Intravitreal Triamcinolone for the Treatment of Diabetic Macular Edema

Abstract

Diabetic macular edema is one of the leading causes of visual loss in first world countries and the first cause in diabetic retinopathy. The Early Treatment Diabetic Retinopathy Study showed a significant benefit in using focal laser photocoagulation for the treatment of macular edema, more specifically defined as clinically significant macular edema. Nevertheless, progressive visual loss is found in the 26% of patients with diabetic macular edema treated with photocoagulation. The failure of laser treatment and the destructive nature of the therapy has forced researchers to pursue new alternatives including vitrectomy with or without internal limiting membrane peels, the use of proteinkinase C inhibitors, intravitreal injections of antibodies that inhibit the vascular endothelial growth factor, somatostatin analog, or the intravitreal injection with corticosteroids. Triamcinolone acetonide is glucocoticosteroid with antiangiogenic and antiedematous properties. Publications evaluating the safety and efficacy of intravitreal injection of triamcinolone in the treatment of diabetic macular edema show varying outcomes with respect to the increases of visual acuity and decreases in foveal thickness. Despite this, intravitreal triamcinolone is a treatment that has evolved quickly and is considered increasingly useful.

The Combination of Intravitreal Bevacizumab and Phacoemulsification Surgery in Patients with Cataract and Coexisting Diabetic Macular Edema

“…triamcinolone acetonide alone. [26][27][28] However, the i.v.t. triamcinolone acetonide injection is not without potential risks, including transient rise in IOP, cataract progression, vitreous hemorrhage, retinal detachment, sterile pseudoendophthalmitis of uncertain etiology, as well as endophthalmitis.…”

Mechanistic Insights into Pathological Changes in the Diabetic Retina

“…Nevertheless, there is evidence that these inflammatory-like processes contribute to the pathogenesis of DR in both animal and patient studies, in that inhibition of proinflammatory enzymes or deletion of such enzymes inhibits diabetes-induced vascular pathology in animal models of DR. 32 Studies also have shown that leukocytes play an important role in the structural and functional abnormalities that characterize DR. 33,34 In patients, the most compelling evidence that inflammatory processes play an important role in DR pathogenesis is the dramatic effect of corticosteroids on DME. 7,35 Therefore, the specific cell types that mediate these proinflammatory effects are of great interest.…”

Efficacy and safety of triamcinolone acetonide posterior subtenon injection in patients with diabetic maculopathy

“…Poslednja suptenonska primena triamcinolon-acetonida nije praćena značajnim porastom IOP, te predstavlja efikasan i relativno Ključne reči: dijabetesna makulopatija, oštrina vida, centralna makularna debljina, intraokularni pritisak pseudohipopiona (12). Triamcinolon-acetonid (TA) je kortikosteroid koji u visokim lokalnim koncentracijama u zadnjem segmentu oka ispoljava antiinflamatorni, angiostatički efekat i smanjuje ekstravazaciju tečnosti (13,14). Cilj rada je procena efikasnosti i sigurnosti (merenjem IOP, centralne makularne debljine i oštrine vida pre i nakon dva meseca) poslednje suptenonske injekcije kortikosteroida TA u lečenju dijabetesne makulopatije.…”