Optical coherence tomographic pattern may predict visual outcome after intravitreal triamcinolone for diabetic macular edema

Objective: To identify an optical coherence tomography (OCT) pattern predictive of visual outcome in patients with diabetic macular edema (DME) who underwent a single dose of intravitreal triamcinolone. Design: Retrospective case analysis with prospective data collection for controls. Participants: Ninety-three cases and 25 controls. Methods: Two independent masked observers retrospectively examined preoperative macular OCTs of 93 eyes of 93 patients who were given a single dose (4 mg in 0.1 ml) of intravitreal triamcinolone for DME and categorized them as belonging to 2 groups: 1, comprised of eyes with high reflectivity (bright colors) from inner retinal layers, and 2, comprised of eyes that had low reflectivity (darker colors) from inner retinal layers. Logarithm of the minimum angle of resolution visual acuity (VA) and macular thickness measured by OCT were assessed preoperatively and postoperatively at 1 and 3 months. Main Outcome Measures: Optical coherence tomographic appearance of inner retinal layers. Results: All patients completed 3 months of follow-up. In group 1, 45 of 51 eyes (88%) experienced visual improvement of >= 2 lines on an Early Treatment Diabetic Retinopathy Study (ETDRS) chart at 1 month of follow-up. Forty-four of 51 patients (86%) experienced visual improvement of >= 2 lines on an ETDRS chart at 3 months of follow-up. In group 2, 18 of 42 patients (43%) experienced visual improvement of >= 1 lines on an ETDRS chart at 1 and 3 months of follow-up. For the remaining patients, VA remained unchanged during the postoperative course of 3 months. Conclusions: Patients in whom OCT demonstrated the high reflectivity of inner retinal layers achieved greater VA though macular thickness decreased significantly after intravitreal triamcinolone in both groups. It may be hypothesized that a lower optical reflectivity of inner retinal layers is related to the atrophy of the inner retinal layers, thus resulting in a failure of VA recovery in these patients. The level of reflectivity from inner retinal layers on OCT may provide objective criteria in predicting the response of DME to intravitreal triamcinolone and help in preoperative counseling of patients with DME.