Diabetic Macular Edema : Juxtascleral (JS) versus Intravitreal (IV) Triamcinolone Acetonide (TA) Injections

Abstract

Abstract: : Purpose: To evaluate the short–term efficacy of juxtascleral triamcinolone acetonide (JSTA) versus intravitreal triamcinolone acetonide (IVTA) injections on macular thickness measured by Optical Coherence Tomography (OCT) and on visual acuity (VA) in eyes affected by diffuse diabetic macular edema (DME) refractory to laser treatment. Methods: Eyes of diabetic patients affected by DME without vitreo–retinal interface anomalies are being randomized to one of the following two treatment groups: JSTA (group 1) and IVTA (group 2). All patients had normal intraocular pressure (IOP) and underwent previous laser treatment of posterior pole. At present are included in group 1 (JSTA) 9 eyes of 9 patients, and in group 2 (IVTA) 14 eyes of 14 patients. Controls (complete ophthalmological examination, OCT, fundus photographies) were scheduled at days 0, 7, 30, 90, 180. Fluorescein angiography was scheduled at days 0, 30, 90,180. The patients of group 1 that, at seven days control, showed a decrease of DME ≤ 100 µ m on OCT, underwent a second injection (JSTA). Results: Seven days after injection, macular thickness significantly decreased only in group 2 (mean Δ thickness: – 47.5 ± 125 µ m in group 1; mean Δ thickness: – 316.3 ± 159 µ m in group 2) while VA significantly increased in both groups (mean Δ VA : 0.1 ± 0.21 in group 1; mean Δ VA : 0.2 ± 0.17 in group 2). Pearson’s p was respectively – 0.2 in group 1 and – 0.3 in group 2. 5 patients of group 1, that showed a decrease of DME ≤ 100 µ m, underwent a 2^nd JSTA injection. After 30 days macular thickness was significantly decreased in both groups (mean Δ thickness : – 150.5 ± 162 µ m in group 1 and – 357.3 ± 149.4 µ m in group 2). The mean Δ VA was 0.09 ± 0.10 in group 1 and 0.23 ± 0.17 in group 2. Pearson’s p was respectively 0.1 and 0.018. Conclusions: Both JSTA and IVTA injections can rapidly reduce DME and increase VA. IVTA appears to be more effective in short–term. Longer follow–up would enable the assessment of long–term effectiveness of both techniques.

Keywords: diabetic retinopathy • drug toxicity/drug effects • imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound)