Table of Contents - WOC 2012

WOC2012 Abstract Book
FP-RET-SA 197 (4)
Rationale of Diabetic Retinopathy Clinical Research Network
Intravitreal Anti vEGF Treatment and Follow up of Center Involved
Diabetic Macular Edema
Chalam K.V. (1)
1. Diabetic Reitnipathy Clinical Research Network, National Institute of Health
Objective: To provide guidelines to ophthalmologists for administering antivascular
endothelial growth factor (anti-VEGF) based on the DRCR.net
protocol.
Methods: The Diabetic Retinopathy Clinical Research Network (DRCR.net)
conducted a comparative effectiveness randomized clinical trial which included
evaluation of ranibizumab for treatment of diabetic macular edema (DME)
using a detailed web-based system. The underlying rationale for this system is
interpreted by the DRCR.net investigators into clinical guidelines for providing
intravitreal anti-VEGF and focal/grid laser for DME without a web-based real
time data entry system.
Results: DRCR.net guidelines include an initial series of injections followed by
monthly treatment as long as there is OCT improvement compared with the
previous month, or untilthickening resolves. If treatment is not repeated and
edema recurs/worsens, treatment is resumed. If no recurrence/worsening
occur when treatment is deferred follow-up can be doubled, up to 4 months.
Focal/grid laser considered initially or deferred >6 months for persistent edema
not improving from injections, then as often as every 4 months.
Conclusions: Treatment following these guidelines likely is similar to the
DRCR.net web-based real time data entry system. However it is unknown if
following this clinical protocol would result in better, same, or worse outcomes
compared with clinical trial results.
FP-RET-SA 197 (5)
A Randomized Clinical Trial to Compare The Efficacy and Safety of
Isolated or Combined Intravitreal Injection of Triamcinolone
Acetonide and Bevacizumab for Diabetic Macular Edema ATEMD
Protocol - A Brazilian Clinical Trial
Oliveira Neto Hermelino (1) , Andrade Rafael (2) , Casella Marcelo (3) , Nobrega
Mario (4) , Belfort Jr Rubens (5)
1. UNIFESP - Federal University of Sao Paulo; UEFS - University of Feira de
Santana
2. UNIFESP - Federal University of Sao Paulo
3. UNIFESP - Federal University of Sao Paulo; UEL - University of Londrina
4. UNIFESP - Federal University of Sao Paulo
5. UNIFESP - Federal University of Sao Paulo
Purpose: To evaluate the efficacy and safety of intravitreal triamcinolone or
bevacizumab alone and associated injections for the treatment of diabetic
macular edema.
Methods: Randomized multicenter clinical study with injection of 0.05ml (1.25
mg) of bevacizumab (AVA group);0.1 ml (4mg) of triamcinolone acetonide
(TAAC group); and the combination of the two drugs at the same dosage
(AVA+TAAC group) during 6 months. Inclusion criteria: diabetic macular
edema, BCVA between 20/400 and 20/40 and central macular thickness ?275
?m by OCT.
Results: One hundred and twenty eyes of 120 patients were injected and 58
eyes (48.3%) completed the study. BCVA converted to LogMAR revealed
similar among AVA and TAAC groups and short difference in the AVA+TAAC
group: The intraocular pressure (IOP) increased in TAAC and AVA groups and
also in the TAAC group. The analysis of retinal macular thickness measured by
OCT showed reduction in all 3 groups. However, the difference among these
results was not statistically significant (p = 0.368).
Conclusion: All groups showed short-term improvement in visual acuity and
decreased diabetic macular edema after separated or combined injections of
triamcinolone and bevacizumab; however, at this time of the study, there was
no difference among the 3 groups.
202
FP-RET-SA 197 (6)
Tachyphylaxis and Rebound Effect Following Intravitreal
Triamcinolone for Diffuse Diabetic Macular Edema
Al Amro Saleh (1)
1. College of Medicine, King Saud University
Purpose: To see if tachyphylaxis (resistance) develops after repeated
Intravitreal triamcinolone (IVTA) injections for diabetic macular edema and
is there a rebound effect after the drug wears off? Patients 7 patients who
received a repeat injection of the same dose (4 mg in 0.01 cc) of triamcinolone
acetonide at least 7 months after the first injection for recurrent diffuse diabetic
macular edema (DDME) were reviewed. The main outcome measure is central
foveal thickness (CFT) measured by optical coherent tomography (OCT) at 1
and 3 months following first and second injections. Wilcoxon Signed Ranks
test was used.
Results: Mean CFT were 556, 385, and 436 µ at pre-injection, 1 month, and 3
months respectively for the first injection, whereas CFT were 490, 441, 496 for
the second injection (P=0.01). The mean CFT before first injection was 556 µ
and 490 µ before second injection (P=0.499), showed no rebound increase in
macular edema.
Conclusion: There is decreasing efficacy of repeated IVTA injection for DDME.
However, there is no rebound increase in retinal thickness as the drug wears
off.
FP-RET-SA 197 (7)
Impact of Intravitreal Pharmacotherapy as an Adjunctive to Macular
Laser Photocoagulation on Contrast Sensitivity in Patients with
Diabetic Macular Edema
Fegde Sachin (1) , Haldipurkar Suhas (1) , Shetty Vijay (1) , Sarwate Nikit (1)
1. Laxmi Eye Institute
Purpose: Contrast Sensitivity may be deteriorated significantly in Diabetic
macular Edema (DME). The purpose of the study was to assess contrast
sensitivity function in patients of DME treated with intravitreal pharmacotherapy
as adjunct to macular laser photocoagulation.
Design: Prospective, Comparative, Interventional study involving 60 eyes
divided into 2 groups (30 each) receiving intravitreal triamcinolone (IVTA) vs.
Bevacizumab (IVA). Best Corrected Visual Acuity, Central Macular Thickness
on OCT and Contrast sensitivity on Pelli Robsons Charts were measured pretreatment
and 6 weeks post treatment.
Results: 60 eyes of 39 patients aged between 44-70 years were studied.
Contrast Sensitivity (CS) improved in all eyes following treatment. The mean
difference in CS in IVTA group was 0.165(0.10) log units and in IVA group
was 0.122 (0.09) log units. The mean improvement in BCVA in IVTA group
was 0.18(0.08) and in IVA group was 0.195 (0.14) logMAR units. The mean
improvement in CMT in IVTA group was 167.38 (65.02) and in IVA group was
123.87 (54.12) microns. Secondary Glaucoma was significantly high in IVTA
group.
Conclusion: Contrast Sensitivity function improves after intravitreal
pharmacotherapy. There is no significant difference in pharmacotherapy with
IVTA or IVA on a short term follow-up.