Treatment of diabetic macular edema in real-world clinical practice: The effect of aging.

AIMS/INTRODUCTION: In older patients, the management of diabetic macular edema (DME) can be complicated by comorbidities, geriatric syndrome, and socioeconomic status. This study aims to evaluate the effects of aging on the management of DME. MATERIALS AND METHODS: This is a real-world clinical study including 1,552 patients with treatment-naïve center-involved DME. The patients were categorized into 4 categories by age at baseline (C1, <55; C2, 55-64; C3, 65-74; and C4, ≥75 years). The outcomes were the change in logarithm of the minimum angle of resolution best-corrected visual acuity (logMAR BCVA) and central retinal thickness (CRT), and the number of treatments from baseline to 2 years. RESULTS: From baseline to 2 years, the mean changes in logMAR BCVA from baseline to 2 years were -0.01 in C1, -0.06 in C2, -0.07 in C3, and 0.01 in C4 (P = 0.016), and the mean changes in CRT were -136.2 µm in C1, -108.8 µm in C2, -100.6 µm in C3, and -89.5 µm in C4 (P = 0.008). Treatments applied in the 2 year period exhibited decreasing trends with increasing age category on the number of intravitreal injections of anti-VEGF agents (P = 0.06), selecting local corticosteroid injection (P = 0.031), vitrectomy (P < 0.001), and laser photocoagulation outside the great vascular arcade (P < 0.001). CONCLUSIONS: Compared with younger patients with DME, patients with DME aged ≥75 years showed less frequent treatment, a lower BCVA gain, and a smaller CRT decrease. The management and visual outcome in older patients with DME would be unsatisfactory in real-world clinical practice.

Arm-to-retina time predicts visual outcome of anti-vascular endothelial growth factor treatment for macular edema due to central retinal vein occlusion.

To explore the factors associated with best-corrected visual acuity (BCVA) after anti-vascular endothelial growth factor (anti-VEGF) treatment for macular edema secondary to central retinal vein occlusion (CRVO). We retrospectively reviewed the medical charts of 22 eyes of 22 treatment-naïve patients with CRVO diagnosed between September 2014 and December 2020. They received anti-VEGF treatment and follow-up for > 12 months. Mean patient age was 64.3 years; 13 (59.1%) were men. Eyes with baseline arm-to-retina (AR) time ≥ 16 s had better BCVA at 12 months (adjusted for baseline BCVA and age; B, - 0.658; 95% confidence interval - 1.058 to - 0.257; P = 0.003), greater mean BCVA change (P = 0.006), lower frequency of residual macular edema at 12 months (P = 0.026) and recurrent and/or unresolved macular edema during 12 months (P = 0.046), and higher frequency of reduction in central retinal thickness ≥ 150 µm at 1 and 12 months (both P = 0.046). Delayed AR time was associated with a better visual outcome and macular edema improvement in CRVO after anti-VEGF treatment regardless of initial BCVA and age. Our results may help understand the pathogenesis and predict the visual prognosis of patients before anti-VEGF therapy initiation.

Functional and anatomical changes in diabetic macular edema after hemodialysis initiation: One-year follow-up multicenter study.

Diabetic nephropathy and retinopathy (DR) including diabetic macular edema (DME) are representative microvascular complications of diabetes. We conducted a retrospective multicenter study analyzing records from patients with DR (132 eyes in 70 patients) and end-stage renal diseases (ESRD) who underwent hemodialysis for the first time. We demonstrated that the central retinal thickness (CRT) values were significantly decreased (p < 0.0001), and the best-corrected visual acuity (BCVA) values were improved (p < 0.05) at 1, 3, 6, 9, and 12 months after hemodialysis initiation, in spite of a lack of specific ocular treatments for DME in 93.2% of eyes. We found a significant positive correlation in the rates of CRT changes between right and left eyes. The CRT reductions were greater in eyes with DME type subretinal detachment than in those with spongelike swelling and cystoid macular edema. The visual outcome gain was associated with the CRT reduction at 12 months in the eyes with good initial BCVA (≧20/50). Hemodialysis induction contributed to functional and anatomical improvements after 1 year, independently of initial laboratory values before the hemodialysis.

