Intravitreal triamcinolone acetonide for diffuse diabetic macular edema: Phase 2 trial comparing 4 mg vs 2 mg
ABSTRACT To prospectively compare the efficacy and safety of 4 vs 2 mg intravitreal triamcinolone acetonide (TA) injection for diabetic macular edema.
Interventional case series.
Thirty-two patients with diabetic macular edema unresponsive to laser photocoagulation.
Patients were randomly assigned to receive 4 or 2 mg intravitreal TA in one eye (16 patients in each group).
The main outcome was central macular thickness (CMT) measured by optical coherence tomography (OCT) at four, 12, and 24 weeks. Secondary outcomes were gain in Early Treatment Diabetic Retinopathy Study (ETDRS) scores, intraocular pressure (IOP), cataract progression, and duration of effect.
Before injection, mean (+/- SD) CMT was 564.5 +/- 119 microm and 522.9 +/- 148.5 microm in the 4- and 2-mg groups, respectively. At four, 12, and 24 weeks after injection, it was 275.0 +/- 79.8, 271.4 +/- 128.7, and 448.7 +/- 146.4 microm, respectively, in the 4-mg group, and 267.3 +/- 82.4, 289.8 +/- 111.4, and 394.7 +/- 178.9 microm, respectively, in the 2-mg group. At no time was the difference in CMT between both groups statistically significant (P> 0.3). The between-group differences in the gain in the ETDRS score and in IOP were not statistically significant either. Diabetic macular edema recurred after a median period of 20 weeks vs 16 weeks in the 4- and 2-mg groups, respectively (P = 0.11).
In the short term, intravitreal injection of 4 or 2 mg TA does not have different effects on CMT, visual acuity, or IOP.
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ABSTRACT: PURPOSE: To describe changes of the foveal photoreceptor layer using optical coherence tomography (OCT) in diabetic macular edema (DME) treated with argon laser photocoagulation (ALP) or intravitreal triamcinolone (IVTA) and correlate these changes with visual outcome. DESIGN: Analysis of OCT images from a prospective randomised controlled trial of ALP versus IVTA for DME. METHODS: We studied the final OCT images of 71 eyes with diabetic macular edema. The tomographic finding of the foveal third hyper-reflective band (HRB) was classified into 2 groups: intact HRB and disrupted or absent HRB. The final visual outcome in these groups were compared in both the laser group and the IVTA group RESULTS: The presence of the third HRB at the fovea was associated with better visual outcome in both treatment groups with the laser group showing statistically significant correlation. CONCLUSION: Intact foveal third HRB is a reliable indicator of favourable final visual outcome following treatment of DME.
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ABSTRACT: Abstract Purpose: Evaluation of diabetic macular edema (DME) after phacoemulsification by optical coherence tomography (OCT) and the use of deferred intravitreal triamcinolone acetonide (IVTA) as a therapy. Methods: This was an institutional, nonrandomized, retrospective study. Within a period of 18 months, 5,684 eyes underwent phacoemulsification in our department, 1,634 of which were diabetic. Eight weeks after surgery, 55 out of 1,634 diabetic eyes that had undergone phacoemulsification developed DME and were treated with a 3.2 mg IVTA injection. The mean best-corrected visual acuity (BCVA) and mean central macular thickness (CMT) were measured before and after phacoemulsification and 3 months after IVTA. Results: The mean BCVA at baseline, after phacoemulsification, and 3 months after deferred IVTA was 49.0±17.7, 53.7±17.4, and 66.36±20.66, respectively. The mean CMT for the same endpoints was 268.9±76.3, 554.6±137.8, and 275.0±76.3 μm, respectively. Eyes were subdivided into 2 subgroups: eyes with a previous history of DME and eyes with de novo DME. Three months after deferred IVTA, there was a statistically significant difference between these 2 subgroups in BCVA (P<0.001) and in CMT (P=0.002). The OCT features before and after IVTA defined 2 subgroups of DME, with respect to cyst color and symmetry and OS/IS line integrity after IVTA. Conclusions: Our data suggest that DME progresses after uncomplicated phacoemulsification in diabetic eyes and that IVTA is an appropriate therapeutic tool. The response to IVTA treatment depends on previous history of DME and its OCT profile.Journal of Ocular Pharmacology and Therapeutics 08/2014; 30(9). DOI:10.1089/jop.2013.0172 · 1.42 Impact Factor
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ABSTRACT: The treatment of diabetic macular edema is rapidly evolving. The era of laser therapy is being quickly replaced by an era of pharmacotherapy. Several pharmacotherapies have been recently developed for the treatment of retinal vascular diseases such as diabetic macular edema. Several intravitreal injections or sustained delivery devices have undergone phase 3 testing while others are currently being evaluated. The results of clinical trials have shown the superiority of some of these agents to laser therapy. However, with the availability of several of these newer agents, it may be difficult to individualize treatment options especially those patients respond differently to various therapies. As such, more effort is still needed in order to determine the best treatment regimen for a given patient. In this article, we briefly summarize the major new therapeutic additions for the treatment of diabetic macular edema and allude to some future promising therapies.12/2013; 4(6):324-338. DOI:10.4239/wjd.v4.i6.324