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.
Adrenal Cortex Hormones ; therapeutic use ; Bevacizumab ; therapeutic use ; Biomedical Research ; organization & administration ; Diabetic Retinopathy ; therapy ; Disease Management ; Disease Progression ; Humans ; Light Coagulation ; Macular Edema ; therapy ; Ranibizumab ; therapeutic use ; Retina ; pathology ; Tomography, Optical Coherence ; Triamcinolone ; therapeutic use ; Vascular Endothelial Growth Factor A ; antagonists & inhibitors ; Visual Acuity ; Vitrectomy

PURPOSE: To analyze the correlation between microperimetric parameters and optical coherent tomographic findings in the eyes of patients with macular diseases. METHODS: A total of 64 eyes were included in this retrospective cross-sectional study. Differences in the macular integrity index and microperimetric parameters were analyzed according to types of outer retinal band defects. Correlations between average threshold values and retinal thickness in the corresponding areas were analyzed. Finally, microperimetric parameters were compared between inner and outer retinal lesions. RESULTS: Measures of best-corrected visual acuity, macular integrity index, and average threshold values were significantly worse in eyes with defects in the ellipsoid portion of the photoreceptor inner segment (ISe), the cone outer segment tip (COST), and the external limiting membrane (ELM) than in eyes without ISe, COST, and ELM defects. Also, visual functionality is more significantly impacted by ELM defects than by other hyper-reflective band defects. There was a significant negative correlation between retinal thickness and the average threshold of the corresponding area in the Early Treatment Diabetic Retinopathy Study grid. Microperimetric parameters in the eyes of patients with inner retinal lesions were better than in the eyes of patients with outer retinal lesions. CONCLUSIONS: The macular integrity index may be a useful factor for reflecting the functional aspects of macular diseases. Specifically, ELM, ISe, and COST defects are significantly associated with poor retinal sensitivity and macular integrity index values that suggest abnormalities. Among eyes with these particular defects, the visual functionality of patients is most sensitively impacted by ELM defects. This finding suggests that microperimetric parameters are sensitive and useful for evaluating functional abnormalities in the eyes of patients with macular disease, particularly in patients with outer retinal pathology.
Cross-Sectional Studies ; Female ; Fluorescein Angiography ; Fundus Oculi ; Humans ; Macula Lutea/*pathology ; Macular Edema/*diagnosis ; Male ; Middle Aged ; Retrospective Studies ; Tomography, Optical Coherence/*methods ; Visual Field Tests/*methods

PURPOSE: To report transient corneal edema after phacoemulsification as a predictive factor for the development of pseudophakic cystoid macular edema (PCME). METHODS: A total of 150 eyes from 150 patients (59 men and 91 women; mean age, 68.0 ± 10.15 years) were analyzed using spectral domain optical coherence tomography 1 week and 5 weeks after routine phacoemulsification cataract surgery. Transient corneal edema detected 1 week after surgery was analyzed to reveal any significant relationship with the development of PCME 5 weeks after surgery. RESULTS: Transient corneal edema developed in 17 (11.3%) of 150 eyes 1 week after surgery. A history of diabetes mellitus was significantly associated with development of transient corneal edema (odds ratio [OR], 4.04; 95% confidence interval [CI], 1.41 to 11.54; p = 0.011). Both diabetes mellitus and transient corneal edema were significantly associated with PCME development 5 weeks after surgery (OR, 4.58; 95% CI, 1.56 to 13.43; p = 0.007; and OR, 6.71; CI, 2.05 to 21.95; p = 0.003, respectively). In the 8 eyes with both diabetes mellitus and transient corneal edema, 4 (50%) developed PCME 5 weeks after surgery. CONCLUSIONS: Transient corneal edema detected 1 week after routine cataract surgery is a predictive factor for development of PCME. Close postoperative observation and intervention is recommended in patients with transient corneal edema.
Adult ; Aged ; Aged, 80 and over ; Cornea/*pathology ; Corneal Edema/*diagnosis/etiology ; Female ; Fluorescein Angiography ; Follow-Up Studies ; Fundus Oculi ; Glucosinolates ; Humans ; Macular Edema/diagnosis/*etiology ; Male ; Middle Aged ; *Phacoemulsification ; Pseudophakia/*complications/diagnosis ; Retrospective Studies ; Tomography, Optical Coherence

