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, 12, 1845-1852
eCollection

Oral Kallidinogenase Improved Visual Acuity and Maintained Chorioretinal Blood Flow Levels After Treatment for Diabetic Macular Edema

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Oral Kallidinogenase Improved Visual Acuity and Maintained Chorioretinal Blood Flow Levels After Treatment for Diabetic Macular Edema

Eiko Tsuiki et al. Clin Ophthalmol.

Abstract

Purpose: This study was designed to investigate the therapeutic effects of oral kallidinogenase medication as an adjuvant therapy in treating patients with diabetic macular edema (DME).

Study design: This was a prospective, open-labeled, randomized study.

Methods: All patients were given posterior sub-Tenon triamcinolone acetonide (STTA) injection and focal laser treatment session for DME. The patients were subdivided into two groups: 1) those treated with oral kallidinogenase for at least 6 months after local treatment (treated group) and 2) those treated without oral kallidinogenase (untreated group). In this study, best-corrected visual acuity (BCVA), central retinal thickness (CRT), subfoveal choroidal thickness (SCT), and chorioretinal blood flow level were measured in 17 patients (19 eyes). Chorioretinal blood flow levels at the disc and macula were measured by laser speckle flowgraphy and evaluated using the mean blur rate (MBR). These data were measured at baseline and at 1, 3, and 6 months after treatment initiation.

Results: BCVA at 6 months after treatment significantly improved in treated group (P<0.05). But the mean CRT after treatment significantly decreased in both groups. There was no significant difference in the mean SCT at baseline between the two groups. The mean SCT after treatment in treated group was significantly thinner than that before treatment (P<0.05). Compared to baseline (100%), MBR at the disc and the macula at 6 months after treatment significantly decreased to 84.8% and 86.2%, respectively, in untreated group (P<0.05), though it remained unchanged at 98.7% and 99.7% in treated group.

Conclusion: Oral kallidinogenase medication is useful as an adjuvant therapy to enhance the therapeutic effect of STTA in DME patients.

Keywords: diabetic macular edema; enhanced depth imaging optical coherence tomography; kallidinogenase; laser speckle flowgraphy.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
The mean blur rate (MBR) displayed as a 2D color-coded map. (A) MBR at the disc as the retinal blood flow, which was calculated automatically after circling the margin of the optic disc with a rubber band (▲). Since the MBR in the vessel area (MV) includes the MBR in the tissue area (MT), the MBR (MV-MT) was used as the retinal blood flow. (B) MBR at the macula which calculated automatically after configured isometric areas compared MBR maps with fundus photographs was used as the choroidal blood flow.
Figure 2
Figure 2
(A) Change in the best-corrected visual acuity (BCVA). BCVA was significantly improved in the treated group at 3 and 6 months from baseline (*P<0.05) and remained unchanged in the untreated group. (B) Change in the central retinal thickness (CRT). CRT was significantly improved during the whole follow-up period in both groups (*P<0.05). There was no significant difference between the two groups. (C) Change in the subfoveal choroidal thickness (SCT). SCT was significantly reduced during the whole follow-up period in the treated group (*P<0.05). On the other hand, SCT was significantly reduced only at 1 month from baseline in the untreated group (*P<0.05).
Figure 3
Figure 3
(A) Change in the mean blur rate (MBR) at the disc as the retinal blood flow. Although the retinal blood flow significantly decreased in the untreated group at 3 and 6 months from baseline (*P<0.05), it remained unchanged during the whole follow-up period in the treated group. (B) Change in MBR at the macula as the choroidal blood flow. Although the choroidal blood flow significantly decreased in the untreated group at 6 months from baseline (*P<0.05), it remained unchanged during the whole follow-up period in the treated group. There was a significant difference between the two groups after 6 months (§P<0.05).
Figure 4
Figure 4
Spearman’s correlation between the mean blur rate (MBR) at the disc and the best-corrected visual acuity (BCVA). Significant negative correlation between BCVA and retinal blood flow was noted in the treated group at 6 months (P=0.01).

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