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A. R. Edwards, for the Diabetic Retinopathy Clinical Research Network; Progression of Diabetic Retinopathy at 1 Year and 2 Years in a Retrospective Analysis of a Randomized Clinical Trial Comparing Intravitreal Triamcinolone With Focal/Grid Photocoagulation. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4333.
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Compare effect of intravitreal triamcinolone acetonide with focal/grid photocoagulation on progression of diabetic retinopathy.
Retrospective analysis performed on subjects with diabetic macular edema randomly assigned to laser or intravitreal triamcinolone acetonide (1 mg or 4 mg). Fundus photographs were obtained at baseline, 1 year and 2 years. Main outcome defined as progression to proliferative diabetic retinopathy (PDR) or worsening of 2 or more severity levels on reading center masked assessment of 7-field fundus photographs, plus additional eyes that received panretinal photocoagulation (PRP) or had a vitreous hemorrhage.
The cumulative probability of progression of retinopathy up to 1 year was 21% in the laser group, 19% in the 1 mg group, and 14% in the 4 mg group (P=0.71 comparing the laser and 1 mg groups, P=0.03 comparing the laser and 4 mg groups, and P=0.08 comparing the 1 mg and 4 mg groups) and up to 2 years was 31%, 29%, and 21%, in the three groups, respectively (P=0.65, 0.005, and 0.03, respectively).
Retrospective analysis suggests that 4 mg of intravitreal triamcinolone acetonide can reduce the risk of progression of retinopathy. Use of this intravitreal corticosteroid preparation for this purpose does not seem warranted because of an increased risk of glaucoma and cataract. Any treatment to be used routinely to prevent PDR likely needs to be relatively safe since PDR can be treated successfully and relatively safely with PRP. Further investigation on the role of pharmacotherapy for reducing the incidence of progression of retinopathy appears warranted.
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