| PURPOSE: Diabetic macular edema (DME) is one of the mainreasons leading to visual damage of diabetic patients. It is of great clinical significance to treat DME for patients to improve their visual acuity and life quantity.Triamcinolone acetonide (TA) is one of artifically synthesized steroids which has stronge effect to relieve imflammation, and has little toxic effects. It can be injected into the vitreous cavity directly. Intravitreal injection of TA is widely used to treat macular edema associated with various diseases. In this study we used this method to treat DME, and to observe it's efficacy and safety. Optical coherence tomography (OCT), multifocal eletroretinogram (m-ERG), ophthalmic routine examination including ophthalmoscopy, slit lamps and intraocular pressure (IOP) measurement were performed to document the results.METHODS: This study included twenty-five eyes of twenty-one patients with diffuse DME. Each eye received one injection of 4mg/0.1ml into the vitreous. Twenty normal eyes were chosen to check OCT and m-ERG as controls, in order to achieve the normal thickness of the neurosensory retina and eletroretinogram. Evaluation methods include visual acuity, OCT, m-ERG, IOP, ophthalmoscopy and slit lamps. All the cases were screened with crossing line programm of OCT and the thickness of neurosensory retina were measured with programm of retinal map. The 103-hexagonal-element stimulus of m-ERG were chosen and the reponse densities and the peak latencies of first negative wave(Nl), first positive wave(Pl), and second negative wave(N2) from the first ring to the sixth ring recorded and analyzed.RESULTS: Mean best-corrected visual acuity (BCVA) was 0.15±0.09 before treatment. One month after injection it improved to 0.27±0.13, which was significantly better than that at baseline (P=0.0004). At the three months follow-up, BCVA improved continuously to 0.39±0.16 ,which was significantly better compared to that at one month follow-up time point (P=0.0006). At the six months follow-up BCVA was 0.21±0.117, which had not significantly difference with the baseline (P=0.0935). There was only one case that had no visual improvement from the beginning to the end.The thickness of neurosensory retina at 1.00mm, 2.22mm and 3.45mm from the macular fovea were 601.08±227.32um, 566.8±202.98um and 501.98±184.50um before treatment, respectively. One month after injecton they decreased significantly to 280.8±125.56 um, 339.63±94.64um and 334.69±80.28um, respectively, and at the three months follow-up to 231.87±47.16um, 298.04±43.58um and 321.48±62.19um, respectively.While six months after injection they increased to 438.17±169.54um, 426.37±104.39um and 391.49±92.68um, respectively. The thickness of neurosensory retina at 1.00mm from the macular fovea at one month after injedction had an significantly decline compared to baseline (P=0.0000), andit at three months follow-up time points was significantly better compared to that at one month follow-up time points (P=0.303). However at six months follow-up the thickness of neurosensory retina increased again, but they were still fewer than the baseline (P=0.0000).Compared to normal values, the average amplitudes and latencies values without treatment of N1, P1 and N2 from the first ring to the sixth ring in the first order kernel responses decreased significantly, and the latencies prolonged. At the one month follow-up, in comparison with average values before treatment, the average amplitude values of N1, P1, N2 increased, and the average latency values declined. At the three months follow-up, compared with average values before treatment, the average amplitude values increased, and the average latency values declined. While at the six months follow-up, the average latency values increased compared with that at three months follow-up, however declined compared to that before treatment. The changes of average amplitude values of N1, P1 and N2 were not regularly.The mean IOP was 16.24±3.97mmHg before treatment. Then they were 44.83±4.52 mmHg, 24.27±4.21 mmHg and 17.28±6.25mmHg at ten minutes, forty minutes and one day after injection, respectively. At ten minutes and forty minutes follow-up point, IOP after treatment were significantly higher (P=0.0000) than the baseline while after one day it decreased to the normal level.CONCLUSION: In this study, we used intravitreal injection of 4mg/0.1ml TA for treatment of DME.After injection we observed that DME relieved obviously .The structure of the macular region resumed, visual acuity improved, the average amplitude values of m-ERG increased and the average latency values declined. While at six months follow-up DME recurred, the... |
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