Real-world management of treatment-naïve diabetic macular oedema: 2-year visual outcome focusing on the starting year of intervention from STREAT-DMO study.

BACKGROUND/AIMS: To investigate the yearly change of real-world outcomes for best corrected visual acuity (BCVA) after 2-year clinical intervention for treatment-naïve diabetic macular oedema (DMO). METHODS: Retrospective analysis of aggregated, longitudinal medical records obtained from 27 retina specialised institutions in Japan from Survey of Treatment for DMO database. A total of 2049 treatment-naïve centre involving DMO eyes of which the initial intervention started between 2010 and 2015, and had been followed for 2 years, were eligible. As interventions, antivascular endothelial growth factor (VEGF) agents, local corticosteroids, macular photocoagulation and vitrectomy were defined. In each eye, baseline and final BCVA, the number of each intervention for 2 years was extracted. Each eye was classified by starting year of interventional treatment. RESULTS: Although baseline BCVA did not change by year, 2-year improvement of BCVA had been increased, and reached to +6.5 letters in the latest term. There is little difference among starting year about proportions of eyes which BCVA gained >15 letters, in contrast to those which lost >15 letters were decreased by year. The proportion of eyes receiving anti-VEGF therapy was dramatically increased, while those receiving the other therapies were gradually decreased. The proportion of eyes which maintained socially good vision of BCVA>20/40 has been increased and reached to 59.0% in the latest term. CONCLUSION: For recent years, treatment patterns for DMO have been gradually but certainly changed; as a result, better visual gain, suppression of worsened eyes and better final BCVA have been obtained. Anti-VEGF therapy has become the first-line therapy and its injection frequency has been increasing.

Real-world management of treatment-naïve diabetic macular oedema in Japan: two-year visual outcomes with and without anti-VEGF therapy in the STREAT-DME study.

BACKGROUND/AIMS: To investigate real-world outcomes for best-corrected visual acuity (BCVA) after 2-year clinical intervention for treatment-naïve, centr-involving diabetic macular oedema (DME). METHODS: Retrospective analysis of longitudinal medical records obtained from 27 institutions specialising in retinal diseases in Japan. A total of 2049 eyes with treatment-naïve DME commencing intervention between 2010 and 2015 who were followed for 2 years were eligible. Interventions for DME included anti-vascular endothelial growth factor (VEGF) therapy, local corticosteroid therapy, macular photocoagulation and vitrectomy. Baseline and final BCVA (logMAR) were assessed. Eyes were classified by the treatment pattern, depending on whether anti-VEGF therapy was used, into an anti-VEGF monotherapy group (group A), a combination therapy group (group B) and a group without anti-VEGF therapy (group C). RESULTS: The mean 2-year improvement of BCVA was -0.04±0.40 and final BCVA of >20/40 was obtained in 46.3% of eyes. Based on the treatment pattern, there were 427 eyes (20.9%) in group A, 807 eyes (39.4%) in group B and 815 eyes (39.8%) in group C. Mean improvement of BCVA was -0.09±0.39, -0.02±0.40 and -0.05±0.39, and the percentage of eyes with final BCVA of >20/40 was 49.4%, 38.9%, and 52.0%, respectively. CONCLUSION: Following 2-year real-world management of treatment-naïve DME in Japan, BCVA improved by 2 letters. Eyes treated by anti-VEGF monotherapy showed a better visual prognosis than eyes receiving combination therapy. Despite treatment for DME being selected by specialists in consideration of medical and social factors, a satisfactory visual prognosis was not obtained, but final BCVA remained >20/40 in half of all eyes.

Minimally invasive laser treatment combined with intravitreal injection of anti-vascular endothelial growth factor for diabetic macular oedema.

