The visual acuity changes in patients with different patterns of optical coherence tomography of diabetic macular edema after intravitreal ranibizumab injection and/or laser photocoagulation_Chinese Journal of Ocular Fundus Diseases

Authors：

Wang Xiangning , Li Shuting , Du Xinhua , Chen Yongdong ,  Wu Qiang

Department of Ophthalmology, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai 200233, China;

Corresponding author：

Wu Qiang, Email: wyansh@163.com

Keywords：

Diabetic retinopathy/therapy; Macular edema /therapy; Angiogenesis inhibitors/ therapeutic use; Antibodies, monoclonal/therapeutic use; Laser coagulation; Tomography, optical coherence

DOI：

10.3760/cma.j.issn.1005-1015.2017.02.006

Video：

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Objective To observe the visual acuity change in patients with different patterns of optical coherence tomography (OCT) of diabetic macular edema (DME) after intravitreal ranibizumab injection and/or laser photocoagulation. Methods A retrospective observational case series. Seventy patients (99 eyes) with DME were enrolled. Best-corrected visual acuity (BCVA) was evaluated using the international vision test chart, and then convert the result to the logarithm of the minimum angle of resolution (logMAR). According to the morphological characteristics of OCT, the DME was divided into 3 patterns, including diffuse macular edema (DRT), cystoid macular edema (CME) and serous neuroepithelial layer detachment. The average follow-up was (80.43±74.89) days. The patients were divided into 3 groups according to the different treatments, including intravitreal ranibizumab injection group (group A, 21 patients, 25 eyes), intravitreal ranibizumab injection and laser photocoagulation group (group B, 23 patients, 26 eyes), laser photocoagulation group (group C, 26 patients, 48 eyes). The changes of absolute BCVA (ABCVA) and improved visual acuity were compared between different treatment groups and different OCT patterns. ABCVA = logMAR BCVA before treatment－logMAR BCVA after treatment. Improvement more than 0.3 of logMAR value was considered as improved visual acuity. Results There was no significant difference in ABCVA between different treatment groups (F=0.050,P＞0.05). The improved visual acuity in group A and B were great than group C (χ²=5.645, 6.301;P＜0.05). In group A, B and C, there was no significant difference in ABCVA and improved visual acuity between different OCT patterns (P＞0.05). Improved visual acuity of DRT and CME eyes were higher in group A&B (70.59% and 50.00%) than in group C (26.47% and 14.29%), the difference was statistically significant (χ²=5.075, 4.453;P＜0.05). Conclusions There is no obvious change of visual acuity in patients with different OCT patterns of DME after the same treatment by intravitreal ranibizumab injection and/or laser photocoagulation. The improved visual acuity is not consistent in same OCT patterns after different treatment.

Citation： Wang Xiangning, Li Shuting, Du Xinhua, Chen Yongdong, Wu Qiang. The visual acuity changes in patients with different patterns of optical coherence tomography of diabetic macular edema after intravitreal ranibizumab injection and/or laser photocoagulation. Chinese Journal of Ocular Fundus Diseases, 2017, 33(2): 134-138. doi: 10.3760/cma.j.issn.1005-1015.2017.02.006 Copy

1.	Ip MS, Bressler SB, Antoszyk AN, et al. A randomized trial comparing intravitreal triamcinolone and focal/grid photocoagulation for diabetic macular edema: baseline features[J]. Retina, 2008, 28(7): 919-930. DOI: 10.1097/IAE.0b013e 31818144a7.
2.	Early Treatment Diabetic Retinopathy Study Research Group. Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1[J]. Arch Ophthalmol, 1985, 103(12): 1796-1806.
3.	Wang H, Sun X, Liu K, et al. Intravitreal ranibizumab (Lucentis) for the treatment of diabetic macular edema: a systematic review and meta-analysis of randomized clinical control trials[J]. Curr Eye Res, 2012, 37(8): 661-670. DOI: 10.3109/02713683.2012.675616.
4.	Srinivasan VJ, Wojtkowski M, Witkin AJ, et al. High-definition and 3-dimensional imaging of macular pathologies with high-speed ultrahigh-resolution optical coherence tomography[J]. Ophthalmology, 2006, 113(11): 2051-2054. DOI: 10.1016/j.ophtha. 2006.05.046.
5.	Kim BY, Smith SD, Kaiser PK. Optical coherence tomographic patterns of diabetic macular edema[J]. Am J Ophthalmol, 2006, 142(3): 405-412. DOI: 10.1016/j.ajo.2006.04.023.
6.	Otani T, Kishi S, Maruyama Y. Patterns of diabetic macular edema with optical coherence tomography[J]. Am J Ophthalmol, 1999, 127(6): 688-693.
7.	Wilkinson CP, Ferris FR, Klein RE, et al. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales[J]. Ophthalmology, 2003, 110(9): 1677-1682. DOI: 10.1016/S0161-6420(03)00475-5.
8.	Nguyen QD, Brown DM, Marcus DM, et al. Ranibizumab for diabetic macular edema: results from 2 phase Ⅲ randomized trials: RISE and RIDE[J]. Ophthalmology, 2012, 119(4): 789-801. DOI: 10.1016/j.ophtha.2011.12.039.
9.	Mitchell P, Wong TY. Management paradigms for diabetic macular edema[J]. Am J Ophthalmol, 2014, 157(3): 505-513. DOI: 10.1016/j.ajo.2013.11.012.
10.	Chan A, Duker JS. A standardized method for reporting changes in macular thickening using optical coherence tomography[J]. Arch Ophthalmol, 2005, 123(7): 939-943. DOI: 10.1001/archopht. 123.7.939.
11.	Browning DJ, Glassman AR, Aiello LP, et al. Optical coherence tomography measurements and analysis methods in optical coherence tomography studies of diabetic macular edema[J]. Ophthalmology, 2008, 115(8): 1366-1371. DOI: 10.1016/j.ophtha. 2007.12.004.
12.	Holladay JT. Visual acuity measurements[J]. J Cataract Refract Surg, 2004, 30(2): 287-290. DOI: 10.1016/j.jcrs.2004.01.014.
13.	Shimura M, Yasuda K, Yasuda M, et al. Visual outcome after intravitreal bevacizumab depends on the optical coherence tomographic patterns of patients with diffuse diabetic macular edema[J]. Retina, 2013, 33(4): 740-747. DOI: 10.1097/IAE. 0b013e31826b6763.
14.	Seo KH, Yu SY, Kim M, et al. Visual and morphologic outcomes of intravitreal bevacizumab for diabetic macular edema based on optical coherence tomographic patterns[J]. Retina, 2016, 36(3): 588-595. DOI: 10.1097/IAE.0000000000000770.
15.	Cunha-Vaz J. Diabetic macular edema[J]. Eur J Ophthalmol, 1998, 8(3): 127-130.

