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D. Roman Pognuz, A. Polito, P. Monaco, A. Dimastrogiovanni, P. Lanzetta, F. Bandello; Intravitreal Triamcinolone as an Adjunctive Treatment to Panretinal Photocoagulation for Proliferative Diabetic Retinopathy . Invest. Ophthalmol. Vis. Sci. 2005;46(13):1437.
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Purpose: To evaluate the effects of intravitreal injection of triamcinolone acetonide (IVTA) as an adjunctive treatment to laser panretinal photocoagulation (PRP) in the treatment of proliferative diabetic retinopathy (PDR). Methods: This prospective interventional case series included 9 patients with bilateral mild to high–risk PDR. In all patients one eye received one intravitreal injection of 4 mg of TA before PRP (IVTA+PRP eyes), and the other underwent PRP alone and served as control (control eyes). PRP was performed 1 month after the injection in the IVTA + PRP eyes. The main outcome measure was change of the planimetric area (mm2) occupied by fluorescein leakage (PAFL) from new vessels on the optic disc (NVD) or elsewhere (NVE) at 1, 3 and 6 months. Secondary endpoints were change in ETDRS visual acuity, change in central macular thickness (CMT) on optical coherence tomography (OCT), IOP, and progression of cataract. Results: All patients completed 3 months and 6 patients 6 months of follow–up. At baseline, mean (SD) PAFL from NVD and NVE was 7.22 (5.70) mm2 in IVTA + PRP eyes and 9.08 (6.17) mm2 in control eyes. At 1 month it was 3.09 (2.20) mm2 in IVTA + PRP eyes and 6.91 (5.10) mm2 in control eyes (P= 0.038), after 3 months it was 1.97 (2.02) mm2 and 6.49 (6.04) mm2 (P=0.008), and after 6 months it was 1.93 (2.41) mm2 and 8.11 (4.97) mm2 (P=0.028, bilateral Wilcoxon test for paired samples), respectively. At baseline mean (SD) CTM was 372.11 (91.88) µm in IVTA + PRP eyes and 333.44 (106.51) µm in control eyes. At 3 months it was 243.89 (52.10) µm in IVTA + PRP eyes and 355.33 (104.19) µm in control eyes (P=0.021), and after 6 months it was 247.50 (42.48) µm and 348.17 (110.27) µm (P=0.046), respectively. TA+ PRP eyes gained 2 lines and control eyes lost 1 line at 6 months (P=0.044). In 5 of the 9 IVTA + PRP eyes, IOP exceeded 21 mmHg, and was controlled by topical medications. No cataract progression or other injection related complications were observed in our study. Conclusions: IVTA, by significantly reducing the leakage from NVD and NVE and CMT, may be useful in increasing the beneficial effects of PRP.
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