Objective To compare the efficacy of intravitreal triamcinolone(IVTA) injection and IVTA combined with macular laser grid photocoagulation（MLGP）to treat macular edema.Methods Consecutive 89 patients （109 eyes）diagnosed with macular edema by examinations of ocular fundus and optical coherence tomography (OCT).The visual acuity was hand moving-0.8 (0.19plusmn;0.13)；the intraocular pressure（IOP）ranged from 7 mm Hg to 21 mm Hg（1 mm Hg=0.133 kPa）and the average IOP was 13.78 mm Hg.All the patients received OCT and microperimetry examinations，the central macular thickness was （570plusmn;182）mu;m；the average light sensitivity was （5.07plusmn;3.94） dB and the fixation percentage was 70.67% within 4 deg;area around the macular fovea. All the patients received IVTA treatment，39 patients（48 eyes）further received MLGP 1 month later (IVTAMLGP group). The remaining 50 patients (61 eyes) without MLGP treatment was the IVTA group. Best corrected visual acuity (BCVA),IOP,lens,OCT and microprimetry examinations before and after IVTA (1,3,6,12 months) were followed and analyzed.Results On the 12th months，the BCVA in IVTAMLGP and IVTA group was （0.41plusmn;0.20）、（0.24plusmn;0.19）respectively (P＜0.05)；the central macular thickness was （309plusmn;187） and （487plusmn;206） mu;m respectively（P＜0.05）；the mean light sensitivity of 4deg; central macular was （8.24plusmn;4.64）and（6.30plusmn;3.22）dB respectively（P＜0.05）；the fixation percentage was（87.01plusmn;19.70）% and（78.85plusmn;20.41）% respectively （P＜0.05）. During the followup recurrent macular edema was noticed in 28 eyes of IVTA group and 8 eyes of IVTAMLGP group.Conclusions IVTA combined with MLG was more effective than IVTA to cure macular edema.
Objective To observe the efficiency and safety of a single intravi treal injection of Bevacizumab (Avastin) in patients with diabetic macular edema. Methods Prospective, open label study of 18 eyes of 18 patients with diabetic macular edema which was diagnosed by examination of regular inspection, fundus fluorescein angiography(FFA) and optic coherence tomography(OCT). The patients without general or partial surgery contraindications, aged from 34-75 years with a mean age of 54plusmn;11 years. The best corrected visual acuity of logMAR was 1.023plusmn;0.45 and the retinal thickness of macular foveal was 486 mu;m before the treatment. The eyes have intravitreal injection with Bevacizumab at dose 1.5 mg (0. 06 ml). After the treatment, the follow-up period ranging from 12 to 20 weeks (m e an 16plusmn;4 weeks). The changes of visual acuity, intraocular pressure, OCT and FFA before and after the treatment were observed and analyzed. Results All 18 patients had a mean logMAR BCVA of 1.023plusmn;0.45 at baseline and at the follow-up weeks 1, 4, 12, the mean logMAR BCVA was significantly improved as 0.864plusmn;0.48 （P=0.001）, 0.739plusmn;0.51 (P=0.003), 0.792plusmn;0.50 (P=0.015) respectively, and the differences are statistically significant compared with before. Sixteen eyes (88.9%) had a improved or stable visual acuity, the BCVA increased 2 lines (0.2 logMAR vision) or better in 10 eyes (55.6%) and decreased in 2 eyes at 12 weeks after injection. OCT demonstrated that retinal thickness of macular foveal decreased from 486 mu;m to 413 mu;m at 4 weeks, decreased to 383mu;m at 12 weeks（P=0.002， P=0.001）, and the differences are statistically significant compared with before. There are remarkable resolution of central retinal edema in 13 eyes (72.2%) at 12 weeks after the injection. No local or systemic adverse events were observed in any patients. Conclusions The preliminary result in our observati on showed that int ravitreal injection of Bevacizumab therapy was well tolerated with a significant improvement in BCVA and decrease in macular edema for patients with diabetic macular edema. A randomly controlled multicenter clinical trial is necessary. (Chin J Ocul Fundus Dis,2008,24:172-175)
