Korean J Ophthalmol.  2013 Jun;27(3):186-193. 10.3341/kjo.2013.27.3.186.

Vitrectomy Combined with Intravitreal Triamcinolone Acetonide Injection and Macular Laser Photocoagulation for Nontractional Diabetic Macular Edema

• Kim JH
• Kang SW
• Ha HS
• Kim JR

• KMID: 1798056
• DOI: http://doi.org/10.3341/kjo.2013.27.3.186

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.

Keyword

Anti-vascular endothelial growth factor; Diabetic macular edema; Triple therapy; Vitrectomy

MeSH Terms

Aged
Combined Modality Therapy
Diabetic Retinopathy/*drug therapy/*surgery
Female
Humans
Immunosuppressive Agents/administration & dosage
Intravitreal Injections
Light Coagulation/*methods
Macula Lutea/drug effects/surgery
Macular Edema/*drug therapy/*surgery
Male
Middle Aged
Retrospective Studies
Triamcinolone Acetonide/*administration & dosage
Vitrectomy/*methods
Immunosuppressive Agents
Triamcinolone Acetonide

Figure

• 

  Fig. 1 Graph illustrating changes in the logarithm of the minimal angle of resolution (logMAR) best-corrected visual acuity (BCVA, A), and the central subfield thickness (CST, B) at baseline and one, three, and six months after sequential combined vitrectomy, intravitreal triamcinolone acetonide, and macular laser photocoagulation for the treatment of diabetic macular edema between eyes refractory to anti-vascular endothelial growth factor. Statistical significance was determined using repeated measures analysis of variance. Asterisks indicate statistically signif icant results after Bonferroni's correction. Cataract extraction was not conducted during the study period.

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