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J.P. Kytö, E. Lumiste, P.A. Summanen; Intravitreal Triamcinolone in Severe Bilateral Diabetic Cystoid Macular Edema . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3847.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the effect and safety of intravitreal triamcinolene acetonide (IVT) in bilateral severe diabetic cystoid macular edema (CME) – best corrected visual acuity (BCVA) in the better eye < 0.3
12 eyes of 9 patients (6 men) aged 53 ± 15 with DM 17 ± 6 years (T1DM, LADA, T2DM, each n = 3), HbA1c 9.5 ± 1.2%, 8 on hypertensive medication, were treated for refractory CME (1.3 ± 1.0 year). Optical coherence tomography (OCT) revealed the mean minimum macular thickness of 600 µm (459–863 µm). The mean IOP was 16 ± 2 mmHg. Two eyes were pseudophakic and one had slight axial opacity. BCVA using ETDRS chart (2 and 1 m) expressed as logMAR was 1.0 ± 0.3 before treatment with IVT – the median dose of 6.0 mg (4–6.8 mg). Antibiotic drops were used pre– and postoperatively. Follow–up: 4 days, 2 weeks, and monthly for one year.
All patients had the minimum follow–up of one year. By 2 months' follow–up, 11/12 eyes (92%) achieved clinical response, but edema recurred in 6/11 eyes (54%), mainly between 4 and 6 months. Vision improved somewhat in all and to logMAR 0.5 in 4/12 (33%). Median macular thickness was lowest, 293 µm (183–433 µm), at 2 and 3 months. IOP increased > 21 mmHg in 9/12 (75%). Posterior subcapsular cataract occurred in 9/9 eyes – in 3 after one year. No endophthalmitis arose. RPE atrophy in the macula appeared in 4/12 eyes. 2 eyes received a second IVT, 6 eyes underwent cataract extraction and 4 eyes vitrectomy (2 because of vitreous haemorrhage and 2 traction).
We aimed at prolonged duration of IVT effect using a higher dose than 4 mg since the optimal dose remains unknown. In spite of the side–effects and the limited duration of the effect of a single injection, IVT is a valuable adjuvant therapy for diabetic CME.
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