Scleral abscess following posterior subtenon triamcinolone acetonide injection for diabetic macular edema

A 65-year-old male with uncontrolled diabetes, received posterior subtenon triamcinolone [PST] injection in the right eye for diabetic macular edema. Two days following PST, he developed scleral abscess at the injection site. The Gram stain showed Gram positive cocci in clusters. He responded favorably with systemic control of diabetes, topical concentrated cefazolin, concentrated tobramycin, and intravenous antibiotics. Possibility of infective complications should be considered when using periocular steroids, especially in diabetics. Strict control of diabetes and aggressive systemic antibiotics favor rapid healing in such cases

Comparison of intravitreal bevacizumab, intravitreal triamcinolone acetonide, and macular grid augmentation in refractory diffuse diabetic macular edema: a prospective, randomized study

In spite of laser being the gold standard treatment for Diabetic Macular edema [DME], some patients do not respond to laser. Various treatment modalities are being tried in the management of refractory diffuse DME [DDME]. To compare the efficacy of intravitreal bevacizumab [IVB], intravitreal triamcinolone acetonide [IVTA], and macular grid augmentation in the management of refractory DDME. Prospective randomized study in a tertiary eye care center. Sixty patients with refractory DDME were randomly assigned to three groups: Group 1 received IVB [1.25 mg/0.05 ml], Group 2 received IVTA [4 mg/0.1ml], and Group 3 underwent laser augmentation. Primary outcome measures were best corrected visual acuity [BCVA] and central macular thickness [CMT] at the end of 6 months. Analysis was performed using SPSS 14.0. Group 1 and 2 showed significant improvement in mean BCVA from 20/160 at baseline to 20/80 and from 20/125 to 20/63, respectively, at 6 months [P < 0.05]. These groups also showed a significant reduction in the mean CMT from 457 +/- 151 micro at baseline to 316 +/- 136 micro and from 394 +/- 61 micro to 261 +/- 85 micro, respectively, at 6 months [P < 0.05]. Group 3 showed only small improvement in mean BCVA from 20/100 to 20/80 [P = 1.0] while mean CMT increased from 358 +/- 89 micro at baseline to 395 +/- 127 micro at 6 months [P = 0.191]. Eight [40%] eyes in Group 2 had intraocular pressure [IOP] rise and 10 [50%] eyes developed cataract. Both IVB and IVTA may be effective in the treatment of refractory DDME compared with macular grid augmentation. IVTA may be associated with side effects such as IOP rise and cataract formation