Diabetic Macular Edema Before and After Intravitreal Triamcinolone Injection

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Abstract

Purpose

To compare intravitreal triamcinolone acetonide (IVT) versus natural course in refractory diabetic macular edema.

Methods

In a prospective interventional case series, twenty five eyes with refractory DME which had been allocated to the sham group of a previous clinical trial underwent new examination and optical coherence tomography about 9 months after their first enrollment. Twenty eyes that met the inclusion criteria, visual acuity (VA) < 20/50 and central macular thickness (CMT) > 200 μm, were treated by 4 mg IVT. Evaluations were repeated at 2 and 4 months post-injection to imitate the similar examination intervals after sham injection. Corrected visual acuity and macular thickness changes following IVT were compared to the corresponding changes after sham injection (the natural course).

Results

Visual acuity changes within and between each period were not statistically significant. Visual acuity decreased 0.08 & 0.09 logMAR by 2 months and 0.06 & 0.04 logMAR by 4 months after sham and IVT injections, respectively. The changes of macular thickness after IVT and sham intervention were not meaningful either. However, the difference between thickness changes by 4 months (52±50 μm increase after sham vs. 262±115 μm reduction after IVT) was significant (P=0.014).

Conclusions

Concerning macular thickness, IVT has beneficial effect on refractory diabetic macular edema as opposed to observation. However, considering visual acuity, it does not induce significant difference in comparison to the natural course of the disease.

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Most cited references 13

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Intravitreal triamcinolone acetonide for diabetic diffuse macular edema: preliminary results of a prospective controlled trial.

Alain Gaudric, Rym Benosman, Ali Erginay … (2004)

To evaluate prospectively the efficacy and safety of 1 intravitreal injection of 4 mg of triamcinolone acetonide for refractory diffuse diabetic macular edema. Interventional case series. Fifteen patients with bilateral diabetic macular edema unresponsive to laser photocoagulation. In all patients, one eye received the injection, and the other served as a control. Intravitreal injection of 4 mg of triamcinolone acetonide under subconjunctival anesthesia. The main outcome measure was central macular thickness (CMT) at 1, 3, and 6 months, measured by optical coherence tomography. Secondary outcomes were Early Treatment Diabetic Retinopathy Study (ETDRS) scores, intraocular pressure, and cataract progression. In this preliminary report, we give the results for 12 patients who had a follow-up of at least 3 months. Seven of them were followed up for 6 months. Before injection, CMT was 509.6+/-143.5 microm (mean +/- standard deviation [SD]) in injected eyes, versus 474.4+/-82.6 microm in control eyes. Four weeks after injection, it was 207.3+/-44.2 microm in injected eyes and 506.7+/-122.4 microm in control eyes (P<0.001, bilateral Wilcoxon test for paired samples), and after 12 weeks, 207+/-96.7 microm and 469.3+/-117.6 microm, respectively (P = 0.005). The difference between the CMTs of injected and control eyes was no longer significant at 24 weeks because of the recurrence of macular edema in 5 of 12 injected eyes. Before triamcinolone injection, the ETDRS score was 47.8+/-13 (mean +/- SD; range, 28-66) in injected eyes, versus 51.9+/-14.6 (range, 31-71) in control eyes. Twelve weeks thereafter, the corresponding values were 52.7+/-10.8 (range, 34-70) and 50.8+/-14.3 (range, 29-69), respectively, and at 24 weeks, 54.7+/-7.6 (range, 47-68) and 50.6+/-18.4 (range, 28-71). At no time was the difference between the ETDRS scores for injected and control eyes significant. In 6 of the 12 injected eyes, intraocular pressure exceeded 25 mmHg, and was controlled by topical medication. Intravitreal injection of triamcinolone effectively reduces macular thickening due to diffuse diabetic macular edema, at least in the short term. Further studies are required to demonstrate that it provides visual benefit.

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Intraocular pressure elevation after intravitreal triamcinolone acetonide injection.

