Korean J Ophthalmol.  2014 Aug;28(4):298-305.

Efficacy of Intravitreal Anti-vascular Endothelial Growth Factor or Steroid Injection in Diabetic Macular Edema According to Fluid Turbidity in Optical Coherence Tomography

• Lee K
• Chung H
• Park Y
• Sohn J

Abstract

PURPOSE
To determine if short term effects of intravitreal anti-vascular endothelial growth factor or steroid injection are correlated with fluid turbidity, as detected by spectral domain optical coherence tomography (SD-OCT) in diabetic macular edema (DME) patients.
METHODS
A total of 583 medical records were reviewed and 104 cases were enrolled. Sixty eyes received a single intravitreal bevacizumab injection (IVB) on the first attack of DME and 44 eyes received triamcinolone acetonide treatment (IVTA). Intraretinal fluid turbidity in DME patients was estimated with initialintravitreal SD-OCT and analyzed with color histograms from a Photoshop program. Central macular thickness and visual acuity using a logarithm from the minimum angle of resolution chart, were assessed at the initial period and 2 months after injections.
RESULTS
Visual acuity and central macular thickness improved after injections in both groups. In the IVB group, visual acuity and central macular thickness changed less as the intraretinal fluid became more turbid. In the IVTA group, visual acuity underwent less change while central macular thickness had a greater reduction (r = -0.675, p = 0.001) as the intraretinal fluid was more turbid.
CONCLUSIONS
IVB and IVTA injections were effective in reducing central macular thickness and improving visual acuity in DME patients. Further, fluid turbidity, which was detected by SD-OCT may be one of the indexes that highlight the influence of the steroid-dependent pathogenetic mechanism.

Keyword

Bevacizumab; Diabetic macular edema; Intravitreal triamcinolone acetonide injection; Optical coherence tomography; Turbidity

MeSH Terms

Aged
Angiogenesis Inhibitors/*therapeutic use
Bevacizumab/*therapeutic use
Diabetic Retinopathy/*drug therapy/physiopathology
Female
Glucocorticoids/*therapeutic use
Humans
Intravitreal Injections
Macular Edema/*drug therapy/physiopathology
Male
Middle Aged
Nephelometry and Turbidimetry
Retina/pathology
*Subretinal Fluid
Tomography, Optical Coherence
Treatment Outcome
Triamcinolone Acetonide/*therapeutic use
Vascular Endothelial Growth Factor A/antagonists & inhibitors
Visual Acuity/physiology
Angiogenesis Inhibitors
Bevacizumab
Glucocorticoids
Triamcinolone Acetonide
Vascular Endothelial Growth Factor A

Figure

• 

  Fig. 1 The measurement of intraretinal fluid turbidity. Fluid turbidity was measured using a Photoshop program. Every cystoid area in intraretinal layer was dragged using the Photoshop dragging tool and a tablet pen. The color histogram of every dragged image was examined and the median value of each image was obtained.

• 

  Fig. 2 Change of the mean best-corrected visual acuity after intravitreal injection. The best-corrected visual acuity was expressed as a logarithm of the minimum angle of the resolution chart (logMAR). After a period of 2 months after intravitreal injection, both intravitreal bevacizumab injection (IVB) and intravitreal triamcinolone acetonide injection (IVTA) groups showed statistically significant improvement in visual acuity (p = 0.0012 in IVB and p = 0.0024 in IVTA, respectively). *Statistically significant (p < 0.05) by Mann-Whitney test.

• 

  Fig. 3 Change of central macular thickness after intravitreal injection. At the 2 month postoperative time point central macular thickness was significantly reduced after intravitreal injection in intravitreal bevacizumab injection (IVB) and intravitreal triamcinolone acetonide injection (IVTA) groups (p = 0.000 in IVB and p = 0.0001 in IVTA, respectively). *Statistically significant (p < 0.05) by Mann-Whitney test.

• 

  Fig. 4 Correlation between intraretinal fluid turbidity and the change of both the mean best-corrected visual acuity (A) and central macular thickness (CMT) (B) in the intravitreal bevacizumab injection (IVB) group. Change of the best mean corrected visual acuity is defined as the subtraction between initial best-corrected visual acuity and the 2 month postoperative best-corrected visual acuity. Further the change of CMT is defined as [(CMTat baseline - CMTat postoperative 2 months) / CMTat baseline] × 100. As the intraretinal fluid turbidity increased in the IVB group, the best-corrected visual acuity (A) and CMT (B) remained unchanged compared to initial measurements.

• 

  Fig. 5 Change of the mean best-corrected visual acuity (A) and central macular thickness (CMT) (B) according to the intraretinal fluid turbidity in the intravitreal triamcinolone acetonide injection (IVTA) group. Change of mean best-corrected visual acuity is defined as the subtraction between initial best-corrected visual acuity and the 2 month postoperative best-corrected visual acuity. The change of CMT is defined as [(CMTat baseline - CMTat postoperative 2 months) / CMTat baseline] × 100. In the IVTA group, as the intraretinal fluid turbidity increased, the best-corrected visual acuity was unchanged in comparison with those of initial measurements (A), and the CMT reduced greatly (B).

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