1. Ip MS, Bressler SB, Antoszyk AN, et al. A randomized trial comparing intravitreal triamcinolone and focal/grid photocoagulation for diabetic macular edema: baseline features[J]. Retina, 2008, 28(7): 919-930. DOI: 10.1097/IAE.0b013e 31818144a7.
2. Early Treatment Diabetic Retinopathy Study Research Group. Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1[J]. Arch Ophthalmol, 1985, 103(12): 1796-1806.
3. Wang H, Sun X, Liu K, et al. Intravitreal ranibizumab (Lucentis) for the treatment of diabetic macular edema: a systematic review and meta-analysis of randomized clinical control trials[J]. Curr Eye Res, 2012, 37(8): 661-670. DOI: 10.3109/02713683.2012.675616.
4. Srinivasan VJ, Wojtkowski M, Witkin AJ, et al. High-definition and 3-dimensional imaging of macular pathologies with high-speed ultrahigh-resolution optical coherence tomography[J]. Ophthalmology, 2006, 113(11): 2051-2054. DOI: 10.1016/j.ophtha. 2006.05.046.
5. Kim BY, Smith SD, Kaiser PK. Optical coherence tomographic patterns of diabetic macular edema[J]. Am J Ophthalmol, 2006, 142(3): 405-412. DOI: 10.1016/j.ajo.2006.04.023.
6. Otani T, Kishi S, Maruyama Y. Patterns of diabetic macular edema with optical coherence tomography[J]. Am J Ophthalmol, 1999, 127(6): 688-693.
7. Wilkinson CP, Ferris FR, Klein RE, et al. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales[J]. Ophthalmology, 2003, 110(9): 1677-1682. DOI: 10.1016/S0161-6420(03)00475-5.
8. Nguyen QD, Brown DM, Marcus DM, et al. Ranibizumab for diabetic macular edema: results from 2 phase Ⅲ randomized trials: RISE and RIDE[J]. Ophthalmology, 2012, 119(4): 789-801. DOI: 10.1016/j.ophtha.2011.12.039.
9. Mitchell P, Wong TY. Management paradigms for diabetic macular edema[J]. Am J Ophthalmol, 2014, 157(3): 505-513. DOI: 10.1016/j.ajo.2013.11.012.
10. Chan A, Duker JS. A standardized method for reporting changes in macular thickening using optical coherence tomography[J]. Arch Ophthalmol, 2005, 123(7): 939-943. DOI: 10.1001/archopht. 123.7.939.
11. Browning DJ, Glassman AR, Aiello LP, et al. Optical coherence tomography measurements and analysis methods in optical coherence tomography studies of diabetic macular edema[J]. Ophthalmology, 2008, 115(8): 1366-1371. DOI: 10.1016/j.ophtha. 2007.12.004.
12. Holladay JT. Visual acuity measurements[J]. J Cataract Refract Surg, 2004, 30(2): 287-290. DOI: 10.1016/j.jcrs.2004.01.014.
13. Shimura M, Yasuda K, Yasuda M, et al. Visual outcome after intravitreal bevacizumab depends on the optical coherence tomographic patterns of patients with diffuse diabetic macular edema[J]. Retina, 2013, 33(4): 740-747. DOI: 10.1097/IAE. 0b013e31826b6763.
14. Seo KH, Yu SY, Kim M, et al. Visual and morphologic outcomes of intravitreal bevacizumab for diabetic macular edema based on optical coherence tomographic patterns[J]. Retina, 2016, 36(3): 588-595. DOI: 10.1097/IAE.0000000000000770.
15. Cunha-Vaz J. Diabetic macular edema[J]. Eur J Ophthalmol, 1998, 8(3): 127-130.

Chinese Journal of Ocular Fundus Diseases

The visual acuity changes in patients with different patterns of optical coherence tomography of diabetic macular edema after intravitreal ranibizumab injection and/or laser photocoagulation

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