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D. Roman Pognuz, F. Menchini, A. F. Dimastrogiovanni, A. Papayannis, L. Morgante, A. Polito, J. Paissios, P. Lanzetta, F. Bandello; Intravitreal Injection versus Posterior Juxtascleral Infusion of a New Formulation of Triamcinolone Acetonide for Refractory Diabetic Macular Edema. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5037.
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To compare the effectiveness of posterior juxtascleral infusion (PJI) of a new formulation of triamcinolone acetonide (TA) versus the intravitreal injection (IVI) of commercially available formulation for the treatment of refractory diffuse diabetic macular edema.
Non randomized clinical trial. Retrospective review of 40 consecutive patients with refractory diabetic macular edema. Patients received either 40 mg of TA, mixed with 20 mg sodium chondroitin sulphate and 15 mg sodium hyaluronate (1.5 ml), PJI or 4 mg IVI of TA. The higher viscosity, obtained by mixing the TA with sodium chondroitin sulphate and sodium hyaluronate, may represent an advantage over the standard formulation of TA in avoiding reflux.All patients reached 6 months follow-up. Comprehensive ophthalmic evaluation was performed at baseline and 7 days, 1, 3, and 6 months. Macular morphologic changes detected by optical coherence tomography (OCT), visual acuity (VA), and intraocular pressure (IOP) were evaluated.
A total of 20 eyes were treated with PJI of TA and 20 underwent IVI of TA. Both groups were similar with regards to age, duration of diabetes, macular retinal thickness and visual acuity. In PJI treated patients, mean (SD) central macular thickness (CMT) decreased from 433.0 (114.3) µm at baseline to 301.0 (95.2), 276.2 (65.7), 288.7 (75.7) and 342.8 (109.2) at 7 days, 1, 3 and 6 months. In IVI treated patients, mean (SD) CMT decreased from 454.0 (85.54) µm at baseline to 377.6 (112.8), 288.1 (71.6), 309.8 (111.1) and 358.4 (123.1) at 7 days, 1, 3 and 6 months. In PJI treated patients, mean VA (in logarithm of the minimal angle of resolution [logMar]) increased from 0.57 (0.37) at baseline to 0.46 (0.38), 0.44 (0.34), 0.38 (0.26) and 0.37 (0.25) at 7 days, 1, 3 and 6 months. In IVI treated patients, mean VA increased from 0.69 (0.41) at baseline to 0.53 (0.36), 0.54 (0.34), 0.53 (0.35) and 0.56 (0.36) at 7 days, 1, 3 and 6 months. Macular edema recurred in 7 patients treated with PJI and 9 eyes vith IVI. Intraocular pressure exceeded 21 mmHg in 7 eyes treated with PJI and 8 eyes with IVI. In PJI treated patients no reflux was observed.
In this retrospective study the changes in central macular thickness and visual acuity observed after treatment suggest that results obtained with PJI of a new formulation of TA are similar to those obtained with IVI of TA for the management of refractory diabetic macular edema, without the side effects, such as endophthalmitis or retinal detachment, reported with IVI.
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