Intravitreal triamcinolone for the treatment of refractory diabetic macular oedema with hard exudates: an optical coherence tomography study (original) (raw)
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Intravitreal triamcinolone for refractory diabetic macular edema
OPHTHALMOLOGY, 2002
To evaluate the effect of intravitreal triamcinolone acetonide (IVT) on clinical, angiographic, and optical coherence tomographic parameters in refractory diabetic macular edema (DME). Methods: In a double-masked placebo-controlled randomized clinical trial, 88 eyes of 61 patients with DME refractory to previous laser therapy or not suitable for such treatment were included in the study. Eligible eyes were randomly assigned into two groups. The treatment group (45 eyes) received 4 mg IVT and the placebo group (43 eyes) received subconjunctival injection of placebo. Complete ophthalmologic examination, fluorescein angiography, and optical coherence tomography (OCT) were performed before intervention and repeated after 2 and 4 months. Quantitative measurement of variables on angiograms including hard exudates (HE), size of foveal avascular zone, and leakage severity was performed using Photoshop software. Results: Two months after intervention, visual acuity (VA) improved in the treatment group (-0.13 LogMAR, P=0.01) but slightly deteriorated in the placebo group (0.02 LogMAR, P=0.63). The difference of the above changes (0.15 LogMAR) was statistically significant at 2 months (P=0.02) but reduced to 0.11 LogMAR (P=0.08) after 4 months. Mean (standard deviation) of central macular thickness (CMT) by OCT before and 2 and 4 months after injection was 393 (151), 293 (109), and 362 (119) microns in the treatment group and 393 (166), 404 (134), and 405 (160) microns in the placebo group, respectively. The second month difference was statistically significant (P=0.01). Reduction of the amount of HE (51%, P=0.004) and petaloid pattern (P=0.012) was significant in the treatment group as compared with the placebo group. There was no significant IVT-related side effects except for transient ocular hypertension in 32.6% of patients after 2 months. Conclusion: The greatest therapeutic effect of IVT on DME according to CMT and VA occurs at 2 months and decreases up to the fourth month. However, concerning cyctoid macular edema and hard exudates, the effect is maintained up to 4 months.
Journal francais d'ophtalmologie
Long-term follow-up of patients with diabetic macular edema (DME) treated with intravitreal antivascular endothelial growth factor (anti-VEGF) combined focal laser and identification of prognostic morphological characteristics. Methods. Prospective clinical trial (50 treatment-naive eyes) with DME randomized 1 : 1 receiving intravitreal ranibizumab (0.5 mg/0.05 ml) and prompt grid laser compared with ranibizumab and deferred laser. Morphological characteristics potentially relevant for prognosis were assessed at baseline, month 6, month 9, and years 1, 2, 3, 4, and 5 of follow-up. Results. Although functional results were slightly higher in the prompt group at week 12 (0.5; 20/40 Snellen (SD � 0.04, 0.3 logMAR) versus 0.4; 20/50 Snellen (SD � 0.04, logMAR: 0.4), p � 0.4) and month 9 (prompt group: 0.5; 20/40 Snellen (SD � 0.03, 0.3 logMAR) versus deferred group: 0.4; 20/50 Snellen (SD � 0.04, 0.4 logMAR), p � 0.4), these were statistically insignificant. ere was no significant benefit regarding functionality during long-term follow-up in the prompt group compared to the deferred group. BCVA in the eyes with clusters of hyperreflective foci in the central macular region was inferior compared with the eyes without these alterations at year 5 (0.39; 20/50 Snellen, (SD � 0.25, 0.4 logMAR) versus 0.63; 20/80 Snellen (SD � 0.22, 0.2 logMAR), p < 0.01). Conclusion. Grid laser and ranibizumab therapy are effective in DME management during the long-term follow-up. Intraretinal hyperreflective material in SD-OCT is negatively related to BCVA.
Acta Ophthalmologica, 2008
To evaluate the effect of intravitreal injections of triamcinolone acetonide (IVTA) combined with panretinal photocoagulation (PRP) on visual acuity (VA) and foveal thickness in patients with concomitant high-risk proliferative diabetic retinopathy (PDR) and clinically significant macular oedema (CSMO). Methods: This retrospective interventional case series included seven eyes diagnosed with both high-risk PDR and CSMO that underwent PRP and a single injection of 4 mg of IVTA. The main outcome measures were VA and foveal thickness, measured by optical coherence tomography (OCT) before treatment and throughout the follow-up period. Results: Median follow-up was 301 days (range 180-715 days). Foveal thickness data were available for four of seven eyes. Before the combined treatment, median LogMAR (logarithm of the minimum angle of resolution) VA and median foveal thickness were 1 (Snellen 20 ⁄ 200, range 20 ⁄ 40-20 ⁄ 800) and 559 lm (range 333-689 lm), respectively. After treatment, median vision improved to LogMAR 0.544 (Snellen 20 ⁄ 70, range 20 ⁄ 40-20 ⁄ 1000) (P ¼ 0.13). Vision improved or remained stable in six of seven eyes. Median foveal thickness at final follow-up was 436 lm (range 259-623 lm) (P ¼ 0.15). Foveal thickness decreased or remained stable in all eyes. Conclusion: The addition of IVTA to PRP in the treatment of eyes with high-risk PDR and CSMO may prevent PRP-induced foveal thickening and loss of vision.