Bietti crystalline retinal dystrophy is a rare, inherited disorder whose hallmark is the presence of retinal crystal deposits associated with later chorioretinal degeneration. This condition may rarely be complicated by the development of cystoid macular oedema leading to rapid visual decline. Currently, treatment options for this complication of Bietti dystrophy are limited and the visual prognosis is poor. Here, we present a case of cystoid macular oedema associated with Bietti dystrophy that was successfully diagnosed using multimodal imaging techniques including optical coherence tomography and fluorescein angiography. These modalities confirmed the diagnosis of macular oedema and excluded other possible causes of oedema such as choroidal neovascularisation. In this patient, cystoid macular oedema was resolved with oral acetazolamide therapy, a treatment that has not been previously reported in this context. Acetazolamide treatment resulted in oedema resolution and improvement in visual function, and can be considered a therapeutic option for other patients with Bietti dystrophy who develop cystoid macular oedema.
Acetazolamide/*administration & dosage ; Administration, Oral ; Adult ; Corneal Dystrophies, Hereditary/*drug therapy/pathology ; Diuretics/*administration & dosage ; Humans ; Macular Edema/*drug therapy/pathology ; Male ; Retinal Diseases/*drug therapy/pathology ; Tomography, Optical Coherence ; Treatment Outcome

PURPOSE: To determine if short term effects of intravitreal anti-vascular endothelial growth factor or steroid injection are correlated with fluid turbidity, as detected by spectral domain optical coherence tomography (SD-OCT) in diabetic macular edema (DME) patients. METHODS: A total of 583 medical records were reviewed and 104 cases were enrolled. Sixty eyes received a single intravitreal bevacizumab injection (IVB) on the first attack of DME and 44 eyes received triamcinolone acetonide treatment (IVTA). Intraretinal fluid turbidity in DME patients was estimated with initialintravitreal SD-OCT and analyzed with color histograms from a Photoshop program. Central macular thickness and visual acuity using a logarithm from the minimum angle of resolution chart, were assessed at the initial period and 2 months after injections. RESULTS: Visual acuity and central macular thickness improved after injections in both groups. In the IVB group, visual acuity and central macular thickness changed less as the intraretinal fluid became more turbid. In the IVTA group, visual acuity underwent less change while central macular thickness had a greater reduction (r = -0.675, p = 0.001) as the intraretinal fluid was more turbid. CONCLUSIONS: IVB and IVTA injections were effective in reducing central macular thickness and improving visual acuity in DME patients. Further, fluid turbidity, which was detected by SD-OCT may be one of the indexes that highlight the influence of the steroid-dependent pathogenetic mechanism.
Aged ; Angiogenesis Inhibitors/*therapeutic use ; Bevacizumab/*therapeutic use ; Diabetic Retinopathy/*drug therapy/physiopathology ; Female ; Glucocorticoids/*therapeutic use ; Humans ; Intravitreal Injections ; Macular Edema/*drug therapy/physiopathology ; Male ; Middle Aged ; Nephelometry and Turbidimetry ; Retina/pathology ; *Subretinal Fluid ; Tomography, Optical Coherence ; Treatment Outcome ; Triamcinolone Acetonide/*therapeutic use ; Vascular Endothelial Growth Factor A/antagonists & inhibitors ; Visual Acuity/physiology

PURPOSE: To determine the correlation between renal dysfunction and the morphologic changes of macular edema in diabetes. METHODS: The current study included 93 patients with diabetic macular edema based on optical coherence tomography (OCT) who completed systemic condition testing one month before or after the OCT. Based on the OCT findings, patients were divided into the following five groups: group A (diffuse), group B (cystoid), group C (serous), group D (vitreomacular tractional), and group E (a mixed presence of cystoid and serous types). In each group, we performed a retrospective analysis of serum albumin, urine albumin, and serum creatinine. We also analyzed the patients in whom serum albumin was <3.0 mg/dL and serum creatinine was >1.6 mg/dL. Urine albumin was measured in all five groups. In each group, a comparative analysis was performed using Fisher's exact test. RESULTS: The number of patients who were assigned to groups A to E was 15, 46, 6, 3, and 23, respectively. According to a comparison of the patients in whom the serum albumin and serum creatinine were abnormal, there was no significant difference among the five groups. The proportion of patients in whom the urine albumin was abnormal was significantly greater in group C (67%) than in groups A (7%), B (20%), or E (22%). CONCLUSIONS: Serous-type macular edema occurred more frequently than other types of macular edema in patients with albuminuria.
Aged ; Diabetic Nephropathies/*pathology ; Diabetic Retinopathy/*pathology ; Female ; Humans ; Macular Edema/*classification/*pathology ; Male ; Middle Aged ; Retrospective Studies ; *Tomography, Optical Coherence

