Elsevier

Ophthalmology

Volume 111, Issue 2, February 2004, Pages 218-224
Ophthalmology

Original article
Intravitreal triamcinolone acetonide for diabetic diffuse macular edema1 2: Preliminary results of a prospective controlled trial,

Presented at: American Academy of Ophthalmology Annual Meeting, November 2002; Orlando.
https://doi.org/10.1016/j.ophtha.2003.05.037Get rights and content

Abstract

Objective

To evaluate prospectively the efficacy and safety of 1 intravitreal injection of 4 mg of triamcinolone acetonide for refractory diffuse diabetic macular edema.

Design

Interventional case series.

Participants

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.

Intervention

Intravitreal injection of 4 mg of triamcinolone acetonide under subconjunctival anesthesia.

Main outcome measures

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.

Results

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 μm (mean ± standard deviation [SD]) in injected eyes, versus 474.4±82.6 μm in control eyes. Four weeks after injection, it was 207.3±44.2 μm in injected eyes and 506.7±122.4 μm in control eyes (P<0.001, bilateral Wilcoxon test for paired samples), and after 12 weeks, 207±96.7 μm and 469.3±117.6 μm, 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.

Conclusion

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.

Section snippets

Patients and methods

The protocol was approved by the Institutional Review Board of the Hôpital Saint-Louis, Paris, France. Patients were recruited and enrolled at the Diabetic Retinopathy Unit of the Lariboisière Hospital in Paris.

Results

Between November 2001 and September 2002, 17 patients fulfilled the inclusion criteria and agreed to participate in the study. Two were excluded because of an IOP rise exceeding 15 mmHg after 1 month of treatment with topical 0.1% dexamethasone. Therefore, 15 patients (30 eyes) were included in the study. In this preliminary report, we give the results for the 12 patients (5 males and 7 females) who had a follow-up of at least 3 months. Seven of them were followed up for 6 months.

The mean (±

Discussion

The preliminary results of this prospective controlled study demonstrate the efficacy of one intravitreal injection of TA in reducing macular thickening due to refractory diffuse diabetic ME, at least in the short term. In all injected eyes, we indeed observed, compared with control eyes, a dramatic anatomic improvement in diabetic ME that had been resistant to all previous treatments (Fig 2). This improvement occurred as soon as 1 month after injection. These results confirm those previously

References (28)

  • N Benhamou et al.

    Intravitreal triamcinolone for refractory pseudophakic macular edema

    Am J Ophthalmol

    (2003)
  • G.J Jaffe et al.

    Fluocinolone acetonide sustained drug delivery device to treat severe uveitis

    Ophthalmology

    (2000)
  • Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1

    Arch Ophthalmol

    (1985)
  • L.T Chylack et al.

    The Lens Opacities Classification System (LOCS) III

    Arch Ophthalmol

    (1993)
  • Cited by (0)

    Manuscript no. 220670.

    1

    The authors have no proprietary interest in this study.

    2

    Dr Audren, co–first author, contributed equally to the work.

    View full text