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A. Meza-de Regil, C.S. Martínez-Jardón, C. Leizaola-Fernandez, J.L. Guerrero-Naranjo, H. Quiroz-Mercado; Intravitreal Triamcinolone Acetonide (Kenalog(R)) for the Treatment of Persistent Diffuse Macular Edema in Diabetics . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4002.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To evaluate the efficacy of intravitreal injection of triamcinolone acetonide in treating diffuse diabetic macular edema unresponsive to conventional laser photocoagulation. Methods:50 diabetic patients were diagnosed with diffuse clinically significant macular edema over an average duration of 24 months (range 8 to 48 months). During this time they received an average of 2.1 macular laser treatments (range 2 to 3). Upon presentation they were determined to have refractory edema despite adequate macular grid photocoagulation. On optical coherence tomography (OCT) minimal central macular thickness exceeded 300µ in all patients (normal <200µ). After signed informed consent, patients were injected with 0.1cc of triamcinolone acetonide (4mg) through pars plana. Response to therapy was monitored with OCT and ETDRS visual acuity (VA) chart Results: Mean initial central macular thickness measure was 493 µ (range: 268 to 1000) by OCT. After intravitreal injection, macular thickness decreased to 318 µ (range: 200 to 390) at 15 days, to 255µ (range: 128 to 350) at 1 month, to 183µ (range: 128 to 248) at 3 months and to 231 µ (140 to 290) at 6 months. Mean initial VA (logMAR) was -1.4 (range -2.7 to -0.52) prior to injection. At 1 month post injection mean VA was -1.4 (range -1.4 to -0.1) and -1.18 (range -1.4 to -0.1) at 3 months post injection. Mean intraocular pressure was 14.30 mmHg (range: 8 to 20) prior to injection and 16.46 mmHg (range 10 to 25), 15.44 mmHg (range 10 to 20), 14.9 mmHg (range 9 to 24), and 16.8 mg (range 12 to 21) at 15 days, 1, 3 and 6 months respectively. 7 patients (14 %) required temporary ocular anti-hypertensive therapy. There was 1 case of sterile endophthalmitis (that responded to intravitreal antibiotics and steroids) and in one eye, as intravitreal injection was performed, triamcinolone passed to the anterior chamber (it resolved spontaneously). Conclusions: Intravitreal triamcinolone appears to be an effective treatment for diffuse diabetic macular edema unresponsive to grid photocoagulation, with minimal complications.
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