Objective To evaluate the long-term result of vitrectomy for macular epiretinal membranes(ERM) and the relationship between bestcorrected visual acuity(VA) and macular thickness. Methods In a retrospective consecutive series, twenty-two eyes(17eyes of idiopathic（77％） and 5 of secondary ERM（23％）) of 2 2 patients with macular ERM who underwent pars plana vitrectomy and membrane peeling which had more than 1 yearprime;s (12.40 months，mean(23plusmn;8)months)follow up were included. All the patients were examined by VA, fundus color photography, fluo rescein fundus angiography (FFA) optical coherence tomography (OCT) before and after treatment. VA was adopted 5 points record; FFA and OCT were underway as common way. The mean of VA was (4.25plusmn;0.36), the mean of macular thickness was (4.99 plusmn;114) mu;m. Compared the VA, appearance of fundus photography, fluorescein angio graphy and optical coherence tomography (OCT) before and after surgery. Results Visual improvement was achieved in 13 eyes (59%), meanwhile, 6 eyes (27%) were s table and 3 eyes (14%) were worse; VA of 15 eyes (66%) was more than 4.5 at last follow-up. The mean VA increased from (4.25plusmn;0.36) to (457plusmn;031) postope rative ly, the difference was statistically significant (P＜0.05). Mean macular thi cknes s decreased from (499plusmn;114) mu;m (317-774 mu;m) to (286plusmn;104) mu;m (150-597 mu;m) (P＜0.05) postoperatively, the difference was statistically significant (P＜0.05), but still different to the opposite eyesprime;((184plusmn;37) mu;m)(P＜0.05).VA correlated with macular thickness preoperatively (r=-0.64,P=0.001)and postoperat ively(r=-0.58, P=0.01) except the patients with cataract improvement without therapy. 6 eyes(27%) had retinal hemorrhage and 2 eyes(9%) had peripheral retinal breaks intraoperati vely; 5 eyes(23%) had secondary higher intraocular pressure, 1 eye(5%) had macul a hole and 8 eyes(36%) had cataract improvement postoperatively. Conclusions Surgery is successful in treating ERM. It can relieve macular edema and improve visual acuity. （Chin J Ocul Fundus Dis，2008，24：206-209）
Objective To investigate the feasibility and clinical significance of monitoring diabetic macular edema by Heidelberg retina tomograph Ⅱ (HRT). Methods The diabetic macular edema (DME) was diagnosed by slit-lamp microscopy combined with three-mirror contact lens examination and fundus fluorescein angiography (FFA). The exponential of macular edema (e value) of healthy people and patients with DME or without DME (NDME) (the total number is 77 individuals and 120 eyes) were detected by HRT Ⅱ. All of the 77 people were divided into three groups. In DME group, there were 23 patients (40 eyes), including 13 males (23 eyes) and 10 females (17 eyes), at the age of 44-68 (average of 55.17plusmn;8.26). In NDME group, there were 32 patients (40 eyes), including 18 males (22 eyes) and 14 females (18 eyes), at the age of 44-68 (average of 55.17plusmn;6.5). In normal control group, there were 22 patients (40 eyes), including 10 males (19 eyes) and 12 females (21 eyes), at the age of 42-65 (average of 53.32plusmn;6.04). According to the results of FFA, the 40 eyes in DME group were divided into: grade 1 of FFA in 9 eyes, with macular suspicious leakage or the area of leakage of lt;25%; grade 2 of FFA in 10 eyes, with the area of leakage between 25% and 66%; grade 3 of FFA in 21 eyes, with the area of leakage of gt;66%. The differences of sex and age among the 3 groups were not significant (Pgt;0.05). The relationship among e value, leakage area, and visual acuity was observed. Results There was a significant difference of e value (the macular diameter was 1, 2, and 3 mm) among the 3 groups(Plt;0.05). The e value in normal control group didnrsquo;t differ much from which in NDME group (Pgt;0.05), but was statistically different from which in DME group (Plt;0.05). Significant difference of e value was also found between NDME group and DME group (Plt;0.05). There was a correlation between visual acuity and e value in DME group (Plt;0.05). In DME group, the difference of e value among FFA grade 1, 2, and 3 groups was found according to the variance analysis; the macular leakage area in FFA grade 3 group differed much from which in grade 1 (Plt;0.05) and grade 2 group (Plt;0.05), while no significant difference was found between grade 1 and grade 2 group. The result was not correlated with the macular diameter. Conclusion E value in the macular module of HRT Ⅱ can detect and evaluate the degree of DME. (Chin J Ocul Fundus Dis,2007,23:252-255)