Intravitreal triamcinolone acetonide for diffuse diabetic macular oedema: 6-month results of a prospective controlled trial (original) (raw)
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The Israel Medical Association journal : IMAJ, 2006
The major cause of visual impairment in diabetic patients is macular edema. The failure of laser photocoagulation in a large subgroup of patients with clinically significant diabetic macular edema has prompted interest in other treatment methods. To evaluate the long-term efficacy and safety of an intravitreal injection of triamcinolone acetonide for clinically significant diabetic macular edema. In a retrospective case series 31 diabetic patients with persistent, recurrent or diffuse clinically significant diabetic macular edema received a single 4 mg (0.1 ml) intravitreal triamcinolone acetonide injection and were followed for at least 6 months. The main outcome measures evaluated were classified as primary: visual acuity and central macular thickness, and secondary: intraocular pressure and cataract progression. Statistical analysis included Student's t-test, chi-square test and the MacNamar test. Best visual acuity results were observed 2.6 +/- 2.4 months post-injection. At ...
Ophthalmology, 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 ...
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.
Decreasing efficacy of repeated intravitreal triamcinolone injections in diabetic macular oedema
British Journal of Ophthalmology, 2006
Background/aim: Intravitreal triamcinolone (IVTA) results in transient improvements in diabetic macular oedema (DMO), necessitating repeated injections. The authors report a case series of 10 eyes of 10 patients with DMO, who received a repeat injection of 4 mg IVTA, at least 26 weeks after the first injection of the same dose. Method: Pre-injection and at 2, 4, 9, and 17 weeks post-injection, best corrected visual acuity (BCVA) and central foveal thickness (CFT) on optical coherence tomography, after the first and repeat injections, were compared using paired t test. Side effects were monitored. Results: BCVA, CFT, intraocular pressure (IOP), and cataract scores were not significantly different before initial and repeat injections (given at 32.5 (SD 3.5) weeks after the first injection). Transient improvements of BCVA and CFT were achieved after both injections. However, after the repeat injection, the BCVA was significantly worse at all time points (p,0.05) and so were the best achieved CFT and the CFT at 4 weeks post-injection (p = 0.034 and 0.011 respectively), compared with the initial injection. Post-injection maximum IOPs and increase in cataract scores were not significantly different between the two injections. Conclusion: A repeat injection of 4 mg of IVTA may not be as effective as an initial injection for the treatment of DMO.
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.
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.
Is the effect of intravitreal triamcinolone acetonide on diabetic macular edema dose-dependent
To determine whether the effect of intravitreal triamcinolone acetonide in diffuse diabetic macular edema is dose-dependent regarding the velocity and duration of macular edema reduction, visual acuity improvement, and induction of predictable complications. Methods: This clinical prospective study included 32 consecutive patients (32 eyes) with diffuse diabetic macular edema. All patients had visual acuity, fluorescein angiogram, and optical coherence tomography performed at the initial visit (baseline). Single triamcinolone acetonide injection was applied intravitreally in different high doses using sterile technique followed by timolol-maleate 0.5%/ acetazolamide fixed combination eyedrops twice a day for 6 consecutive months. Macular edema, intraocular pressure, and best-corrected distance visual acuity were reviewed after 5 days and 1, 3, and 6 months. results: Intraocular pressure did not change significantly during 6 months and was maintained within normal levels in all patients using prescribed antiglaucoma therapy. Best-corrected distance visual acuity and macular edema were better than preoperatively even 6 months after treatment while the highest improvement was recorded 1 month after treatment. There was a slight correlation of macular edema reduction and triamcinolone dose, especially in central 1-mm diameter zone 6 months post triamcinolone acetonide intravitreal injection, but it was not statistically significant. conclusions: Triamcinolone intravitreal injection is a relatively safe, inexpensive, and effective method used for diabetic macular edema reduction but its effect is not proven to be dose-dependent, at least in 10-32 mg dose range. Macular edema reduction rate correlated significantly with preoperative edema.
IP innovative publication pvt. ltd, 2019
Aim: To study the efficacy of intravitreal triamcinolone acetonide (IVTA) for the treatment of refractory diabetic macular edema (DME) in type 2 diabetes mellitus patients. Materials and Methods: A prospective, interventional, non-comparative case series. There were 13 eyes of 13 patients with refractory DME. An intravitreal injection of triamcinolone acetonide at the dose of 4 mg in 0.1 ml was administered. Best corrected visual acuity was measured at each examination. The amount of hard exudates deposition in the macula was subjectively evaluated using colour fundus photographs. Central macular thickness (CMT) was measured, on OCT. Results: 13 patients completed 6 months or more of follow up and were included in the study. Sex distribution in the study was 12 (92.40%) males and 1 female (7.60%). There was significant improvement in the visual acuity, 2.42 ± 1 (mean ± SD) (p<0.001). There was improvement in BCVA in all thirteen patients, though the improvement was very less in 2 patients, excluding these patients 84% patients had at least 1 Snellen’s line improvement, in Log MAR units this corresponds to 0.90 ± 0.36 (mean ± SD). In 76% eyes there was one or more Snellen’s line improvement. Mean central macular thickness (CMT) improved significantly. Conclusions: Intravitreal injection of 4 mg of triamcinolone acetonide may be beneficial for improving visual acuity in type 2 diabetes patients which have refractory diabetic macular edema.
To compare the effectiveness of posterior sub-Tenon's infusion (STi) and intravitreal injection (IVI) of triamcinolone acetonide (TA) for treatment of refractory diffuse diabetic macular edema. METHODS. Thirty-six phakic diabetic patients with refractory diffuse diabetic macular edema were prospectively enrolled. Patients randomly received either 40 mg STi or 4 mg IVI of TA. Comprehensive ophthalmic evaluation was performed at baseline and 1, 2, 4, 8 Ϯ 1, 12 Ϯ 2 and 24 Ϯ 2 weeks after treatment. Macular morphologic changes detected by optical coherence tomography and visual acuity, intraocular pressure, and lens status were evaluated. RESULTS. Twenty-eight patients (28 eyes) completed the 24week study. Central macular thickness was significantly reduced in the IVI group when compared with the STi group at 2, 4, 8, 12, and 24 weeks after treatment (P Ͻ 0.01). Mean visual acuities (in logarithm of the minimum angle of resolution [logMAR]) at week-4, -8, and -12 follow-up examinations were significantly higher in the IVI group (0.74, 0.75, and 0.82, respectively) when compared with the STi group (0.88, 0.88, and 0.90, respectively; P Ͻ 0.01). A significant change from baseline in mean intraocular pressure (mm Hg) was seen at weeks 4 (Ϯ3.21) and 8 (Ϯ3.35) in STi the group (P Ͻ 0.01), and at week 8 (Ϯ2.78) in the IVI group (P Ͻ 0.05). No patient had cataract progression during the study. CONCLUSIONS. Although the number of patients and length of follow-up in this preliminary study were limited, the changes in central macular thickness and visual acuity observed after treatment suggest that IVI TA may be more effective than STi for the management of refractory diffuse diabetic macular edema. Further studies are needed to confirm these preliminary findings. (Invest Ophthalmol Vis Sci. 2005;46:3845-3849)