The purpose of this study was to investigate the effect of the combination of minimally invasive laser treatment to the intravitreal injection of anti-vascular endothelial growth factor (VEGF) for diabetic macular oedema (DME). This study was retrospective longitudinal study of thirty-four eyes of 31 patients with DME. Either once or several times of intravitreal anti-VEGF injection was followed by the single minimally invasive laser within a month. The mean best corrected visual acuity (VA) and the central macular thickness (CMT) were measured before treatment, 1, 3, 6 and 12 months after the first anti-VEGF injection. The mean logMAR VA had improved from 0.52 ± 0.34 at baseline to 0.44 ± 0.32 (p = 0.003), 0.40 ± 0.34 (p = 0.006), 0.43 ± 0.33 (p = 0.063), and 0.41 ± 0.34 (p = 0.009), at 1, 3, 6, and 12 months after treatment, respectively. The mean CMT decreased significantly by 1 month and maintained over 12 months (491.1 ± 133.9 µm at baseline, 396.6 ± 116.8 µm (p = 0.001), 385.2 ± 156.2 µm (p = 0.002), 336.5 ± 86.3 µm (p = 0.000), and 354.8 ± 120.4 µm (p = 0.000) at 1, 3, 6, and 12 months, respectively). The average number of the anti-VEGF injection in 1 year was 3.6 ± 2.1 in all patients. The combined intravitreal anti-VEGF and minimally invasive laser therapy improves the VA, alleviates DME, and may decrease the required number of anti-VEGF injections.

Interdigitation Zone Band Restoration After Treatment of Diabetic Macular Edema.

PURPOSE: To investigate whether the integrity of the interdigitation zone band, the ellipsoid zone band, and the external limiting membrane are reliable markers of treatment outcome in diabetic macular edema (DME). METHODS: In this retrospective study, we examined 41 treatment-naïve eyes (38 patients) with DME that were treated with laser therapy, pharmacotherapy, and/or vitrectomy. Best-corrected visual acuity and the integrity of the interdigitation zone band, the ellipsoid zone band, and the external limiting membrane were assessed before treatment and at 3, 6, and 12 months after DME treatment. RESULTS: One year after treatment, the external limiting membrane, ellipsoid zone band, and interdigitation zone band were completely visible in 30 (73.2%), 24 (58.5%), and 2 (4.9%) eyes, respectively. Interdigitation zone band status improved significantly (P = 0.005) 1 year after treatment. The interdigitation zone did not improve in the absence of the ellipsoid zone band. Likewise, ellipsoid zone status did not improve in the absence of the external limiting membrane at any time after treatment. CONCLUSION: The results of this study show that restoration of the interdigitation zone band constitutes a very sensitive marker of DME treatment outcome when the ellipsoid zone band is visible before treatment.

Prognosis of patients with diabetic macular edema before Japanese approval of anti-vascular endothelial growth factor.

PURPOSE: To examine the prognosis of patients with diabetic macular edema (DME) before Japanese approval of antivascular endothelial growth factor (VEGF). METHODS: This retrospective study included 135 eyes of 115 patients who received treatments (photocoagulation, pharmacological treatments, vitrectomy) for DME between January 2003 and August 2012. The best-corrected visual acuity (BCVA) before and 1, 3, 6, 12, and 24 months after treatment was examined. BCVA was classified based on the decimal value of BCVA before treatment as good (BCVA > 0.7, BCVA = 0.7), moderate (BCVA > 0.7 but <0.2), or poor (BCVA < 0.2, BCVA = 0.2), and each prognosis of BCVA was investigated. RESULTS: Thirty-five (25.9%) patients were classified with good BCVA, while 69 (51.1%) had moderate and 31 (23.0%) poor BCVA. Following 24 months of treatment, the averaged good BCVA maintained its value (0.0513 ± 0.0954 to 0.0773 ± 0.258). Similarly, the averaged moderate BCVA maintained its value (0.449 ± 0.169 to 0.441 ± 0.431), whereas the averaged poor BCVA significantly improved (1.070 ± 0.291 to 0.879 ± 0.361: p < 0.001). Specifically, the averaged BCVA of patients who initially received vitrectomy increased 0.380 logMAR after 24 months (0.859 ± 0.414 to 0.479 ± 0.549). CONCLUSION: DME patients with good BCVA at the time of initial treatment generally maintained the averaged BCVA at 24 months, while patients with moderate BCVA did not significantly improve without a standard regimen of anti-VEGF therapy. However, the results indicate that early vitrectomy is a potential treatment option for DME patients with poor BCVA.

