Treatment of diffuse diabetic maculopathy with intravitreal triamcinolone and laser photocoagulation: randomized clinical trial with morphological and functional evaluation

Abstract

Purpose: Treatment of diffuse macular edema in diabetes mellitus is currently unsatisfactory. The purpose of this double blind randomized clinical trial was to compare the treatment of diffuse diabetic macular edema with intravitreal triamcinolone or laser in type 2 diabetes mellitus patients using a morphofunctional assessment. Methods: Fourteen patients (21 eyes) with clinically significant diffuse macular-edema, previously untreated and with a macular thickness >250 μm at optical coherence tomography were randomized for treatment with laser or intravitreal injection of triamcinolone acetate. Optical coherence tomography, biomicroscopy, fundoscopy, fluorescein angiography, tonometry, scotometry, visual and contrast acuities were performed at 0, 1, 3 and 6 months. Results: At pre-treatment stage, Laser (n=9) and Triamcinolone (n=12) groups did not differ regarding retinal thickness, visual and contrast acuities. In Triamcinolone group macular thickness decreased after 1 month (424.1 ± 19.9 μm to 358.4 ± 18.2 μm; p=0.04) and started to return to the initial values in the 3 rd month (p=0.02). No changes occurred in macular scotometry and visual and contrast acuities. No side effects were observed with both treatments. Conclusion: During the study macular thickness diminished in the triamcinolone group, especially in the first month of treatment. At 3 and 6 months there was no difference. Macular thickness did not change during the study in the laser group. In the study sample it was not possible to demonstrate differences relates to visual acuity and scotometry between the two groups. ClinicalTrials.

Macular Laser Grid Alone Versus Combined With Intravitreal Triamcinolone Plus Bevacizumab for Diabetic Macular Edema

“…10,11 This is supposed to be the first study comparing MLG alone and combined with IVTA + IVB for treatment of diffuse DME as our knowledge. 17,18 , IVB vs IVTA + IVB 19 , IVB vs IVTA + MLG20, IVB vs MLG 21 and IVB vs IVB + MLG 22 . There was modest correlation between CMT and visual acuity after focal laser treatment for DME.…”

Corticosteroidi per via Intravitreale per il Trattamento Dell'edema Maculare: Revisione e Valutazione Della Qualità Dell'evidenza

“…Iluvien® rilascia inizialmente 0,25 µg di FA/die. Gli studi SCORE (68, 69), DRCR.net (2009) (59) e DRCR.net (2010) (60) hanno sperimentato con una sospensione di PFTA approvata negli Stati Uniti, Trivaris®; lo studio IBEME (63) e quello di Ding et al (71) hanno utilizzato PFTA preparato dal laboratorio Ophthalmos (Sao Paulo, Brasile) e da Pharm Co (Kunming, China), mentre che per lo studio di Gil et al (61) è stata utilizzata una preparazione di PFTA non specificata. Gli altri studi (56-58, 62, 64, 70, 72) hanno applicato una sospensione di TA non specificata dagli articoli.…”

Intravitreal Triamcinolone Acetonide in the Treatment of Ophthalmic Inflammatory Diseases with Macular Edema: A Meta-Analysis Study

“…A total of 8 studies met the inclusion criteria and were finally included in this review for quantitative analysis. 13,[28][29][30][31][32][33][34] The main characteristics of the studies reviewed are outlined in Table 1. Five studies 28-32 were conducted on patients with DME and one 13 on patients with cystoid macular edema secondary to both diabetic and retinal vein occlusion, all treated with either intravitreal TA or laser photocoagulation as standard of care (Table 1).…”