Repeatability and Agreement of Macular Thickness Measurement Using Time and Spectral Domain OCT in Diabetic Macular Edema

PURPOSE: To evaluate the repeatability of macular thickness measurements using time domain (TD) OCT and spectral domain (SD) OCT in diabetic macular edema. METHODS: In 42 eyes of 42 patients with diabetic macular edema, three consecutive macular measurements were performed with TD OCT and SD OCT, and measurements for macular thickness and total macular volume obtained by the two OCTs were compared. The within-subject standard deviation (Sw), coefficient of variation (CVw), and intraclass correlation coefficient (ICC) were calculated to assess repeatability, with agreement between measurements assessed with Bland Altman plots. The correlations were also evaluated via the Pearson's correlation coefficient. RESULTS: The Sw of TD OCT and SD OCT for foveal thickness, total macular volume were 29.67 micrometer/16.44 micrometer, 1.26 mm3/0.23 mm3, respectively, and were significantly lower in SD OCT. The ranges of the respective CVw and ICC values were 1.10-2.78%, 0.78~0.96 for TD OCT, and 0.29~0.94%, 0.92~0.99 for SD OCT. The SD OCT showed better repeatability for macular thickness measurements (all p< or =0.001). The 95% limits of agreement for foveal and total macular volume were 88.9 micrometer, 2.4 mm3, respectively. The Pearson's correlation coefficients of macular thickness and total macular volume between the two OCT methods were statistically significant (p=0.88-0.99). CONCLUSIONS: Although both OCTs proved reliable for macular thickness measurements in diabetic macular edema, SD OCT shows better repeatability than TD OCT. Although macular thickness measurements obtained from the two OCTs cannot be used interchangeably, there were statistically significant correlations between measurements obtained using the two OCTs.

Effects and Prognostic Factors of Intravitreal Bevacizumab Injection on Choroidal Neovascularization from Age-Related Macular Degeneration

PURPOSE: To investigate the effects and prognostic factors related to intravitreal injection of bevacizumab on patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration. METHODS: The medical records of patients who received 3 consecutive intravitreal injections of bevacizumab (1.25 mg/0.05 ml, 6 weeks interval) for subfoveal choroidal neovascularization secondary to age-related macular degeneration and followed up for more than 12 months were reviewed (a total of 31 eyes; male, 20; mean age, 72.3+/-7.5 years). Baseline best corrected visual acuity, foveal thickness, and total macular volume were compared with those after 1, 4, and 12 months. The therapeutic effects were investigated with regard to factors such as age, sex, initial visual acuity, lesion size, subtypes of choroidal neovascularization, pigment epithelial detachment, submacular hemorrhage, and previous history of photodynamic therapy. RESULTS: Initial visual acuity (logMAR), foveal thickness, and total macular volume were 0.74+/-0.49, 320+/-88 microm and 9.50+/-2.99 mm3, respectively. Visual acuity improved to 0.68+/-0.61 (p=0.012), and foveal thickness and total macular volume decreased to 218+/-69 microm and 6.32+/-0.71 mm3 (p<0.001), respectively, at 12 months. Visual improvement was achieved less often in patients who were 75 years or older and who had lesions 3 disc areas or greater and relatively good initial vision at 12 months. CONCLUSIONS: Intravitreal bevacizumab injection has beneficial effects for patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration with regard to function and anatomy. However, it should be noted that visual improvement may be limited in older patients with larger lesions and good initial vision.

Repeatability and Agreement of Macular Thickness Measurement Using Time Domain OCT and Spectral Domain OCT in Normal Subjects

