Vitrectomy Combined with Intravitreal Triamcinolone Acetonide Injection and Macular Laser Photocoagulation for Nontractional Diabetic Macular Edema
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Purpose: To evaluate the efficacy of vitrectomy combined with intravitreal injection of triamcinolone acetonide (IVTA) and macular laser photocoagulation for the treatment of nontractional diabetic macular edema (DME)refractory to anti-vascular endothelial growth factor (VEGF) therapy. Methods: Twenty-eight eyes from 28 subjects who were diagnosed with nontractional DME refractory to three or more sequential anti-VEGF injections underwent sequential vitrectomy, IVTA, and macular laser photocoagulation. Changes in best-corrected visual acuity (BCVA) and central subfield thickness (CST) during the six months following vitrectomy were evaluated. Additionally, the CST and BCVA outcomes were compared with those of 26 eyes treated with the same triple therapy for nontractional DME refractory to conventional treatment,such as IVTA or macular laser photocoagulation, or both. Results: The mean logarithm of the minimum angle of resolution BCVAs before and one, three, and six months after vitrectomy were 0.44 ± 0.15, 0.36 ± 0.18, 0.31 ± 0.14, and 0.34 ± 0.22, respectively. The mean CSTs were 433.3 ± 77.9, 329.9 ± 59.4, 307.2 ± 60.2, and 310.1 ± 80.1 microns, respectively. The values of both BCVA and CST at one, three, and six months were significantly improved from baseline (p < 0.05). The extent of CST reduction during the first month after triple therapy was greater in eyes refractory to conventional treatment than in eyes refractory to anti-VEGF (p = 0.012). Conclusions: Vitrectomy combined with IVTA and macular laser photocoagulation had a beneficial effect on both anatomical and functional outcomes in eyes with nontractional DME refractory to anti-VEGF therapy.
Abstract
Purpose: To evaluate the efficacy of vitrectomy combined with intravitreal injection of triamcinolone acetonide (IVTA) and macular laser photocoagulation for the treatment of nontractional diabetic macular edema (DME)refractory to anti-vascular endothelial growth factor (VEGF) therapy. Methods: Twenty-eight eyes from 28 subjects who were diagnosed with nontractional DME refractory to three or more sequential anti-VEGF injections underwent sequential vitrectomy, IVTA, and macular laser photocoagulation. Changes in best-corrected visual acuity (BCVA) and central subfield thickness (CST) during the six months following vitrectomy were evaluated. Additionally, the CST and BCVA outcomes were compared with those of 26 eyes treated with the same triple therapy for nontractional DME refractory to conventional treatment,such as IVTA or macular laser photocoagulation, or both. Results: The mean logarithm of the minimum angle of resolution BCVAs before and one, three, and six months after vitrectomy were 0.44 ± 0.15, 0.36 ± 0.18, 0.31 ± 0.14, and 0.34 ± 0.22, respectively. The mean CSTs were 433.3 ± 77.9, 329.9 ± 59.4, 307.2 ± 60.2, and 310.1 ± 80.1 microns, respectively. The values of both BCVA and CST at one, three, and six months were significantly improved from baseline (p < 0.05). The extent of CST reduction during the first month after triple therapy was greater in eyes refractory to conventional treatment than in eyes refractory to anti-VEGF (p = 0.012). Conclusions: Vitrectomy combined with IVTA and macular laser photocoagulation had a beneficial effect on both anatomical and functional outcomes in eyes with nontractional DME refractory to anti-VEGF therapy.
참고문헌 (41)
- Early Treatment Diabetic Retinopathy Study research group, "Photocoagulation for diabetic macular edema: Early Treatment Diabetic Retinopathy Study report number 1", Arch Ophthalmol, 103, pp.1796~1806 (1985)
- Jonas JB, "Intraocular injection of crystalline cortisone as adjunctive treatment of diabetic macular edema", Am J Ophthalmol, 132, pp.425~427 (2001)
- Martidis A, "Intravitreal triamcinolone for refractory diabetic macular edema", Ophthalmology, 109, pp.920~927 (2002)
- Massin P, "Intravitreal triamcinolone acetonide for diabetic diffuse macular edema: preliminary results of a prospective controlled trial", Ophthalmology, 111, pp.218~224 (2004)
- Chew E, "Randomized trial of peribulbar triamcinolone acetonide with and without focal photocoagulation for mild diabetic macular edema: a pilot study", Ophthalmology, 114, pp.1190~1196 (2007)
- Entezari M, "Posterior sub-tenon triamcinolone for refractory diabetic macular edema: a randomized clinical trial", Eur J Ophthalmol, 15, pp.746~750 (2005)
- Kang SW, "Macular grid photocoagulation after intravitreal triamcinolone acetonide for diffuse diabetic macular edema", Arch Ophthalmol, 124, pp.653~658 (2006)
- Lam DS, "Intravitreal triamcinolone plus sequential grid laser versus triamcinolone or laser alone for treating diabetic macular edema: six-month outcomes", Ophthalmology, 114, pp.2162~2167 (2007)
- Chun DW, "A pilot study of multiple intravitreal injections of ranibizumab in patients with center-involving clinically significant diabetic macular edema", Ophthalmology, 113, pp.1706~1712 (2006)
