Anterior Subtenon’s Triamcinolone Acetonide (ASTA) Injection for the Treatment of Diabetic Macular Edema: 4 to 6 Month Clinical Followup

Abstract

Abstract: : Purpose: While intravitreal injection of steroid is under study for the treatment of diabetic macular edema (DME), anterior subtenon's triamcinolone acetonide injection (ASTA) may provide an alternative method of steroid delivery in certain clinical situations. The objective of this study is to evaluate the safety and efficacy of ASTA in patients with DME. Methods: This is a retrospective review of patients with DME who were injected with 20 mg of Kenalog® into the anterior subtenon’s space. They had eye exams that included best–corrected visual acuity assessments, intraocular pressure measurements, fluorescein angiography, and optical coherence tomography. Retinal thickness was determined on OCT by manual measurement of absolute thickening (actual measurement in µm minus 175 µm) at the center of the fovea. Results: 9 eyes of 8 patients with DME were examined (5 males, 3 female, average age 65 years, age range 53–74 years). Follow–up of patients ranged from 4 months to 7 months. Clinically, 6/9 eyes showed an improvement in DME as measured by OCT with an absolute retinal thickening decrease over the treatment period of 116 µm +/– 88 µm*. 1/9 showed no change and 2/9 worsened. Of the 6 eyes with an absolute retinal thickening decreased over the treatment period, 3/6 showed improved visual acuity and 3/6 showed stable visual acuity. None of the eyes required intraocular pressure–lowering therapy during the treatment period. No other complications were noted. Conclusions: Early clinical experience with ASTA suggests a modest therapeutic effect on DME. ASTA may offer an alternative to intravitreal steroid injection, with a different morbidity profile. (* = mean +/– standard deviation).

Keywords: diabetes • diabetic retinopathy • injection