Comparative efficacy of pure yellow (577-nm) and 810-nm subthreshold micropulse laser photocoagulation combined with yellow (561-577-nm) direct photocoagulation for diabetic macular edema.

PURPOSE: To compare the efficacy of 577- and 810-nm subthreshold micropulse laser photocoagulation (SMLP) combined with direct photocoagulation to microaneurysms in diabetic macular edema (DME). METHODS: A prospective nonrandomized interventional case series. Forty-nine consecutive patients (53 eyes) with DME were recruited. In 20/24 (83.3%) eyes, 810-nm SMLP (810-nm MP) to achieve a confluent grid pattern was followed by direct photocoagulation to microaneurysms via a continuous 561-nm wavelength laser. In 21/29 (72.5%) eyes, 577-nm SMLP (577-nm MP) was combined with direct photocoagulation to microaneurysms via the same instrument. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were examined 1, 2, 3, 6 and 12 months after treatment. RESULTS: The mean power required for SMLP was lower in the 577-nm than in the 810-nm MP group (204.1 vs. 954.1 mW) (p < 0.0001). Significant reductions in CMT persisted from 3 to 12 months after treatment in all patients (p < 0.01). There were no significant intergroup differences in CMT until 12 months. In both groups, mean BCVA remained stable until 12 months after treatment. Additional treatment for persistent macular edema was performed within 12 months in 4/24 eyes (16.7%) in the 810-nm MP group and 1/29 eyes (3.4%) in the 577-nm MP group. CONCLUSION: Either 577-nm MP or 810-nm MP combined with direct photocoagulation for microaneurysm closure reduced DME, maintained visual acuity and reduced the additional treatment rate within 12 months. The 577-nm MP apparatus required less energy for SMLP than the 810-nm MP instrument and was suitable for direct photocoagulation of microaneurysms.

[Association between pioglitazone and diabetic macular edema].

PURPOSE: To assess the early association between pioglitazone and diabetic macular edema (DME). METHODS: 570 eyes of 285 patients who began taking pioglitazone (ACTOS) between 23 July 2003 and 31 December 2010 at St. Luke's International Hospital participated. Of the 570 eyes seen during the study period, the study included 304 eyes in which the macula was evaluated by slit-lamp biomicroscopy or optical coherence tomography within 3 months of the start of pioglitazone therapy. The participants were divided into two groups, one without DME and one with DME before taking pioglitazone, and the proportion of DME appearance in the first group and DME increase in the latter group were assessed. RESULTS: There were 297 eyes without DME before taking pioglitazone. DME appeared in one eye out of 297 eyes (0.34%) after taking pioglitazone. There were 7 eyes with DME before taking pioglitazone. DME increased in 2 eyes out of these 7 eyes (28.6%). CONCLUSION: For the patients without DME, the occurrence of DME was extremely low after taking pioglitazone. However, for patients with DME, caution is needed, as there were some cases in which DME increased after taking pioglitazone. The ophthalmologist should monitor macular edema in cooperation with a physician after giving pioglitazone.

Bacterial culture after three sterilization methods for cataract surgery.

