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Effect of grid laser photocoagulation in diffuse diabetic macular edema in correlation to glycosylated haemoglobin (HbA1c)

  • Clinical Investigation
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Abstract

Background

Glycosylated haemoglobin (HbA1c) correlates with the amount of hyperglycemia in diabetic patients. High HbA1c levels often predict clinically significant macular edema (CSME), which then needs to be treated with grid laser photocoagulation. The question asked in this study was whether there is a correlation between the effect grid laser photocoagulation in diffuse diabetic macular edema and HbA1c, using an optical coherence tomography (OCT) for the evaluation of the retinal thickness.

Methods

A prospective, non-comparative case series was performed to find a correlation between the effect of grid laser photocoagulation in diffuse diabetic macular edema and HbA1c. Thirty eyes with CSME of diabetic patients were included in the study. Complete ophthalmic examinations and OCT were performed at baseline, 1 month, 3, and 6 months after grid laser photocoagulation therapy. HbA1c was measured at the end of study.

Results

Significance level was set at P<0.05. A significant difference in the foveal (P=0.02) and superior (P=0.021) retinal thickness 6 months after laser therapy, no correlation between HbA1c and retinal thickness after photocoagulation, and an insignificant decrease in visual acuity (P=0.9) were found. The correlation between foveal retinal thickness and visual acuity was P=0.24 6 months after treatment.

Conclusion

There was no significant correlation between HbA1c and the effect of grid laser photocoagulation therapy in diffuse diabetic macular edema. The retinal thickness decreased significantly in the foveal and superior area 6 months after therapy. No correlation between the foveal retinal thickness and the visual acuity was found. The visual acuity did not increase after treatment. There are many factors influencing the retinal thickness, such as the blood pressure and the attached posterior hyaloid.

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References

  1. Baumann M, Gentile RC, Liebmann JM, Ritch R (1998) Reproducibility of retinal thickness measurements in normal eyes using optical coherence tomography. Ophthalmic Surg Lasers 29:280–285

    CAS  Google Scholar 

  2. Besenthal I (2000) Glukosestoffwechsel. In: Neumeister B, Besenthal I, Liebich H (eds) Klinikleitfaden Labordiagnostik. Urban und Fischer Verlag, München Jena, pp 126–127

    Google Scholar 

  3. Brancato R (1999) Optical coherence tomography in macular edema. Doc Ophthalmol 97:337–339

    Article  PubMed  CAS  Google Scholar 

  4. Bresnick GH (1983) Diabetic maculopathy. A critical review highlighting diffuse macular edema. Ophthalmology 90:1301–1317

    PubMed  CAS  Google Scholar 

  5. Capone A Jr, Panozzo G (2000) Vitrectomy for refractory diabetic macular edema. Semin Ophthalmol 15:78–80

    Article  PubMed  Google Scholar 

  6. Chantelau E (2001) What may be gained from standard photocoagulation during early worsening of diabetic retinopathy? An observational study in type-1 diabetic patients after tightening of glycemic control. Diabetes Metab 27:366–371

    PubMed  CAS  Google Scholar 

  7. Chauhan DS, Marshall J (1999) The interpretation of optical coherence tomography images of the retina. Invest Ophthalmol Vis Sci 40:2332–2342

    PubMed  CAS  Google Scholar 

  8. Early Treatment Diabetic Retinopathy Study Research Group (1991) ETDRS report number 7: Early Treatment Diabetic Retinopathy Study design and baseline patient characteristics. Ophthalmology 98:741–756

    Google Scholar 

  9. Frank RN, Schulz L, Abe K, Iezzi R (2004) Temporal variation in diabetic macular edema measured by optical coherence tomography. Ophthalmology 111:211–217

    Article  PubMed  Google Scholar 

  10. Goebel W, Kretzchmar-Gross T (2002) Retinal thickness in diabetic retinopathy: a study using optical coherence tomography (OCT). Retina 22:759–767

    Article  PubMed  Google Scholar 

  11. Hee MR, Izatt JA, Swanson EA, Huang D, Schuman JS, Lin CP, Puliafito CA, Fujimoto JG (1995) Optical coherence tomography of the human retina. Arch Ophthalmol 113:325–332

    PubMed  CAS  Google Scholar 

  12. Hee MR, Puliafito CA, Duker JS, Reichel E, Coker JG, Wilkins JR, Schuman JS, Swanson EA, Fujimoto JG (1998) Topography of diabetic macular edema with optical coherence tomography. Ophthalmology 105:360–370

    Article  PubMed  CAS  Google Scholar 

  13. Hee MR, Puliafito CA, Wong C, Duker JS, Reichel E, Rutledge B, Schuman JS, Swanson EA, Fujimoto JG (1995) Quantitative assessment of macular edema with optical coherence tomography. Arch Ophthalmol 113:1019–1029

    PubMed  CAS  Google Scholar 

  14. Hikichi T, Fujio N, Akiba Y, Takahashi M, Yoshida A (1997) Association between the short-term natural history of diabetic macular edema and the vitreomacular relationship in type II diabetes mellitus. Ophthalmology 104:473–478

