BACKGROUND The reported prevalence of diabetic retinopathy in diabetics is around 40 %. Diabetic macular oedema (DME) is defined as macular thickening resulting from diabetic retinopathy, due to leakage from micro aneurysms, or from a diffuse leakage of hyper permeable capillaries. Intravitreal injection of triamcinolone acetonide (IVTA) has gained considerable interest and clinical use because it often has beneficial effect on retinal thickening in DME. The synergistic action of IVTA and laser photocoagulation might increase and prolong the beneficial effects of IVTA in reducing ME. Hence the need for a study to compare efficacies of grid laser, and combination of sequential IVTA and grid laser in treating patients with DME. We wanted to evaluate functional and morphological outcome of grid laser versus combination of sequential intravitreal triamcinolone acetonide and grid laser in treatment of diabetic macular oedema. METHODS The study included 62 eyes with DME. There were 31 eyes which received grid laser photocoagulation (group 1) and 31 eyes which received grid laser photocoagulation following IVTA (group 2) and visual acuity, CMT on OCT was compared at baseline and after day 1, 1st week, 4th week and 12th week. Outcome and comparative efficacies were evaluated. RESULTS Our study shows reduced macular thickness and improved visual acuity in group 2 compared to group 1 in all follow ups. On intragroup analysis, we found a significant reduction in CMT in both groups at 1 week, 4 weeks and 12 weeks as compared to baseline. In our study we also compared CMT between group 1 and group 2 which did not show significant difference at baseline. But, difference in CMT from baseline at each follow up which is at 1 week, 4 weeks and 12 weeks between two groups showed more reduction in CMT in group 2 compared to group 1. CONCLUSIONS There was a significant reduction in CMT in all the follow ups of both groups, but group 2 had more reduction in CMT compared to group 1. The synergistic action of IVTA and laser photocoagulation might increase and prolong the beneficial effect of IVTA in reducing ME. This study found evidence of synergistic effects of IVTA and laser photocoagulation in DME in terms of improving visual acuity and in reducing CMT compared to grid laser alone and should be tried as a modality of treatment in DME. KEYWORDS DME, IVTA, CMT, Macular grid laser, OCT
BACKGROUND Diabetes mellitus (DM) is a global epidemic with significant morbidity. Diabetic retinopathy (DR) is a specific microvascular complication of DM which affects around 1 in 3 persons with DM. Epidemiological studies and clinical trials have shown that optimal control of blood glucose can reduce the risk of developing retinopathy and slow its progression. Diabetic Macular Oedema (DME) is a major cause for visual impairment. The aim of the study is to evaluate correlation between glycaemic indices and central foveal thickness in patients with diabetic retinopathy with macular oedema. METHODS Fifty eyes of fifty patients with moderate non-proliferative diabetic retinopathy (NPDR) were enrolled in the study. All patients underwent complete ophthalmic examinations including OCT measurements of central macular thickness (CMT). Patients also underwent FBS, PPBS and glycosylated haemoglobin level tests. The correlation between the CMT and glycaemic indices was noted and evaluated. RESULTS Out of the fifty patients, males accounted for 32 and females 18. The mean age of patients with DME was 57.31 ± 6.32 and patients without DME was 60.60 ± 4.32 (range, 40-70 years). The duration of the study was 8 months. The mean value of HbA1c was 9.07 ± 2.01 in patients with DME and without DME it was 5.58 ± 0.34 (range, 5.2-14.8). The mean central retinal thickness was 409.66 ± 127.18 μm in patients with DME and 205.13 ± 7.94 in patients without DME (range, 186-812 μm). Univariate Analysis revealed that the DME diagnosed by OCT in diabetes was not statistically significant with age (p value-0.073). Whereas it was statistically significant with HbA1c (p value-0.0001), Fasting blood sugar (p value-0.0001), post prandial blood sugar (p value-0.0001). The HbA1c level (>7%) showed a significant (p value-0.001) and positive association with macular thickness in OCT. CONCLUSIONS In patients with HbA1c of above 7% had an increased chance of macular thickness (DME) as measured by OCT, is statistically significant and in patients with poor metabolic control (FBS, PPBS) is associated with macular oedema. Good sugar control decreased the risk of diabetic macular oedema.
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