Yonsei Med J.  2008 Dec;49(6):955-964. 10.3349/ymj.2008.49.6.955.

Comparison of Combination Posterior Sub-Tenon Triamcinolone and Modified Grid Laser Treatment with Intravitreal Triamcinolone Treatment in Patients with Diffuse Diabetic Macular Edema

• Chung EJ
• Freeman WR
• Azen SP
• Lee H
• Koh HJ

• KMID: 1782944
• DOI: http://doi.org/10.3349/ymj.2008.49.6.955

Abstract

PURPOSE
To compare the efficacy of posterior sub-Tenon's capsule triamcinolone acetonide injection combined with modified grid macular photocoagulation (PSTI + MP) with intravitreal triamcinolone acetonide (IVTA) injection in the treatment of diffuse diabetic macular edema (DME). MATERIALS AND METHODS: Forty eyes of 33 patients with diffuse DME were randomly allocated into either PSTI + MP (20 eyes) or IVTA (20 eyes). Best corrected visual acuity (VA) and foveal thickness were measured. RESULTS: The ETDRS scores at baseline were 25.2 +/- 13.6 (mean +/- SD) letters in the PSTI + MP group, whereas 21.7 +/- 16.3 letters in the IVTA group. The ETDRS scores improved by 33.2 +/- 15.9, 34.7 +/- 16.6 and 30.9 +/- 19.0 letters in the PSTI + MP group whereas by 30.9 +/- 15.4, 30.1 +/- 17.9 and 31.5 +/- 15.0 letters in the IVTA group at 1, 3, and 6 months after the treatments, respectively. The VA improved significantly at 1 month and 3 months after both treatments (all p < 0.02, paired t-test). The VA improvements were no longer significant at 6 months in either group. There were no statistically significant differences at any time points between the 2 groups (all p > 0.05, Student's t-test). The foveal thicknesses at baseline and 1, 3, and 6 months after the treatments were 382.8 +/- 148.3, 309.1 +/- 131.3, 319.3 +/- 93.3, 340.4 +/- 123.5micrometer (mean +/- SD) in the PSTI + MP group vs. 369.1 +/- 123.1, 241.4 +/- 52.3, 277.5 +/- 137.4, 290.2 +/- 127.9micrometer in the IVTA group, respectively. Pairwise comparisons revealed significant decrease in foveal thickness at 1 month (p = 0.01, paired t-test) for the PSTI + MP group, and at both 1 month (p < 0.001) and 3 months (p = 0.016) for the IVTA group. There were no statistically significant differences at any time points between the 2 groups (all p > 0.05, Student's t-test). In contrast to the PSTI + MP group, where no complications were noted, the elevation of intra-ocular pressure in 3 of 20 eyes (15%) and a significant increase in average cataract grading were observed in the IVTA group. CONCLUSION: PSTI + MP treatment provides significant improvement of vision in patients with diffuse DME over 3 months, and achieves outcomes comparable to those after IVTA treatment, however, with fewer complications.

Keyword

Diabetic macular edema; combined treatment; intravitreal triamcinolone injection; posterior sub-Tenon triamcinolone injection

MeSH Terms

Adult
Aged
Anti-Inflammatory Agents/administration & dosage
Diabetic Retinopathy/*drug therapy/physiopathology/*surgery
Female
Fovea Centralis/pathology
Humans
*Laser Coagulation
Macular Edema/complications/*drug therapy/physiopathology/*surgery
Male
Middle Aged
Prospective Studies
Triamcinolone/*administration & dosage
Visual Acuity
Vitreous Body

Figure

• 

  Fig. 1 Changes in mean ETDRS scores after treatments. ETDRS, Early Treatment Diabetic Retinopathy Study. PSTI, posterior subtenon triamcinolone injection; IVTA, intravitreal triamcinolone acetonide injection; ETDRS, Early Treatment of Diabetic Retinopathy Study

• 

  Fig. 2 Changes in mean foveal thicknesses after treatments. PSTI, posterior subtenon triamcinolone injection; IVTA, intravitreal triamcinolone acetonide injection.

• 

  Fig. 3 Changes in mean intraocular pressures after treatments. IOP, intraocular pressure; PSTI, posterior subtenon triamcinolone injection; IVTA, intravitreal triamcinolone acetonide injection. *IOP was significantly higher in the IVTA group (p = 0.006 at 1 month, p = 0.026 at 3 months; Student's t-test).

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