Intravitreal Triamcinolone Acetonide for the Treatment of Diabetic Macular Edema Refractory to Laser Photocoagulation

Abstract

Abstract: : Purpose: To investigate the clinical outcome and the safety of intravitreal injection of triamcinolone acetonide (TA) for the treatment of diabetic macular edema (DME) unresponsive to prior laser photocoagulation. Methods: This prospective clinical case series included eleven eyes of eleven diabetic patients that received at least two prior sessions of laser photohocoagulation, using ETDRS guidelines. Six months after the last unsuccessful laser treatment, in all cases visual acuity loss or unchanged from baseline was observed. The patients affected by Clinically Significant Macular Edema (CSME), diagnosed according to ETDRS criteria, received an intravitreal injection of 4 mg of TA. Results: All patients completed three months of follow–up, and eight of eleven patients completed 6 or more months of follow–up. Mean improvement in Snellen visual acuity measured 1.95 at one month, 1.8 at three months and 1.44 at six months after treatment. Mean foveal thickness as measured by Optical Coherence Tomography (OCT) decreased by 50.8%, 48.7% and 40.1% over this same follow–up intervals, respectively, from a pretreatment mean of 520 µm. We documented recurrence of macular edema in 2 eyes at six^th month. A transient IOP elevation occurred in 4 eyes (36%). After six months one eye showed cataract progression, whereas no other complications were observed. Conclusions:Intravitreal TA is a promising treatment for refractory diabetic macular edema. An improvement of DME and VA is observed in most patients, however CSME recurrence is possible. Complications do not appear to be prohibitive. OCT aids in the management of these cases.

Keywords: diabetic retinopathy • macula/fovea • laser