Comparison of Intravitreal Triamcinolone Treatment and Intravitreal Triamcinolone with Grid Laser Treatment in Patients with Diffuse Diabetic Macular Edema

Abstract

Objective: To compare the efficacy of intravitreal triamcinolone acetonide (IVTA) and IVTA plus macular laser grid photocoagulation therapy in diffuse diabetic macular edema (DME). Material and Methods: Sixteen patients affected by diffuse DME were retrospectively evaulated. Patients were divided into two groups: control group (IVTA injection) and laser group (IVTA plus grid laser). Main outcomes were best corrected visual aquity (BCVA) and central macular thickness (CMT) at the 3rd and 6th months of treatment. IVTA associated complications and reinjection necessity were assessed. Results: Our study comprised 18 eyes of 16 patients. The baseline BCVA and CMT were 0.93±0.45 and 530±136μm for the control and 1.02±0.52 and 509±177μm for the laser group respectively. Posttreatment BCVA at the 3rd and 6th month were 0.73±0.4 and 0.75±0.45 for control and 0.98±0.44 and 1.04±0.4 for laser group respectively (p>0.05 for all). CMT values at the 3rd and 6th months were 260±174μm (p=0.008) and 362±163 μm (p=0.05) for control and 331±161μm (p=0.05) and 388±215 μm (p>0.05) for laser groups. 55% of control and 66% of laser groups needed reinjection with an avarage of 7±4 months after the first injection. 22% cataract progression and 33% intraocular pressure elevation were noted. Conclusion: Macular grid laser photocoagulation after IVTA does not have beneficial effects for diffuse DME. Turkish Başlık: Diffüz Diabetik Maküler Ödemli Hastalarda İntravitreal Triamsinolon Tedavisi İle İntravitreal Triamsinolon ve Grid Lazer Tedavisinin Karşılaştırılması Anahtar Kelimeler: Diabetik maküler ödem, İntravitreal triamsinolon, grid lazer Amaç: Diffüz diabetik maküla ödeminde (DMÖ), intravitreal triamsinolon asetonid (İVTA) ve İVTA'ya ek maküler lazer grid fotokoagülasyon tedavisinin etkinliğini karşılaştırmak. Materyal-Metod: Diffüz DME mevcut 16 hasta retrospektif olarak değerlendirildi. Hastalar iki gruba ayrıldı: kontrol grubu (İVTA enjeksiyonu) ve lazer grubu (İVTA artı grid lazer). Tedavinin 3. ve 6. ayındaki en iyi düzeltilmiş görme keskinliği (DGK) ve santral maküler kalınlık (SMK) değerlendirildi. Aynı zamanda İVTA ile ilişkili komplikasyonlar ve tekrarlayan enjeksiyon gereksinimi değerlendirildi. Sonuçlar: Çalışmamızda 16 hastanın 18 gözü değerlendirilmiştir. Başlangıç DGK ve SMK sırasıyla kontrol grubunda 0.93±0.45 ve 530±136µm ve lazer grubunda 1.02±0.52 and 509±177µm idi. Tedavi sonrası DGK, 3. ve 6. ayda sırasıyla kontrol grubunda 0.73±0.4 and 0.75±0.45 ve lazer grubunda 0.98±0.44 and 1.04±0.4 idi (tüm değerler için p˃0.05). 3. ve 6. ayda SMK değerleri, kontrol grubunda 260±174µm (p=0.008) ve 362±163µm (p=0.05) ve lazer grubunda 331±161µm (p=0.05) ve 388±215µm (p˃0.05) idi. Kontrol grubunun %55'inde ve lazer grubunun %66'sında ilk enjeksiyondan ortalama 7±4 ay sonra ek enjeksiyon gerekmiştir. %22 katarakt gelişimi ve %33 göziçi basınç artışı izlendi. Tartışma: Diffüz diabetik maküla ödeminde İVTA enjeksiyonu sonrası uygulanan maküler grid lazer fotokoagülsayonun ek faydasının olmadığı izlenmiştir.

Keywords

• Diabetic macular edema (DME), intravitreal triamcinolone (IVTA), grid laser

Comparison of Intravitreal Triamcinolone Treatment and Intravitreal Triamcinolone with Grid Laser Treatment in Patients with Diffuse Diabetic Macular Edema

