Abstract
Abstract: :
Purpose: To evaluate the visual outcomes and stability of refractory diabetic macular edema (DME) after intravitreal triamcinolone acetonide (IVTA) injection. Methods: Retrospective medical record review of 24 eyes with refractory DME that had either one or a series of 1 to 3 injections of IVTA between October 2002 and April 2003 was performed. All eyes had undergone previous focal macular laser (FML) treatment and 16 eyes had also received previous periocular corticosteroid injection. Relevant clinical findings, fluorescein angiography, and optical coherence tomography results were complied onto a Microsoft Excel spreadsheet for statistical analysis. Minimum follow up was 6 months. Results:After a series of 1 to 3 IVTA injections, best corrected visual acuities (BCVA), intraocular pressures (IOP), and the stability of DME were examined. BCVA at baseline ranged from 20/40 to 20/400. The mean BCVA at baseline was 20/200, which improved at 1 month, 3 months, and 6 months post–injection to 20/140, 20/160, and 20/180, respectively. The mean number of lines of visual improvement was 1.5 at 1 month post–injection and 1 line at 3 months and 6 months post–injection. 83% of eyes had stable or improved visual acuity at six months post–injection. Decreased or resolved DME was observed in 63%, 30%, and 37% of eyes at 1 month, 3 months, and 6 months post–injection, respectively. Persistent but stable DME was observed in 33%, 37%, and 33% of eyes at 1, 3, and 6 months post–injection, respectively. Increased DME occured in 4%, 33%, and 29% of eyes at 1, 3, and 6 months post–injection, respectively. There was no previous history of glaucoma in any eye at baseline. IOP ranged from 11 to 26 at baseline, 10 to 28 at 1 month post–injection, 11 to 36 at 3 months post–injection, and 11 to 30 at 6 months post–injection. IOPs were >28mmHg in 8% of eyes at 1 month post–injection and in 4% of eyes at 3 and 6 months post–injection. There was a >6mmHg increase in IOP from baseline in 13% of eyes at 1 month post–injection and in 17% of eyes at 3 and 6 months post–injection. 79% required topical medications for post–injection IOP control, and no eye required further intervention. Conclusions: IVTA injection may be effective in improving visual acuity and refractory DME in eyes with a poor response to FML treatment. No adverse complications were observed in our study, and although there was an increased incidence of IOP elevation, this was temporary and effectively controlled with topical antiglaucoma medications alone.
Keywords: diabetic retinopathy • macula/fovea • corticosteroids