Persistent diffuse macular edema (ME) or cystoid ME is a result of chronic inflammation with the generalized breakdown of the inner blood retinal barrier and fluid accumulation, primarily in the outer plexiform layer. This process is characterized by the development of hard exudates and progressively lost of vision.

Triamcinolone acetonide is the most effective anti-inflammatory agent. After injection into the vitreous cavity concentration of medicine considerably higher in compare with other methods of introductions, therapeutic effect more longer due to slowly dissolving in the vitreous up to three month. Intra vitreous using of triamcinolone has no systemic effect, which is very important in patients with diabetes – (2 minutes).

Intravitreal 4mg triamcinolone injection was done to 29 patients (33 eyes) with (ME). Injections performed by standard method. We used TA injection in cases of persistent diffuse macular edema (ME) with hard exudates. We did not take into consideration the thickness of retina, main indication was the presence of hard exudates on the big area in posterior pole of the eye at list 3 months or more. On of the advantages of TA is ability to stimulate the dissolving of hard exudates with the diminished of retinal thickness.

We did not repeat injection in short period of time. Next injection we did after 6 months (3 eyes – 3 injections, 6 eyes – 2 injections, in all cases interval between injections was 6 month).
After 3 months macular thickness diminished on all eyes from mean 552,5±96,3µm on 203,8±97,7µm (p<0,01 by Wilcoxon test), best-corrected visual acuity improved on 26 eyes (78,8%), on 7 eyes remained the same. During next 12 months on 9 (27,3%) eyes macular edema recurred, and intravitreal 4mg triamcinolone injection repeated (Will be present OCT) – (2 minutes).
Whole period of observation is 3 years. During this period stable ME resolution was on 12 eyes (36,4%), ME stabilization on 13 eyes (39,4%), ME progression – 8 eyes (24,2%). Сomplications: 1 eye – pseudohypopion (3%), cataract progression – 10 eyes (30,3%), on 2 eyes (6,0%) cataract surgery was performed in a period of 1 year after first injection, 5 eyes (15%) temporary ocular pressure increasing. There were not any cases with glaucoma progression. Progression of cataract decreased visual acuity.  Best-corrected visual acuity in a period of 3 years worsened from baseline on 6 eyes (18,2%), stable increased on 19 eyes (57,6%) and on the 8 eyes (24,2%) did not changed.
In this presentation we presented only cases with TA injections without combination with laser treatment
Main cause of failure of any treatment of diabetic patients is inadequate systemic control of diabetes also it takes place in cases of TA injections. Of course, diffuse failure of foveal capillaries plays an important role in a recurrent of edema, especially after all TA crystals dissolved in vitreous cavity. We did not do TA injections in cases of retinal ischemia, excluded them after fluorescent angiography investigation. TA injection influence on the development of ischemia but less than avastin or lucentis. All these reasons together decrease the efficacy of TA treatment of macular edema.