The Short-term Effect of Triple Therapy for Diabetic Macular Edema With Vitreomacular Traction

Jong Hun Bak; Song Ee Chung; Se Woong Kang

doi:10.3341/jkos.2008.49.12.1941

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Bak, Chung, and Kang: The Short-term Effect of Triple Therapy for Diabetic Macular Edema With Vitreomacular Traction

Original Article

J Korean Ophthalmol Soc 2008;49(12):1941-1947.

Published online: 7 September 2008

DOI: https://doi.org/10.3341/jkos.2008.49.12.1941

The Short-term Effect of Triple Therapy for Diabetic Macular Edema With Vitreomacular Traction

Jong Hun Bak, M.D., Song Ee Chung, M.D., Se Woong Kang, M.D., Ph.D.

Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Address reprint requests to Se Woong Kang, M.D., Ph.D. Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine #50 Ilwon-dong, Gangnam-gu, Seoul 135-710, Korea Tel: 82-2-3410-3562, Fax: 82-2-3410-0074, E-mail: swkang@skku.edu

Received 24 September 2008 Accepted 17 June 2008

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 evaluate the short‐ term effect and safety of a triple therapy on diabetic macular edema (DME) with vitreomacular traction.

Methods

Twenty‐ four eyes from 24 subjects, diagnosed with DME with vitreomacular traction, were subjected to vitrectomy. Intravitreal triamcinolone acetonide injection and macular laser photocoagulation were conducted sequentially at one and 14 days after vitrectomy. Best‐ corrected visual acuity (BCVA) and central macular thickness (CMT) were recorded before surgery and at three and six months after triple therapy.

Results

The mean (±standard deviation [SD]) logarithm of the minimum angle of resolution BCVAs before, three, and six months after the triple therapy were 0.77±0.38, 0.48±0.27, and 0.47±0.36, respectively. The mean (±SD) CMTs before, three, and six months after the triple therapy were 407.9±127.1 µm, 272.4±104.6 µm, and 263.5±131.2 µm, respectively. The changes in BCVA at three and six months from treatment were statistically significant. Macular thickness decreased significantly at 3 and 6 months postoperatively.

Conclusions

Triple therapy is a good therapeutic option for diabetic macular edema with vitreomacular traction to improve visual acuity and macular thickness.

Keywords: Diabetic macular edema, Triple therapy, Vitreomacular traction

References

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Figure 1.

Graph demonstrating the changes in the mean best corrected visual acuity (BCVA) after sequentially combined vitrectomy, intravitreal triamcinolone acetonide, and macular laser photocoagulation for the treatment of diabetic macular edema (DME) with vitreomacular traction (VMT). In all subjects, the BCVA significantly improved at three months after the triple therapy and remained improved at six months after treatment. The lens status when the vision was examined is appended on the graph. (logMAR: logarithm of the minimum angle of resolution, Nt=total number of eyes, Nps=number of pseudophakic eyes; Nph=number of phakic eyes, Wilcoxon's signed rank test)

Figure 2.

Graph demonstrating the changes in the mean central macular thickness (CMT) after triple therapy for the treatment of DME with VMT. In all subjects, the CMT significantly decreased at three months after the administration of triple therapy and remained decreased at six months after treatment (Nt=total number of eyes, Nps= number of pseudophakic eyes; Nph=number of phakic eyes, Wilcoxon's signed rank test).

Figure 3.

(Top) Color fundus photographs and (Bottom) optical coherence tomography (OCT) scans before and 6 months after the administration of triple therapy for the treatment of intractable diabetic macular edema with vitreomacular traction. (Top and Bottom left) Before surgery, the BCVA was 20/2000, and the CMT was 507 µm. Note the significant retinal thickening and a bright refractive band adherent to the surface of the retina that appeared to be an epiretinal membrane (Top and Bottom right). Six months after the application of triple therapy, we can see the resolution of macular edema. At that time, the BCVA was improved to 20/250, and the CMT was 101 µm.

Figure 4.

Table 1.

Baseline Characteristics

Characteristics	No. (%)
Number of eyes	24
Male	10 (41.7)
Female	14 (58.3)
Duration of diabetes (yrs, mean±SD∗)	14.0±5.5
Mean age±SD∗ (yrs)	62.4±8.8
Lens type
Phakia	17 (70.8)
Pseudophakia	7 (29.2)
Diabetic retinopathy
Nonproliferative	10 (41.7)
Proliferative	14 (58.3)
No. of prior IVTA^†, mean±SD∗	1.2±1.1
No. of prior macular laser photocoagulation, mean±SD∗	1.1±0.6
Best corrected visual acuity (logMAR), mean±SD∗	0.77±0.38
Central macular thickness (µm), mean±SD∗	407.9±127.1

^∗ SD=standard deviation

^† IVTA=intravitreal triamcinolone injection.

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