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Park and Song: Macular Thickness and Visual Acuity Before and After Panretinal Photocoagulation in Severe Diabetic Retinopathy
Original Article

J Korean Ophthalmol Soc 2009;50(5):717-724.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.5.717

Macular Thickness and Visual Acuity Before and After Panretinal Photocoagulation in Severe Diabetic Retinopathy

Sang Hoon Park, MD, Su Jeong Song, MD, PhD

Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea

Address reprint requests to Su Jeong Song, MD, PhD Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of medicine #108 Pyung-dong, Jongno-gu, Seoul 110-746, Korea Tel: 82-2-2001-2250, Fax: 82-2-2001-2262, E-mail: eye-su@hanmail.net

Received 25 September 2008       Accepted 4 February 2009

Copyright © 2009 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare macular thickness and visual acuity before and after panretinal photocoagulation in patients with severe diabetic retinopathy without diabetic macular edema.

Methods

Macular thickness and visual acuity (LogMAR) of 40 eyes were compared before and after panretinal photocoagulation, for severe diabetic retinopathy. Macular thickness was measured by optical coherence tomography(OCT). In addition, changes in macular thickness and visual acuity were compared with the patient's level of HbA1c, blood pressure, and diabetic nephropathy.

Results

Mean visual acuity before and 1.47±0.80 months after panretinal photocoagulation were 0.28±0.23 and 0.33±0.27, respectively, which was not a significant decrease (p=0.131). However mean central macular thickness (216.98±34.09 μ m to 255.22±73.40 μ m), and mean peripheral macular thickness (269.26±34.59 μ m to 291.96±46.49 μ m) did increase significantly after panretinal photocoagulation (p=0.001). The decrease of mean visual acuity and increase of mean macular thickness were greater in patients with high blood glucose, high blood pressure and diabetic nephropathy.

Conclusions

In eyes with severe diabetic retinopathy treated with panretinal photocoagulation, mean visual acuity did not decrease significantly, but mean central and peripheral macular thickness significantly increased after treatment. We posit that visual prognosis after panretinal photocoagulation in eyes with severe diabetic retinopathy without macular edema is influenced by the control of blood glucose and blood pressure and the presence of diabetic nephropathy.

Keywords: Diabetic Retinopathy, Macular Edema, Optical Coherence Tomography (OCT), PanRetinal Photocoagulation (PRP), Visual Acuity

References

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Figure 1.
Alteration of visual acuity. Two eyes (A) showed increase of visual acuity. Most eyes (29 eyes, B) maintained their visual acuity during the experimental period, and 9 eyes (C) showed decrease of visual acuity in this clinical course of 18 weeks.
jkos-50-717f1.tif
Figure 2.
Alterations of macular thickness before and 1.47 months after the last panretinal photocoagulation (PRP). Macular thickness of 2 eyes (A), which showed increase of visual acuity, decreased after PRP. Macular thickness of 29 eyes (B), which maintained their visual acuity during the experimental period, increased after PRP. Macular thickness of 9 eyes (C), which showed decrease of visual acuity, increased more than that of B after PRP.
jkos-50-717f2.tif
Figure 3.
Alterations of macular thickness before and after panretinal photocoagulation (PRP). Central and peripheral macular thickness increased 1.47 and 8 months after PRP.
jkos-50-717f3.tif
Table 1.
Characteristics of patients before panretina photocoagulation
Number of eyes 40
Gender
Male (eyes) 27
Female (eyes) 13
Age (years) 54.15±8.25 (45∼72)
Type of DMR*
NPDR† 19
PDR‡ 21
Duration of DMR (years) 11.93±6.70 (1∼30)
Visual acuity (LogMAR) 0.28±0.23
Macular thickness
Central (μm) 216.98±34.09
Peripheral (μm) 269.26±34.59

* Diabetic retinopathy

† Nonproliferative diabetic retinopathy

‡ Proliferative diabetic retinopathy.

Table 2.
Comparison of the visual acuity (VA) by glucose control, described by LogMAR scale
HbA1c (mg/dL) No. of eyes VA before PRP* VA after PRP* p-value
≤ 7.0 8 0.26±0.32 0.27±0.34 0.901
> 7.0 16 0.24±0.22 0.28±0.27 0.475

* Panretinal photocoagulation.

Table 3.
Comparison of the macular thickness (MT) by glucose control
HbA1c (mg/dL) No. of eyes MT (μm) before PRP* MT (μm) after PRP* p-value
Central ≤ 7.0 8 219.38±30.45 238.25±35.63 0.019
> 7.0 16 210.13±27.30 228.31±29.46 0.039
Peripheral ≤ 7.0 8 264.27±27.10 273.96±31.24 0.144
> 7.0 16 269.17±32.70 285.11±28.00 0.003

* Panretinal photocoagulation.

Table 4.
Comparison of the macular thickness (MT) by hypertension
Hypertension No. of eyes MT (μm) before PRP* MT (μm) after PRP* p-value
Central Well controlled 11 213.00±36.25 222.82±29.78 0.198
Poorly controlled 16 216.50±27.07 257.81±86.74 0.101
Peripheral Well controlled 11 265.13±39.86 272.85±34.91 0.206
Poorly controlled 16 266.74±19.44 293.99±44.60 0.030

* Panretinal photocoagulation.

Table 5.
Comparison of the visual acuity (VA) by nephropathy, described by LogMAR scale
No. of eyes VA before PRP* VA after PRP* p-value
No nephropathy 25 0.33±0.19 0.36±0.22 0.627
Nephropathy 15 0.19±0.28 0.29±0.34 0.044

* Panretinal photocoagulation.

Table 6.
Compairson of the macular thickness (MT) by nephropathy
Hypertension No. of eyes MT (μm) before PRP* MT (μm) after PRP* p-value
Central No nephropathy 25 216.16±33.97 252.48±62.86 0.001
Nephropathy 15 218.33±35.45 259.80±90.55 0.127
Peripheral No nephropathy 25 272.65±36.33 291.64±44.67 0.003
Nephropathy 15 263.61±31.86 292.49±50.99 0.033

* Panretinal photocoagulation.

Table 7.
Comparison of the macular thickness (MT) by PRP spots
No. of PRP* spot No. of eyes MT (μm) before PRP* MT (μm) after PRP* p-value
Central 1600≤ 21 213.26±29.58 238.32±43.62 0.001
1600> 19 220.33±38.13 270.52±90.97 0.023
Peripheral 1600≤ 21 267.02±37.50 280.55±33.52 0.011
1600> 19 271.28±32.52 302.28±54.48 0.005

* Panretinal photocoagulation.

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