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

Purpose:

To report our two-years experience with the safety and efficacy of intravitreal triamcinolone acetonide (TA) in treating diffuse diabetic macular edema refractory to laser.

Setting:

Department of Ophthalmology, Cairo University Hospitals, Cairo, Egypt.

Methods:

Fourteen eyes of 10 patients with clinically significant macular edema (CSME) that failed to respond to at least one session of laser photocoagulation were included. At least 3 months after initial laser therapy, the response was measured by clinical examination and optical coherence tomography (OCT). Eyes with a residual central macular thickness of more than 250 µm and a visual loss from baseline were offered intravitreal 4 mg TA. Visual acuity and quantitative changes in OCT macular thickening were assessed. Potential surgery- and steroid-related complications were monitored.

Results:

All patients completed one year of follow-ups and 4 patients (50% of eyes) completed 2 years. Mean improvement of visual acuity from baseline was 1.5, 1.8, 1.7, 2, and 3 Snellen lines at 3, 6, 12, 18 and 24 months, respectively. The central macular thickness as measured by OCT decreased by 57%, 58%, 56%, 40% and 36% at the same intervals respectively from an initial pretreatment mean of 415.75 +/- 262 µm. The mean increase in intraocular pressure was 5.5, 6.5, 3.2, 2- and 2mmHg at the same intervals from a mean baseline of 14mmHg. One patient exhibited progression of nuclear cataract in both eyes, one of which was injected. No other complications were note during the follow-up periods.

Conclusion:

Intravitreal triamcinolone is a promising therapeutic method for diabetic macular edema the fails to respond to conventional laser photocoagulation. Complications don’t appear to be prohibitive. Further studies with larger amount of patients are required.

Take-home Message:

Intravitreal triamcinolone injections could be used for patients with refractory diffuse CSME.