Intravitreal triamcinolone improves vision in eyes with chronic diabetic macular oedema refractory to laser photocoagulation

Abstract

Purpose To evaluate the clinical and visual outcome of an intravitreal injection of triamcinolone in patients with diabetic macular oedema refractory to laser treatment. Material and methods Prospective, interventional nonrandomised case series of 24 eyes of 24 patients that underwent intravitreal injection of 4 mg triamcinolone for chronic diabetic macular oedema refractory to previous laser treatment. All patients had best corrected visual acuity (bcva) on the LogMAR scale, near vision, slit-lamp biomicroscopy for the presence of clinically significant macular oedema, and intraocular pressure check at 1, 3, and 6 months. Results The average duration of macular oedema before the injection was 38.2 months (range ¼ 6-120 months) with the mean number of laser treatments before the injection being 2.2 (range ¼ 1-5). The visual acuity improved in 19 of the 23 (83%) eyes at 1 month, 16 of the 21 eyes (76%) at 3 months and six of 11 eyes (55%) at 6 months follow-up. The mean bcva improved by an average of 10, nine, and six letters, respectively, compared to the baseline at 1, 3, and 6 months (P ¼ 0.0002 at 1 month and 0.001 at 3 months with the Wilcoxon signed-ranked test). The intraocular pressure rose by an average of 2.4, 2.8, and 2.7 mmHg at the same follow-up visits.Conclusion Intravitreal triamcinolone appears to be promising in the short term, for improving the vision in eyes with chronic diabetic macular oedema unresponsive to conventional laser treatment. Randomised controlled trials utilising varying doses of steroid are now required to define optimum treatment regimens.

Dosage dependency of intravitreal triamcinolone acetonide as treatment for diabetic macular oedema

“…[5][6][7][8][9][10][11][12][13][14][15][16] In case series studies and in a recent randomised study, doses of 4 mg or about 20 mg triamcinolone acetonide were used and resulted in a significant The dosage was measured before filtration of the triamcinolone acetonide crystals. Peak time was defined as the time, at which visual acuity started to decline again.…”

“…3 4 Recent studies have suggested that intravitreal triamcinolone acetonide may be an alternative treatment option leading to a reduction of macular oedema, and depending on the degree of macular ischaemia, to an increase in visual acuity. [5][6][7][8][9][10][11][12][13][14][15][16] In these studies, however, different doses varying between about 4 mg to about 20 mg triamcinolone acetonide have been employed. [5][6][7][8][9][10][11][12][13][14][15][16] It is unknown so far whether efficacy and duration of the effect of intravitreal triamcinolone acetonide are dosage dependent.…”

The Effect of Macular Laser Photocoagulation on Visual Prognosis Before and After Intravitreal Triamcinolone Acetonide Injection in Diabetic Macular Edema

“…9,10 Some studies reported significant results in 1 and 3. months, and insignificant results in 6. month. [11][12][13] And finally some studies reported significant results even at the 6. month. 14,15 Previously, IVTA was considered as an alternative in resistant DME cases, but now some authors suggest it as a first choice treatment without combination.…”

Prognostic factors for visual acuity improvement after intravitreal triamcinolone injection

“…Intravitreal triamcinolone acetonide injection (IVTA) is being increasingly used to treat patients with macular oedema resulting from a variety of conditions such as diabetes, 1,2 retinal vein occlusion, 3,4 pseudophakia, 5 various types of uveitis, 6 radiation retinopathy, 7 and idiopathic cystoid macular oedema (CME). 8 It has also been tried in patients with choroidal neovascular membranes associated with age-related macular degeneration, 9 presumed ocular histoplasmosis syndrome, or choroiditis.…”