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Graefe's Archive for Clinical and Experimental Ophthalmology

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01-01-2006 | Clinical Investigation

Intravitreal triamcinolone injection for chronic diabetic macular oedema with severe hard exudates

Authors: Remzi Avci, Berkant Kaderli

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology | Issue 1/2006

Abstract

Background

The purpose of the study was to determine the efficacy and safety of intravitreal triamcinolone acetonide (TA) in chronic diabetic macular oedema with severe hard exudates.

Methods

This prospective, interventional consecutive case series study consisted of 33 eyes of 28 patients with chronic diabetic macular oedema and severe foveal hard exudates who received an intravitreal injection of 4 mg of TA. The patients were divided into two groups according to the type of foveal hard exudates: group I, plaque-like (17 eyes) and group II, dot-like scattered hard exudates (16 eyes). The results of both groups, evaluated by colour fundus photography and fluorescein angiography, were compared and complications were recorded.

Results

All patients completed at least 6 months of follow-up. In all eyes, the hard exudates were completely resolved (24% in group I and 50% in group II) or decreased (76% in group I and 50% in group II). In group I, the mean diameter of the exudates plaques significantly decreased from 5.5±3.8 mm² in the pre-treatment period to 2.2±2.7 mm² at the end of the follow-up period. There was no recurrence of the hard exudates in either of the groups. The mean ± SD visual acuity (VA) improved from 0.07±2.5 at the baseline to a maximum of 0.09±2.1 lines in group I (P<0.01) and from 0.13±3.9 to a maximum of 0.27±2.7 lines in group II (P<0.01). The mean VA improvement in group II was better than group I (3.2±2.5 vs. 1.4±1.0 lines, P<0.05). Intraocular pressure exceeded 21 mmHg in 10 eyes (30%), which was then controlled by topical medication. Three eyes (9%) exhibited signs of subcapsular cataract progression.

Conclusions

Intravitreal TA appears to be a valuable treatment in chronic diabetic macular oedema with severe foveal hard exudates. In all eyes in this study the hard exudates were completely resolved or decreased, and the mean VA improved significantly in both groups. However, the VA improvement was significantly worse in eyes with plaque-like exudates suggesting the possible value of earlier treatment. Further studies would enable the assessment of the universal effectiveness of this treatment.

Antonetti DA, Wolpert EB, DeMaio L, Harhaj NS, Scaduto RC Jr (2002) Hydrocortisone decreases retinal endothelial cell water and solute flux coincident with increased content and decreased phosphorylation of occludin. J Neurochem 80:667–777CrossRefPubMed

Bakri SJ, Beer PM (2004) Intravitreal triamcinolone injection for diabetic macular edema: a clinical and fluorescein angiographic case series. Can J Ophthalmol 39:755–760PubMed

Bresnick GH (1983) Diabetic maculopathy: a critical review highlighting diffuse macular edema. Ophthalmology 90:1301–1317PubMed

Ciardella AP, Klancnik J, Schiff W, Barile G, Langton K, Chang S (2004) Intravitreal triamcinolone for the treatment of refractory diabetic macular oedema with hard exudates: an optical coherence tomography study. Br J Ophthalmol 88:1131–1136CrossRefPubMed

Fisher S, Renz D, Schaper W, Karliczek GF (2001) In vitro effects of dexamethasone on hypoxia-induced permeability and expression of vascular endothelial growth factor. Eur J Pharmacol 411:231–243CrossRefPubMed

Fong DS, Segal PP, Myers F, Ferris FL, Hubbard LD, Davis MD (1997) Subretinal fibrosis in diabetic macular edema. ETDRS report 23. Early Treatment Diabetic Retinopathy Study Research Group. Arch Ophthalmol 115:873–877PubMed

Jonas JB, Degenring RF, Kamppeter BA, Kreissig I, Akkoyun I (2004) Duration of the effect of intravitreal triamcinolone acetonide as treatment for diffuse diabetic macular edema. Am J Ophthalmol 138:158–160CrossRefPubMed

Jonas JB, Kreissig I, Sofker A, Degenring RF (2003) Intravitreal injection of triamcinolone for diffuse diabetic macular edema. Arch Ophthalmol 121:57–61CrossRefPubMed

Jonas JB, Sofker A (2001) Intraocular injection of crystalline cortisone as adjunctive treatment of diabetic macular edema. Am J Ophthalmol 132:425–427CrossRefPubMed

10.

Klein R, Klein BE, Moss SE, Davis MD, DeMets DL (1984) The Wisconsin Epidemiologic Study of Diabetic Retinopathy. IV. Diabetic macular edema. Ophthalmology 91:1464–1474PubMed

11.

Levine RM, Rasmussen JE (1983) Intralesional corticosteroids in the treatment of nodulocystic acne. Arch Dermatol 119:480–481CrossRefPubMed

12.

Martidis A, Duker JS, Greenberg PB, Rogers AH, Puliafito CA, Reichel E, Baumal C (2002) Intravitreal triamcinolone for refractory diabetic macular edema. Ophthalmology 109:920–927CrossRefPubMed

13.

Massin P, Audren F, Haouchine B, Erginay A, Bergmann JF, Benosman R, Caulin C, Gaudric A (2004) Intravitreal triamcinolone acetonide for diabetic diffuse macular edema: preliminary results of a prospective controlled trial. Ophthalmology 111:218–224CrossRefPubMed

14.

Mohan K, Dhir SP, Munjal VP, Jain IS (1986) The use of intralesional steroids in the treatment of chalazion. Ann Ophthalmol 18:158–160PubMed

15.

Otani T, Kishi S (2001) Tomographic findings of foveal hard exudates in diabetic macular edema. Am J Ophthalmol 131:50–54CrossRefPubMed

16.

Ozkiris A, Evereklioglu C, Erkilic K, Tamcelik N, Mirza E (2004) Intravitreal triamcinolone acetonide injection as primary treatment for diabetic macular edema. Eur J Ophthalmol 14:543–549PubMed

17.

Sakuraba T, Suzuki Y, Mizutani H, Nakazawa M (2000) Visual improvement after removal of submacular exudates in patients with diabetic maculopathy. Ophthalmic Surg Lasers 31:287–291PubMed

18.

Takagi H, Otani A, Kiryu J, Ogura Y (1999) New surgical approach for removing massive foveal hard exudates in diabetic macular edema. Ophthalmology 106:249–256CrossRefPubMed

19.

Takaya K, Suzuki Y, Mizutani H, Sakuraba T, Nakazawa M (2004) Long-term results of vitrectomy for removal of submacular hard exudates in patients with diabetic maculopathy. Retina 24:23–29CrossRefPubMed

20.

Yang CM (2000) Surgical treatment for severe diabetic macular edema with massive hard exudates. Retina 20:121–125CrossRefPubMed

Title: Intravitreal triamcinolone injection for chronic diabetic macular oedema with severe hard exudates
Authors: Remzi Avci
Berkant Kaderli
Publication date: 01-01-2006
Publisher: Springer-Verlag
Published in: Graefe's Archive for Clinical and Experimental Ophthalmology / Issue 1/2006
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI: https://doi.org/10.1007/s00417-005-0069-5

At a glance: The STEP trials

Springer Medicine

Intravitreal triamcinolone injection for chronic diabetic macular oedema with severe hard exudates

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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