Öz

Kaynakça

1. Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. The Wisconsin Epidemiologic Study of Diabetic Retinopathy, IV: diabetic macular edema. Ophthalmology 1984;91:1464-74.
2. Diabetic Retinopathy Clinical Research Network Ophthalmology. A randomized trial comparing intravitreal triamcinolone acetonide and focal/grid photocoagulation for diabetic macular edema. Ophthalmology 2008;115:1447-9. [CrossRef]
3. Bresnick GH. Diabetic maculopathy: a critical review highlighting diffuse macularedema. Ophthalmology 1983;90:1301-17.
4. Lee CM, Olk RJ. Modified grid laser photocoagulation for diffuse diabetic macular edema: long term visual results. Ophthalmology 1991;98:1594-602.
5. Sutter FK, Simpson JM, Gillies MC. Intravitreal triamcinolone for diabetic macular edema that persists after laser treatment: three month efficacy and safety results of a prospective, randomized, double-masked, placebo-controlled clinical trial. Ophthalmology 2004;111:2044-9. [CrossRef]
6. Kuppermann BD, Blumenkranz MS, Haller JA, Williams GA, Weinberg DV, Chou C, et al. Dexamethasone DDS Phase II Study Group. Randomized controlled study of an intravitreous dexamethasone drug delivery system in patients with persistent macular edema. Arch Ophthalmol 2007;125:309-17. [CrossRef]
7. Arevalo JF, Fromow-Guerra J, Quiroz-Mercado H. Pan-American Collaborative Retina Study Group. Primary intravitreal bevacizumab (Avastin) for diabetic macular edema: results from the Pan-American Collaborative Retina Study Group at 6-month followup. Ophthalmology. 2007;114:743-75. [CrossRef]
8. Massin P, Audren F, Haouchine B, Erginay A, Bergmann JF, Benosman R, et al. Intravitreal triamcinolone acetonide for diabetic macular edema: preliminary results of a prospective controlled trial. Ophthalmology 2004;111:218-25. [CrossRef]

9. Jonas JB, Kreissig I, Degenring RF. Intraocular pressure after intravitreal injection of triamcinolone acetonide. Br J Ophthalmol 2003;87:24-7. [CrossRef]
10. Yoshikawa K, Kotake S, Ichiishi A, Sasamoto Y, Kosaka S, Matsuda H. Posterior sub-Tenon injections of repository corticosteroids in uveitis patients with cystoid macular edema. Jpn J Ophthalmol 1995;39:71-6.
11. Diabetic Retinopathy Clinical Research Network Ophthalmology. A randomized trial comparing intravitreal triamcinolone acetonide and focal/grid photocoagulation for diabetic macular edema. Ophthalmology 2008;115:1447-9. [CrossRef]
12. Gottfredsdóttir MS, Stefánsson E, Jónasson F, Gíslason I. Retinal vasoconstriction after laser treatment for diabetic macular edema. Am J Ophthalmol. 1993;115:64-7.
13. Martidis A, Duker JS, Greenberg PB, Rogers AH, Puliafito CA, Reichel E, et al. Intravitreal triamcinolone for refractory diabetic macular edema. Ophthalmology 2002;109:920-7. [CrossRef]
14. Kang SW, Sa HS, Cho HY. Macular grid photocoagulation after intravitreal triamcinolone acetonide for diffuse diabetic macular edema. Arch Ophthalmol 2006;124:653-8. [CrossRef]
15. Lam DS, Chan CK, Mohamed S, Lai TY, Lee VY, Liu DT, Li KK, et al. Intravitreal Triamcinolone plus sequential grid laser versus Triamcinolone or laser alone for treating diabetic macular edema: Six month outcomes. Ophthalmology 2007;114:2162-7. [CrossRef]
16. Jonas JB, So¨fker A. Intraocular injection of crystalline cortisone as adjunctive treatment of diabetic macular edema. Am J Ophthalmol 2001;132:425-7. [CrossRef]
17. Wilson CA, Berkowitz BA, Sato Y, Ando N, Handa JT, de Juan E Jr. Treatment with intravitreal steroid reduces blood-retinal barrier breakdown due to retinal photocoagulation. Arch Ophthalmol 1992;110:1155-9. [CrossRef]
18. Sakamoto T, Miyazaki M, Hisatomi T, Nakamura T, Ueno A, Itaya K, et al. Triamcinolone-assisted pars plana vitrectomy improves the surgical procedures and decreases the postoperative bloodocular barrier breakdown. Graefes Arch Clin Exp Ophthalmol 2002;240:423-9. [CrossRef]
19. Jonas JB, Degenring RF, Kamppeter BA, Kreissig I, Akkoyun I. Duration of the effect of intravitreal triamcinolone acetonide as treatment of diffuse diabetic macular edema. Am J Ophthalmol 2004;138:158-60. [CrossRef]
20. Larsson J, Zhu M, Sutter F, Gillies MC. Relation between reduction of foveal thickness and visual acuity in diabetic macular edema treated with intravitreal triamcinolone. Am J Ophthalmol 2005;139:802-6. [CrossRef]
21. Photocoagulation for diabetic macular edema: Early Treatment Diabetic Retinopathy Study report number 1. Arch Ophthalmol 1985;103:1796-806 [CrossRef]
22. Treatment techniques and clinical guidelines for photocoagulation of diabetic macular edema: Early Treatment Diabetic Retinopathy Study report number 2. Ophthalmology 1987;94:761-74.
23. Photocoagulation for diabetic macular edema: Early Treatment Diabetic Retinopathy Study report number 4. Int Ophthalmol Clin 1987;27:265-72. [CrossRef]
24. Özkırış A, Erkılıç K. Complications of intravitreal injection of triamcinolone acetonide. Can J Ophthalmol 2005;40:63-8.