Abstract
Abstract: :
Purpose: To evaluate the efficacy and side effects of sub-tenon's triamcinolone acetonide injection for chronic diabetic macular edema (DME). Methods: Retrospective review of the medical records of 108 eyes (81 patients) with chronic DME who were treated with a series of sub-tenon's triamcinolone acetonide 40mg injections. The location of the injections was either inferior fornix or superotemporal quadrant. Most eyes were treated with focal laser prior to the study but had residual macular edema. None of the eyes underwent laser treatment during the study period. Patients were followed for changes in Snellen visual acuity, clinical resolution of macular edema, and elevation of intraocular pressure (IOP). Results: There were 81 patients (37 male/44 female) and 108 eyes in this series. Sixty-five patients were Caucasian and 16 were African-American. Patient age ranged from 35 to 86 (mean 64). Forty-six patients had Insulin-dependent diabetes mellitus (IDDM) and 35 had non-Insulin-dependent diabetes mellitus (NIDDM). Six patients had primary open angle glaucoma (POAG) under medical treatment prior to the study. Baseline visual acuity ranged from 20/20 to hand motion. Thirty-nine eyes had one injection; 22 eyes underwent two injections, and 47 eyes had three or more injections. The mean time between injections was four weeks. The mean follow-up period was 3.2 months. Forty-six eyes (43%) improved two or more lines of Snellen acuity. Forty-five eyes (42%) maintained stable vision within one acuity line. Only 16 eyes (15%) had worsening vision. The IOP of the treatment group at baseline, after injection #1, after injection #2, after injection #3 was >20mm Hg in 16%, 36%, 44%, and 34% of the eyes respectively. The percentage of eyes with IOP >28mm Hg at baseline, after injection #1, after injection #2, and after injection #3 was 0%, 7%, 12% and 12% respectively. Twenty-four (24%) of the treated eyes required glaucoma medications for IOP control. Conclusions: Sub-tenon's injection of triamcinolone acetonide is an effective way to treat refractory DME. Eighty-five percent of the eyes in this series had improvement or stabilization of vision. The most common side effect was elevated IOP which was effectively treated with topical medications alone.
Keywords: diabetic retinopathy • macula/fovea • pharmacology