.05 ml/0.3 mg), the patient presented no visual acuity improvement and complained of newly developed metamorphopsia. Fundus biomicroscopy and OCT revealed deep reduction of the cystoid macular edema, with lamellar macular hole formation, characterized by visibly detached posterior hyaloid, roof of the cyst above the macula, and foveal photoreceptors layer intact below the area of foveal dehiscence. Despite a lamellar hole could result from the degenerative process associated with cystoid macular edema, the pathogenesis of lamellar macular hole can be attributed in our case to the intravitreal injection, which may have induced vitreous incarceration, causing a vitreoretinal traction at the macula and the development of a lamellar macular hole. Alternatively or in association, pegaptanib itself may have caused the lamellar macular hole by inducing a sudden reduction of the diabetic macular edema and hence, the exacerbation of tangential traction of the posterior vitreous on the overlying macular retina. On the other hand, in our patient, we were not able to detect any other potential causes, such as epiretinal membrane formation and/or contraction, after the intravitreal pegaptanib injection. Lamellar macular hole seems to be a potential complication of pegaptanib injection, even in patients without pre treatment clinically detectable vitreo-macular traction.

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.

Bevacizumab (Avastin) for Diabetic Macular Edema in Previously Vitrectomized Eyes

To report the visual acuity (VA) and foveal thickness (FT) changes after intravitreal bevacizumab for diabetic macular edema (DME) in previously vitrectomized eyes. Retrospective, noncomparative, interventional case series. Medical records of 11 eyes of 10 patients who underwent intravitreal bevacizumab injection for persistent DME were reviewed. This retrospective study included eyes that had persistent DME despite prior pars plana vitrectomy with internal limiting membrane removal at our institution with optical coherence tomography (OCT) assessment of DME. All eyes received three intravitreal injections of bevacizumab 1.25 mg/0.05 ml monthly. Mean FT was 408 +/- 77 microm at baseline, 453 +/- 97 microm at three months, and 454 +/- 101 microm at six months (P = .172). Mean Early Treatment Diabetic Retinopathy Study (ETDRS) letter scores were 59 +/- 15 (20/80) at baseline, 59 +/- 16 (20/80) at three months, 57 +/- 15 (20/80) at six months (P = .398). No change in VA and FT was observed in the short-term after intravitreal bevacizumab for DME in previously vitrectomized eyes.

The Effect of Subtenon Triamcinolone Acetonide Injection for Diabetic Macular Edema on Retinal and Choroidal Circulation

To evaluate changes in retinal and choroidal circulation after subtenon triamcinolone acetonide (TA) injection for diabetic macular edema. Prospective interventional case series. Thirteen eyes of 13 patients with diabetic macular edema were studied. Fluorescein and indocyanine green angiograms were performed at three periods: before the injection and 1 week and 6 months after subtenon injection of TA (40 mg). Retinal arteriovenous passage time (as an indicator of retinal circulation) and choroidal tau (as an indicator of early filling velocity of choroid) were obtained with image analysis software. Choroidal tau values before and 1 week after subtenon TA injection were, respectively, 3.2 +/- 0.4 and 4.0 +/- 0.7 seconds, which showed a significant delay (P = .01, Wilcoxon signed-rank test). The delayed choroidal tau values returned to pretreatment level at 6 months after TA injection. In contrast, the arteriovenous passage time remained unchanged. Subtenon TA injection transiently influences choroidal blood flow.

Posterior subtenon triamcinolone acetonide for refractory diabetic macular edema

To evaluate posterior subtenon injection of triamcinolone acetonide for refractory diabetic macular edema (DME). Retrospective, interventional, case series. Clinical practice. Patients with persistent clinically significant DME involving the center of the fovea 3 or more months after one or more treatments of focal macular photocoagulation were included. Exclusion criteria were a history of corticosteroid-responsive intraocular pressure (IOP) rise, intraocular surgery within 3 months, and any laser treatment within 1 month. All patients received an ophthalmic history and examination including best-corrected Snellen visual acuity, IOP measurement, anterior segment examination including evaluation of lens status with LOCS II criteria, dilated fundus examination, and a posterior subtenon injection of 40 mg triamcinolone acetonide at baseline. Patients were reevaluated at 1, 3, 6, and 12 months after injection. Seventy-three injections were performed in 63 eyes of 50 patients. The mean baseline visual acuity was 20/80. Mean visual acuity significantly improved to 20/50 at 1 month, then stabilized to 20/65 at 3 months, 20/68 at 6 months, and 20/63 at 12 months. Complications were rare, with a transient significant rise in intraocular pressure at the 3-month evaluation and ptosis in two patients. Visual acuities remained stable or improved over a 12-month period after posterior subtenon triamcinolone injections for refractory DME. There was a statistically significant improvement in visual acuity at 1 month.

Intravitreal triamcinolone injection for diabetic macular edema: a clinical and fluorescein angiograhic case series

Background: A significant number of eyes with diabetic macular edema remain refractory to treatment despite numerous attempts at photocoagulation. Triamcinolone acetonide, a minimally water soluble steroid injected in suspension form, has been reported to be a well-tolerated agent for intravitreal injection, prompting a decrease in diabetic macular edema on optical coherence tomography. We report our experience with this treatment in 19 eyes with persistent diabetic macular edema.Methods: We reviewed the charts of 16 patients (19 eyes) from a clinical practice with diabetic macular edema persistent after focal or grid laser photocoagulation. All eyes had received 4 mg of triamcinolone, injected into the vitreous cavity 3.5 mm posterior to the limbus. Fluorescein angiography was performed before and about 2 weeks after the injection. Snellen visual acuity and intraocular pressure (as determined with Goldmann applanation tonometry) were also measured before and after the injection.Results: Fluorescein angiography showed marked improvement of macular edema in 4 eyes (21.0%), mild improvement in 10 eyes (52.6%) and no change in 5 eyes (26.3%); no patient had worsening of macular edema. Visual acuity improved by at least 1 line in 13 eyes (68.4%), by 2 or more lines in 5 eyes (26.3%), by 3 or more lines in 2 eyes (10.5%) and by 4 lines in 1 eye (5.3%); visual acuity remained unchanged in 5 eyes (26.3%) and deteriorated by 1 line in 1 eye (5.3%). Intraocular pressure elevation of 10 mm Hg or greater occurred in two eyes (10.5%) and was successfully treated with topical administration of 0.15% brimonidine.The triamcinolone was well tolerated, and there were no other ocular complications.Interpretation: Intravitreal injection of triamcinolone has potential in the treatment of diabetic macular edema and warrants investigation in a randomized prospective clinical trial.