Trans–Tenon’s Triamcinolone Acetonide Infusion for the Primary Treatment of Diabetic Macular Edema

Abstract

Abstract: : Purpose: To study the effects of trans–Tenon’s triamcinolone acetonide (TA) infusion for the primary treatment of diabetic macular edema (DME). Methods: Prospective monocentric pilot study of patients who had received a posterior trans–Tenon’s infusion of 40mg TA as the primary treatment of DME. Included were 32 eyes of 29 patients (aged 28 to 78 years). All eyes were examined before and during post–treatment follow–up periods with measurements of visual acuity, intraocular pressure (IOP), flare in the anterior chamber, and fluorescein angiography (FA). The feature of macular edema and the central macular thickness measured by optical coherence topography (OCT) were also observed. Results: Mean follow–up period was 6.8 ± 4.2 months (range, 3 to 16 months). The central retinal thickness had reduced after trans–Tenon’s TA injection, however the edema recurred in 7 eyes (21.9%) after trans–Tenon’s TA injection. In the final examinations with and without additional TA infusion, the central retinal thickness had significantly reduced after trans–Tenon’s TA injection in 24 (75 %) of the 32 eyes, unchanged or worsened in 3 eyes (9%). Visual acuity improved in 20 eyes (63%), remained in 10 eyes (31%), and reduced in 2 eyes (6%). The features of macular edema were categorized into 3 types, cystoid, diffuse, and mixed (cystoid + diffuse) edema types. Trans–Tenon’s TA infusions were effective in 7 (88%) of the 8 eyes with cystoid edema, and 3 (100%) of the 3 eyes with diffuse edema type, whereas it is effective only in 14 (67%) of the 21 eyes with mixed edema type. IOP elevations equal to or more than 21 mmHg were observed in 4 (13%) of the 32 eyes. Conclusions: Our results showed that trans–Tenon’s infusion of TA is effective for the primary treatment of DME akthough care should be taken about IOP elevation after TA infusion.

Keywords: diabetic retinopathy • corticosteroids • diabetes