multiple intravitreal injections of triamcinolone for refractory diabetic diffuse macular edema

Abstract

Abstract: : Purpose: To evaluate the efficacy and safety of multiple intravitreal injections of triamcinolone acetonide for refractory diabetic diffuse macular edema. Methods: We reviewed the data of patients who had diabetic diffuse macular œdema refractory to laser phoocoagulation and received at least one intravitreal injection of 0.1ml of acetonide triamcinolone (40mg/ml) between september 2001 and september 2003. Patients were examined at Day 0, Day 15, Day 30 and every month during the study. The main outcome measure was central macular thickness (CMT) measured by Optical Coherence Tomography . Secondary outcomes were Early Treatment Diabetic Retinopathy Study (ETDRS) scores, intraocular pressure and cataract progression. Results: 23 eyes of 19 patients received a first intravitreal injection of acetonide triamcinolone, 18 of them received a second injection and five of them a third injection. Macular thickness decreased from 566.5 ± 148.5µm before treatment to 210.3 ± 44 µm at one month after the first intravitreal injection, 213 ± 76.4µm at three month (p<0.0001). At six month we observed an increase of macular thichness to 353.8 ± 152.7µm due to the recurrence of macular edema. After the second injection, macular thickness decreased from 531.6 ± 127.5µm to 217.9 ± 71.2µm at one month and 220.1 ± 64µm at three months (p<0.0003), but increased again to 460.1 ± 159.2µm at six months. ETDRS score improved from 43 ± 12.7 to 52 ± 10.8 at one month, to 50 ± 10.4 at three months and 50 ± 8.8 at six months (p<0.002) and decreased to 44 ± 11.6 at seven months after the first injection. After the second injection , ETDRS score improved from 43 ± 11.6 to 51 ± 12.2 at one month, 52 ± 15.1 at three months, 51 ± 14.1 (p<0.01) at six months and decreased again to 37 ± 20.9 at seven months. No significant difference in the efficacy of intravitreal triamcinolone was observed between the first and the second injections. Intraocular pressure raise was observed in 50% and 60% of eyes after the first and the second injections respectively. Lens opacities increased in 43.5% of eyes. No other complication was observed. Conclusions: Multiple intravitreal injections of acetonide triamcinolone are efficient to reduce macular thickness due to diffuse diabetic edema and improve visual acuity. The effect of intravitreal triamcinolone seems reproducible from one injection to another, and no major complication was observed in our study.

Keywords: diabetes • corticosteroids • macula/fovea