Clinical Assessment of Macular Involvement and Its Correlation to the Severity of Diabetic Retinopathy in Uncomplicated Type 2 Diabetes Mellitus Patients.

India has roughly 50% of the world’s burden of diabetes and is expected to double by the year 2025. Macular oedema is the leading cause of central vision loss among the diabetic population. Our aim was to detect the presence of macular oedema in type 2 diabetic patients and correlate it to the type and severity of diabetic retinopathy.METHODSThis was a cross-sectional study done on two hundred patients with type 2 diabetes mellitus fulfilling our inclusion criteria. After entering patients’ details, complete history including duration and treatment of diabetes, detailed clinical slit lamp examination, with biomicroscopy/IDO was done and the fundus findings were documented using the fundus camera, and retinopathy was graded according to the ETRS Classification system. Patients' glucose level, HbA1c, cholesterol, urea and creatinine values were collected. BMI was calculated from their height and weight. Macular findings were documented and correlated to the patient variables and also to the severity of diabetic retinopathy and analysed using the Chi-square test.RESULTSOut of 200 patients, 128 were male and 72 were female. Our incidence of CSME was 14% and was more prevalent in patients with Non-Proliferative Diabetic Retinopathy and they all showed statistically significant reduction in their visual acuity. BMI, cholesterol, duration of diabetes, HbA1c and insulin therapy didn’t show any significant correlation to the occurrence of CSME.CONCLUSIONSPeriodic fundus evaluation to detect macular oedema associated with retinopathy is mandatory for diabetic patients. Proper diagnosis and early intervention will help in reducing central vision loss in diabetic patients.

Advances in the management of diabetic macular oedema based on evidence from the Diabetic Retinopathy Clinical Research Network

The Diabetic Retinopathy Clinical Research Network (DRCR.net) performs studies on new treatments for diabetic retinopathy. This review aims to summarise recent findings from DRCR.net studies on the treatment of diabetic macular oedema. We performed a PubMed search of articles from the DRCR.net, which included all studies pertaining to the treatment of diabetic maculopathy. The main outcome measures were retinal thickening as assessed by central subfield thickness on optical coherence tomography and improvement of visual acuity on the Early Treatment Diabetic Retinopathy Study (ETDRS) chart. Findings from each study were divided into modalities of treatment, namely photocoagulation, bevacizumab, triamcinolone, ranibizumab and vitrectomy. While modified ETDRS focal/grid laser remains the standard of care, intravitreal corticosteroids or anti-vascular endothelial growth factor agents have also proven to be effective, although they come with associated side effects. The choice of treatment modality for diabetic macular oedema is a clinical judgement call, and depends on the patient's clinical history and assessment.

The effect of triamcinolone acetonide by single intravitreous injection or repeatedly sub-Tenoninfusion on relieving diabetic macular oedema / 眼科

Objective To study the efficacy of intravitreous injection (IVI) or sub-Tenaninfusion (STi) of triamcinolone acetonide (TA) for diabetic macular oedema. Design Retrospective cases series. Participants 37 cases (37 eyes) with diabetic macular oedema confirmed by fundus fluorescence angiography (FFA) and optical coherence tomography (OCT). Methods Patients were received 4mg TA by single intravitreous injection or 40mg TA by three times sub-Tenoninfusion at 0d, 2w, 4w. The best corrected visual acuity, fundus examination, intraocular pressure, fundus fluorescence angiography were further analyzed, and the retinal thickness of macular fovea were measured by OCT. Main Outcome Measures The visual acuity, thickness of retinal macular fovea, ocular pressure was measured. Results 32 cases (32 eyes) completed the 24 week followed-up. In group IVI, the visual acuity before and after injection was 0.10±0. 03, 0.24±0.06(F=15.459, P=0.000) respectively; and retinal thickness of macular fovea is(460.73±46.33)μm,(394.53±41.43)μm (F=25. 282, P=0.0000) respectively. But in group STi, the visual acuity before and after injection is 0.11±0.04, 0.18±0.07(F=6.989, P=0.000) accordingly; and retinal thickness of maculur fovea is (454.76±56.28)μm,(424.94±42.69)μm (F=5.145, P=0.000) respectively. There was obvious statistical significance between two methods at same time point(all P<0.05). The serious, irreversible complications had not been found in all patients during follow-up. Conclusion Triamcinolone acetonide by single intravitreous injection or repeatedly sub-Tenoninfasion are good ways to relieve diabetic macular oederna, IVA-TA is more effective, and STi-TA safer. (Ophthaimol CHN, 2009, 18: 246-250)

Laser treatment for diabetic mcular oedema / 眼科

Objective To investigate the effects of krypton laser photocoagulation for diabetic macular edema(DMO).Design Retrospective cases series.Participants 58 patients(110 eyes)with DMO.Methods Average 18.9 months follow-up was performed af- ter grid pattern and/or focal laser photocoagulation in patients with DMO.Examination of visual acuity,ophthalmoscope or color fundus photography were performed at follow-up.Fluorescein angiography(FFA)and optical coherence tomography(OCT)were performed in some patients.Main Outcome Measures The changes of DMO and visual acuity.Results In 110 eyes of all patients with DMO,there was a marked reduction or disappearance of macular edema(that is satisfactory for laser therapy)in 83.6%(92 eyes),verified with FFA or/and OCT.Unsatisfactory for laser therapy was only in 16.4%(18 eyes).Visual acuity improved and unchanged in 78.2%(86 eyes), decreased in 21.8%(24 eyes).Conclusions Krypton laser grid pattern or/and focal photocoagulation is an effective and safe first-line therapy techniques for DMO.But the result is affected by many factors.