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P.G. Massin, F. Audren, A. Erginay, B. Haouchine, J.–F. Bergmann, A. Gaudric; Intravitreal Triamcinolone Acetonide For Diabetic Diffuse Macular Edema: Results Of A Prospective Controlled Trial . Invest. Ophthalmol. Vis. Sci. 2004;45(13):3463.
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Purpose: To evaluate prospectively the efficacy and safety of one intravitreal injection of 4mg triamcinolone acetonide for refractory diffuse diabetic macular edema. Methods: Seventeen patients with bilateral diabetic macular edema unresponsive to laser photocoagulation were included in this prospective randomized trial. In all patients, one eye was injected, and the other served as control. The main outcome measure was central macular thickness (CMT) at 1, 3 and 6 months, measured by Optical Coherence Tomography . Secondary outcomes were Early Treatment Diabetic Retinopathy Study (ETDRS) scores, intraocular pressure. Results: Before injection, mean ± SD CMT was 565.7 ± 183.0 (380 to 958) µm in injected eyes vs. 490.8 ± 117.5µm (377 to 848) in control eyes. Twelve weeks after injection, it was 228.4 ± 47.7µm (164 to 317) in injected eyes and 500.8 ± 123.9 µm (327 to 784) in control eyes (p<0.001, bilateral Wilcoxon test for paired samples). The difference between the CMT of injected and control eyes remained significant at 12 weeks after injection, but was no longer significant at 24 weeks because of the recurrence of macular edema in 9/17 injected eyes. The mean visual gain was 7.0 ± 7.4 letters ( –4 to 24) in treated eyes and –0.9 ± 6.4 letters (–21 to 6) in control eyes (p=0.005) 4 weeks after injection; 12 weeks after injection, it was 9.7 ± 9.5 letters ( –2 to 29) and –2.8 ± 6.6 letters (–19 to 6) respectively (p=0.002) and 24 weeks after injection 6.9 ± 10.7 letters (–12 to 29) and –2.6 ± 7.8 letters (–26 to 7) respectively (p= 0.01). In 9 of the 17 injected eyes, intraocular pressure exceeded 25 mmHg, and was controlled by topical medication Conclusion: Intravitreal injection of triamcinolone effectively reduces macular thickening due to diffuse diabetic macular edema, and improves visual acuity at least in the short term. The occurrence of a relapse may justify further injections, whose tolerance and frequency will have to be evaluated.
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