Decreasing efficacy of repeated intravitreal triamcinolone injections in diabetic macular oedema (original) (raw)
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Eye, 2005
Purpose To evaluate the clinical and volumetric improvement 1 week after an injection of intravitreal triamcinolone acetonide in eyes with diabetic macular oedema. Methods Seven phakic eyes of seven diabetic patients diagnosed with clinically significant macular oedema were treated with a single 4mg intravitreal injection of triamcinolone acetonide (0.1 ml). LogMAR best corrected visual acuity (logMAR BCVA), best corrected reading ability (RA), and central macular thickness (CMT) with optical coherence tomography (OCT) were assessed prior and 1 week subsequent to treatment. Results Mean improvement in logMAR BCVA was 0.146 (P ¼ 0.03). Mean reduction in CMT was 150.9 lm (P ¼ 0.02, Wilcoxon signed-rank test). Mean improvement in RA was 3 lines. Conclusion Reduction in macular oedema was demonstrated on OCT at 1 week, in most cases associated with improvement in central visual function, in particular, reading ability. Total resolution of diabetic macular oedema may occur at 1 week following intravitreal steroid injection.
British Journal of Ophthalmology, 2007
To compare the safety and efficacy of different doses of intravitreal triamcinolone (ivTA) in treating clinically significant diabetic macular oedema (CSMO). Methods: 63 eyes of 63 patients with CSMO and central foveal thickness (CFT) of >250 mm on optical coherence tomography were randomised to receive 4 mg (n = 23), 6 mg (n = 20) or 8 mg (n = 20) ivTA. Patients were followed up for 6 months, and changes in best-corrected visual acuity (BCVA), optical coherence tomography CFT, standardised change in macular thickness (SCMT), and side effects such as intraocular pressure and cataractogenesis were compared between the three groups. Results: After ivTA injection, improvements of BCVA and CFT occurred in all groups. The mean BCVA improvement at 6 months was significantly higher for the 8 mg group compared with the 4 mg group, with 9.9 and 3.1 improvement in letters on the Early Treatment of Diabetic Retinopathy Study chart, respectively (p = 0.047). The mean SCMT at 6 months for the 4, 6 and 8 mg groups was 28.7%, 42.3% and 60.5%, respectively (p = 0.06). The proportion of eyes with SCMT >75% at 6 months was higher in the 8 mg group, but the difference failed to reach significance (p = 0.06). Ocular hypertensive responses (.21 mm Hg) occurred in 39%, 30% and 55% of eyes in the 4, 6, and 8 mg groups, respectively (p = 0.27). Conclusions: Higher doses of ivTA may prolong the duration of visual benefit in diabetic CSMO and seemed to result in more sustained reduction in macular oedema. Further studies are warranted to investigate the optimum dose of ivTA in treating diabetic CSMO.
British Journal of Ophthalmology, 2007
To evaluate the predictive factors for visual outcome after intravitreal triamcinolone acetonide injection to treat refractory diabetic macular oedema (DME). Methods: A retrospective chart review of patients with DME who met the following inclusion criteria was performed: clinically significant diabetic macular oedema, receipt of a 4 mg/0.1 ml intravitreal triamcinolone acetonide injection and an optical coherence tomography (OCT) of the macula performed up to 10 days before injection. All patients received a full ophthalmic examination including best-corrected Snellen visual acuity (VA). The main outcome measure was the mean change in vision 3 months after injection. Results: Data from 73 eyes of 59 patients were analysed. After a mean follow-up of 324 days, the mean change in vision was 20.075 logarithm of minimum angle of resolution (logMAR) units, with 27.3% improving >3 lines, 6.8% declining >3 lines and 60.2% remaining stable within 1 line of baseline vision. Statistical analysis was performed using multivariate generalised estimating equations on the basis of data from 52 eyes of 42 patients. Factors associated with an improvement in vision 3 months after injection were worse baseline VA (20.27 logMAR units/unit increase in baseline VA, p = 0.002) and presence of subretinal fluid (20.17 logMAR units, p = 0.06). The presence of cystoid macular oedema negatively affected the visual outcome (0.15 logMAR units, p = 0.03). In addition, the presence of an epiretinal membrane (ERM) was associated with less visual improvement. ERM modified the effect of baseline VA as demonstrated by a significant interaction between these two variables (0.34 logMAR units/unit increase in baseline VA, p = 0.04). Conclusions: OCT factors and baseline VA can be useful in predicting the outcomes of VA 3 months after intravitreal triamcinolone acetonide injection in patients with refractory DME.
