Intravitreal triamcinolone acetonide as an adjuvant therapy to panretinal photocoagulation for proliferative retinopathy with high risk characteristics in type 1 diabetes: case report with 22 weeks follow‐up

Abstract

ABSTRACT.Purpose: To describe a new treatment protocol to deliver panretinal photocoagulation that may avoid further deterioration of vision in patients with type 1 diabetes mellitus with proliferative retinopathy with high risk characteristics for severe visual loss and cystoid macular oedema. Methods: Fundus photography, measurement of foveal thickness with optical coherence tomography and best corrected visual acuity (BCVA) determined by Snellen and ETDRS charts were measured before and after treatment in a 28-year-old man. Results: Over 9 weeks, BCVA improved from 0.05 to 0.25 and the number of letters read at 2 metres from four to 39 after panretinal photocoagulation and adjuvant intravitreal triamcinolone injection under intraconal anaesthesia. Foveal thickness decreased from 691 mm to 239 mm and cysts disappeared by 15 weeks. By 22 weeks, foveal thickness had increased to 282 mm and small cysts had reappeared, but BCVA remained at 0.2 and the number of letters read at 30. Conclusion: Proliferative retinopathy regressed, cystoid macular oedema disappeared and vision improved after panretinal photocoagulation and adjuvant intravitreal triamcinolone acetonide injection under intraconal anaesthesia. This represents a feasible option in cases where pain during laser treatment and impairment of vision afterwards due to cystoid macular oedema result in poor compliance with standard laser treatment under topical anaesthesia.

Photodynamic therapy with intravitreal application of triamcinolone acetonide in age‐related macular degeneration: functional results in 54 patients

“…triamcinolone acetonide in AMD (Schmidt-Erfurth et al 2003;Rechtman et al 2004;Jonas 2005;Krebs et al 2005;Kyto et al 2005;Augustin & Schmidt-Erfurth 2006;Chan et al 2006;Nicolo et al 2006), as well as in other ophthalmic diseases such as diabetic oedema (Jonas et al 2003a(Jonas et al , 2003b and CNV resulting from parafoveal telangiectasia (Smithen & Spaide 2004).…”

Assessing the Usage Anesthesia in the Surgical Treatment of Diabetic Macular Edema

“…Sample Size (Eyes) Besirli (2020) [4] Subconjunctival CA, LC the vast majority of healthcare professionals only use topical anesthetics [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. While subconjunctival anesthesia is known to reduce patient harm more than topical anesthetics, it has been demonstrated to increase the risk of subconjunctival bleeding [9] .…”

“…Our search results included 17 papers that discussed surgical techniques including anesthetics and people with diabetic macular edema. The papers that were selected for this investigation can be seen in Table 1 [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. The sample size, the application locations, the types of medications administered, and the types of anesthetics utilized were all information that was taken from each report (Figure 1).…”

Intravitreal triamcinolone as adjunctive treatment to laser panretinal photocoagulation for concomitant proliferative diabetic retinopathy and clinically significant macular oedema

“…These studies have prompted investigators to study the effect of intravitreal injection of TA on CSMO in patients treated with PRP (Beer et al. 2003; Kytö et al. 2005; Bandello et al.…”