American Journal of Ophthalmology, 2009
PURPOSE: To evaluate laser combined with intravitreal triamcinolone acetonide (IVTA) for the management of patients with proliferative diabetic retinopathy (PDR) and clinically significant macular edema (CSME). • DESIGN: Randomized clinical trial. • METHODS: SETTINGS: Single center. STUDY POPULATION: Twenty-two patients with bilateral treatment-naïve moderate PDR and CSME. INTERVENTION: Laser (panretinal and macular) photocoagulation was performed in each eye, followed by IVTA in one randomly assigned eye. Best-corrected visual acuity (BCVA), fundus photography, and optical coherence tomography were performed at baseline and at months 1, 3, 6, 9, and 12. MAIN OUTCOME MEASURES: Changes in BCVA, central macular thickness (CMT), and total macular volume (TMV). • RESULTS: The mean logarithm of the minimal angle of resolution (logMAR) BCVA improved significantly, and mean CMT and TMV were significantly reduced in the IVTA group compared with the laser-only group (controls) at all study follow-up visits (P < .001). The mean logMAR BCVA (Snellen equivalent) was 0.44 (20/ 50 ؊2 ) for the IVTA group and 0.38 (20/50 ؉1 ) for the controls at baseline, and 0.12 (20/25 ؊1 ) for the IVTA group and 0.32 (20/40 ؊1 ) for the controls at 12 months (P < .001). The mean CMT and TMV were, respectively, 360 m and 8.59 mm 3 for the IVTA group and 331 m and 8.44 mm 3 for the controls at baseline, and 236 m and 7.32 mm 3 for the IVTA group and 266 m and 7.78 mm 3 for the controls at 12 months (P < .001). • CONCLUSIONS: The combination of laser photocoagulation with IVTA was associated with improved BCVA and decreased CMT and TMV when compared with laser photocoagulation alone for the treatment of moderate PDR with CSME. (Am J Ophthalmol 2009;147:291-297.
Outcomes of Intravitreal Triamcinolone Acetonide Injection in Patients With Diabetic Macular Edema
Van Medical Journal
Diabetes mellitus (DM), with increasing incidence across worldwide, is the most frequent cause of end stage renal disease, nontraumatic amputation of lower extremities and adulthood blindness. Due to progression in the treatment of DM, surveillance of patients improved and frequency of retinopathy increased. Macular edema; diminishing visual acuity significantly in diabetic ABSTRACT Objective: To evaluate the effectiveness of intravitreal triamcinolone acetonide injection (IVTA) in chronic diabetic macular edema (DME) and to assess complications of treatment. Material and Method: 4 mg/0.1ml triamcinolone acetonide was injected into the intravitreal cavity of 34 eyes of 20 patients. 7 male and 13 female patients; with diabetic retinopathy that unresponsive to laser photocoagulation were enrolled. The visual acuity, intraocular pressure (IOP) and macular edema were compared in pretreatment and posttreatment 1st week, 1st, 3rd, and 5th months. Results: Median duration of follow-up was 5.05±0.76 months (4-6 months). The macular edema was significantly improved (27/34 eyes (79.4%); 30/34 eyes (88.2%), and 27/34 eyes (79.4%) at the 1st, 3rd, and 5th months; respectively). Visual acuity improved 13/34 eyes (38.2 %) at the 1st week, 23/34 eyes (67.6%) in the 1st month, 23/34 (67.6%) in the 3rd month, and 24/34 (70.5%) in the 5th month. Except cataract formation in 2 eyes, none of other patient experienced a complication related to IVTA injection. In addition, none of the patients had IOP above 21 mmHg. Conclusion: IVTA is a safe and effective therapeutic method for chronic diabetic macular edema unresponsive to prior laser photocoagulation. However, further studies with longer follow-up and larger number of patients are required to assess the long-term efficacy and to determine the criterias for retreatment.
American Journal of Ophthalmology, 2009
PURPOSE: To evaluate laser combined with intravitreal triamcinolone acetonide (IVTA) for the management of patients with proliferative diabetic retinopathy (PDR) and clinically significant macular edema (CSME). • DESIGN: Randomized clinical trial. • METHODS: SETTINGS: Single center. STUDY POPULATION: Twenty-two patients with bilateral treatment-naïve moderate PDR and CSME. INTERVENTION: Laser (panretinal and macular) photocoagulation was performed in each eye, followed by IVTA in one randomly assigned eye. Best-corrected visual acuity (BCVA), fundus photography, and optical coherence tomography were performed at baseline and at months 1, 3, 6, 9, and 12. MAIN OUTCOME MEASURES: Changes in BCVA, central macular thickness (CMT), and total macular volume (TMV). • RESULTS: The mean logarithm of the minimal angle of resolution (logMAR) BCVA improved significantly, and mean CMT and TMV were significantly reduced in the IVTA group compared with the laser-only group (controls) at all study follow-up visits (P < .001). The mean logMAR BCVA (Snellen equivalent) was 0.44 (20/ 50 ؊2 ) for the IVTA group and 0.38 (20/50 ؉1 ) for the controls at baseline, and 0.12 (20/25 ؊1 ) for the IVTA group and 0.32 (20/40 ؊1 ) for the controls at 12 months (P < .001). The mean CMT and TMV were, respectively, 360 m and 8.59 mm 3 for the IVTA group and 331 m and 8.44 mm 3 for the controls at baseline, and 236 m and 7.32 mm 3 for the IVTA group and 266 m and 7.78 mm 3 for the controls at 12 months (P < .001). • CONCLUSIONS: The combination of laser photocoagulation with IVTA was associated with improved BCVA and decreased CMT and TMV when compared with laser photocoagulation alone for the treatment of moderate PDR with CSME. (Am J Ophthalmol 2009;147:291-297.