The Effect of Intravitreal Triamcinolone Injection According to the OCT Patterns of Diabetic Macular Edema

Sang Chul Yoon; Dae Young Lee; Dong Heun Nam

doi:10.3341/jkos.2008.49.10.1611

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Chul Yoon, Young Lee, and Nam: The Effect of Intravitreal Triamcinolone Injection According to the OCT Patterns of Diabetic Macular Edema

Original Article

J Korean Ophthalmol Soc 2008;49(10):1611-1618.

Published online: 7 September 2008

DOI: https://doi.org/10.3341/jkos.2008.49.10.1611

The Effect of Intravitreal Triamcinolone Injection According to the OCT Patterns of Diabetic Macular Edema

Sang Chul Yoon, M.D, Dae Young Lee, M.D, Dong Heun Nam, M.D., Ph.D.

epartment of Ophthalmology, Gachon University of Medicine and Science, Incheon, Korea

Address reprint requests to Dong Heun Nam, M.D. Ph.D. Department of Ophthalmology, Gachon University of Medicine and Science, Gil Medical Center #1198 Kuwol-dong, Namdong-gu, Incheon 405-760, Korea Tel: 82-32-460-3364, Fax: 82-32-460-3358, E-mail: eyedawns@gilhospital.com

Received 2 July 2008 Accepted 2 October 2007

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 determine the preoperative factors of different types of diabetic macular edema (DME) classified using Optical Coherence Tomography (OCT) and to evaluate the short-term therapeutic effects and pattern changes of intravitreal triamcinolone acetonide injection (IVTA).

Methods

Seventy-seven eyes of 60 patients, who had been previously diagnosed with DME through fundoscopy and fluorescein angiography, were enrolled, and each patient was classified as one of three DME types according to his/her OCT features: Type 1, diffuse retinal thickening; Type 2, cystoid macular edema; and Type 3, serous macular detachment. We compared age, sex, the duration of diabetes mellitus (DM), and decreased visual acuity (VA). We analyzed VA, intraocular pressure (IOP), foveal thickness (FT), total macular volume (TMV), and pattern changes that occurred between pre-operation and 1 month post-operation.

Results

The duration of DM was short in Type 3 DME patients. There were no differences in age or the duration of decreased VA. Pre-operative VA was higher in Type 1 than in Type 2 or 3 patients. FT and TMV increased in thickness from Type 1 through Type 3. VA after IVTA improved in Types 2 and 3. FT and TMV after IVTA decreased in each type. However, the extent of the changes in Types 2 and 3 was greater than that in Type 1. Seventy-four percent of Type 2 and 83% of Type 3 changed to Type 1 after IVTA.

Conclusions

This study found that there were differences in the therapeutic effect of IVTA among patients with different DME patterns. According to our results, the effectiveness of IVTA can be predicted, which we believe will help to objectively determine DME treatment.

Keywords: Diabetic macular edema, Intravitreal triamcinolone injection, Optical coherence tomography

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Figure 1.

The classification of clinically significant diabetic macular edema by OCT features. Type 1 (top): the thickening of the fovea with homogeneous optical reflectivity throughout the whole layer of the retina. Type 2 (middle): the thickening of the fovea with markedly decreased optical reflectivity in the outer retinal layer. Type 3 (bottom): the foveolar detachment without vitreofoveal traction; OCT=optical coherence tomography.

Figure 2.

An analysis of the VA before and after IVTA. Pre-operative VA was significantly higher in type 1 than in types 2 and 3 (Kruskal-Wallis test= p<.01, with p<.05 regarded as significant). VA after IVTA improved significantly in types 2 and 3 (Wilcoxon’s signed rank test, p=.04, p=.01, with p<.05 regarded as significant); VA=visual acuity; IVTA=intravitreal triamcinolone acetonide injection; log MAR=the logarithm of the minimum angle of resolution.

Figure 3.

An analysis of the foveal thickness before and after IVTA. Foveal thickness significantly decreased in every types (Wilcoxon’s signed rank test, p=.002, p<.0001, p=.0001, with p<.05 regarded as significant). But the extent of changes in Types 2 and 3 was greater than in Type 1 (Kruskal-Wallis test p<.01, with p<.05 regarded as significant).

Figure 4.

An analysis of total macular volume before and after IVTA. Total macular volume was significantly decreased in every types (Wilcoxon’s signed rank test, p=.0002, p<.0001, p=.0001, with p<.05 regarded as significant). But the extent of changes in Types 2 and 3 was greater than in Type 1 (Kruskal-Wallis test p<.01, with p<.05 regarded as significant).

Figure 5.

DME pattern changes before and after IVTA injection at 1 month. The OCT feature changed to diffuse thickened macula (Type 1) in (A) 74% of cystoid macular edema (Type 2), (B) 83% of serous retinal detachment (Type 3); DME=diabetic macular edema; OCT=optical coherence tomography.

Table 1.

Basic characteristics of eyes with different OCT types

	Type1	Type2	Type3
No of eyes	34	31	12
Age (yr)	52.1	55.3	53.7
Sex (M:F)	22:12	21:10	7:5
DM duration (yr)	10.67±0.63	14.21±8.13	4.14±3.61*
Decreased VA duration (yr)	0.47±0.69	0.71±1.18	0.60±0.38
Preoperative VA (log MAR)	0.23±0.21*	0.62±0.30	0.62±0.31
IOP (mmHg)	15.7±4.49	16.1±12.2	15.6±3.63
Foveal thickness (µm)	242.1±64.2*	395.9±117.5*	511.8±127.2*
Macular volume (mm³)	8.2±1.23*	9.7±1.41*	12.0±2.26*

^* Krusckal-Wallis test: p<0.05; VA=visual acuity; IOP=intraocular pressure.

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