Article

Posterior sub-Tenon's capsule injection of triamcinolone acetonide prevents panretinal photocoagulation-induced visual dysfunction in patients with severe diabetic retinopathy and good vision.

Department of Ophthalmology, NTT East Japan Tohoku Hospital, Sendai, Miyagi, Japan.
Ophthalmology (impact factor: 5.45). 03/2006; 113(3):381-7. DOI:10.1016/j.ophtha.2005.10.035 pp.381-7
Source: PubMed

ABSTRACT To evaluate prospectively the efficacy of a single sub-Tenon's capsule injection of triamcinolone acetonide (TA) against panretinal photocoagulation (PRP)-induced macular thickening and visual disturbance in patients with severe diabetic retinopathy and good vision.
Prospective, comparative, interventional case series.
Twenty eyes of 10 patients with severe nonproliferative diabetic retinopathy or non-high-risk proliferative diabetic retinopathy whose visual acuity was 20/40 or better (<0.3 in logarithm of the minimum angle of resolution [logMAR] acuity) before the PRP, whose retinopathy was bilateral and symmetrical. The averaged parafoveal retinal thickness was more than 300 microm, leading to a worse visual prognosis after PRP.
Sub-Tenon's capsule injection of 20 mg TA.
Best-corrected visual acuity (BCVA) with logMAR chart and averaged foveal thickness (FT) using the retinal mapping program of optical coherence tomography.
In all patients, PRP was performed every other week for 4 sessions on both eyes, and 1 week before PRP; 1 eye received the TA injection, and the other eye served as a control. The clinical course of BCVA and FT was monitored for up to 24 weeks after beginning PRP.
Before TA injection, BCVA and FT were 0.055+/-0.072 and 235.5+/-37.5 microm in the TA-injected eye and 0.065+/-0.071 and 233.7+/-39.8 microm in the control eye, respectively; there was no significant difference between eyes. After the TA injection, FT in the TA-injected eyes was significantly decreased. During and after the PRP, FT in the control eye increased dramatically and reached 312.0+/-68.2 microm at 24 weeks, which was significantly different from that in the TA-injected eyes (235.3+/-38.6 microm at 24 weeks). Best-corrected visual acuity in the control eye decreased with time to 0.24+/-0.13; in contrast, and BCVA in the TA-injected eye was good (to 0.085+/-0.11) .
As a pretreatment for PRP, a single sub-Tenon's capsule injection of TA has beneficial effects for preventing PRP-induced foveal thickening and visual dysfunction in patients with severe diabetic retinopathy and good vision.

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    Article: Management of type 2 diabetics requiring panretinal photocoagulation and cataract surgery.
    Chikako Suto, Sadao Hori, Satoshi Kato
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    ABSTRACT: To evaluate the outcomes in patients with diabetic retinopathy and cataract who had panretinal photocoagulation (PRP) first and cataract surgery second in 1 eye and cataract surgery followed by PRP in the fellow eye. Department of Ophthalmology, Saiseikai Kurihashi Hospital, Saitama, Japan. Fifty-eight eyes of 29 patients with similar bilateral cataracts and severe nonproliferative or early proliferative diabetic retinopathy were randomly assigned for treatment with cataract surgery performed after PRP (PRP-first group) or before PRP (surgery-first group). Treatment was performed in the opposite order in the contralateral eye. The main outcome measure was best corrected visual acuity (BCVA) 12 months after surgery. The secondary outcome measures were the laser parameters, progression of retinopathy and macular edema, and aqueous flare intensity. The percentage of eyes with a BCVA of 20/40 or better was statistically significantly higher in the surgery-first group (96.6%) than in the PRP-first group (69.0%) (P = .012). The rate of the progression of macular edema was significantly decreased in the surgery-first group (P = .033). There was no significant difference between the 2 groups in the other outcome measures. Although the order in which PRP and cataract surgery were performed had no effect on postoperative retinopathy, the BCVA was better and the rate of the progression of macular edema was decreased in the surgery-first group.
    Journal of Cataract [?] Refractive Surgery 07/2008; 34(6):1001-6. · 2.26 Impact Factor
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Keywords

1 eye
 
10 patients
 
averaged parafoveal retinal thickness
 
Best-corrected visual acuity
 
clinical course
 
control eye
 
good vision
 
interventional case series
 
minimum angle
 
non-high-risk proliferative diabetic retinopathy
 
optical coherence tomography
 
panretinal photocoagulation
 
PRP)-induced macular thickening
 
PRP-induced foveal thickening
 
single sub-Tenon's capsule injection
 
TA-injected eye
 
TA-injected eyes
 
triamcinolone acetonide
 
visual disturbance
 
visual dysfunction
 

Masahiko Shimura