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C. Takata, M. S. P. A. Folgosa, L. R. Lucena, A. Messias, R. Jorge, I. U. Scott, D. R. Lucena; Intravitreal Injection versus Sub-Tenon’s Infusion of Triamcinolone Acetonide for Refractory Diabetic Macular Edema During Cataract Surgery: 12-Week Results of a Prospective Randomized Trial. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1354.
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To compare the effectiveness of intravitreal injection (IVI) versus posterior sub-Tenon’s infusion (STI) of triamcinolone acetonide (TA) during phacoemulsification cataract surgery in eyes with refractory diffuse diabetic macular edema.
Twenty-four eyes of 24 patients with refractory diffuse diabetic macular edema and scheduled to undergo phacoemulsification cataract surgery were randomized to receive either 4 mg IVI (n=12) or 40 mg STI (n=12) of TA during cataract surgery. Comprehensive ophthalmic evaluation, including best-corrected visual acuity (BCVA), intraocular pressure (IOP) and central macular thickness (CMT) measured with optical coherence tomography, was performed at baseline and at 2, 4, 8±1 and 12±2 weeks postoperatively.
Ten patients from each group completed the 12-week study visit. Mean baseline BCVA was 1.07 ± 0.11 logMAR and 1.04 ± 0.13 logMAR in the IVI and STI groups, respectively (p=0.87). A significant improvement of BCVA was observed only in the IVI group at 4 weeks (mean difference ± SE: 0.35 ± 0.16 logMAR; (p<0.05), 8 weeks (0.33 ± 0.16 logMAR; p<0.05) and 12 weeks (0.31 ± 0.15 logMAR; p<0.05) postoperatively. There was no significant change from baseline in mean intraocular pressure (mmHg) in either group. Mean ± SE baseline CMT was 474 ± 42 µm and 480 ± 70 µm in the IVI and STI groups, respectively (p=0.94). The CMT reduction at 2, 4 and 8 weeks postoperatively was significantly greater in the IVI compared to the STI group (p<0.05).
For the management of refractory diffuse diabetic macular edema in eyes undergoing phacoemulsification, intraoperative intravitreal injection is more effective than sub-Tenon's infusion of TA. Further investigation of a larger number of patients with longer follow-up is warranted.
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