Sengül Özdek, Umut Bahçeci, Gökhan Gürelik, Bahri Aydın, Berati Hasanreisoglu

Aim:

To evaluate prospectively the results of posterior subtenon (PSTT) and intravitreal (IVT) triamcinolone injections in diabetic macular edema refractory to conventional grid laser photocoagulation.

Material and methods:

Eyes with resistant clinically significant macular edema had complete ophthalmic examination including FA and OCT before and 1st, 3rd and 6th months of the treatment. IVT group received 4mg/0.1cc and PSTT group received 20mg/0.5cc triamcinolone injection. IVT was also applied to eyes with resistant macular edema after PSTT injection (secondary IVT group). Paired t-test and Students’ t-test were used to compare the results.

Results:

There were 76 eyes in the PSTT group and 31 eyes in IVT group. There were 15 eyes in the primary IVT group and 16 eyes in the secondary IVT group. Mean follow-up time was 3.9 and 4.5 months after PSTT and IVT groups respectively. In PSTT group, the mean visual acuity increased from 0.16 to 0.23 (p≤0.05) and central foveal thickness decreased from 440.1µ to 305.8µ (p≤0.05) at the end of 6th month. In IVT group, the mean visual acuity and central foveal thickness was found to be 0.14 and 471.7µ before treatment and 0.11 and 394.5µ at the 6th month. In the 1st and 3rd month follow-up, the decrease in central foveal thickness was significantly greater in IVT group (p≤0.05). The visual results were better in the primary IVT group than both the PSTT and secondary IVT groups. Significant intraocular pressure increase was found in 7.8% of PSTT group and in 16.1% of IVT group.

Conclusion:

PSTT and primary IVT injections caused a significant increase in visual acuity and a decrease in central foveal thickness especially in the short-term. Decrease in central foveal thickness was more prominent in IVT group especially when performed as a primary injection.

Take-home message:

Both PSTT and IVT injections seem to be effective treatment modalities in eyes with refractory diabetic macular edema.