Diabetic macular edema (DME) is a common ocular complication of diabetes patients. It mainly involve macular which is closely related with visual function, thus DME is one of the major reasons causing visual impairment or blindness for diabetes patients. How to reduce the visual damage of DME is always a big challenge in the ophthalmic practice. In the past three decades, there are tremendous developments in DME treatments, from laser photocoagulation, antiinflammation drugs to antivascular endothelial growth factor therapy. However, the mechanism of DME development is not yet completely clear; every existing treatment has its own advantages and weaknesses. Therefore DME treatment still challenges us to explore further to reduce the DME damages.
Objective To compare the clinical results of yellow micro-pulse laser and traditional laser grid (MLG) photocoagulation for diabetic macular edema (DME). Methods Seventy-eight patients (106 eyes) with DME diagnosed by fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) were enrolled in this study. The patients were divided into micro-pulse group (39 patients, 51 eyes) and MLG group (39 patients, 55 eyes). The patients of micropulse group underwent 577 nm yellow micro-pulse laser therapy, while the patients of MLG group underwent continuous wavelength laser photocoagulation with a 561 nm yellow green laser. All the patients were examined documenting corrected visual acuity, macular retinal thickness (CMT) and mean sensitivity within macular 10 deg; examination before and after treatment. Six months after treatment was considered as the judgment time for the therapeutic effects. The mean corrected visual acuity, CMT and MS were comparatively analyzed. Results Six months after treatment, the mean corrected visual acuity of micropulse group and MLG group were 0.45plusmn;0.20 and 0.42plusmn;0.20, which increased significantly compared to those before treatment (t=3.404,2.316; P＜0.05). The difference of mean corrected visual acuity between before and after treatment of micro-pulse group and MLG group were 0.08plusmn;0.02 and 0.06plusmn;0.03, the difference was statistically significant between two groups (t=0.532, P＞0.05). The mean CMT of micropulse group and MLG group were (323.94plusmn;68.30) and (355.85plusmn;115.88) mu;m, which decreased significantly compared to those before treatment (t=4.028, 2.039; P＜0.05). The difference of mean CMT between before and after treatment of micro-pulse group and MLG group were (55.12plusmn;13.68) and (22.25plusmn;10.92) mu;m. The difference was not statistically significant between two groups (t=1.891,P＞0.05). The mean MS of micro-pulse group and MLG group were (6.63plusmn;2.65) and (4.53plusmn;1.81) dB. The mean MS of micro-pulse group increased significantly compared to that before treatment(t=3.335,P＜0.05). The mean MS of MLG group decreased significantly compared to that before treatment (t=3.589,P＜0.05). The difference of mean MS between before and after treatment of micro-pulse group and MLG group were (1.10plusmn;0.33) and (-0.91plusmn;0.25) dB.The difference was statistically significant between groups (t=4.872，P＜0.05). Conclusions In the treatment of DME, yellow micro-pulse laser therapy and MLG can improve visual acuity, and reduce CMT. In addition, yellow micro-pulse laser therapy can improve the MS, but MLG reduces MS.
Objective To observe the subfoveal choroidal thickness (SFCT) in eyes of patients with diabetic macular edema (DME). Methods Twenty patients (32 eyes) with DME were enrolled in this crosssectional observational study. The patients included 12 males and eight females, with a mean age of (47.3plusmn;10.2) years. All the patients were examined documenting best corrected visual acuity (BCVA), spectraldomain optical coherence tomography (OCT) and ophthalmological examination. According to OCT DME morphology, samples are divided into diffuse macular edema, cystoid macular edema, serous retinal detachment and hard exudate groups. The SFCT was measured by a Cirrus HD-OCT with enhanced depth imaging (EDI) and was compared with the average SFCT (286.84plusmn;28.80) mu;m of same age group. Correlation between SFCT and age, diopter, diabetic duration, fasting blood glucose, BCVA and central retinal thickness were analyzed by Pearson Analysis. SFCT of different DME types were analyzed by ANOVA Analysis. Results The mean SFCT of 32 eyes was (223.81plusmn;43.74) mu;m (ranging from 120.50 to 361.50 mu;m), which was lower by 63.03 mu;m (95% confidence interval, -78.80 to -47.26 mu;m, P＜0.01) from normal SFCT. SFCT was independent of age (r=0.124), diopter (r=0.277), diabetic duration (r=0.286), fasting blood glucose (r=0.408), BCVA (r=0.087), and central retinal thickness (r=0.036). There was no significant difference of SFCT between different DME types (F=0.042，P＞0.05). Conclusion SFCT is thinner in eyes with DME as compared to normal eyes of the same age.
