Posterior hyaloid changes following intravitreal triamcinolone and macular laser for diffuse diabetic macular edema.
OBJECTIVE
To compare the effects of intravitreal triamcinolone and macular grid laser photocoagulation on the vitreomacular relationship in diffuse diabetic macular edema.


METHODS
Review of optical coherence tomography images gathered in a prospective, interventional randomized clinical trial.


METHODS
Institutional Practice.


METHODS
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.


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.
Sivaprasad
Sobha
S
Moorfields Eye Hospital, 162, City Road, London, EC1V 2PD, United Kingdom. senswathi@aol.com
Ockrim
Zoe
Z
Massaoutis
Panos
P
Ikeji
Felicia
F
Hykin
Phil G
PG
Gregor
Zdenek J
ZJ
D003131:Combined Modality Therapy; D003930:Diabetic Retinopathy / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D005260:Female; D005451:Fluorescein Angiography; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007267:Injections; D017075:Laser Coagulation; D008269:Macular Edema / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D041623:Tomography, Optical Coherence; D014222:Triamcinolone Acetonide / Q000009:adverse effects* / Q000627:therapeutic use; D014792:Visual Acuity / Q000502:physiology; D014822:Vitreous Body / Q000187:drug effects*; D020255:Vitreous Detachment / Q000139:chemically induced* / Q000175:diagnosis
D005938:Glucocorticoids; D014222:Triamcinolone Acetonide