Intravitreal triamcinolone injection for diabetic macular edema: a clinical and fluorescein angiographic case series.

Abstract

BACKGROUND:

A significant number of eyes with diabetic macular edema remain refractory to treatment despite numerous attempts at photocoagulation. Triamcinolone acetonide, a minimally water soluble steroid injected in suspension form, has been reported to be a well-tolerated agent for intravitreal injection, prompting a decrease in diabetic macular edema on optical coherence tomography. We report our experience with this treatment in 19 eyes with persistent diabetic macular edema.

METHODS:

We reviewed the charts of 16 patients (19 eyes) from a clinical practice with diabetic macular edema persistent after focal or grid laser photocoagulation. All eyes had received 4 mg of triamcinolone, injected into the vitreous cavity 3.5 mm posterior to the limbus. Fluorescein angiography was performed before and about 2 weeks after the injection. Snellen visual acuity and intraocular pressure (as determined with Goldmann applanation tonometry) were also measured before and after the injection.

RESULTS:

Fluorescein angiography showed marked improvement of macular edema in 4 eyes (21.0%), mild improvement in 10 eyes (52.6%) and no change in 5 eyes (26.3%); no patient had worsening of macular edema. Visual acuity improved by at least 1 line in 13 eyes (68.4%), by 2 or more lines in 5 eyes (26.3%), by 3 or more lines in 2 eyes (10.5%) and by 4 lines in 1 eye (5.3%); visual acuity remained unchanged in 5 eyes (26.3%) and deteriorated by 1 line in 1 eye (5.3%). Intraocular pressure elevation of 10 mm Hg or greater occurred in two eyes (10.5%) and was successfully treated with topical administration of 0.15% brimonidine.The triamcinolone was well tolerated, and there were no other ocular complications.

INTERPRETATION:

Intravitreal injection of triamcinolone has potential in the treatment of diabetic macular edema and warrants investigation in a randomized prospective clinical trial.

• Authors: Sophie J Bakri, Paul M Beer
• Journal: Canadian journal of ophthalmology. Journal canadien d'ophtalmologie (Can J Ophthalmol) Vol. 39 Issue 7 Pg. 755-60 (Dec 2004) ISSN: 0008-4182 [Print] England
• PMID: 15696765 (Publication Type: Journal Article)

Chemical References

• Antihypertensive Agents
• Glucocorticoids
• Quinoxalines
• Brimonidine Tartrate
• Triamcinolone Acetonide

Topics

• Aged
• Aged, 80 and over
• Antihypertensive Agents (administration & dosage)
• Brimonidine Tartrate
• Diabetic Retinopathy (diagnosis, drug therapy)
• Female
• Fluorescein Angiography
• Glucocorticoids (therapeutic use)
• Humans
• Injections
• Intraocular Pressure (drug effects)
• Laser Coagulation
• Macular Edema (diagnosis, drug therapy)
• Male
• Middle Aged
• Pilot Projects
• Quinoxalines (administration & dosage)
• Retrospective Studies
• Triamcinolone Acetonide (therapeutic use)
• Visual Acuity
• Vitreous Body