Objective To observe the levels of vascular endothelial growth factor (VEGF), interleukin-6 (IL-6) and monocyte chemotactic protein-1 (MCP-1) in aqueous humor of patients with macular edema secondary to central retinal vein occlusion (CRVO). Methods Forty eyes of 40 consecutive patients with macular edema secondary to CRVO (CRVO group) were enrolled in this study. The patients included 25 males and 15 females. The patient age ranged from 38 to 76 years. The control group was 20 patients with senile cataract who underwent phacoemulsification, including 10 males and 10 females. The levels of VEGF165, VEGF165b, IL-6 and MCP-1 in aqueous humor were determined by enzymelinked immunosorbent assay. The correlation of VEGF, and IL-6, and MCP-1 were analyzed. Results The median aqueous level of VEGF165, IL-6 and MCP-1 were 1089.0, 165.6, 1253.0 pg/ml respectively in CRVO group, which were higher than the control group's results (168.2, 4.7, 216.4 pg/ml respectively), the differences were statistically significant (Z=-4.549, -6.008, -5.343;P＜0.001). The VEGF165b in CRVO group and control group were 834.0, 915.9 pg/ml respectively, the difference was not statistically significant (Z=-0.207，P＞0.05). The ratio of VEGF165b to VEGF165 in CRVO group and control group were 2.71, 7.28 respectively, the difference was statistically significant (t=-3.007，P＜0.05). There was a highly positive correlation between IL-6 and VEGF in CRVO group (r=0.526,P=0.001) and also mild positive correlation in control group (r=0.425，P=0.070). No correlation between MCP-1 and VEGF was observed in both groups (CRVO group: r=0.211,P＞0.05. Control group: r=-0.019,P＞0.05). Conclusions VEGF165, IL-6 and MCP-1 levels were increased in CRVO patients while the VEGF165b was normal. The ratio between VEGF165b and VEGF165 in aqueous humor of patients with macular edema secondary to CRVO was decreased.
Objective To observe the choroidal changes of diabetic macular edema (DME) with serous macular detachment (SMD) in non-proliferative diabetic retinopathy (NPDR) patients by optical coherence tomography (OCT).Methods Nine NPDR patients including DME with SMD in one eye (SMD group) and only DME in the other eye (DME group) were enrolled. These 18 eyes were also divided into PRP group (six eyes, received panretinal photocoagulation before) and non-PRP group (12 eyes). Spectral domain EDI (enhance depth imaging) OCT and fundus photograph were performed in all the eyes. The subfoveal choroidal thickness was measured. The choroidal simulation area acquired by horizontal EDI-OCT scan through the center of the fovea was calculated by Image Plus Pro 6.0 software. The difference between DME and SMD group was compared and analyzed with matched t- test; the difference between PRP and non-PRP group was compared and analyzed with F test.Results In SMD group, spindle-like or domelike low signal of detachment areas with intact external limiting membrane were found in the retinal detachment region, and the inner and outer segments (IS/OS) were separated from the retinal pigment epithelium (RPE) Bruch membrane. Both subfoveal choroidal thickness and choroidal simulation area in SMD group were significant greater than those in DME group (t=2.306, 2.306;P＜0.05). Choroidal simulation area in PRP group was larger than that in nonPRP group (F=5.227,P＜0.05). But there was no significant difference of subfoveal choroidal thickness between PRP and non-PRP group (F=3.276,P＞0.05). Conclusion EDI-OCT detects spindlelike or domelike low signal areas in detachment region of SMD with DME in NPDR patients.
Objective To observe the therapeutic effects of photodynamic therapy（PDT）on choroidal neovascularization（CNV）with or without cystoid macular edema（CME）in patients with wet agerelated macular degeneration（AMD）. Methods The clinical data of 54 patients (54 eyes) with wet AMD who had undergone the standard PDT，including 16 patients（21 eyes）with CME and 28 patients（33 eyes）without CME were retrospectively analyzed. The visual acuity and BFT of patients were examined by early treatment diabetic retinopathy study (ETDRS) and optical coherence tomography（OCT）before and per three months after PDT. The follow up was 3-18 months with the mean of 8.3 months.Results At the last time of follow up, in CME group，ETDRS letter score was（29.429plusmn;17.907）and the BFT was （316.429plusmn;77.161）mu;m，compared with that before the treatment, the difference were statistically significant (t=-0.389，2.246；P＝0.701，0.019). In nonCME group, ETDRS letter score was (48.121plusmn;17.911) and the BFT was (244.667plusmn;37.619) mu;m, compared with that before the treatment, the difference were statistically significant (t=-3.424，6.880；P＝0.002，0.000). There were statistical significance for the change of ETDRS letter score and BFT between the two groups (t=-2.194，2.212；P＝0.033，0.031）). Conclusions Therapeutic effect of PDT on CNV with CME was better than without CME in patients with wet AMD.
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)