British Journal of Ophthalmology, 2007
The efficacy and safety of repeated injections of intravitreal triamcinolone (IVTA) for diabetic macular oedema is unclear, with results of previous reports conflicting. Methods: This is a prospective, observational case series of 27 eyes receiving IVTA for diabetic macular oedema. LogMAR visual acuity (VA) and central macular thickness (CMT) were measured at baseline and in 3 to 6 monthly intervals for up to 24 months, then correlated with the number of IVTA injections given. Results: One IVTA injection was required in 6 (18%) eyes, 2 in 8 (24%) eyes, 3 in 13 (39%) eyes and 4-5 in 6 (18%) eyes. VA improved in all patients, but neither the final improvement in VA nor the absolute improvement in CMT from baseline to 24 months correlated with the number of injections received (p = 0.44 and 0.84, respectively). Cataract surgery was more frequent in eyes receiving more injections (p = 0.01). Conclusions: This study suggests that repeated injections of IVTA continue to be as effective as the first over a 2-year period. The probability of cataract surgery increases with an increasing number of injections.
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.
Acta Ophthalmologica Scandinavica, 2006
Purpose: To evaluate prospectively the efficacy and safety of one intravitreal injection of 4 mg triamcinolone acetonide for refractory diffuse diabetic macular edema.Methods: Seventeen patients with bilateral diabetic macular edema unresponsive to laser photocoagulation. In all patients, one eye was injected, and the other served as a control. The intervention consisted in intravitreal injection of 4 mg triamcinolone acetonide. The main outcome measure was central macular thickness (CMT) at 4, 12 and 24 weeks, measured by Optical Coherence Tomography. Secondary outcomes were Early Treatment Diabetic Rentinopathy Study (ETDRS) scores, intraocular pressure and cataract progression.Results: Before injection, mean ± SD CMT was 566.4 ± 182.4 μm in injected eyes. Four, 12, and 24 weeks after injection, it was 228.4 ± 47.5 μm, 210.9 ± 87.2 μm and 358.5 ± 160.5 μm respectively. CMT was significantly lower in injected eyes vs. control eyes except 24 weeks after injection because of a recurrence of macular edema in 9/17 injected eyes. Mean ± SD gain in ETDRS score was significantly better in injected eyes vs. control eyes 4, 12 and 24 weeks after TA injection. In 9 of the 17 injected eyes, intraocular pressure exceeded 24 mmHg and was controlled by topical medication.Conclusion: In the short-term, intravitreal injection of triamcinolone effectively reduces macular thickening due to diffuse diabetic macular edema and improves visual acuity in most cases. The long-term effect of this treatment and predictive factors of visual recovery remain to be elucidated.
