[Intravitreal triamcinolone for treatment of refractory diabetic macular edema]

To determine if intravitreal injection of triamcinolone acetonide is safe and effective in the treatment of diabetic macular edema unresponsive to prior laser photocoagulation. Fifty-four eyes of 38 patients with clinically significant macular edema which had received at least two sessions of laser photocoagulation according to Early Treatment Diabetic Retinopathy Study guidelines were enrolled in this study. At least four months after laser therapy; eyes with residual central macular thickness [CMT] greater than 250 microm on optical coherence tomography [OCT] and visual loss from baseline were offered intravitreal injection of 4 mg triamcinolone acetonide. Visual and anatomic responses as well as complications related to the injection procedure and corticosteroid medication were observed. Mean baseline best corrected visual acuity [BCVA] and CMT were 0.77 +/- 0.5 LogMAR and 443 +/- 138 microm, respectively. All patients completed one month of follow up and 39 of 54 eyes [72.2%] completed 6 months of follow up. Mean BCVA was 0.64 +/- 0.45, 0.56 +/- 0.48, and 0.79 +/- 0.55 LogMAR at months 1, 3, and 6, respectively. Central macular thickness measured by OCT decreased by 39% and 23.5%, at the third and sixth month visits, respectively. Intraocular pressure exceeded 21 mmHg in 36.3% of the eyes. Cataract progression was noted in 12.8% of phakic eyes. Intravitreal triamcinolone seems a promising therapeutic method for diabetic macular edema refractory to conventional laser photocoagulation without any significant complication, however the effect seems to be temporary. Further studies are warranted to assess the long-term efficacy and safety and also the need for retreatment

Vitrectomy for diffuse refractory diabetic macular edema associated with a taut premacular posterior hyaloid

To evaluate the anatomic and visual results and complications of vitrectomy in eyes with diffuse refractory diabetic macular edema associated with a taut posterior hyaloid. This prospective interventional case series was conducted in 25 eyes of 22 patients with diffuse clinically significant diabetic macular edema, macular thickness greater than 250 microns on optic coherence tomography [OCT] and thickened posterior hyaloid. Best-corrected visual acuity [BCVA] and macular thickness measured by OCT were evaluated preoperatively and 3 and 6 months postoperatively. Macular perfusion was evaluated by fluorescein angiography, preoperatively. Mean BCVA was 1.14 +/- 0.51 LogMAR, preoperatively and 0.89 +/- 0.53 LogMAR 6 months postoperatively [P=0.005]. Mean preoperative macular thickness was 506 +/- 121.9 micro m which decreased to 318 +/- 90.5 micro m, postoperatively [P=0.001]. Vitrectomy with removal of the posterior hyaloid membrane appears to be beneficial in some cases of diffuse persistent diabetic macular edema with a taut premacular posterior hyaloid unresponsive to laser therapy. Careful selection of eyes with favorable preoperative clinical characteristics may improve surgical outcomes