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S. Shah, M.P. Blair, N.P. Blair, M. Shahidi, L.J. Ulanski, II, A. Shakoor, R. Zelkha, M.J. Shapiro, J. Stokes; Posterior Sub–Tenon versus Intravitreal Triamcinolone Acetonide for Clinically Significant Diabetic Macular Edema . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3862.
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© ARVO (1962-2015); The Authors (2016-present)
To compare the efficacy of posterior sub–tenon’s (PST) versus intravitreal triamcinolone acetonide (IVTA) injection as a treatment for clinically significant diabetic macular edema (CSME).
Patients with CSME and best–corrected visual acuity of >= 20/100 were recruited. The patients were randomized to either a single 40 mg PST or a 4 mg IVTA injection. Outcome measures included Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity scores, retinal thickness by coherence tomography (OCT) and retinal thickness analysis (RTA), and intraocular pressure (IOP). Central macular thickness (CMT) and maximal perifoveal thickness (MPT) were measured from OCT images. Ophthalmic evaluation and imaging were performed at baseline and one month after the treatment.
To date, six and five patients were randomized for PST and IVTA treatment, respectively. The baseline (pretreatment) CMT, MPT, visual acuity, and IOP were not statistically different (p > 0.4) between PST and IVTA groups.
In the PST group, at one month follow up, 4/6 (67%) and 2/6 (33%) patients had a significant (change greater than 2 standard deviation of mean measurement at baseline) decrease in MPT and CMT, respectively. In the IVTA group, MPT and CMT decreased significantly in 3/4 (75%) at one month follow up. No patients in either group demonstrated a decrease in foveal thickness and perifoveal thickness on RTA.
Mean ETDRS visual acuity score (68) was unchanged in either group at 1 month. There was no change in IOP at 1 month in the PST group. The IVTA group experienced a mean increase of 5.7 mm Hg (p=0.06) and 2 patients required the use of one ocular hypotensive agent.
The initial results suggest that both PST and IVTA treatments reduce retinal thickness as measured by OCT, but this may not be associated with improvement in ETDRS visual acuity.
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