PURPOSE: To determine the correlation between renal dysfunction and the morphologic changes of macular edema in diabetes. METHODS: The current study included 93 patients with diabetic macular edema based on optical coherence tomography (OCT) who completed systemic condition testing one month before or after the OCT. Based on the OCT findings, patients were divided into the following five groups: group A (diffuse), group B (cystoid), group C (serous), group D (vitreomacular tractional), and group E (a mixed presence of cystoid and serous types). In each group, we performed a retrospective analysis of serum albumin, urine albumin, and serum creatinine. We also analyzed the patients in whom serum albumin was <3.0 mg/dL and serum creatinine was >1.6 mg/dL. Urine albumin was measured in all five groups. In each group, a comparative analysis was performed using Fisher's exact test. RESULTS: The number of patients who were assigned to groups A to E was 15, 46, 6, 3, and 23, respectively. According to a comparison of the patients in whom the serum albumin and serum creatinine were abnormal, there was no significant difference among the five groups. The proportion of patients in whom the urine albumin was abnormal was significantly greater in group C (67%) than in groups A (7%), B (20%), or E (22%). CONCLUSIONS: Serous-type macular edema occurred more frequently than other types of macular edema in patients with albuminuria.
Aged ; Diabetic Nephropathies/*pathology ; Diabetic Retinopathy/*pathology ; Female ; Humans ; Macular Edema/*classification/*pathology ; Male ; Middle Aged ; Retrospective Studies ; *Tomography, Optical Coherence

The purpose of this study is to describe the correlation of findings between results from spectral domain optical coherence tomography (SD-OCT) and microperimetry in a case series regarding patients with Goldmann-Favre syndrome. Goldmann-Favre syndrome is a rare autosomal recessive hereditary vitreo-retinal degeneration that impacts the functionality of vision in subjects. Three men with this condition were assessed and subjected to microperimetry and SD-OCT. Two of the men were brothers. This study finds that the retinoschisis and macular cystoid changes noted in the SD-OCT matched the scotomas revealed by the microperimetry. The findings of each of the individual cases are reported herein.
Adult ; Eye Diseases, Hereditary/*pathology ; Humans ; Macular Edema/*pathology ; Male ; Retinoschisis/*pathology ; Scotoma/pathology ; *Tomography, Optical Coherence ; *Visual Field Tests ; Young Adult

INTRODUCTIONThis study aims to compare the long-term efficacy of 25-gauge vitrectomy to that of intravitreal bevacizumab (IVB) for the treatment of macular edema (ME) secondary to branch retinal vein occlusion (BRVO).

MATERIALS AND METHODSThe medical records of 46 eyes of 46 consecutive patients were reviewed. Twenty-seven eyes underwent 25-gauge vitrectomy (VIT Group) and 19 eyes received 1.25 mg of IVB (IVB Group). The best-corrected visual acuities (BCVAs) in logarithm of minimum angle resolution units and central macular thicknesses (CMTs) were evaluated before and 3, 6, and 12 months after the initial treatment.

RESULTSThere was no significant difference in the pre-treatment BCVA and CMT between the 2 groups. In the VIT Group, the preoperative BCVA was 0.59 and the CMT was 587.3 μm and the BCVA was 0.35 and the CMT was 286.6 μm, 12 months after the vitrectomy. Both values were significantly (P <0.05) better at 12 months than the preoperative values. In the IVB Group, the average number of IVB was 2.4 during the 1-year period. The BCVA was 0.69 and the CMT was 590.9 μm before the IVB, and the BCVA was 0.36 and the CMT was 360.1 μm, 12 months after the initial IVB. The improvements of these 2 parameters were significant (P <0.05) at 12 months after the initial IVB. The differences in the BCVA and CMT at 12 months between the 2 groups were not significant.

CONCLUSIONThese results suggest that the 25-gauge vitrectomy and IVB have similar effects in improving the BCVA and CMT in eyes with ME secondary to BRVO. However, IVB often required several injections to preserve the improvement.

Aged ; Angiogenesis Inhibitors ; therapeutic use ; Antibodies, Monoclonal, Humanized ; therapeutic use ; Bevacizumab ; Female ; Follow-Up Studies ; Humans ; Intravitreal Injections ; Macula Lutea ; pathology ; Macular Edema ; etiology ; therapy ; Male ; Middle Aged ; Retinal Vein Occlusion ; complications ; Retrospective Studies ; Treatment Outcome ; Vascular Endothelial Growth Factor A ; antagonists & inhibitors ; Visual Acuity ; Vitrectomy ; methods

Aged ; Aged, 80 and over ; Anti-Inflammatory Agents, Non-Steroidal ; therapeutic use ; Cataract ; pathology ; Female ; Humans ; Macular Edema ; pathology ; Male ; Middle Aged ; Tomography, Optical Coherence ; methods