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M. Timmermann, J. Riese, V. Loukopoulos, C. Meier, H. Gerding; Focal Laser Photocoagulation Facilitated by Previous Intravitreal Triamcinolone in Eyes With Clinically Significant Diabetic Macular Edema: 6 Months Results. Invest. Ophthalmol. Vis. Sci. 2008;49(13):3477. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To perform a 6 months interim analysis on the development of visual acuity, OCT central foveal thickness, and fluorescence angiographic findings after combined intravitreal triamcinolone (4 mg) and focal laser photocoagulation in eyes with clinically significant diabetic macular edema.
Retrospective analysis of 47 eyes (47 patients, mean age 68 +/- 9.5 years) with persistent macular edema due to diabetic retinopathy. Patients received an intravitreal injection of 4 mg triamcinolone and laser coagulation (dense focal grid coagulation) after subsequent remission of edema within the previously edematous area. 26 patients received 1, 15 patients 2, 7 patients 3, 3 patients 4, and 1 patient 5 sessions of laser treatment after the first injection of triamcinolone. The first laser application was performed at a median of 18 days after triamcinolone injection (range: 14 - 70 days). Standardized clinical examinations were including best corrected visual acuity testing, anterior and posterior segment biomicroscopy, IOP, and OCT before triamcinolone injection and at day 1, after 1 week, 2 weeks, 1 month, 2 months, 3 months and 6 months postoperatively. Fluorescein angiography was performed before triamcinolone injection and 3 and 6 months later. 3 patients received a second injection and photocoagulation at 3 months and 8 patients at 6 months, respectively.
Mean visual acuity improved from baseline 0.32 (+/- 0.17, n=47) to 0.36 (+/- 0.24, n=44, p<0.025) after 1 month, 0.38 (+/- 0.22, n=41, p<0.05) after 3 months, and 0.41 (+/- 0.21, n=30, p<0.05) after 6 months. OCT-central foveal thickness of preoperatively 421µm (+/- 112) decreased to 309µm (+/- 75) at 1 month (n=32, p<0.00025), 324µm (+/- 96) at 3 months (n=32, p<0.001), and 352µm (+/- 123) after 6 months (n=25, p<0.05). In all cases a significant reduction of macular and foveal edema was observed at 3 and 6 months follow-up fluorescence angiography. 28% of the patients developed a secondary ocular hypertension which was controlled by local therapy
According to these previous results a combination of intravitreal triamcinolone injection and subsequent laser photocoagulation is an effective treatment for cases with clinically significant diabetic macular edema. Contrary to previous strategies, triamcinolone offers a better approach to photocoagulation of diseased retinal areas during the time period of edema regression.
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