Maia Otacilio O, Takahashi Beatriz S, Costa Rogerio A, Scott Ingrid U, Takahashi Walter Y
Department of Ophthalmology, Hospital São Rafael, Monte Tabor Foundation, Salvador, BA, Brazil.
Am J Ophthalmol. 2009 Feb;147(2):291-297.e2. doi: 10.1016/j.ajo.2008.08.024. Epub 2008 Oct 17.
To evaluate laser combined with intravitreal triamcinolone acetonide (IVTA) for the management of patients with proliferative diabetic retinopathy (PDR) and clinically significant macular edema (CSME).
Randomized clinical trial.
settings: Single center. study population: Twenty-two patients with bilateral treatment-naïve moderate PDR and CSME. intervention: Laser (panretinal and macular) photocoagulation was performed in each eye, followed by IVTA in one randomly assigned eye. Best-corrected visual acuity (BCVA), fundus photography, and optical coherence tomography were performed at baseline and at months 1, 3, 6, 9, and 12. main outcome measures: Changes in BCVA, central macular thickness (CMT), and total macular volume (TMV).
The mean logarithm of the minimal angle of resolution (logMAR) BCVA improved significantly, and mean CMT and TMV were significantly reduced in the IVTA group compared with the laser-only group (controls) at all study follow-up visits (P < .001). The mean logMAR BCVA (Snellen equivalent) was 0.44 (20/50(-2)) for the IVTA group and 0.38 (20/50(+1)) for the controls at baseline, and 0.12 (20/25(-1)) for the IVTA group and 0.32 (20/40(-1)) for the controls at 12 months (P < .001). The mean CMT and TMV were, respectively, 360 microm and 8.59 mm(3) for the IVTA group and 331 microm and 8.44 mm(3) for the controls at baseline, and 236 microm and 7.32 mm(3) for the IVTA group and 266 microm and 7.78 mm(3) for the controls at 12 months (P < .001).
The combination of laser photocoagulation with IVTA was associated with improved BCVA and decreased CMT and TMV when compared with laser photocoagulation alone for the treatment of moderate PDR with CSME.
评估激光联合玻璃体内注射曲安奈德（IVTA）治疗增殖性糖尿病视网膜病变（PDR）和具有临床意义的黄斑水肿（CSME）患者的效果。
随机临床试验。
地点：单中心。研究人群：22例双侧未经治疗的中度PDR和CSME患者。干预：对每只眼睛进行激光（全视网膜和黄斑）光凝，然后对一只随机分配的眼睛注射IVTA。在基线以及第1、3、6、9和12个月时进行最佳矫正视力（BCVA）、眼底照相和光学相干断层扫描。主要观察指标：BCVA、中心黄斑厚度（CMT）和黄斑总体积（TMV）的变化。
在所有研究随访中，与单纯激光组（对照组）相比，IVTA组的最小分辨角平均对数（logMAR）BCVA显著改善，平均CMT和TMV显著降低（P <.001）。IVTA组基线时平均logMAR BCVA（Snellen等效值）为0.44（20/50（-2）），对照组为0.38（20/50（+1））；12个月时，IVTA组为0.12（20/25（-1）），对照组为0.32（20/40（-1））（P <.001）。IVTA组基线时平均CMT和TMV分别为360微米和8.59立方毫米，对照组为331微米和8.44立方毫米；12个月时，IVTA组为236微米和7.32立方毫米，对照组为266微米和7.78立方毫米（P <.001）。
与单纯激光光凝相比，激光光凝联合IVTA治疗中度PDR合并CSME时，可改善BCVA，并降低CMT和TMV。
