PURPOSE: To verify the clinical correlation between retinopathy progression and the change of venous filling time (VFT), measured before and after panretinal photocoagulation (PRP), in proliferative diabetic retinopathy (PDR) patients. METHODS: We conducted this study on 32 patients (32 eyes) who received PRP for PDR. These patients were subdivided into two groups in accordance with the clinical course of PRP: the stabilized group in which retinal neovascularization was regressed and the progressed group in which retinal neovascularization was continued and a complication, such as vitreous hemorrhage or tractional retinal detachment, was developed within 12 months of laser treatment. Arteriovenous passage time (AVP) and VFT were measured by video fluorescein angiogram (FAG) using scanning laser ophthalmoscope (SLO) before and after PRP. VFT values were assigned by measuring by the time duration from start of venous lamina flow to the fullness of fluorescence on the vascular arch. RESULTS: In the stabilized group, AVP was decreased by 0.20+/-0.89sec and VFT was decreased by 0.30+/-1.69 sec through PRP. In the progressed group, AVP was increased in 0.12+/-1.22 sec and VFT was increased by 0.99+/-1.60 sec through PRP. In both groups, the VFT changes were significant (P=0.04) but the AVP changes were not (P=0.34). CONCLUSIONS: VFT was significantly decreased in the stabilized group and significantly increased in the progressed group after PRP. Accordingly, we suggest that VFT changes after PRP can be utilized as a prognostic indicator for evaluating clinical course of diabetic retinopathy after performing PRP and for monitoring the clinical effect of PRP.
Veins ; Time Factors ; Retinal Vessels/*physiopathology ; Regional Blood Flow ; *Light Coagulation ; Humans ; Diabetic Retinopathy/*physiopathology/*surgery

Aged ; Diabetic Retinopathy ; physiopathology ; surgery ; Electroretinography ; Female ; Humans ; Macular Edema ; physiopathology ; surgery ; Male ; Middle Aged ; Retina ; physiopathology ; Visual Acuity ; Vitrectomy

To analyse the results of diabetic vitrectomy according to the severity of proliferation [severe (SPG) vs. less-severe proliferation group (LSPG)], and methods of the operation, which was complete removal of anteroposterior vitreous traction with or without complete removal of preretinal memebrane, we compared both groups by using anatomic success rate and postoperative visual acuities (VA). The results were as follows: The anatomic success rate and postoperative VA were significantly better in LSPG than in SPG. In SPG, anatomic success rate and postoperative VA tended to be better when complete removal of anteroposterior traction was possible than when impossible. In SPG, postoperative VA tended to be better when complete removal of preretinal membrane was possible, but the anatomic success rate was the same for each group. So, when severe proliferation (including table-top elevation of posterior retina), complete removal of anteroposterior traction only can improve the anatomic success rate of the surgery.
Adult ; Aged ; Cell Membrane ; Diabetic Retinopathy/physiopathology/*surgery ; Female ; Humans ; Male ; Middle Aged ; Visual Acuity/physiology ; Vitrectomy/*methods

Changes in retinal sensitivity within central 30 degrees following panretinal photocoagulation (PRP) for more severe diabetic retinopathy were investigated. Twenty-five eyes with visual acuity of 0.4 or better and minimal maculopathy were studied prospectively. All underwent PRP in two sittings, and Humphrey field analyzer 30-2 threshold test was done before and 1 week, 1 and 3 months after the treatment. The mean retinal sensitivity threshold was obtained from each hemifield between 15 and 30 degrees and from the central 15 degree area, and the changes in the values were analyzed. Mean sensitivity threshold in the upper visual field at pre-PRP, post-PRP 1 week, 1, 3 months were 15.62, 13.81, 14.31, 14.85, respectively. Values in the lower field were 18.71, 17.25, 17.10, 18.17. Difference between pre-PRP and post-PRP was statistically significant at 1 week but no longer thereafter. Retinal sensitivity within the central 15 degrees remained stable. The data show that retinal sensitivity decreases significantly 1 week after PRP but recovers upto 95% of pre-PRP level over the following 3 months.
Adult ; Aged ; Diabetic Retinopathy/*physiopathology/surgery ; Female ; Follow-Up Studies ; Humans ; *Laser Coagulation ; Male ; Middle Aged ; Prospective Studies ; Retina/*physiopathology ; Sensory Thresholds ; Visual Acuity/physiology ; Visual Fields/*physiology