    PubMed  CAS  Google Scholar 

  15. Izatt JA, Hee MR, Swanson EA, Lin CP, Huang D, Schuman JS, Puliafito CA, Fujimoto JG (1994) Micrometer-scale resolution imaging of the anterior eye in vivo with optical coherence tomography. Arch Ophthalmol 112:1548–1589

    Google Scholar 

  16. Kang SW, Park CY, Ham DI (2004) The correlation between fluorescein angiographic and optical coherence tomographic features in clinically significant diabetic macular edema. Am J Ophthalmol 137:313–322

    Article  PubMed  Google Scholar 

  17. Klein R, Klein BE, Moss SE (1984) Visual impairement in diabetes. Ophthalmology 91:1–19

    CAS  Google Scholar 

  18. Klein R, Klein BE, Moss SE, Davis MD, DeMets DL (1984) The Wisconsin Epidemiologic Study of Diabetic Retinopathy, IV: diabetic macular edema. Ophthalmology 91:1464–1474

    PubMed  CAS  Google Scholar 

  19. Klein R, Moss SE, Klein BE, Davis MD, DeMets DL (1989) The Wisconsin epidemiologic study of diabetic retinopathy. XI. The incidence of macular edema. Ophthalmology 96:1501–1510

    PubMed  CAS  Google Scholar 

  20. Kojima T, Terasaki H, Nomura H, Suzuki T, Mori M, Ito Y, Miyake Y (2003) Vitrectomy for diabetic macular edema: effect of glycemic control (HbA(1c)), renal function (creatinine) and other local factors. Ophthalmic Res 35:192–198

    Article  PubMed  Google Scholar 

  21. Kremser BG, Kunze C, Troger J, Ulmer H, Kieselbach GK (1996) Grid pattern photocoagulation for diabetic macular edema–long term visual results. Ophthalmologica 210:160–162

    PubMed  CAS  Google Scholar 

  22. Lattanzio R, Brancato R, Pierro L, Bandello F, Iaccher B, Fiore T, Maestranzi G (2002) Macular thickness measured by optical coherence tomography (OCT) in diabetic patients. Eur J Ophthalmol 12:482–487

    PubMed  CAS  Google Scholar 

  23. Lee CM, Olk RJ (1991) Modified grid laser photocoagulation for diffuse diabetic macular edema: long-term visual results. Ophthalmology 98:1594–1602

    PubMed  CAS  Google Scholar 

  24. Lopes de Faria JM, Jalkh AE, Trempe CL, McMeel JW (1999) Diabetic macular edema: risk factors and concomitants. Acta Ophthalmol Scand 77:170–175

    Article  PubMed  CAS  Google Scholar 

  25. Martidis A, Duker JS, Greenberg PB, Rogers AH, Puliafito CA, Reichel E, Baumal C (2002) Intravitreal triamcinolone for refractory diabetic macular edema. Ophthalmology 109:920–927

    Article  PubMed  Google Scholar 

  26. Massin P, Viscaut E, Haouchine B, Erginay A, Paques M, Gaudric A (2001) Reproducibility of retinal mapping using optical coherence tomography. Arch Ophthalmol 119:1135–1142

    PubMed  CAS  Google Scholar 

  27. McDonald HR, Schatz H (1985) Macular edema following panretinal photocoagulation. Retina 5:5–10

    Article  PubMed  CAS  Google Scholar 

  28. Moreira RO, Trujillo FR, Meirelles RM, Ellinger VC, Zagury L (2001) Use of optical coherence tomography (OCT) and indirect ophthalmoscopy in the diagnosis of macular edema in diabetic patients. Int Ophthalmol 24:331–336

    Article  PubMed  CAS  Google Scholar 

  29. Nasrallah FP, Jalkh AE, Van Coppenrolle F, Kado M, Trempe CL, McMeel JW, Schepens CL (1988) The role of the vitreous in diabetic macular edema. Ophthalmology 95:1335–1339

    PubMed  CAS  Google Scholar 

  30. Nasrallah FP, Van de Velde F, Jalkh AE, Trempe CL, McMeel JW, Schepens CL (1989) Importance of the vitreous in young diabetics with macular edema. Ophthalmology 96:1511–1517

    PubMed  CAS  Google Scholar 

  31. Olk RJ (1986) Modified grid blue-green laser photocoagulation for diffuse diabetic macular edema. Ophthalmology 93:938–950

    PubMed  CAS  Google Scholar 

  32. Olk RJ (1990) Argon green (514 nm) versus krypton red (647 nm) modified grid laser photocoagulation for diffuse diabetic macular edema. Ophthalmology 97:1101–1112

    PubMed  CAS  Google Scholar 

  33. Otani T, Kishi S, Maruyama Y (1999) Patterns of diabetic macular edema with optical coherence tomography. Am J Ophthalmol 127:688–693

