Factors associated with improvement and worsening of visual acuity 2 years after focal/grid photocoagulation for diabetic macular edema.
OBJECTIVE
To identify factors associated with the visual acuity outcome after focal/grid photocoagulation for diabetic macular edema (DME) among eyes randomized to the focal/grid photocoagulation treatment group within the Diabetic Retinopathy Clinical Research Network (DRCR.net) trial comparing triamcinolone with focal/grid laser.


METHODS
Multicenter, randomized, clinical trial.


METHODS
Three hundred thirty eyes with DME assigned to the focal/grid photocoagulation group, visual acuity 20/40 to 20/320, and optical coherence tomography (OCT) central subfield thickness > or =250 microns.


METHODS
Eyes were treated with a protocol-defined photocoagulation technique, which was repeated at 4-month intervals for persistent or recurrent edema. Separate logistic regression models were used to evaluate the associations of demographic, clinical, OCT, and fundus photographic variables with visual acuity improvement or worsening of > or =10 letters from baseline to 2 years. The association of the initial visual acuity outcome after treatment with the subsequent visual acuity course also was evaluated.


METHODS
Visual acuity measured with the electronic Early Treatment Diabetic Retinopathy Study method.


RESULTS
Worse baseline visual acuity was the only factor found to be associated with more frequent visual acuity improvement (P<0.001), and both greater baseline OCT-measured retinal volume (P = 0.001) and better baseline visual acuity (P = 0.009) were found to be associated with more frequent visual acuity worsening. Visual acuity outcomes were similar in eyes with and without prior macular or panretinal photocoagulation. The initial visual acuity outcome at 4 months was not generally predictive of the subsequent course. Many eyes that worsened > or =10 letters from baseline to 4 months subsequently improved, and many eyes that initially improved, subsequently worsened.


CONCLUSIONS
At this time, focal/grid photocoagulation remains the standard management for DME and these results do not alter this paradigm.
Aiello
Lloyd Paul
LP
Joslin Diabetes Center and Department of Ophthalmology, Harvard Medical School, Cambridge, Massachusetts, USA.
Edwards
Allison R
AR
Beck
Roy W
RW
Bressler
Neil M
NM
Davis
Matthew D
MD
Ferris
Frederick
F
Glassman
Adam R
AR
Ip
Michael S
MS
Miller
Kellee M
KM
D003930:Diabetic Retinopathy / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D017075:Laser Coagulation; D008269:Macular Edema / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000627:therapeutic use; D014786:Vision Disorders / Q000503:physiopathology*; D014792:Visual Acuity / Q000502:physiology*
D005938:Glucocorticoids; D014222:Triamcinolone Acetonide