K. C. Apaydin, Y. Akar, H. Ozer

Purpose:

To evaluate the effect of intravitreal triamcinolone injection on the retinal sensitivity during the course of diabetic macular edema.

Methods:

The study population consisted of one eye of 33 patients with type 2 diabetes mellitus with clinically significant macular edema. None of the patients had proliferative diabetic retinopathy or a history of retinal laser photocoagulation. All eyes had received 4 mg of triamcinolone, injected into the vitreous cavity 3.5 mm posterior to the limbus. Fluorescein angiography was performed before and about 6 weeks after the injection. Snellen visual acuity and intraocular pressure (as determined with Goldmann applanation tonometry) were also measured before and after the injection. Once before injection(within 30 minutes), and repeated within 1 week, 4 weeks, and 8 weeks after injection; all treated eyes underwent visual field analysis using a Model 750 Humphrey Field Analyzer II (Humphrey Instruments Inc., San Leandro, Calif., USA) with fullthreshold, central 30-2 program. Macular visual fields were divided into four regions: superior temporal, inferior temporal, superior nasal and inferior nasal. Visual field mean sensitivity (MS), the reliability criteria and the test duration were noted during each exam.

Results:

The mean age of the patients was 39.7 (SD 3.9) years. Following injection, in the first and the fourth week exams, treated eyes did not demonstrate a change in MS values with respect to baseline (P > 0.05). However, they showed a significant increase in mean MS values in the eighth week exam (P > 0.05). This increase was most marked in the superonasal macular region (P > 0.05). Fluorescein angiography showed marked improvement of macular edema in 12 eyes (36.4%), mild improvement in 14 eyes (42.4%) and no change in 4 eyes (12.1%); two eyes had worsening of macular edema.

Conclusion:

Intravitreal triamcinolone acetonide injection seems to be a promising and very effective treatment alternative in diabetic patients with macular edema. Present findings may highlight its additional role in the improvement of the macular sensitivity. However, this effect requires approximately 8 weeks to occur.