Intravitreal Triamcinolone in Diabetic Macular Edema : A Comparative Study of 1 MG and 4MG Doses
Journal of evolution of medical and dental sciences, 2015
Macular edema is a frequent manifestation of diabetic retinopathy and animportant cause of visual disturbance in diabetic patients. AIM: To compare the efficacy and safety of 1mg and 4mg intravitreal triamcinolone acetonide (IVTA) in the management of diabetic macular edema. SETTING: Sarojini Devi Eye Hospital, Hyderabad. MATERIAL AND METHODS: 42 eyes of 42 patients with diabetic macular edema were randomly assigned toreceive either 1-mg or 4-mg dose of Intravitreal triamcinolone acetonide (IVTA). Each patient underwent a complete comprehensive eye examination at baseline andat each visit.Fundus fluorescein angiography and optical coherence angiographywas done at baseline and at 1, 3 and 6 months.BCVA, lens status, IOP wererecorded at each follow up visit. Each patient's BCVA was measured in snellen's lines and converted into logarithm of minimum angle of resolution (log MAR) scale for analysis. STATISTICAL ANALYSIS USED: The data were statistically evaluated using the Wilcoxon signedrank test, Mann-Whitney test and t tests wherever applicable. A p value of lessthan.05 was considered significant. RESULTS: There was no statistically significant difference in the mean foveal thickness measurement at baseline (p=.723) or at 3 rd month (p=.878) between the subgroups. BCVA significantly improved from baseline to subsequent visits in both the groups, but there was no statistically significant difference observed in the mean baseline BCVA between the two subgroups (p=.754). There was no statistically significant difference observed in IOP between the two subgroups at any follow up visit. CONCLUSIONS: The results of our study suggest that 1-mg dose of IVTA is as effective as 4-mgdose of IVTA in improving the functional and anatomical outcome in macularedema associated with diabetic retinopathy.
Pakistan Journal of Ophthalmology, 2010
The visual outcome in patients with refractory diabetic macular edema receiving intravitreal triamcinolone acetonide injection. Materials and Methods: This was an interventional, prospective hospital based study conducted at LRBT Eye Hospital Lahore from Jan 2007 to Aug 2007. Fifty eyes of 50 patients received lntravitreal injection of triamcinolone in a single dose of 4mg/0.1 ml. visual acuity was measured preoperatively and at postoperative visit of 1 week, 1 month and 3 months using Snellen's Visual Acuity chart. Results: Pre operatively there was 1 (2%) eye with VA > 6/18, 28 (56%) eyes with VA 6/24-6/60 and 21 (42%) eyes had VA <6/60. On third post operative month follow up visit day there were 6 (12%) eyes with VA > 6/18, 31 (62%) eyes with VA 6/24-6/60 and 13 (26%) eyes had VA <6/60. There is statistically significant difference between the preoperative and postoperative visual acuity, p=0.005. Conclusion: This study suggests that lntravitreal injection of triamcinolone acetonide in a dose of 4mg/0.1ml considerably improved vision in patients with diffuse diabetic macular edema refractory to previous macular grid photocoagulation at three months after the injection.
IP Innovative Publication Pvt. Ltd., 2018
Aim: To assess the efficacy and complications of the intravitreal injection of Triamcinolone Acetonide (IVTA) as compared to posterior subtenon injection of triamcinolone (PST) for the treatment of diabetic macular edema. Materials and Methods: Twenty four patients with type II diabetes, having diabetic retinopathy with macular edema were recruited. One eye of each patient was assigned to 4mg IVTA and the other eye was given 40 mg PST. Before and one, three and six months after treatment we measured visual acuity as well as thickness of the macula, with optical coherence tomography (OCT), and intraocular pressure (IOP). Results: In the IVTA group, a reduction in foveal thickness of 150µ was observed (p = 0.012) at 3 months compared to baseline. A reduction of around 70 microns was observed in the PST group which was not statistically significant (p = 0.290). In the IVTA group, the mean visual acuity increased from 1.048+/-0.512 at baseline to 0.707+/-0.552 at 6 months, which was statistically significant (p = 0.001). In the PST group, the mean visual acuity improved from 0.797 +/-0.425 at baseline to 0.727 +/-0.448 after 6 months with visual improvement maintained in 9 eyes (45%) throughout the study period. IOP rise in IVTA group was not statistically significant; whereas, in the PST group it became statistically significant. However, IOP rise lost its significance at 6 months (p = 0.09) owing to treatment with anti-glaucoma medications. Conclusion: Both IVTA and PST can be used as effective treatment options for diabetic macular edema. Keywords: Diabetic macular edema, Foveal thickness, Intravitreal injection, Posterior subtenon injection, Triamcinolone acetonide, Visual acuity.