PURPOSE: To compare bacterial cultures from three sterilization methods immediately before and after cataract surgery. DESIGN: A prospective randomized open-label group-comparison study. METHODS: We investigated 75 eyes in 73 consecutive patients undergoing cataract surgery. After swabbing the eyelid and surrounding area, patients were randomly assigned to one of 3 eye-washing methods: patients administered one drop of 5 % povidone-iodine (Group A); patients whose conjunctival sac was washed with 0.02 % chlorhexidine while everting the eyelid (Group B); or 0.02 % chlorhexidine as above but without eyelid eversion (Group C). In each group, specimens were collected from the conjunctival sac immediately before and after eye washing and again at completion of surgery, along with aqueous humor. The post-surgical condition of the corneal epithelium and the severity of anterior chamber inflammation were assessed by use of a slit-lamp microscope. RESULTS: In Groups A and C, the percentage of eyes with conjunctival bacteria decreased significantly from immediately before to immediately after washing (Group A, p = 0.008; Group C, p = 0.016), but there was no significant decrease in Group B (p = 0.125). Slit-lamp microscopy showed that inflammation of the anterior chamber 1 day after surgery was significantly milder in Group C than in Group B (p = 0.032). CONCLUSION: Eye-washing methods without eyelid eversion are more effective in reducing conjunctival bacteria before surgery and anterior chamber inflammation after surgery than those with eyelid eversion.

[Subthreshold micropulse diode laser photocoagulation combined with direct photocoagulation for diabetic macular edema in Japanese patients].

PURPOSE: To investigate the efficacy of subthreshold micropulse diode laser photocoagulation (SMDLP) combined with direct photocoagulation. METHODS: Twenty one eyes of 20 patients with diabetic macular edema were treated with SMDLP and direct photocoagulation for microaneurysms within 1 month after SMDLP. The mean visual acuity in logMAR units and central macular thickness (CMT) were evaluated both before and after laser treatment by retrospective chart review and optical coherence tomography (OCT). RESULTS: The mean visual acuity did not change significantly at 3 and at 6 months. The mean CMT was significantly reduced at 3 and 6 months (3 months: p = 0.018, 6 months: p = 0.004). Visual acuity improved or maintained for 6 months in all of the patients (100%, 20 eyes of 20 patients). CONCLUSION: SMDLP combined with direct photocoagulation maintains visual acuity and improves diabetic macular edema for at least 6 months.

Spectral-domain optical coherence tomography imaging of retinal changes after conventional multicolor laser, subthreshold micropulse diode laser, or pattern scanning laser therapy in Japanese with macular edema.

PURPOSE: To perform optical coherence tomography imaging of retinal healing after conventional multicolor laser, pattern scanning laser, or micropulse laser treatment and compare the characteristics of each method. METHODS: This was a single-center interventional case series study. Twenty-nine patients with macular edema underwent laser photocoagulation. Changes of retinal morphology because of laser-tissue interaction were assessed within 3 months by using a spectral-domain optical coherence tomography. RESULTS: Immediately after conventional multicolor laser or pattern scanning laser treatment, a hyperreflective band appeared at the laser sites. The photoreceptor inner segment-outer segment line disappeared in all the patients treated with a conventional multicolor laser, but was intact in 22.2% (2/9 eyes) after pattern scanning laser. From 1 week to 1 month, the bands resolved. At 3 months, recovery of the inner segment-outer segment line surrounding the laser site was seen in all patients after conventional grid photocoagulation and pattern scanning laser. Retinal morphology did not change at any time during the observation period after subthreshold micropulse diode laser photocoagulation. CONCLUSION: The characteristic in vivo effects of retinal photocoagulation were monitored over time by spectral-domain optical coherence tomography. Changes of retinal morphology appeared less intense after pattern scanning laser than conventional grid laser treatment.

[Retinal sensitivity following subthreshold diode laser micropulse photocoagulation for diabetic macular edema].

