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D. I. Sanchez Chicharro, Sr., M. I. Lopez-Galvez, I. Fernandez, E. Rodriguez de la Rua, Sr., J. C. Pastor, Sr.; Efficacy of a Single Intravitreal Injection of Triamcinolone Acetonide for Diffuse Diabetic Macular Edema. Invest. Ophthalmol. Vis. Sci. 2008;49(13):3474.
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Intravitreal triamcinolone acetonide (TA) for diffuse diabetic macular edema (DME) is still a matter of controversy. Although some prospective, randomized controlled clinical trial are now being conducted no definitive results have been supplied. Thus, information from small non-randomized series is still valuable.
Descriptive, retrospective, non randomized study without control has been done on 35 eyes of 27 diabetic patients (15 with insulin, 7 oral hypoglucemiants and 5 insulin + hypoglucemiants) with DME treated with a single injection of TA. After checking a negative response to topical dexamethasone test, 4mg of TA (Trigon Depot®) were intravitreally injected. Mean follow up was 7.4±3.6 months (minimum 3 months). Visual Acuity (VA) estimated by Snellen chart was considered as main outcome, and persistency of angiographic macular leakage (AML) as secondary outcome. Statistical analysis was performed by contingency tables, Chi-square and Fisher exact test.
Median pre-operative VA was 0.16±0.2 observing an improvement of two or more lines in 31.4% of eyes at first month after injection and 34.3% at the end of follow up. OCT showed a reduction (p:0.006) of retinal thickness (445 µ ± 70.2 to 260 µ ± 34.3). No significant relationship was observed between VA and OCT. AML was resolved in 42.9% of patients at first month, but persisted in 77.1% by the end of the study. Absence of AML was related to a better final VA (OR 0,095; 95% CI 0,015-0,599). A major effect on VA was observed among patients treated with insulin + oral hypoglucemiants (p:0.02). Seven eyes developed ocular hypertension (3 the day after the injection and 4 at the first month). All were controlled by topical treatment. No endophthalmitis were observed.
Results in this series were similar to others. In addition, a significant relationship was observed between VA and AML during follow up. Patients with combined systemic treatment of insulin + oral hypoglucemiants seemed to have a better response to the intravitreal TA in the control of DME. These findings deserve further studies.
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