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Yuta Kitamura, Toshiyuki Oshitari, Sakiko Nonomura, Miyuki Arai, Eiju Sato, Yoko Takatsuna, Shuichi Yamamoto; Risk factors for refractory diabetic macular edema after sub-Tenon capsule injection of triamcinolone injection. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1776.
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To identify the risk factors for a recurrence and/or a persistence of diabetic macular edema (DME) after sub-Tenon capsule triamcinolone acetonide (STTA) injection.
All of the procedures conformed to the tenets of the World Medical Association Declaration of Helsinki. The medical records of 124 patients (124 eyes) treated by STTA were reviewed. Seventy-four patients (59.7%; 42 men, 32 women) had a persistent DME or a recurrence within a year. The age, sex, HbA1c, best-corrected visual acuity (BCVA), central macular thickness (CMT), insulin use, pioglitazone use, hypertension, serous retinal detachment (SRD), diabetic nephropathy, pan-retinal photocoagulation (PRP), microaneurysm photocoagulation (MAPC), subthreshold micropulse diode laser photocoagulation (SMDLP), cataract surgery, and history of vitrectomy were examined by logistic regression analysis.
At the time of treatment, the mean age was 61.5±13.0 years, mean HbA1c was 6.8±1.3%, mean BCVA was 0.6±0.4 logMAR units, and mean CMT was 557.2±143.7um. Twenty-three patients (31.1%) used insulin, 8 used pioglitazone (10.8%), 33 patients (44.6%) had hypertension, and 29 patients (39.2%) had nephropathy. Thirty-three patients (44.6%) underwent PRP and 15 patients (20.3%) underwent cataract surgery. These factors were found not to be risk factors. Thirty-five patients (47.3%) underwent MAPC and 11 patients (14.9%) underwent SMDLP combined with STTA. These procedures were determined to be significantly associated with DME treated with STTA (P=0.0315, P=0.04, respectively). However, 7 patients (9.5%) with a history of PPV were found to have significantly fewer recurrences and/or persistent DME after STTA (P=0.0464).
Patients who had combined MAPC and SMDLP had significantly higher refractoriness to DME after STTA, but avitreous may prevent the recurrence and/or persistent DME after STTA.
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