PURPOSE: To report the retinal sensitivity after subthreshold diode laser micropulse photocoagulation(SDM) to evaluate its safety. METHODS: Eight eyes of 8 diabetic patients with clinically significant macular edema were treated with SDM. SDM was applied with a 15% duty cycle, 0.2 to 0.3 sec, 200 microm, at 700 to 800 mW. Postoperative retinal sensitivity (1-2 weeks) was compared to preoperative retinal sensitivity measured by microperimeter-1 (MP-1, Nidek technologies, Padova, Italy) using a 1 x 1 mm square test grid with 49 stimulus locations. RESULTS: The retinal sensitivity improved (more than 2 dB) in 3 eyes and remained stable (within 2 dB) in 5 eyes. The median retinal sensitivity increased significantly in 5 eyes and decreased significantly in 3 eyes. The average retinal sensitivity of 8 eyes was 12.04 +/- 3.69 dB before laser treatment, and 13.20 3.47 dB after laser treatment and there was no statistically significant change in retinal sensitivity at 2 weeks (p = 0.09). CONCLUSION: Short duration SDM for diabetic macular edema has no significant effect on retinal sensitivity.

Visualization of subthreshold micropulse diode laser photocoagulation by scanning laser ophthalmoscopy in the retro mode.

PURPOSE: To assess the efficacy of scanning laser ophthalmoscopy in the retro mode, employing a new dark-field aperture, for detecting laser spots created by subthreshold diode laser micropulse photocoagulation. DESIGN: Interventional case series. METHODS: setting: Institutional. patients: Eight consecutive patients (8 eyes) with clinically significant diabetic macular edema and 1 patient (1 eye) with macular edema attributable to branch vein occlusion underwent subthreshold diode laser micropulse photocoagulation. Scanning laser ophthalmoscopy images were obtained before and immediately after subthreshold laser photocoagulation. Application of the laser was done under 3 different sets of conditions with a 15% duty cycle for 0.2 seconds in the micropulse mode: condition I was 200-µm spots at 200% of the threshold power in the continuous wave mode, condition II was 200-µm spots at 300%, and condition III was 125-µm spots at 250% or 300%. The laser-treated area was monitored on both color images and by scanning laser ophthalmoscopy (F-10, NIDEK, Gamagori, Japan). RESULTS: Immediately after subthreshold laser photocoagulation, there were no obvious laser scars affecting the treated area in any of the patients on color images. Scanning laser ophthalmoscopy with a diode laser in the retro mode showed no obvious changes after treatment under condition I. However, conditions II and III resulted in dark spots at the sites where the laser had been applied in 5 out of 7 patients. CONCLUSIONS: Scanning laser ophthalmoscopy in the retro mode is useful to detect sites of subthreshold micropulse laser application. The dark spots detected by retro mode scanning laser ophthalmoscopy are probably related to swelling of the pigment epithelium after laser application. This method is useful to confirm the invisible spots created by subthreshold diode laser micropulse photocoagulation.

Bullous exudative retinal detachment due to infiltration of leukemic cells in a child with acute lymphoblastic leukemia.

Acute lymphoblastic leukemia (ALL) is known to cause several ocular involvements, but exudative retinal detachment is a rare complication. We describe a case report of a 4-year-old boy with T cell ALL who developed bilateral exudative retinal detachment caused by leukemic infiltration in the retinas after achieving hematological remission. Intravenous steroid pulse therapy and local irradiation reversed the condition, but it recurred concurrently with disease progression after a second relapse in the bone marrow. It is suggested that ophthalmic examination is crucial for ALL patients, especially for those whose white blood cell count is very high at onset.

Subthreshold micropulse diode laser photocoagulation for diabetic macular edema in Japanese patients.

