Two-year results of intravitreal triamcinolone acetonide injection for the treatment of diabetic macular edema.

摘要

PURPOSE: To investigate 2-year results of intravitreal triamcinolone acetonide injection for the treatment of diffuse diabetic macular edema unresponsive to previous laser photocoagulation. METHOD: The study included 75 eyes of 75 diabetic patients with clinically significant diffuse macular edema that had failed to respond to previous laser photocoagulation. An intravitreal injection of triamcinolone acetonide at the dose of 4 mg/0.1 ml was administered. Best-corrected visual acuity was measured as the logarithm of the minimum angle of resolution (logMAR), and central macular thickness was obtained by optical coherence tomography at each visit. Intraocular pressure and lenticular status were also evaluated. Differences among measurements were evaluated by Friedman two-way analysis of variance by ranks. Mean follow-up period was 24.7 +/- 5.9 months. RESULTS: The mean central macular thickness, which was obtained 3 days, 1 month, 3 months, 6 months, 9 months, 12 months, 18 months and 24 months postoperatively, was significantly different from the baseline measurement (P < 0.001). Mean best-corrected logMAR visual acuity improved significantly from baseline at the 1- month and 3-month follow-up intervals (P < 0.05), but there was no significant change at the 6- month, 9-month, 12-month, 18-month or 24-month follow-up periods (P > 0.05). During the follow-up, 29 (38.7%) eyes received re-injection of intravitreal triamcinolone. Twenty-one (28%) eyes developed intraocular pressure values higher than 21 mmHg, and 18 (24%) eyes developed cataract. Thirteen (17.3%) eyes required cataract and/or glaucoma surgery. CONCLUSIONS: In refractory diabetic macular edema, intravitreal triamcinolone effectively reduces foveal thickness and improves visual acuity in the short term, but with the extended follow-up, the number of recurrences and steroid-related complications were shown to increase. Nevertheless, it may be a therapeutic option in some patients that do not respond to previous laser photocoagulation.