PURPOSE:To compare the repeatability and agreement of macular thickness measurements using time domain (TD) optical coherence tomography (OCT) and spectral domain (SD) OCT in normal subjects. METHODS: Thirty-four normal subjects were included. Three consecutive macular measurements were taken with TD OCT and SD OCT. Total and regional macular thickness and total macular volume obtained by the two OCTs were compared. Within-subject standard deviation (Sw), coefficient of variation (CVw), and the intraclass correlation coefficient (ICC) were calculated to evaluate repeatability. The agreement was examined with Bland Altman plots. The correlation was also evaluated with Pearson correlation coefficients and multiple regression analysis. RESULTS: Sw for foveal thickness, total macular thickness, and total macular volume were 11.53 microm, 7.58 microm, and 0.48 mm3 for TD OCT and 6.69 microm, 2.55 microm, and 0.09 mm3 for SD OCT, respectively. The values for SD OCT were consistently lower, and this result was statistically significant. The range of the respective CVw and ICC values were 1.10~2.78% and 0.78~0.96% for TD OCT, and 0.29~0.94% and 0.92~0.99% for SD OCT, respectively. The SD OCT showed better repeatability for macular thickness measurements(all with p< or =0.001). The spans of 95% limits of agreement for foveal thickness, total macular thickness, and total macular volume were 67.94 microm, 29.01 microm, and 0.98 mm3, respectively. The Pearson correlation coefficient of foveal thickness, total macular thickness, and total macular volume between the two OCT's was statistically significant. CONCLUSIONS: Although both OCTs are reliable for macular thickness measurements, SD OCT shows better repeatability compared with TD OCT. Although macular thickness measurements obtained from the two OCTs can not be used interchangeably due to low agreement by different standards of measurement, there was a statistically significant correlation between the two OCT's.

Comparison of Effects of Intravitreal Triamcinolone and Bevacizumab in the Treatment of Diabetic Macular Edema

PURPOSE: To compare the effect of an intravitreal injection of triamcinolone acetonide with bevacizumab in the treatment of diabetic macular edema (DME). METHODS: For this study, the medical records of patients with diabetic macular edema, who received intravitreal triamcinolone injection (IVTA) or intravitreal bevacizumab injection (IVB), were reviewed. Best corrected visual acuity (BCVA), central macular thickness (CMT) and total macular volume (TMV) were evaluated before injection and at 1 week, 1 month, 2 months, 3 months, and 6 months after injection. The adverse events, such as increased intraocular pressure, and progression of cataract, were also reviewed. RESULTS: A total of 72 eyes from 72 patients, (IVTA: 40 eyes, IVB: 32 eyes) were included in this study. In the IVTA group, BCVA improved significantly at 1 week after injection and was maintained until 3 months after injection. In the IVB group, BCVA improved significantly at 1 week after injection and was maintained until 2 months after injection. In the IVTA group, CMT and TMV decreased significantly at 1 week after injection and were maintained until 3 months after injection, while in the IVB group CMT and TMV were maintained until 2 months after injection. The IVTA group showed significantly better results in visual improvement, CMT and TMV reduction compared to the results of the IVB group, from 1 month to 3 months after injection. In the IVTA group, intraocular pressure increased to more than 25 mmHg in 12.5% of patients during the follow-up period. CONCLUSIONS: While the functional and anatomical improvements are achieved by both IVTA and IVB for diabetic macular edema, the effect of IVTA is more prominent with longer duration than IVB.

Comparison of Effects of Intravitreal Triamcinolone and Bevacizumab in the Treatment of Diabetic Macular Edema

PURPOSE: To compare the effect of an intravitreal injection of triamcinolone acetonide with bevacizumab in the treatment of diabetic macular edema (DME). METHODS: For this study, the medical records of patients with diabetic macular edema, who received intravitreal triamcinolone injection (IVTA) or intravitreal bevacizumab injection (IVB), were reviewed. Best corrected visual acuity (BCVA), central macular thickness (CMT) and total macular volume (TMV) were evaluated before injection and at 1 week, 1 month, 2 months, 3 months, and 6 months after injection. The adverse events, such as increased intraocular pressure, and progression of cataract, were also reviewed. RESULTS: A total of 72 eyes from 72 patients, (IVTA: 40 eyes, IVB: 32 eyes) were included in this study. In the IVTA group, BCVA improved significantly at 1 week after injection and was maintained until 3 months after injection. In the IVB group, BCVA improved significantly at 1 week after injection and was maintained until 2 months after injection. In the IVTA group, CMT and TMV decreased significantly at 1 week after injection and were maintained until 3 months after injection, while in the IVB group CMT and TMV were maintained until 2 months after injection. The IVTA group showed significantly better results in visual improvement, CMT and TMV reduction compared to the results of the IVB group, from 1 month to 3 months after injection. In the IVTA group, intraocular pressure increased to more than 25 mmHg in 12.5% of patients during the follow-up period. CONCLUSIONS: While the functional and anatomical improvements are achieved by both IVTA and IVB for diabetic macular edema, the effect of IVTA is more prominent with longer duration than IVB.