R Degenring, Imren Akkoyun, Jost Jonas … (2005)

To report on intraocular pressure (IOP) after intravitreal injections of triamcinolone acetonide. Meta-analysis of previously reported data and case series studies. The study included 272 patients (305 eyes) receiving an intravitreal injection of approximately 20 mg triamcinolone acetonide as treatment for diffuse diabetic macular edema (n = 84 patients), exudative age-related macular degeneration (n = 181 patients), retinal vein occlusions (n = 20 patients), uveitis (n = 9), pseudophakic cystoid macular edema (n = 6), and other reasons (n = 5). Mean follow-up was 10.4+/-6.7 months (median, 7.9 months; range, 3.0-35.7 months). Intravitreal injection of approximately 20 mg triamcinolone acetonide. Intraocular pressure. Intraocular pressure readings higher than 21 mmHg, 30 mmHg, 35 mmHg, and 40 mmHg, respectively, were measured in 112 (41.2%) patients, 31 (11.4%) patients, 15 (5.5%) patients, and 5 (1.8%) patients, respectively. Triamcinolone-induced IOP elevation was treated by antiglaucoma medication in all but 3 (1.0%) eyes, for which filtering surgery was performed. Mean IOP started to rise 1 week after injection and returned to baseline values approximately 8 to 9 months after injection. Younger age (P = 0.029) was significantly associated with triamcinolone-induced ocular hypertension. Triamcinolone responders and triamcinolone nonresponders did not vary significantly in gender (P = 0.42), refractive error (P = 0.86), diabetes mellitus status (P = 0.74), and reason for treatment. These findings may be useful for comparing risks and benefits of intravitreal triamcinolone acetonide therapy.

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Intravitreal injection of triamcinolone for diffuse diabetic macular edema.

Jost Jonas, Ingrid Kreissig, Antje Söfker … (2002)

To evaluate the clinical outcome of an intravitreal injection of triamcinolone acetonide as treatment of diffuse diabetic macular edema. This prospective, interventional, clinical case series study included 20 patients (26 eyes) who received an intravitreal injection of 25 mg of triamcinolone acetonide for treatment of diffuse diabetic macular edema. Mean +/- SD follow-up time was 6.64 +/- 6.10 months. The study group was compared with a control group of 16 patients who underwent macular grid laser coagulation. Visual acuity and intraocular pressure. In the study group, visual acuity improved significantly (P<.001), from 0.12 +/- 0.08 at baseline to a maximum of 0.19 +/- 0.14 during follow-up. Seventeen (81%) of 21 eyes with a follow-up period of more than 1 month had improved visual acuity. In the control group, visual acuity did not change significantly. In the study group, intraocular pressure increased significantly (P<.001), from 16.9 +/- 2.5 mm Hg to a mean maximal value of 21.3 +/- 4.7 mm Hg, and decreased significantly (P =.03) to 17.7 +/- 4.7 mm Hg at the study's end. Intravitreal injection of 25 mg of triamcinolone acetonide may be beneficial for improving visual acuity in patients with clinically significant diffuse diabetic macular edema.

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Author and article information

Journal

Journal ID (nlm-ta): Korean J Ophthalmol

Journal ID (publisher-id): KJO

Title: Korean Journal of Ophthalmology : KJO

Publisher: The Korean Ophthalmological Society

ISSN (Print): 1011-8942

Publication date (Print): June 2007

Publication date (Electronic): 20 June 2007

Volume: 21

Issue: 2

Pages: 95-99

Affiliations

Ophthalmic Research Center, Shaheed Beheshti Medical University, Tehran, Iran.

Author notes

Reprint requests to Alireza Ramezani, MD. Ophthalmic Research Center, Labbafinejad Medical Center, Pasdaran Ave. Boostan 9 St. Tehran 16666, Iran. Tel: 98-21-22584733, Fax: 98-21-22562138, arramezani@ 123456gmail.com

Article

DOI: 10.3341/kjo.2007.21.2.95

PMC ID: 2629697

PubMed ID: 17592240

SO-VID: 7df795f4-fcfc-4fec-a82e-1a7945fcc3ed

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Diabetic Macular Edema Before and After Intravitreal Triamcinolone Injection

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Abstract

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Results

Conclusions

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Karger: Ophthalmology

Most cited references 13

Intravitreal triamcinolone acetonide for diabetic diffuse macular edema: preliminary results of a prospective controlled trial.

Intraocular pressure elevation after intravitreal triamcinolone acetonide injection.

Intravitreal injection of triamcinolone for diffuse diabetic macular edema.

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