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R. Jorge, M.A. Bonini–Filho, D. Calucci, J.A. Cardillo, R.A. Costa; Intravitreal Injection versus Sub–Tenon’s Infusion of Triamcinolone Acetonide for the Management of Refractory Diabetic Macular Edema . Invest. Ophthalmol. Vis. Sci. 2005;46(13):1435.
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Purpose: To compare the effectiveness of posterior sub–tenon’s infusion and intravitreal injection of triamcinolone acetonide for the treatment of diabetic macular edema unresponsive to laser photocoagulation. Methods: A total of 36 phakic diabetic eyes with clinically significant macular edema unresponsive to laser photocoagulation and a central macular thickness of more than 300 µm were prospectively enrolled in the study. Patients randomly received either a single 40 mg sub–tenon’s infusion (Group I) or one 4 mg intravitreal injection (Group II) of triamcinolone acetonide. Comprehensive ophthalmic examination and optical coherence tomography evaluation were performed at baseline and 1, 2, 4 ±1, 8 ±2, 12 ±2 and 24 ±2 weeks after the treatment procedure. Results: Twenty–eight patients completed the 24–week period of the study (eight patients lost follow–up and were consequently excluded). Mean improvement in LogMAR visual acuity from baseline was 0.03, 0.06, 0.09, 0.12, 0.10, and 0.03 for Group I patients, and 0.00, 0.11, 0.23, 0.28, 0.19, and 0.17 for Group II patients, at week 1, 2, 4 ±1, 8 ±2, 12 ±2, and 24 ±2, respectively. There was significant improvement in visual acuity in Group II patients 4 and 8 weeks after injection, when compared to group I patients (p<0,05). The central macular thickness measured by OCT decreased by 4.02%, 2.03%, 6,38%, 5.68%, 1.38%, 0.41%, respectively, over these same intervals from an initial pretreatment mean of 432,8 µm for group I patients and 6.41%, 17.24%, 37.81%, 37.09%, 37%, 19.13% for group II patients, which had an initial pretreatment mean of 476,43 µm. There was significant reduction in central macular thickness in group II eyes when compared to Group I at 4, 8 and 12 weeks after injection (p<0,05). Intraocular pressure exceeded 21 mmHg in one patient from group I. No patient had cataract progression during the study. Conclusions: Intravitreal injection of triamcinolone is more effective to improve visual acuity and to reduce central macular thickness in refractory diabetic edema cases 4 and 8 weeks after injection, when compared to subTenon’s injection. Although a significant reduction in macular thickness persists12 weeks after intravitreal injection compared to subtenon's infusion, it is not associated with a significant improvement in visual acuity.
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