    Article  PubMed  CAS  Google Scholar 

  34. Perkovich BT, Meyers SM (1988) Systemic factors affecting diabetic macular edema. Am J Ophthalmol 105:211–212

    PubMed  CAS  Google Scholar 

  35. Pieroth L, Schuman JS, Hertzmark E, Hee MR, Wilkins JR, Coker J, Mattox C, Pedut-Kloizman R, Puliafito CA, Fujimoto JG, Swanson E (1999) Evaluation of focal defects of the nerve fiber layer using optical coherence tomography. Ophthalmology 106:570–579

    Article  PubMed  CAS  Google Scholar 

  36. Puliafito CA, Hee MR, Lin CP, Reichel E, Schuman JS, Duker JS, Izatt JA, Swanson EA, Fujimoto JG (1995) Imaging of macular disease with optical coherence tomography. Ophthalmology 102:217–229

    PubMed  CAS  Google Scholar 

  37. Sanchez-Tocino H, Alvarez-Vidal A, Maldonado MJ, Moreno-Montanes J, Garcia-Layana A (2002) Retinal thickness study with optical coherence tomography in patients with diabetes. Invest Ophthalmol Vis Sci 43:1588–1594

    PubMed  Google Scholar 

  38. Schaudig UH, Glaefke C, Scholz F, Richard G (2000) Optical coherence tomography for retinal thickness measurement in diabetic patients without clinically significant macular edema. Ophthalmic Surg Lasers 31:182–186

    PubMed  CAS  Google Scholar 

  39. Sebag J, Balazs EA (1984) Pathogenesis of CME: anatomic consideration of vitreoretinal adhesions. Surv Ophthalmol 29(suppl):493–498

    Article  Google Scholar 

  40. Sebag J, Buckingham B, Charles MA, Reiser K (1992) Biochemical abnormalities of vitreous in humans with proliferative diabetic retinopathy. Arch Ophthalmol 110:1472–1476

    PubMed  CAS  Google Scholar 

  41. Sebag J, Nie S, Reiser K, Charles MA, Yu NT (1994) Raman spectroscopy of human vitreous in proliferative diabetic retinopathy. Invest Ophthalmol Vis Sci 35:2976–2980

    PubMed  CAS  Google Scholar 

  42. Stefaniotou M, Kalogeropoulos C, Psilas K (1995) Long-term visual results after laser photocoagulation for diabetic maculopathy. Ophthalmologica 209:64–67

    Article  PubMed  CAS  Google Scholar 

  43. Stolba U, Binder S, Gruber D, Krebs I, Aggermann T, Neumaier-Ammerer B (2005) Vitrectomy for persistent diffuse diabetic macular edema. Am J Ophthalmol 140:295–301

    Article  PubMed  Google Scholar 

  44. Toth CA, Narayan DG, Boppart SA, Hee MR, Fujimoto JG, Birngruber R, Cain CP, DiCarlo CD, Roach WP (1997) A comparison of retinal morphology viewed by optical coherence tomography and by light microscopy. Arch Ophthalmol 115:1425–1428

    PubMed  CAS  Google Scholar 

  45. Varano M, Scassa C, Ripandelli G, Capaldo N (1999) New diagnostic tools for macular edema. Doc Ophthalmol 97:373–379

    Article  PubMed  CAS  Google Scholar 

  46. Yamamoto S, Yamamoto T, Hayahi M, Takeuchi S (2001) Morphological and functional analyses of diabetic macular edema by optical coherence tomography and multifocal electroretinograms. Graefe's Arch Ophthalmol 239:96–101

    CAS  Google Scholar 

  47. Yang CS, Cheng CY, Lee CF, Hsu WM, Liu JH (2001) Quantitative assessment of retinal thickness in diabetic patients with and without clinically significant macular edema using optical coherence tomography. Acta Ophthalmol Scand 79:266–270

    Article  PubMed  CAS  Google Scholar 

  48. Yanoff M, Fine BS (1996) Diabetes mellitus. In: Yanoff M, Fine BS (eds) Ocular pathology. Mosby-Wolfe, London, pp 563–565

    Google Scholar 

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Authors and Affiliations

  1. Department of Ophthalmology, The Ludwig Boltzmann Institute of Retinology and Biomicroscopic Lasersurgery, Rudolf Foundation Clinic Vienna, Vienna, Austria

    Katharina E. Schmid, Beatrix Neumaier-Ammerer, Ulrike Stolba & Susanne Binder

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  1. Katharina E. Schmid
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  2. Beatrix Neumaier-Ammerer
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  3. Ulrike Stolba
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Correspondence to Katharina E. Schmid.

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Schmid, K.E., Neumaier-Ammerer, B., Stolba, U. et al. Effect of grid laser photocoagulation in diffuse diabetic macular edema in correlation to glycosylated haemoglobin (HbA1c). Graefe's Arch Clin Exp Ophthalmo 244, 1446–1452 (2006). https://doi.org/10.1007/s00417-006-0322-6

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  • DOI: https://doi.org/10.1007/s00417-006-0322-6

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