- Massin P, "Safety and efficacy of ranibizumab in diabetic macular edema (RESOLVE Study): a 12-month, randomized, controlled, double-masked, multicenter phase II study", Diabetes Care, 33, pp.2399~2405 (2010)
- Michaelides M, "A prospective randomized trial of intravitreal bevacizumab or laser therapy in the management of diabetic macular edema (BOLT study) 12-month data: report 2", Ophthalmology, 117, pp.1078~1086 (2010)
- Soheilian M, "Randomized trial of intravitreal bevacizumab alone or combined with triamcinolone versus macular photocoagulation in diabetic macular edema", Ophthalmology, 116, pp.2009~2116 (2009)
- Arevalo JF, "Primary intravitreal bevacizumab for diffuse diabetic macular edema: the Pan- American Collaborative Retina Study Group at 24 months", Ophthalmology, 116, pp.1488~1497 (2009)
- Nguyen QD, "Primary end point (six months) results of the Ranibizumab for Edema of the mAcula in Diabetes (READ-2) study", Ophthalmology, 116, pp.2175~2181 (2009)
- Elman MJ, "Expanded 2-year follow-up of ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema", Ophthalmology, 118, pp.609~614 (2011)
- Elman MJ, "Randomized trial evaluating ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema", Ophthalmology, 117, pp.1064~1077 (2010)
- Figueroa MS, "Surgical and anatomical outcomes of pars plana vitrectomy for diffuse nontractional diabetic macular edema", Retina, 28, pp.420~426 (2008)
- Kimura T, "Efficacy of surgical removal of the internal limiting membrane in diabetic cystoid macular edema", Retina, 25, pp.454~461 (2005)
- Kumagai K, "Long-term follow-up of vitrectomy for diffuse nontractional diabetic macular edema", Retina, 29, pp.464~472 (2009)
- La Heij EC, "Vitrectomy results in diabetic macular oedema without evident vitreomacular traction", Graefes Arch Clin Exp Ophthalmol, 239, pp.264~270 (2001)
- Otani T, "A controlled study of vitrectomy for diabetic macular edema", Am J Ophthalmol, 134, pp.214~219 (2002)
- Recchia FM, "Pars plana vitrectomy with removal of the internal limiting membrane in the treatment of persistent diabetic macular edema", Am J Ophthalmol, 139, pp.447~454 (2005)
- Stolba U, "Vitrectomy for persistent diffuse diabetic macular edema", Am J Ophthalmol, 140, pp.295~301 (2005)
- Tachi N, "Vitrectomy for diffuse macular edema in cases of diabetic retinopathy", Am J Ophthalmol, 122, pp.258~260 (1996)
- Yamamoto T, "Early postoperative retinal thickness changes and complications after vitrectomy for diabetic macular edema", Am J Ophthalmol, 135, pp.14~19 (2003)
- Lewis H, "Vitrectomy for diabetic macular traction and edema associated with posterior hyaloidal traction", Ophthalmology, 99, pp.753~759 (1992)
- Stefansson E., "The therapeutic effects of retinal laser treatment and vitrectomy: a theory based on oxygen and vascular physiology", Acta Ophthalmol Scand, 79, pp.435~440 (2001)
- Funatsu H, "Relation of diabetic macular edema to cytokines and posterior vitreous detachment", Am J Ophthalmol, 135, pp.321~327 (2003)
- Flaxel CJ, "Factors associated with visual acuity outcomes after vitrectomy for diabetic macular edema: diabetic retinopathy clinical research network", Retina, 30, pp.1488~1495 (2010)
- Haller JA, "Vitrectomy outcomes in eyes with diabetic macular edema and vitreomacular traction", Ophthalmology, 117, pp.1087~1093 (2010)
- Kang SW, "Triple therapy of vitrectomy, intravitreal triamcinolone, and macular laser photocoagulation for intractable diabetic macular edema", Am J Ophthalmol, 144, pp.878~885 (2007)
- Diabetic Retinopathy Clinical Research Network, "A ran domized trial comparing intravitreal triamcinolone acetonide and focal", grid photocoagulation for diabetic macular edema, 2008, pp.115, 1447~1449
- Adamis AP, "Increased vascular endothelial growth factor levels in the vitreous of eyes with proliferative diabetic retinopathy", Am J Ophthalmol, 118, pp.445~450 (1994)
- Antcliff RJ, "The pathogenesis of edema in diabetic maculopathy", Semin Ophthalmol, 14, pp.223~232 (1999)
- Funatsu H, "Association of vitreous inflammatory factors with diabetic macular edema", Ophthalmology, 116, pp.73~79 (2009)
- Meleth AD, "Serum inflammatory markers in diabetic retinopathy", Invest Ophthalmol Vis Sci, 46, pp.4295~4301 (2005)
- Paccola L, "Intravitreal triamcinolone versus bevacizumab for treatment of refractory diabetic macular oedema (IBEME study)", Br J Ophthalmol, 92, pp.76~80 (2008)
- Shimura M, "Comparative therapy evaluation of intravitreal bevacizumab and triamcinolone acetonide on persistent diffuse diabetic macular edema", Am J Ophthalmol, 145, pp.854~861 (2008)
- Gandorfer A, "Resolution of diabetic macular edema after surgical removal of the posterior hyaloid and the inner limiting membrane", Retina, 20, pp.126~133 (2000)
- Patel JI, "Pars plana vitrectomy with and without peeling of the inner limiting membrane for diabetic macular edema", Retina, 26, pp.5~13 (2006)
- Ozturk BT, "Comparison of intravitreal bevacizumab and ranibizumab treatment for diabetic macular edema", J Ocul Pharmacol Ther, 27, pp.373~377 (2011)
