RESUMO
To evaluate the effect of intravitreal triamcinolone acetonide [IVT] on clinical, angiographic, and optical coherence tomographic parameters in refractory diabetic macular edema [DME]. In a double-masked placebo-controlled randomized clinical trial, 88 eyes of 61 patients with DME refractory to previous laser therapy or not suitable for such treatment were included in the study. Eligible eyes were randomly assigned into two groups. The treatment group [45 eyes] received 4 mg IVT and the placebo group [43 eyes] received subconjunctival injection of placebo. Complete ophthalmologic examination, fluorescein angiography, and optical coherence tomography [OCT] were performed before intervention and repeated after 2 and 4 months. Quantitative measurement of variables on angiograms including hard exudates [HE], size of foveal avascular zone, and leakage severity was performed using Photoshop software. Two months after intervention, visual acuity [VA] improved in the treatment group [-0.13 Log MAR, P=0.01] but slightly deteriorated in the placebo group [0.02 Log MAR, P=0.63]. The difference of the above changes [0.15 Log MAR] was statistically significant at 2 months [P=0.02] but reduced to 0.11 Log MAR [P=0.08] after 4 months. Mean [standard deviation] of central macular thickness [CMT] by OCT before and 2 and 4 months after injection was 393 [15 I], 293 [109], and 362 [119] microns in the treatment group and 393 [166], 404 [134], and 405 [160] microns in the placebo group, respectively. The second month difference was statistically significant [P=0.01]. Reduction of the amount of HE [51%, P=0.004] and petaloid pattern [P=0.012] was significant in the treatment group as compared with the placebo group. There were no significant IVT-related side effects except for transient ocular hypertension in 32.6% of patients after 2 months. The greatest therapeutic effect of IVT on DME according to CMT and VA occurs at 2 months and decreases up to the fourth month. However, concerning cyctoid macular edema and hard exudates, the effect is maintained up to 4 months
RESUMO
To evaluate the agreement between a new method for quantitative analysis of fundus or angiographic images using Photoshop software and clinical judgment. Four hundred evaluated by three retina variables were selected for eighteen fundus and angiographic images of diabetic patients were specialists and then by computer using Photoshop 7.0 software. Four amount of hard exudates [HE] on color pictures, amount of HE on red-free pictures, severity of leakage, and size of foveal avascular zone. Available programs in the software such as color selection, luminosity channel, and histogram and tools such as magnetic lasso and magic wand were used for measurement. Coefficients of agreement and kappa measurements were calculated. Agreement [kappa] between the two methods in the amount of HE on color and red-free photographs were 85% [0.69] and 79% [0.59], respectively. This agreement for severity of leakage was 72% [0.46]. In the evaluation of the foveal avascular zone size with two methods of quantification using the magic and lasso software tools the agreement was 54% [0.09] and 89% [0.77], respectively. Quantitative measurement of fundus and angiographic image variables such as HE, leakage, and foveal avascular zone can be performed precisely using Photoshop software