Laser Photocoagulation Combined with Intravitreal Triamcinolone Acetonide Injection in Proliferative Diabetic Retinopathy with Macular Edema

PURPOSE: To evaluate therapeutic effects and usefulness of a combination treatment of intravitreal injection of triamcinolone acetonide (IVTA) and panretinal photocoagulation (PRP) in patients with clinically significant macular edema secondary to proliferative diabetic retinopathy (PDR). METHODS: Visual acuity test, fundoscopy, fluorescein angiography, and optical coherence tomography (OCT) were taken in 20 patients (20 eyes) of macular edema and PDR. A combination of intravitreal injection of triamcinolone acetonide and PRP was performed in 10 patients (10 eyes) and a combination of focal or grid laser photocoaqulation and PRP in the remaining 10 eyes. The postoperative outcomes were compared between the two combination treatments by best corrected visual acuity (BCVA), tonometry, fluorescein angiography, and OCT at 2 weeks, 1, 2, and 3 months. RESULTS: Average BCVA (log MAR) significantly improved from preoperative 0.56+/-0.20 to 0.43+/-0.08 at 1 month (P=0.042) and it was maintained until 3 months after a combination of IVTA and PRP in 10 eyes (P=0.007). The thickness of fovea decreased from average 433.3+/-114.9 micrometer to average 279.5+/-34.1 micrometer at 2 weeks after combined treatment of IVTA and PRP (P=0.005), which was significantly maintained until 3 months, but there was a transient visual disturbance and no significant difference in thickness of the fovea before and after treatment in the groups with PRP and focal or grid laser photocoagulation. CONCLUSIONS: A combination of IVTA and PRP might be an effective treatment modality in the treatment of macular edema and PDR and prevent the subsequent PRP-induced macular edema result in visual dysfunction. In combination with PRP, IVTA might be more effective than focal or grid laser photocoagulation and PRP for reducing diabetic macular edema and preventing aggravation of macular edema without transient visual disturbance in patients requiring immediate PRP.

Protein C and Protein S as a Risk Factor for Retinal Vein Occlusion

PURPOSE: The authors evaluated the possibility of protein C and protein S as risk factors for retinal vein occlusion (RVO). METHODS: We evaluated the medical histories and performed laboratory tests, including protein C and protein S, in patients who were diagnosed with RVO by fundus examination and fluorescein angiography. The same data were obtained from a healthy control group. We analyzed mean activity and the ratio of patients with decreased levels of protein C or protein S. RESULTS: Forty-seven patients with RVO in this study consisted of 14 with central retinal vein occlusion (CRVO) and 33 with branch retinal vein occlusion (BRVO). Sixteen normal subjects were also enrolled in this study as controls. There are no cases that presented decreased protein C activity. However, there was a statistically significant difference in the number of cases with protein S deficiency between the patients and the control group (p<0.05). CONCLUSIONS: Deficiency of anticoagulant proteins, especially protein S, may be a risk factor of retinal vein occlusion. Examination of the coagulation system may be useful in the systemic evaluation of RVO patients.