Abstract
Abstract: :
Purpose: To investigate the safety and efficacy of intravitreal triamcinolone for the treatment of diabetic macular edema refractory to laser photocoagulation. Methods: The medical records were reviewed of all patients treated for diabetic macular edema refractory to laser photocoagulation with 4mg/0.1cc intravitreal triamcinolone acetonide by two vitreoretinal surgeons at a single institution between January 1, 2001 and August 31, 2002. Results: The study included 14 eyes of 14 patients with a median age of 66 years (range, 32-80 years) and followed for a median of 4.5 months (range, 1-6 months). The median duration of macular edema was 18 months (range, 6-54 months). Median visual acuity was 20/300 (range, 20/60-CF) pre-treatment, 20/200 (range, 20/40-20/400) at 1 month following treatment, 20/150 (range, 20/25 to 20/400) at 3 months, and 20/100 (range, 20/25-20/400) at 6 months. The mean change in logMAR visual acuity was 0.3 (halving of the visual angle) at both 3 and 6 months (range, -0.3 to 0.6). Vision improved at 1, 3, and 6 months post-injection (p=0.23, p=0.019, and p=0.093, respectively, paired t-test). Visual acuity was improved by at least one Snellen line in 8/13 eyes (62%) at 1 month, 7/10 (70%) at 3 months, and 5/7 (71%) at 6 months. Visual acuity was stable in 3/13 eyes (23%) at 1 month, 2/10 (20%) at 3 months, and 1/7 (14%) at 6 months. Compared to baseline, acuity was decreased in 2/13 patients (15%) at 1 month, 1/10 (10%) at 3 months and 1/7 (14%) at 6 months. Median foveal thickness as measured by optical coherence tomography (OCT) was 453 µm (range, 259-755 µm) at baseline, compared to 255 µm (range 154-350 µm) at 1 month, 251 µm (range, 116-434 µm) at 3 months, and 214 µm (range, 192-268 µm) at 6 months. Mean foveal thickness decreased at 1, 3, and 6 months post-injection (p=0.017, 0.039, and 0.056, respectively, paired t-test). Intraocular pressure (IOP) was increased >10 mmHg compared to baseline in 3/13 patients (23%) at 1 month, 1/10 (10%) at 3 months, and 1/7 (14%) at 6 months following injection. Two patients (14%) developed recurrence of macular edema and underwent a second injection of intravitreal triamcinolone acetonide. Two patients (14%) experienced progressive lens opacification. No other adverse events occurred. Conclusions: In the current series, intravitreal triamcinolone acetonide was associated with a reduction in macular edema and visual acuity improvement in most patients with diabetic macular edema refractory to laser photocoagulation.
Keywords: diabetes • clinical (human) or epidemiologic studies: out • diabetic retinopathy