Noha Khater, MD, FRCSED, MRCOphth., Mahmoud M. Soliman, MD, Nermeen A. Fawzi, M. Sc., Tamer A. Macky, MD, FRCSED

Purpose:

To evaluate the efficacy of intravitreal triamcinolone acetonide (TA) during phacoemulsification in preventing deterioration of macular edema in diabetic patients with clinically significant cataract.

Setting:

Department of Ophthalmology, Cairo University Hospitals, Cairo, Egypt

Methods:

Twenty four eyes of eighteen diabetic patients with dense cataracts were diagnosed by slit-lamp biomicrosopy and confirmed with flourescein angiography (FA) to have clinically significant macular edema (CSME). The patients were randomly assigned to either receive intravitreal TA during phacoemulsification or not. Postoperative visual acuity (VA), intraocular pressures (IOP), FA and Volumetric Optical Coherence Tomography (VOCT) were assessed, recorded and compared in both the study and the control groups, for up to 4 months postoperative.

Results:

At three months, the mean postoperative visual acuity in the study group was 0.5 (ranging from 0.4-0.9) which was clinically significantly better than the control group (0.3 with a range of 0.1-04). However the mean VOCT at three months showed a statistically significant difference between the study group (2.4 mm3) and the control group (3.9 mm3) (P=0.01). IOP were elevated in 40 % of patients in the study group from a baseline mean of 16+3mmHg to a mean of 21.5+4mmHg one month after injection, all brought under control with antiglaucoma medications. However 4 patients of the study group required additional focal laser treatment.

Conclusion:

Phacoemulsification with intravitreal TA in patients with CSME appears to be a safe intervention to avoid the postoperative exacerbation of the edema in patients with dense cataract precluding macular laser treatment. Postoperative laser treatment may be needed in some cases to augment the effect of intravitreal TA.

Take-home Message:

Intravitreal TA during phacoemulsification may be beneficial in avoiding DME exacerbation postoperatively.