Efficacy and safety of suprachoroidal triamcinolone acetonide in cases of resistant diabetic macular edema

Tayyab, Haroon; Ahmed, Chaudhry Nasir; Sadiq, Muhammad Ali Ayaz

doi:10.12669/pjms.36.2.1194

Cited by 17 publications

(18 citation statements)

References 19 publications

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“…In our study, the improvement in CMT and BCVA was significant until the third month of post-injection in the IV and the 4 mg SC groups, which agreed with Tayyab et al, 20 who injected 4 mg SCTA into treatment-resistant DME, and had significant CMT and BCVA improvements at 1 and 3 months, although they did not follow the patients till 6 months to detect the persistence of this improvement. While Yousef et al had persistent significant improvement in CMT and BCVA till 6 months post-injection of 4 mg SCTA contradicting our results, we had definite regression in CMT in the 4 mg SCTA group at 6 months, although BCVA was relatively stable compared to 3 months.…”

Section: Discussionsupporting

confidence: 91%

Suprachoroidal versus Intravitreal Triamcinolone Acetonide for the Treatment of Diabetic Macular Edema

YG¹,

AG²,

AMA³

et al. 2022

OPTH

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Purpose This article aims to compare between intravitreal (IV) and suprachoroidal (SC) triamcinolone acetonide (TA) injection for the treatment of diabetic macular edema (DME) in terms of improvement in both best-corrected visual acuity (BCVA) and central macular thickness (CMT), and development of complications (intraocular pressure (IOP) rise and cataract progression), and to identify the efficient dose of TA using the SC route. Patients and Methods This prospective interventional randomized comparative study included 45 eyes of 32 patients, randomly divided into three groups, group I received 4 mg/0.1 mL intravitreal TA (IVTA), group II received 4 mg/0.1 mL suprachoroidal TA (SCTA), and group III received 2mg/0.1 mL SCTA. Patients were followed up for 6 months. Results At 1 month, a maximum reduction in CMT (147.33 ± 110.97 µm, 160.80 ± 98.25 µm and 65.64 ± 46.19 µm in groups I, II, and III, respectively) was observed, which was associated with the greatest improvement of BCVA (0.09 ± 0.09, 0.19 ± 0.10 and 0.10 ± 0.09 logMAR lines) in groups I, II, and III, respectively. At 3 months, CMT started to increase, and reduction was not statistically significant compared to baseline, except in group II (4 mg SCTA group) (149.80 ± 106.57 µm with P-value = 0.013). At 6 months, CMT and BCVA returned close to baseline except for group II which had a sustained reduction of 60.16 µm from baseline. Regarding steroid-related complications, IOP elevation of 10 mmHg or more was noted in 1 eye (6.7%), 2 eyes (13.3%), and 1 eye in groups I, II, and III, respectively. Three phakic eyes per group showed cataract progression. Conclusion SCTA is a safe and effective route for the treatment of DME, which has comparable effects to IVTA, and may even last longer.

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Section: Discussionsupporting

confidence: 91%

Suprachoroidal versus Intravitreal Triamcinolone Acetonide for the Treatment of Diabetic Macular Edema

YG¹,

AG²,

AMA³

et al. 2022

OPTH

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“…This elevation in the IOP may be due to higher IOP before injection or a large steroid dose. We also found that suprachoroidal TA is effective for treating DME, which agrees with the nding of Tayyab et al, [11], who included 24 patients with DME and found a signi cant rise in the BCVA and decrease in the Central Sub eld Thickness over three months follow-up.…”

Section: Summary Of the Main Ndingssupporting

confidence: 92%

Suprachoroidal triamcinolone versus Posterior subtenon triamcinolone either alone or formulated in the management of diabetic macular edema.

Tharwat

Ahmed

Eltantawy

et al. 2022

Preprint

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Purpose to compare Posterior Subtenon Triamcinolone acetonide (PSTA) injection either formulated or alone versus suprachoroidal triamcinolone in the management of diabetic macular edema.Methods This study is a prospective interventional study included 75 patients, divided into three groups, each group 25 patients. Group I received a combination of Triamcinolone Acetonide (TA) (40 mg) and VISCOAT, which a combination of sodium chondroitin sulfate (20 mg) and sodium hyaluronate (15 mg). The injection was done in the posterior subtenon space using NAGATA canula. Group II received TA (40 mg) in the posterior subtenon space. Group III underwent injection of 4 mg/100µl of TA in the supra choroidal space.Results We found a statistically significant difference between the three studied groups as regarding to BCVA and CMT at six months postoperative with highest median BCVA and lowest median CMT was observed in the formulated TA group. Conclusion We concluded that early treatment of DME by formulated TA is better than TA alone, and suprachoroidal TA in the form of increasing the BCVA and decreasing the CMT without any elevation of IOP.Trial registration number NCT05464953Date of registration 17/7/2022 (retrospectively registered)

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“…However, targeting the DME from the suprachoroidal space using triamcinolone acetonide may be effective. For persistent cases of DME in particular, 22 as the suprachoroidal space is full of aqueous and is 1 ml in volume, 23 the triamcinolone should be cleared from the suprachoroidal space within 8 weeks. 24 Targeting the suprachoroidal space may offer increased triamcinolone efficacy, as it will be less diluted in the suprachoroidal space versus the vitreous cavity, with less interaction with the angle of the anterior chamber.…”

Section: Discussionmentioning

confidence: 99%

Suprachoroidal injection of triamcinolone acetonide using a custom-made needle to treat diabetic macular edema post pars plana vitrectomy: a case series

Marashi¹,

Zazo

2022

J Int Med Res

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Objective Diabetic macular edema (DME), the most common cause of diabetes-related visual impairment, may occur following pars plana vitrectomy (PPV) to manage proliferative diabetic retinopathy complications. This retrospective single-centre case series evaluated the efficacy and safety of injecting 4 mg/0.1 ml triamcinolone into the suprachoroidal space using a custom-made needle to treat DME post PPV. Methods Data regarding central macular thickness (CMT) using spectral domain-optical coherence tomography and best-corrected visual acuity (by Snellen chart) at baseline (pre-injection), and at 1, 4, and 8 weeks following injection were analysed, along with intraocular pressure (IOP), cataract progression, and ocular safety. Results Eleven eyes in 10 patients received 11 suprachoroidal injections. Vision improvement was noted (0.75 log minimum angle of resolution (MAR) at baseline to 0.40 log MAR after treatment). CMT reduced significantly from 456.45 ± 113.42 μm at baseline to 247.63 ± 53.40 μm at 8 weeks following injection. No rise in IOP, or cataract development in the single treated phakic eye, was observed during 8 weeks of follow-up. Conclusion Suprachoroidal injection of triamcinolone using a custom-made needle to treat DME post PPV shows promising results with acceptable safety outcomes. Large clinical trials with longer follow-up are needed to evaluate this treatment option for countries with limited health-care resources.

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Efficacy and safety of suprachoroidal triamcinolone acetonide in cases of resistant diabetic macular edema

Cited by 17 publications

References 19 publications

Suprachoroidal versus Intravitreal Triamcinolone Acetonide for the Treatment of Diabetic Macular Edema

Suprachoroidal versus Intravitreal Triamcinolone Acetonide for the Treatment of Diabetic Macular Edema

Suprachoroidal triamcinolone versus Posterior subtenon triamcinolone either alone or formulated in the management of diabetic macular edema.

Suprachoroidal injection of triamcinolone acetonide using a custom-made needle to treat diabetic macular edema post pars plana vitrectomy: a case series

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