Vitrectomy versus Intravitreal Triamcinolon in Eyes With Persistent Diffuse Diabetic Macular Edema – A Prospective Trial

Abstract

Abstract: : Purpose: To compare ppVE and intravitreal Triamcinolon for persistent diabetic macular edema in a randomized clinical trial. The 3 month results are reported here. Methods: Eyes with a history of diffuse diabetic edema for a minimum of 6 months and a grid laser treatment at least 4 months before were included. The eyes were randomized either to a vitrectomy group or to an intravitreal Triamcinolon group. Parameter of interest were visual acuity for far (ETDRS charts) and near distance (Jaeger charts) as well as OCT measurements of the retinal thickness. Results: 47 eyes of 47 patients could be evaluated. Initial average ETDRS vision was 0.28 in the vitrectomy group and 0.26 in the Triamcinolon group. After 1 and 3 months it increased to 0.30 and 0.31 respectively in the vitrectomy group and to 0.36 in the Triamcinolon group. One month postoperatively 80% of the eyes in the vitrectomy group compared to 95% of the eyes in the Triamcinolon group were improved or unchanged. 3 months postoperatively 84% of the vitrectomized eyes in comparison to 100% of the injected eyes were improved or stable. Initial average reading vision was 12.2 in the vitrectomy group and 12.18 in the Triamcinolon group. One and 3 months after surgery it improved to 11.28 and 10.88 respectively in the vitrectomy group as against 11.13 and 11 in the Triamcinolon group. One month postoperatively 92% of the eyes in the vitrectomy group compared to 86% of the eyes in the Triamcinolon group were better or unchanged. 3 months postoperatively 92% in comparison to 91% were at least stabilized. Initial average retinal thickness was 544µ in the vitrectomy group and 664µ in the Triamcinolon group. After one month it decreased significantly to 482µ in the vitrectomy group and to 432.5µ in the Triamcinolon group. Thereafter it remained unchanged in the vitectomy group but it increased to 456µ in the Triamcinolon group. Conclusions: Both vitrectomy and intravitreal Triamcinolon show a high rate of postoperative functional improvement or stabilization and decrease of retinal thickness in eyes with persistent diabetic edema. During a 3 months follow up Triamcinolon was more effective with regard to ETDRS vision and OCT measurements. Reading vision was equal in our study. Long term results are needed.

Keywords: diabetic retinopathy • vitreoretinal surgery • corticosteroids