PURPOSE: To assess the efficacy and safety of subthreshold micropulse diode laser photocoagulation for diabetic macular edema (ME). DESIGN: Prospective, nonrandomized interventional case series. SETTING: Institutional. PATIENTS: Thirty-six consecutive diabetic patients (43 eyes) with clinically significant ME and a central macular thickness (CMT) <600 microm by optical coherence tomography. OBSERVATION PROCEDURES: Subthreshold micropulse diode laser photocoagulation was done with a 15% duty cycle (0.2 to 0.3 sec; 200 microm) at 50% to 90% of the burn threshold energy. The treated area was monitored on color images for 12 months. MAIN OUTCOME MEASURES: CMT, best-corrected visual acuity (BCVA), and total macular volume at 3 months. RESULTS: After 3 months, there was a significant reduction of CMT (P = .05, paired t test), but the changes of BCVA and macular volume were not significant. The preoperative CMT, BCVA (logarithm of the minimal angle of resolution; logMAR), and macular volume were 341.8 +/- 119.0 microm, 0.12 +/- 0.20, and 8.763 +/- 1.605 mm(3) respectively, vs 300.7 +/- 124.1 microm, 0.12 +/- 0.21, and 8.636 +/- 1.408 mm(3) at 3 months. CMT decreased significantly from 1 month (P = .015, Friedman test). Visual acuity was improved or maintained within 0.2 logMAR for 12 months in 94.7% of the patients. No obvious laser scars were detected in any patient. CONCLUSIONS: In patients with moderate diabetic ME, subthreshold micropulse diode laser photocoagulation controls ME and maintains visual acuity with minimal retinal damage. These findings confirm the efficacy of this method for Japanese patients.

Efficacy and retention times of intravitreal triamcinolone acetonide for macular edema.

PURPOSE: To evaluate the retention of intravitreal triamcinolone acetonide (TA) particles and the efficacy of TA therapy for patients with cystoid macular edema in branch retinal vein occlusion (BRVO) or diabetic macular edema (DME). We monitored the TA particles until absorption from the vitreous cavity was complete. The correlation between the intravitreal retention time of TA and its efficacy was evaluated based on central macular thickness (CMT). RESULTS: The intravitreal TA retention time was a mean 141.8 +/- 139.6 days in BRVO patients and 114.5 +/- 59.6 days in DME patients. Patient age and retention time were negatively correlated (r = -0.46; P = 0.013). At 6 months posttreatment the mean CMT decreased from 544.1 +/- 143.7 to 322.4 +/- 131.9 mum in BRVO patients and from 454.5 +/- 119.0 to 371.2 +/- 209.4 mum in DME patients. Retention time and CMT reduction were positively correlated in BRVO patient (r = 0.56, P = 0.02) but not in DME patients (P = 0.06). CONCLUSIONS: Intravitreal TA reduced the CMT in BRVO and DME patients over 6 months. The retention time was longer in younger individuals. The efficacy of the therapy depended on the intravitreal TA retention time observed clinically in BRVO patients. Biomicroscopic examination of intravitreal TA is useful for evaluation of its efficacy.

[Visual prognosis and prognostic risk factors after photocoagulation for diffuse diabetic macular edema].

PURPOSE: To investigate the efficacy of photocoagulation for diffuse diabetic macular edema. SUBJECTS AND METHODS: One hundred and fifty eyes with diffuse diabetic macular edema were treated by laser photocoagulation (grid pattern photocoagulation, in some instances combined with direct photocoagulation) and followed up more than 1 year. The visual prognosis of these cases was retrospectively studied. RESULTS: The logarithm of the minimum angle of resolution (Log MAR) final visual acuity after photocoagulation was improved more than 0.2 levels in 62 eyes (41%) of a total 150 eyes, and in 60% of 87 eyes in which preoperative visual acuity had been less than 0.5. Average visual acuity after photocoagulation reached a plateau within three months after surgery, and 84% of the eyes with 0.5 or better preoperative visual acuity achieved 0.5 or better final visual acuity. There was correlation between visual prognosis and the following preoperative factors: preoperative visual acuity, hard exudates, fluorescein leakage, grid area, hyperlipidemia, and renal failure. CONCLUSIONS: Grid photocoagulation as a treatment for diffuse diabetic macular edema is effective to improve or maintain visual acuity. Alternative treatment such as vitrectomy should be considered after three-month observation on the outcome of grid photocoagulation.