We performed a retrospective study of serum factors associated with neovascular glaucoma that can occur following vitrectomy for proliferative diabetic retinopathy. The medical records of 183 patients (241 eyes) who received vitrectomy between August 1996 and August 2000 were studied retrospectively and subsequently analyzed by linear logistic regression analysis and multiple logistic regression tests. Neovascular glaucoma developed at an average of 2.7 months in 31 of 241 eyes (14.1%). The overall anatomical success rate of retinal attachment was 82.5% (199 eyes in 241 eyes), although it decreased to 45.1% (14 eyes in 31 eyes) in eyes with neovascular glaucoma. Serum cholesterol (P = 0.041) and fibrinogen levels (P = 0.020) were significantly associated with the development of neovascular glaucoma. However, no significant association could be found concerning hypertension, diabetic retinopathy or hypercholesterolemia (P > 0.05). We suggest that serum creatinine, cholesterol and fibrinogen levels can be used to predict the development of neovascular glaucoma in vitrectomized eyes with diabetic retinopathy and can further provide a more active approach to preventing the development of this condition.
Adult ; Aged ; Aged, 80 and over ; Blood/metabolism ; Cell Division ; Diabetic Retinopathy/*pathology/*surgery ; Glaucoma, Neovascular/*blood/*complications ; Human ; Middle Age ; Postoperative Period ; Retrospective Studies ; *Vitrectomy

PURPOSE: To examine the effect of panretinal photocoagulation (PRP) on the retinal nerve fiber layer (RNFL) thickness in patients with diabetic retinopathy. METHODS: Subjects included 118 eyes for a treatment group and 164 eyes for a control group. The peripapillary RNFL thickness was measured before and 6 months after PRP in treatment group. In control group, the peripapillary RNFL thickness was measured at baseline and 6 months later. The relationships between changes in RNFL thickness and the number of laser burns, duration of diabetes, HbA1c level, and vision change were analyzed. RESULTS: After 6 months, the RNFL thickness decreased an average of 2.12 microm and 0.93 microm in the treatment and control groups. However, the changes between the two groups were not statistically significant. The relationship between the number of laser burns and changes in RNFL thickness was not significant. No differences were found between changes in the RNFL thickness and the duration of diabetes in either group. However, in the treatment group a higher HbA1c level was correlated with a greater decrease in post-PRP RNFL thickness. This relationship was not observed in the control group. The difference in the change of the RNFL thickness between the two groups was statistically significant. Vision increased an average of 0.02 and 0.01 after 6 months in the treatment and control groups, respectively. However, this difference was not statistically significant. CONCLUSIONS: Although a decrease in peripapillary RNFL thickness was observed in the treatment group after 6 months, it was not statistically significant compared to control group. However, the decrease was greater when the blood HbA1c level was higher.
Diabetic Retinopathy/*surgery ; Follow-Up Studies ; Humans ; Laser Coagulation/*methods ; Middle Aged ; Nerve Fibers/*pathology ; Optic Disk/*pathology/surgery ; Postoperative Period ; Retinal Ganglion Cells/*pathology ; Retrospective Studies ; Tomography, Optical Coherence ; Treatment Outcome ; Visual Acuity ; Visual Fields

PURPOSE: To compare the efficacy between macular laser grid (MLG) photocoagulation and MLG plus intravitreal triamcinolone acetonide (IVTA; MLG+IVTA) therapy in diabetic macular edema (DME) patients. METHODS: A prospective, randomized, clinical trial was conducted of DME patients. A total of 60 eyes (54 patients) affected by DME were observed for a minimum of 6 months. Thirty eyes of 28 patients who received MLG treatment and 30 eyes of 26 patients who received the combined MLG+IVTA treatment were included in the study. Main outcome measures were BCVA and central macular thickness (CMT) as measured by optical coherence tomography (OCT) at 1, 3, and 6 months after treatment. Additionally, the authors examined retrospectively 20 eyes of 20 patients who were treated with only IVTA and compared with the 2 groups (MLG group and MLG+IVTA group). RESULTS: Baseline BCVA was 0.53+/-0.32 and CMT was 513.9+/-55.1 microm in the MLG group. At 1 and 3 months after treatment, the MLG group showed no significant improvement of BCVA and CMT, although there was significant improvement after 6 months. In the MLG+IVTA group, the baseline BCVA was 0.59+/-0.29 and CMT was 498.2+/-19.8 microm. After treatment, significant improvement of BCVA and CMT was observed at all follow-up time periods. When comparing the MLG group with the MLG+IVTA group, the latter had better results after 1 and 3 months, although at 6 months, there was no significant difference of BCVA and CMT between the 2 groups. Additionally, the IVTA group showed more improvement than the MLG group at 1 and 3 months but showed no significant difference at 6 months. In addition, the IVTA group showed no significant difference with the MLG+IVTA group at all follow-up time periods. CONCLUSIONS: For DME patients, the combined MLG+IVTA treatment had a better therapeutic effect than the MLG treatment for improving BCVA and CMT at the early follow-up time periods. IVTA treatment alone could be an additional alternative therapeutic option to combined therapy.
Aged ; Diabetic Retinopathy/*drug therapy/pathology/physiopathology/*surgery ; Follow-Up Studies ; Glucocorticoids/*administration & dosage ; Humans ; Injections ; *Laser Coagulation ; Macular Edema/*drug therapy/pathology/physiopathology/*surgery ; Middle Aged ; Postoperative Period ; Tomography, Optical Coherence ; Triamcinolone Acetonide/*administration & dosage ; Visual Acuity ; Vitreous Body

