Expected effect of retinal thickness after focal photocoagulation in diabetic macular oedema

AbstractBackgroundMacular oedema is a form of diabetic retinopathy that can be treated with photocoagulation. The expected effect of treatment varies, and may depend on the previous characteristics of retinal thickening.ObjectiveTo determine whether the change in retinal thickness after focal photocoagulation for diabetic macular oedema varies due to the presence of anatomical features that may justify a separate assessment.Material and methodsNon-experimental, comparative, retrospective, longitudinal study. The mean percentage change in macular volume was compared in eyes with diabetic macular oedema, 3 weeks after focal photocoagulation. The analysis was stratified according to the presence of central and perifoveal temporal thickening (Mann–Whitney U). A regression analysis was performed to identify the contribution of the anatomical variables before photocoagulation to the change in macular volume.ResultsA total of 72 eyes were evaluated. The mean change of macular volume in the sample was −0.68±3.84%. In the multiple regression analysis, the changes of perifoveal temporal (beta 0.54, p<0.001) and central field thickness (beta 0.3, p=0.01) contributed to the change of macular volume (R=0.64). Macular volume decreased by a mean of −2.1±4.3% in eyes with temporal perifoveal thickening, and increased by 0.5±2.8% (p =0.007) in eyes with no thickening.ConclusionPerifoveal temporal thickening before photocoagulation changes the expected effect of this therapy on macular volume in eyes with focal diabetic macular oedema. It is recommended to evaluate the effect separately, and according to the perifoveal temporal thickness

Falta de asociación entre las características retinianas previas al tratamiento y la mala respuesta funcional a la fotocoagulación focal, en edema macular diabético

ResumenAntecedentesLa fotocoagulación reduce la incidencia de pérdida visual moderada en ojos con edema macular diabético focal, aunque en algunos disminuye la visión. Se desconoce la proporción de ojos que presenta mala respuesta funcional después de la fotocoagulación y si esta se asocia con alguna característica retiniana previa.ObjetivoDeterminar la proporción de ojos con edema macular diabético que presenta mala respuesta funcional a la fotocoagulación y comparar las características retinianas entre ojos con y sin ella.Material y métodosEstudio observacional, longitudinal, comparativo, retrospectivo. Se identificó la proporción e intervalos de confianza (I.C.) del 95% de ojos con edema macular diabético focal, que tuvo mala respuesta funcional después de la fotocoagulación (disminución de agudeza visual 6 semanas después). Se compararon las variables retinianas previas al tratamiento, entre ojos con y sin mala respuesta funcional (t de Student).ResultadosSe trabajó sobre 115 ojos de pacientes con edad promedio 59.3±9.24 años. La agudeza visual era ≥ 0.5 en 63 (54.8%); 33 ojos tuvieron mala respuesta funcional después de la fotocoagulación (28.7%, I.C. 95%: 13.3 a 44.1). Las variables retinianas no difirieron entre los ojos con mala respuesta funcional y los ojos sin ella (p>0.05).ConclusiónEn 71.3% de los ojos con edema macular diabético focal, el engrosamiento retiniano remitió y la agudeza visual se conservó o mejoró con un solo procedimiento de fotocoagulación; las variables retinianas evaluadas habitualmente no permitieron identificar al 28.7% restante, cuya visión puede disminuir después de este tratamiento, y que requeriría intervenciones adicionales.AbstractBackgroundAlthough photocoagulation reduces the incidence of moderate visual loss in eyes with focal diabetic macular oedema, some eyes may lose some vision after treatment. The proportion of eyes with poor functional response after photocoagulation, and whether any retinal variable is associated with this, is unknown.ObjectiveTo determine the proportion of eyes with diabetic macular oedema that have a poor functional response after focal photocoagulation, and their associated features.Material and methodsA non-experimental, longitudinal, comparative and retrospective study was conducted. The proportion and 95% confidence intervals (CI) of diabetics with macular oedema that had a poor functional response after focal photocoagulation (any visual loss after 6 weeks) were identified. The means of retinal variables before treatment were compared between eyes with and without a poor functional response using the Student t test for independent means.ResultsThe study included 115 eyes of patients aged 59.3 (SD 9.24) years. Visual acuity was greater than or equal to 0.5 in 63 eyes (54.8%). A total of 33 eyes had a poor functional response after photocoagulation (28.7%, 95% CI: 13.3 to 44.1). The comparison between retinal variables and visual acuity before treatment did not show any differences between eyes with or without a poor functional response and eyes.ConclusionRetinal thickening and visual acuity improved or did not change in 71.3% of eyes with diabetic macular oedema with a single photocoagulation procedure. Retinal variables that are usually evaluated were unable to identify the remaining 28.7%, which could lose vision after that treatment, and would require additional interventions

Asociación entre la mejoría visual y el uso de inhibidores de la enzima convertidora de angiotensina, en edema macular diabético

