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MD L D Alvarez-Celorio, I Yeshurun, G Reategui, J Guerrero-Naranjo, R Magdalenic, J Fromow-Guerra, H Quiroz-Mercado; Intravitreal Triamcinolone Acetonide (Kenalog) for the Prevention of Visual Loss Associated With Scatter Photocoagulation and Macular Laser Treatment, in Patients With Combined, Macular Edema and Advanced Diabetic Retinopathy . Invest. Ophthalmol. Vis. Sci. 2002;43(13):538.
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Purpose:Concomitant performance of macular laser treatment (MLT) and scatter laser photocoagulation (SLP) in diabetic patients is frequently associated with exacerbation in the clinically significant macular edema (CSME), limiting or preventing post-treatment visual improvement. Immediate moderate visual loss is observed in up to 15% of such treated eyes. In this study we examined the ability of intravitreal Kenalog injected immediately after MLT to protect the macula from the adverse effect of the SLP. Methods:13 patients with bilateral combined CSME and advanced diabetic retinopathy and best corrected visual acuity (BCVA) equal or better than 20/200 were enrolled. Both eyes underwent MLT, followed 2-3 days later by standard SLP (2000- 500 microns burns completed in four weekly sessions). One of the eyes was randomly assigned to intravitreal injection of Kenalog (4mg/0.1cc), performed immediately after MLT. Changes in BCVA and CSME were assessed by clinical examination, fundus color photography, fluorescein angiography and optic coherence tomography performed 3 and 6 weeks, and 3 months after MLT. Adverse effects associated with Kenalog injection were documented. Results:13 patients completed 6 weeks and 5 patients completed 3 months follow up. Median baseline BCVA, and mean foveal thickness (FT) were 20/30, and 257.29 ±86.28m in the Kenalog treated group and 20/30 and 255.83±87.04m in the control group. Six weeks following treatment, BCVA in the Kenalog group improved 1.43±3.82 (-2 to 9) ETDRS lines. BCVA in the control group improved 1±2.31 (-3 to 4) ETDRS lines (p=0.69). FT six weeks following treatment were 198±59.28 and 248.75±119.12 in the Kenalog and control group respectively (p=0.88). Conclusion:At six weeks follow up time, both groups showed a trend for improvement in BCVA and FT. A trend toward greater improvement in both parameters was observed in the Kenalog treated group. However, this suggested benefit should be reassessed at a longer follow-up time and with a larger study group.
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