PURPOSE: To examine the effects of panretinal photocoagulation (PRP) using a pattern scanning laser (PASCAL) system on the retinal nerve fiber layer (RNFL) thickness in patients with diabetic retinopathy. METHODS: This retrospective study included 105 eyes with diabetic retinopathy, which consisted of three groups: the PASCAL group that underwent PRP with the PASCAL method (33 eyes), the conventional group that underwent conventional PRP treatment (34 eyes), and the control group that did not receive PRP (38 eyes). The peripapillary RNFL thickness was measured by optical coherence tomography before, six months, and one year after PRP to evaluate the changes in peripapillary RNFL. RESULTS: The RNFL thickness in the PASCAL group did not show a significant difference after six months (average 3.7 times, p = 0.15) or one year after the PRP (average 3.7 times, p = 0.086), whereas that in the conventional group decreased significantly after six months (average 3.4 times, p < 0.001) and one year after PRP (average 3.4 times, p < 0.001). CONCLUSIONS: The results of this study suggest that the PASCAL system may protect against RNFL loss by using less energy than conventional PRP.
Diabetic Retinopathy/pathology/*surgery ; Disease Progression ; Female ; Fluorescein Angiography ; Fundus Oculi ; Humans ; Laser Coagulation/*methods ; Male ; Middle Aged ; Nerve Fibers/*pathology ; Retinal Ganglion Cells/*pathology ; Retrospective Studies ; Tomography, Optical Coherence ; Visual Acuity

PURPOSE: To compare the efficacy of posterior sub-Tenon's capsule triamcinolone acetonide injection combined with modified grid macular photocoagulation (PSTI + MP) with intravitreal triamcinolone acetonide (IVTA) injection in the treatment of diffuse diabetic macular edema (DME). MATERIALS AND METHODS: Forty eyes of 33 patients with diffuse DME were randomly allocated into either PSTI + MP (20 eyes) or IVTA (20 eyes). Best corrected visual acuity (VA) and foveal thickness were measured. RESULTS: The ETDRS scores at baseline were 25.2 +/- 13.6 (mean +/- SD) letters in the PSTI + MP group, whereas 21.7 +/- 16.3 letters in the IVTA group. The ETDRS scores improved by 33.2 +/- 15.9, 34.7 +/- 16.6 and 30.9 +/- 19.0 letters in the PSTI + MP group whereas by 30.9 +/- 15.4, 30.1 +/- 17.9 and 31.5 +/- 15.0 letters in the IVTA group at 1, 3, and 6 months after the treatments, respectively. The VA improved significantly at 1 month and 3 months after both treatments (all p < 0.02, paired t-test). The VA improvements were no longer significant at 6 months in either group. There were no statistically significant differences at any time points between the 2 groups (all p > 0.05, Student's t-test). The foveal thicknesses at baseline and 1, 3, and 6 months after the treatments were 382.8 +/- 148.3, 309.1 +/- 131.3, 319.3 +/- 93.3, 340.4 +/- 123.5micrometer (mean +/- SD) in the PSTI + MP group vs. 369.1 +/- 123.1, 241.4 +/- 52.3, 277.5 +/- 137.4, 290.2 +/- 127.9micrometer in the IVTA group, respectively. Pairwise comparisons revealed significant decrease in foveal thickness at 1 month (p = 0.01, paired t-test) for the PSTI + MP group, and at both 1 month (p < 0.001) and 3 months (p = 0.016) for the IVTA group. There were no statistically significant differences at any time points between the 2 groups (all p > 0.05, Student's t-test). In contrast to the PSTI + MP group, where no complications were noted, the elevation of intra-ocular pressure in 3 of 20 eyes (15%) and a significant increase in average cataract grading were observed in the IVTA group. CONCLUSION: PSTI + MP treatment provides significant improvement of vision in patients with diffuse DME over 3 months, and achieves outcomes comparable to those after IVTA treatment, however, with fewer complications.
Adult ; Aged ; Anti-Inflammatory Agents/administration & dosage ; Diabetic Retinopathy/*drug therapy/physiopathology/*surgery ; Female ; Fovea Centralis/pathology ; Humans ; *Laser Coagulation ; Macular Edema/complications/*drug therapy/physiopathology/*surgery ; Male ; Middle Aged ; Prospective Studies ; Triamcinolone/*administration & dosage ; Visual Acuity ; Vitreous Body