ResumenAntecedentesEl uso de inhibidores de la enzima convertidora de angiotensina es eficaz para retardar la progresión de retinopatía diabética; se desconoce si su empleo se asocia con un mejor desenlace visual en pacientes con edema macular diabético.Material y métodosEstudio observacional, comparativo, longitudinal y retrospectivo. Se evaluaron pacientes con edema macular diabético tratados mediante fotocoagulación, y con hipertensión arterial sistémica tratados con inhibidores de la enzima convertidora de angiotensina (grupo 1), y no hipertensos (grupo 2). La variable dependiente fue la proporción de mejoría visual, definida operativamente como la ganancia de una o más líneas de visión, 3 semanas después de la fotocoagulación; la variable independiente fue la presencia o ausencia del tratamiento con inhibidores de la enzima convertidora de angiotensina. Se comparó la proporción de ojos con mejoría visual entre grupos mediante χ2.ResultadosTreinta y tres ojos (51.6%) se asignaron al grupo 1 y 31 (48.4%) al 2; el promedio de agudeza visual mejoró a las 3 semanas, con respecto al basal (p=0.002). La proporción de ojos con mejoría visual no difirió entre los pacientes tratados con inhibidores de la enzima convertidora de angiotensina (45.5%) y aquellos que no los recibían (51.6%, p=0.4).ConclusionesLa proporción de ojos con mejoría visual entre los pacientes tratados con inhibidores de la enzima convertidora de angiotensina y quienes no lo usaban no tuvo diferencia significativa. No se sustenta inhibir la angiotensina II como terapia adjunta a la fotocoagulación focal, para mejorar el desenlace en pacientes con edema macular diabético.AbstractBackgroundAngiotensin converting enzyme inhibitors are effective in delaying the progression of diabetic retinopathy. It is unknown if their use is associated with a better visual outcome in patients with diabetic macular oedema.Material and methodsA non-experimental, comparative, longitudinal and retrospective study was performed on patients with diabetic macular oedema treated by focal photocoagulation, and with systemic arterial hypertension treated with angiotensin converting enzyme inhibitors (Group 1), and without hypertension (Group 2). The dependent variable was the proportion with visual improvement, operatively defined as the gain of one or more lines of vision three weeks after photocoagulation. The independent variable was the use of angiotensin converting enzyme inhibitors. The proportion of eyes with visual improvement after treatment was compared between groups using the Chi squared (χ2) test.ResultsA total of 33 eyes (51.6%) were assigned to group 1, and 31 (48.2%), to group 2. The mean of visual acuity improved after three weeks, compared with baseline (p=0.002). The proportion of eyes with visual improvement did not differ between patients treated with angiotensin converting enzyme inhibitors (45.5%) and those that did not use them (51.6%, p=0.4).ConclusionsThere was no statistical difference in the proportion of eyes with visual improvement between patients treated with angiotensin converting enzyme inhibitors and in those where they were not used. There is no support for the inhibition of angiotensin II in addition to photocoagulation for improving the outcome in patients with diabetic macular oedema

Eficacia y seguridad de la terapia antiinflamatoria tópica para tratar el incremento del grosor del punto central, secundario a fotocoagulación focal en edema macular diabético

Tesis (Maestría en Ciencias en Investigación Clínica), Instituto Politécnico Nacional, SEPI, ESM, 2010, 1 archivo PDF, (106 páginas). tesis.ipn.m

Eficacia de la dorzolamida para reducir el grosor retiniano después de fotocoagulación en el edema macular diabético

AbstractBackgroundFocal photocoagulation interrupts vascular leakage in diabetic macular oedema, and allows the retinal pigment epithelium to withdraw fluid that thickens the retina; this mechanism could be enhanced by dorzolamide, a topical carbonic anhydrase inhibitor.ObjectiveTo determine the efficacy of dorzolamide compared to placebo, in reducing retinal thickness after focal photocoagulation in eyes with diabetic macular oedema.Material and methodsExperimental, comparative, prospective, longitudinal, double blind study in diabetics with focal macular oedema treated with photocoagulation. Treated eyes were randomly assigned three weeks after the procedure to receive dorzolamide (group 1) or placebo (group 2), three times daily for three weeks. Means of visual acuity, centre point thickness and macular volume were compared 3 and 6 weeks after photocoagulation within groups (Wilcoxon t) and between groups (Mann-Whitney-U).ResultsSixty-nine eyes form patients aged 58.3±8.3 years; 37 were assigned to group 1 and 42 to group 2. Mean centre point thickness changed from 178.4±34μm to 170±29.1μm in group 1 (p=0.04), and from 179.2±22.4μm to 178.6±20.8 μm in group 2 (p=0.07); mean macular volume changed from 7.63±0.52mm3 to 7.50±0.50 mm3 in group 1 (p=0.002) and from 7.82±0.43 mm3 to 7.76±0.42mm3 in group 2 (p=0.013).ConclusionsThe efficacy of dorzolamide was higher than that of placebo in reducing retinal thickness after focal photocoagulation in diabetics with macular oedema