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

Purpose:

To evaluate the clinical outcome and safety of intravitreal injection of triamcinolone acetonide (TA) as an initial therapy for diffuse diabetic macular edema.

Setting:

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

Methods:

Ten eyes of eight patients with diffuse clinically significant macular edema (CSME) that did not receive previous laser therapy received 4 mg of intravitreal TA. Follow-up periods ranged from 6-12 months. Visual acuity and quantitative changes with optical coherence tomography OCT of macular thickening were assessed. Potential complications were monitored including intraocular pressure, cataract progression, retinal detachment, vitreous hemorrhages and endophthalmitis.

Results:

Visual acuity showed significant improvement from baseline during follow-ups in all eight patients, with a mean improvement of 2.1 and 1.8 lines on Snellen chart at 6 and 12 months respectively. The central macular thickness as measured by OCT decreased by more than 50 % and 45 % at same intervals from an initial pretreatment mean of 540.45 +/- 167 µm. Intraocular pressure increased initially in 30% of patients requiring medications, with return to normal values in all patients at 6 months of follow-up. No other complications were reported.

Conclusion:

Intravitreal injection of 4 mg of triamcinolone acetonide may be beneficial for improving visual acuity in patients with diffuse diabetic macular edema as an initial treatment modality instead of laser photocoagulation.

Take-home Message:

Intravitreal triamcinolone injections could be used as a first line intervention in patients with diffuse CSME.