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: This pilot study aimed to evaluate the efficacy and safety of subthreshold micropulse yellow (577-nm) laser photocoagulation (SMYLP) in the treatment of diabetic macular edema (DME). METHODS: We reviewed 14 eyes of 12 patients with DME who underwent SMYLP with a 15% duty cycle at an energy level immediately below that of the test burn. The laser exposure time was 20 ms and the spot diameter was 100 microm. Laser pulses were administered in a confluent, repetitive manner with a 3 x 3 pattern mode. RESULTS: The mean follow-up time was 7.9 ± 1.6 months. The baseline-corrected visual acuity was 0.51 ± 0.42 logarithm of the minimum angle of resolution (logMAR), which was improved to 0.40 ± 0.35 logMAR (p = 0.025) at the final follow-up. The central macular thickness at baseline was 385.0 ± 111.0 microm; this value changed to 327.0 ± 87.7 microm (p = 0.055) at the final follow-up. CONCLUSIONS: SMYLP showed short-term efficacy in the treatment of DME and did not result in retinal damage. However, prospective, comparative studies are needed to better evaluate the efficacy and safety of this treatment.
Aged ; Diabetic Retinopathy/diagnosis/physiopathology/*surgery ; Female ; Fluorescein Angiography ; Follow-Up Studies ; Humans ; *Laser Coagulation ; Lasers, Semiconductor/*therapeutic use ; Macular Edema/diagnosis/physiopathology/*surgery ; Male ; Middle Aged ; Pilot Projects ; Tomography, Optical Coherence ; Treatment Outcome ; Visual Acuity/physiology

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 evaluate the effectiveness of tramadol for the reduction of pain in panretinal photocoagulation (PRP). METHODS: A double-masked randomized controlled study was performed. Fifty-eight eyes in 29 patients with proliferative diabetic retinopathy were enrolled. The eyes of the patients were randomized into two groups. Group A received an empty capsule. Group B received an oral intake of 100 mg tramadol. The capsule used in Group A had the same appearance as that used in Group B. Pain during PRP was assessed using a visual analog scale. Vital signs, including blood pressure and heart rate, were measured. RESULTS: The mean pain scores for groups A and B were 4.80+/-2.10 and 3.83+/-1.82 (p=0.09). There were no significant differences in the mean pain scores between the two groups. More patients in group A complained of greater pain than moderate intensity (visual analogue scale=4). Systemic blood pressure increased significantly in group A after laser treatment. However, there were no significant differences in the diastolic blood pressure changes between the two groups. We found no statistical correlation in the heart rate changes. CONCLUSIONS: We failed to prove that tramadol is effective for pain relief because of the small sample size. However, tramadol was effective for the relief of more severe pain. It was also found to stabilize vital sign changes, such as systolic blood pressure during PRP.
Administration, Oral ; Adult ; Aged ; Analgesia/*methods ; Analgesics, Opioid/*administration & dosage ; Case-Control Studies ; Diabetic Retinopathy/*surgery ; Dose-Response Relationship, Drug ; Double-Blind Method ; Follow-Up Studies ; Humans ; Laser Coagulation/*methods ; Middle Aged ; Pain/*drug therapy/physiopathology ; Pain Measurement ; Prospective Studies ; Tramadol/*administration & dosage ; Treatment Outcome ; Vitreoretinopathy, Proliferative/*surgery

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