J Korean Ophthalmol Soc.  2008 Jan;49(1):71-80. 10.3341/jkos.2008.49.1.71.

The Combined Effect of Subtenon Triamcinolone Injection and Panretinal Photocoagulation on Diabetic Retinopathy

• Kang S
• Park YH

• KMID: 2211185
• DOI: http://doi.org/10.3341/jkos.2008.49.1.71

Abstract

PURPOSE: To investigate the result of posterior sub-tenon triamcinolone acetonide injection combined with panretinal photocoagulation (PRP) in patients with diabetic retinopathy.
METHODS
A prospective study was performed on patients with diabetic retinopathy who required PRP. The study group consisted of 12 patients (12 eyes) of diabetic retinopathy without clinically significant macular edema (CSME) and 13 patients (13 eyes) with CSME. All patients were injected posteriorly with sub-tenon triamcinolone acetonide (40 mg) one week before PRP. During a six-month follow-up, best-corrected visual acuity, the development of macular edema, changes in fluorescein angiography, and related complications were monitored.
RESULTS
During a six-month follow-up, visual acuity was well preserved in patients with diabetic retinopathy without CSME (12 eyes). Only one patient in this group experienced temporary macular edema at 3 months after combined therapy. In the CSME group (13 eyes), the visual acuities of seven patients (53.8%) increased, those of five patients (38.5%) remained same, and one patient's visual acuity (7.7%) decreased in a study period of six months. Fluorescein angiography showed that macular edema was resolved in most patients except in one patient in whom macular edema remained for up to 6 months. Complications from combined therapy occurred in two patients who showed slight and temporary increase of intraocular pressure.
CONCLUSIONS
Combined treatment with posterior sub-tenon triamcinolone acetonide injection and PRP may provide benefits for patients with diabetic retinopathy who require urgent PRP by preventing exacerbation of macular edema.

Keyword

Panretinal photocoagulation; Posterior sub-tenon injection; Triamcinolone acetonide

MeSH Terms

Diabetic Retinopathy
Fluorescein Angiography
Follow-Up Studies
Humans
Light Coagulation
Macular Edema
Prospective Studies
Triamcinolone
Triamcinolone Acetonide
Visual Acuity
Triamcinolone
Triamcinolone Acetonide

Figure

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  Figure 1. Graph illustrating the change of mean best- corrected visual acuity (logMAR) in four groups. Group I: patients received combined therapy of triamcinolone sub-tenon injection and panretinal photocoagulation. Group II: patients received only panretinal photocoagulation. Group III: patients who had CSME received combined therapy of triamcinolone sub-tenon injection and panretinal photocoagulation. Group IV: patients who had CSME received focal or grid retinal photocoagulation before panretinal photocoagulation. In Group I and II, there was no difference of visual acuity between baseline and at 6 month. In Group III, compared with its baseline, values of visual acuity (logMAR) were significantly lower at 4, 5 and 6 months (p=0.019, p=0.044, p=0.042, respectively). In Group IV, compared with its baseline, values of visual acuity (logMAR) were significantly lower only at 6 months (p=0.028).

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  Figure 2. Color fundus photographs and late-phase fluorescein angiograms of a male patient aged 58 without clinically significan macular edema. Fundus photograph (A) and fluorescein angiogram (B) before posterior sub-tenon injection of triamcinolon acetonide. (C, D) Same patients 6 months after combined sub-tenon injection of triamcinolone acetonide and panretina photocoagulation. Note that there was no macular edema before and after combined therapy.

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  Figure 3. Color fundus photographs and late-phase fluorescein angiograms of a male patient aged 54 with clinically significant macular edema. Fundus photograph (A) and fluorescein angiogram (B) before posterior sub-tenon injection of triamcinolone acetonide showing macular edema and fluorescein leakage at macula (C, D) Same patient 6 months after combined sub-tenon injection of triamcinolone acetonide and panretinal photocoagulation. Note the decreased amount of late leakage in the macula as seen on the fluorescein angiogram. The macular edema improved.

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