PURPOSE: To assess the diagnostic efficacy of macular and peripapillary retinal thickness measurements for the staging of diabetic retinopathy (DR) and the prediction of disease progression. METHODS: In this prospective study, 149 diabetic patients (149 eyes) and 50 non-diabetic control subjects were included. Baseline optical coherence tomography was employed to measure retinal thickness in the macula (horizontal, vertical, and central) and the peripapillary zone (superior, inferior, nasal, and concentric to the optic disc). Seven baseline parameters were correlated with the DR stages identified by fluorescein angiography. Baseline retinal thickness was compared between groups of patients requiring panretinal photocoagulation (PRP) within 6 months (PRP group) and patients not requiring PRP (No-PRP group). RESULTS: Macular and peripapillary retinal thicknesses in diabetic subjects were significantly greater than that in normal controls (p<0.05). All retinal thickness parameters, and particularly peripapillary circular scans, tended to increase with increasing DR severity (p<0.05). The baseline thicknesses of the peripapillary circular scans were greater in the PRP group than in the no-PRP group (p<0.05). CONCLUSIONS: Peripapillary retinal thickness may prove to be a useful criterion for DR severity and may also serve as an indicator of disease progression.
Aged ; Diabetic Retinopathy/*diagnosis/surgery ; Disease Progression ; Female ; Fluorescein Angiography ; Humans ; Light Coagulation ; Male ; Middle Aged ; Optic Disk ; Prospective Studies ; Retina/*pathology/surgery ; *Severity of Illness Index ; *Tomography, Optical Coherence

PURPOSE: To evaluate the efficacy and safety of a pars plana Ahmed valve implantation combined with 23-gauge sutureless vitrectomy in the treatment of patients with medically uncontrolled neovascular glaucoma (NVG) in proliferative diabetic retinopathy (PDR). METHODS: The authors retrospectively reviewed the records of 11 consecutive patients with refractory NVG in PDR who underwent a 23-gauge sutureless vitrectomy combined with pars plana placement of an Ahmed valve implant. Control of intraocular pressure (IOP), pre- and postoperative best-corrected visual acuity and the development of intra- and postoperative complications were evaluated during the follow-up. RESULTS: The mean follow-up was 12.2 months (range, 8 to 25 months). Mean preoperative IOP was 35.9 +/- 6.3 mmHg and mean postoperative IOP at the last visit was 13.3 +/- 3.2 mmHg. Control of IOP (8 to 18 mmHg) was achieved in all patients, but 91% (10 of 11 patients) needed antiglaucoma medication (mean number of medications, 1.2 +/- 0.6). Postoperative visual acuity improved in 11 eyes, and the logarithmically to the minimum angle of resolution mean visual acuity in these eyes improved from 1.67 +/- 0.61 to 0.96 +/- 0.67. The complications that occurred were transient hypotony in one case, transitory hypertension in two cases, and postoperative vitreous hemorrhage which spontaneously cleared in two cases. CONCLUSIONS: We suggest the combination of 23-gauge pars plana vitrectomy and Ahmed valve implantation is safe and effective in PDR patients with refractory NVG.
Adult ; Aged ; Diabetic Retinopathy/*complications/pathology ; Female ; Follow-Up Studies ; *Glaucoma Drainage Implants ; Glaucoma, Neovascular/*complications/pathology/*surgery ; Humans ; Intraocular Pressure ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Vitrectomy/*methods

PURPOSE: To evaluate the effect of pattern scan laser (PASCAL) photocoagulation on peripapillary retinal nerve fiber layer (RNFL) thickness, central macular thickness (CMT), and optic nerve morphology in patients with diabetic retinopathy. METHODS: Subjects included 35 eyes for the PASCAL group and 49 eyes for a control group. Peripapillary RNFL thickness, cup-disc area ratio and CMT were measured before PASCAL photocoagulation and at 2 and 6 months after PASCAL photocoagulation in the PASCAL or control groups. RESULTS: The average RNFL thickness had increased by 0.84 microm two months after and decreased by 0.4 microm six months after PASCAL photocoagulation compared to baseline, but these changes were not significant (p = 0.83, 0.39). The cup-disc area ratio was unchanged after PASCAL photocoagulation. CMT increased by 18.11 microm (p = 0.048) at two months compared to baseline thickness, and partially recovered to 11.82 microm (p = 0.11) at six months in the PASCAL group. CONCLUSIONS: PASCAL photocoagulation may not cause significant change in the peripapillary RNFL thickness, CMT, and optic nerve morphology in patients with diabetic retinopathy.
Adult ; Aged ; Aged, 80 and over ; Diabetic Retinopathy/physiopathology/*surgery ; Female ; Fluorescein Angiography ; Follow-Up Studies ; Humans ; Laser Coagulation/*methods ; Lasers, Solid-State/*therapeutic use ; Macula Lutea/*pathology ; Male ; Middle Aged ; Nerve Fibers/*pathology ; Optic Nerve/*pathology ; Prospective Studies ; Retinal Ganglion Cells/*pathology ; Tomography, Optical Coherence ; Visual Acuity/physiology