Intravitreal triamcinolone for diabetic macular edema: comparison of 1, 2, and 4 mg.

PURPOSE: To compare the efficacy and safety of different doses of intravitreal triamcinolone (IVTA) in treating eyes with refractory diffuse diabetic macular edema (DME) with cystic changes. METHODS: Forty-five eyes of 45 patients with diffuse DME were randomized to receive 1, 2, or 4 mg IVTA. Patients were observed for 6 months and changes in best-corrected visual acuity (VA) in Early Treatment Diabetic Retinopathy Study (ETDRS) scores, retinal thickness analyzer (RTA) central macular thickness (CMT), intraocular pressure, and cataract progression were compared among the three groups. RESULTS: Forty-two patients completed 6 months of follow-up and were included in the analysis. Following IVTA injection, the ETDRS score improved similarly, eight to nine letters, in all three groups at 4 weeks. The standardized CMT improved in all three groups at 4 weeks. This improvement was maintained through 12 and 24 weeks in the 1 and 2 mg groups, but not in the 4 mg group, which was significantly worse than the 1 and 2 mg groups at 12 and 24 weeks (P = 0.01, 0.03, 0.01, and 0.05). CONCLUSIONS: Regarding eyes with refractory diffuse DME with cystic changes, 4 mg IVTA does not appear to be more effective than 1 or 2 mg IVTA.

[Intravitreal triamcinolone acetonide for diffuse diabetic macular edema--one year follow-up].

BACKGROUND: Macular edema is the main cause of visual impairment in diabetic patients. Its treatment is mainly based on laser photocoagulation. Intravitreal triamcinolone acetonide (TA) has recently been proposed as a new treatment for eyes with diabetic macular edema resistant to conventional laser photocoagulation. AIM: To evaluate the one year efficacy and safety of a single TA injection administered for diffuse diabetic macular edema unresponsive to prior laser treatment. DESIGN: Interventional case series. METHODS: Setup: University medical center out-patient clinic. PARTICIPANTS: Twenty-one patients with bilateral diffuse diabetic macular edema. INTERVENTION: A single intravitreal injection of triamcinolone acetonide. MAIN OUTCOME MEASURES: Visual acuity measured by ETDRS score, retinal area evaluation clinically and retinal thickness evaluation by Retinal Thickness Analysis (RTA) at 3 and 12 months following injection. Secondary outcomes were intraocular pressure control and cataract progression. RESULTS: Three months following injection, the mean improvement in visual acuity was 4.7 +/- 11.7 letters in the study group as compared to 0.2 +/- 11.4 in the control group (p = 0.18). No difference was noticed one year following injection. Clinical assessment of the retinal area of edema revealed a substantial difference between patients and controls at 3 months (p = 0.0006) and at one year (p = 0.05). RTA evaluation revealed improvement in retinal thickness solely at the 3 months exam. Four eyes developed high intraocular pressure and required treatment (p = 0.054). No difference in cataract progression was noted between the two groups (p = 0.69). CONCLUSIONS: Injection of TA may improve visual acuity for a limited time. Increased intraocular pressure is a frequent side effect. During a one year follow-up, no evidence of ocular toxicity was noted in eyes with diffuse diabetic macular edema.