Sub Tenons Injection of Triamcinolone Acetonide in the Management of Persistent Diabetic Macular Edema

Abstract

Abstract: : Purpose: To assess the efficacy of subtenons Triamcinolone Acetonide (Kenalog) in the management of persistent diabetic macular edema. Methods: Subtenons injections of 40mg of Triamcinolone were performed in 21 patients with persistent diabetic macular edema unresponsive to macular laser photocoagulation. Best corrected visual acuities were measured and optical coherence tomography performed pre and post injection in all patients and compared using statistical analysis. Change in macular thickness as measured by OCT was used as the primary outcome variable. Results: OCT demonstrated a reduction in average central retinal thickness from 415 microns pre–injection to 292 microns post injection (p<0.0001). Mean foveal thickening was reduced by an average of 57%. Mean visual acuity (converting to logmar visual acuities for statistical analysis) improved from 20/70 to 20/50 following injection (p<0.0005). An improvement in visual acuity of 2 lines or greater was seen in 38% of patients at the most recent follow–up visit . Stabilization or improvement in vision was seen in 20 of 21 patients (96%) with one patient losing one line of visual acuity. IOP increased from a median of 15.5mmHg pre injection to21mmHg post injection at the last follow up (p=0.006). One patient was maintained on glaucoma medication who had not previously been treated. No other complications were noted after an average follow up time of 107 days. No patient has had a repeat injection performed. Conclusions: Posterior subtenons injection of 40mg of Triamcinolone appears to be safe effective in reducing macular thickening and improving or stabilizing vision in patients with persistent macular edema secondary to diabetic retinopathy. Subtenons injection should be considered prior to performing an intravitreal injection of corticosteroids for similar indications.

Keywords: diabetic retinopathy • retina • corticosteroids