Advances in Clinical and Experimental Medicine
2017, vol. 26, nr 1, January-February, p. 45–49
doi: 10.17219/acem/29849
Publication type: original article
Language: English
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The effects and safety of intravitreal triamcinolone injections in the treatment of diabetic macular edema
1 Department of Ophthalmology, Wroclaw Medical University, Poland
Abstract
Background. Diabetic macular edema (DME) is responsible for three-quarters of vision-loss cases in diabetic eye disease. In most cases, early treatment by laser photocoagulation can only stabilize vision. Glucocorticoids have been used as a local pharmacological treatment in DME when the inflammation seems to have a pathological background.
Objectives. The aim of the study was to establish the effectiveness and safety of intravitreal triamcinolone injections in the treatment of DME.
Material and Methods. Twenty mg intravitreal injections of triamcinole acetonide (IVTA) were applied to 110 DME patients after ineffective laserphotocoagulation or as an initial treatment. Best corrected visual acuity (BCVA) for distant and near vision, central retinal thickness and intraocular pressure (IOP) were analyzed before and after the treatment at intervals of 1 week, 1 month, 3 months and 6 months. The measurements were continued in cases of repeated IVTA.
Results. Statistically significant improvements were observed in BCVA in near and distant vision, as well as a decrease in central retinal thickness after all time-intervals following IVTA. BCVA in distant vision was not significantly improved after repeated IVTA. IOP increases were observed 1 week, 1 and 3 months after IVTA, but not at 6 months after IVTA. No sight-threatening side effects of IVTA were observed.
Conclusion. IVTA is useful in stabilizing DME progression, although its therapeutic effect may be timelimited.
Key words
diabetes, macular edema, triamcinolone
References (20)
- Patz A, Schatz H, Berkow JW, Gittelsohn AM, Ticho U. Macular edema – an overlooked complication of diabetic retinopathy. Trans Am Acad Ophthalmol Otolaryngol. 1973;77(1):34–42.
- Zimmet P, Alberti KG, Shaw J. Global and societal implications of the diabetes epidemic. Nature. 2014;14(6865):782–787.
- Klein R, Moss SE, Klein BE, Gutierrez P, Mangione CM. The NEI-VFQ-25 in people with long term type 1 diabetes mellitus: The Wisconsin Epidemiologic Study of Diabetic Retinopathy. Arch Ophthalmol. 2001;119(5):733–740.
- Brown DM. Early Treatment Diabetic Retinopathy Study Research Group. Photocoagulation for diabetic macular edema: Early Treatment Diabetic Retinopathy Study report number 1. Arch Ophthalmol. 1985;103:1796–1806.
- Jonas JB, Sofker A. Intraocular injection of crystalline cortisone as adjunctive treatment of diabetic macular edema. Am J Ophthalmol. 2001;132(3):425–457.
- Jonas JB, Kreissig I, Sofker A, Degenring RF. Intravitreal injection of tiamcinolone for diffuse diabetic macular edema. Arch Ophthalmol. 2003;121(1):57–61.
- Martidis A, Duker JS, Greenberg PB, et al. Intravitreal triamcinolone for refractory diabetic macular edema. Ophthalmology. 2001;109(5):920–927.
- Avitable T, Longo A, Reibaldi A. Intravitreal triamcinolone compared with macular laser grid photocoagulation for the treatment of cystoid macular edema. Am J Ophthalmol. 2005;140(4):695–702.
- Lam DS, Chan CK, Mohamed S, et al. A prospective randomized trial of different doses of intravitreal triamcinolone for diabetic macular oedema. Br J Ophthalmol. 2007;91(2):199–203.
- Gillies MC, Sutter FK, Simpson JM, Larsson J, Ali H, Zhu M. Intravitreal triamcinolone for refractory diabetic macular edema: Two-year results of a double-masked, placebo-controlled, randomized clinical trial. Ophthalmology. 2006;113(9):1533–1538.
- Sutter FK, Simpson JM, Gilies MC. Intravitreal triamcinolone for diabetic macular edema that persists after laser treatment: Three-month efficacy and safety results of a prospective, randomized, double-masked, placebo-controlled clinical trial. Ophthalmology. 2004;111(11):2044–2049.
- Schindler RH, Chandler DB, Thresher R, Machemer R. The clearance of intravitreal triamcinolone acetonide. Am J Ophthalmol. 1982;93:415–417.
- Machemer R. Five cases in which a depot steroid (hydrocortisone acetate and methylprednisolone acetate) was injected into the eye. Reti-na. 1996;16:166–167.
- Mason JO, Somaiva MD, Singh RJ. Intravitreal concentration of clearance of triamcinolone aceonide in nonvitrectomized human eyes. Reti-na. 2004;24(6):900–904.
- Spandau UH, Derse M, Schmitz-Valckenberg P, Popoulis C, Jonas JB. Dosage dependency of intravitreal triamcinolone acetonide as treat-ment for diabetic macular edema. Br J Ophthalmol. 2005,89(8):999–1003.
- Citirik M, Dilsiz N, Batman C, Zilelioglu O. Comparative toxicity of 4 commonly used intravitreally corticosteroids on rat retina. Can J Ophthalmol. 2009,44(3):e3–8.
- Brown DM. Exploring the potential of combination therapies for DME. Retina Today 2009 (January Suppl.);8–10.
- Diabetic Retinopathy Clinical Research Network. A randomized trial comparing intravitreal triamcinolone acetonide and focal/grid photo-coagulation for diabetic macular edema. Ophthalmology. 2008;115:1447–1449.
- ZucchiattiI, Lattanzio R, Querques L, Del Turco C, Cascavilla ML, Bandello F. Intravitreal dexamethasone implant in patients with persistent diabetic macular edema. Ophthalmologica. 2012;228(2):117–122.
- Sanford M. Fluocinolone acetonide intravitreal implant (Iluvien) in diabetic macular oedema. Drugs. 2013;73(2):187–193.