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J.M. Lekse, S. Maguluri, G. Bronner, F.M. Recchia; A Prospective Pilot Study Of Posterior Juxtascleral Injection Of Triamcinolone Acetonide In The Treatment Of Macular Edema . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3830.
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© ARVO (1962-2015); The Authors (2016-present)
Intravitreal steroids in the treatment of macular edema have been used with increasing frequency. The risks of endophthalmitis, retinal detachment, and glaucoma, however, justify an alternate mode of steroid delivery. This study was designed to investigate the results of posterior juxtascleral injection of triamcinolone acetonide with a blunt cannula for the treatment of diabetic macular edema.
Eyes with diabetic macular edema refractory or not amenable to laser photocoagulation were treated with a posterior juxtascleral injection of triamcinolone acetonide (Kenalog–40, Bristol–Myers Squibb, NJ). Briefly, following administration of topical 5% povidone–iodine, a 1–mm incision was made 8 mm posterior to the superotemporal limbus down to sclera. A 21–gauge bent anterior chamber cannula (BD Vistec) was placed in the posterior sub–Tenon space, and 40 mg (1cc) of Kenalog was injected. Topical antibiotics were administered for one week following injection. Complete ophthalmic examination and optical coherence tomography (OCT) were performed pre–injection and at 1 and 2 months post–injection. The primary outcome measures were: (1) best–corrected Snellen visual acuity (BCVA) at two months; (2) IOP > 21 mmHg at any visit. Secondary outcome measures were: (1) central foveal thickness (CFT) by OCT; (2) total macular volume (TMV) by OCT; (3) incidence of ocular infection. Pre–injection and post–injection values were compared with the Wilcoxon matched–pairs signed–ranks test.
To date, 5 eyes of 5 patients (3 males, mean age 61=yrs) have been treated and followed for at least two months. Mean BCVA was 20/80 pre–injection, 20/40 at 1 month (p ≤ 0.19), and 20/40 at 2 months (p ≤ 0.13). The median change in BCVA at 2 months was +3 Snellen lines (range 0 to 7 lines). Mean IOP at pre–injection, 1 month, and 2 months was 13.8mmHg, 19.6mmHg, and 15mmHg, respectively. In one patient, the 1–month IOP was 38 mm Hg, which normalized the following month with 3 pressure–lowering drops. The mean CFT was 465.8µm pre–injection, 303 µm at one month (p ≤ 0.06), and 277µm at two months (p ≤ 0.06). Mean TMV was 8.945 mm3 pre–injection and decreased to 7.585mm3 at one month (p < 0.06) and 7.867mm3 at two months (p ≤ 0.06). There were no cases of endophthalmitis or orbital infection.
Early results from an ongoing, prospective study suggest that this novel technique of steroid delivery for diabetic macular edema warrants further study as an alternative to intravitreal administration.
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