J Korean Ophthalmol Soc.  2011 Sep;52(9):1063-1070.

Posterior Sub-Tenon Triamcinolone Acetonide Injection for Recurrent Diabetic Macular Edema after Repeated Intravitreal Bevacizumab Injections

• Kim JH
• Park DH
• Shin JP
• Kim SY

Abstract

PURPOSE
To evaluate posterior sub-Tenon injection of triamcinolone acetonide (TA) for recurrent diabetic macular edema (DME) after repeated intravitreal bevacizumab (IVB).
METHODS
This is a retrospective interventional case series comprised of 35 eyes (32 patients) with recurrent clinically significant DME after two or more IVB treatments. All patients were administered TA 40 mg injections. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were reevaluated at months 1, 3, and 6.
RESULTS
The baseline OCT showed five eyes with diffuse retinal thickening, 18 eyes with cystoid macular edema, and 12 eyes with serous retinal detachment. Mean BCVA improved at months 1 and 3, and mean CMT decreased at months 1 and 3. However, mean BCVA and CMT at six months was not different from baseline. Each DME pattern showed significant improvements in BCVA and CMT at three months. Mean IOP at months 1, 3, and 6 did not show any significant difference from baseline. No eyes showed complications including cataract progression or endophthalmitis.
CONCLUSIONS
Posterior sub-Tenon injection of TA should be considered for patients with recurrent DME after repeated IVB. The studied eyes showed improvements in BCVA and CMT during three months in all of the three patterns of DME.

Keyword

Bevacizumab; Diabetic macular edema; Posterior sub-Tenon injection; Triamcinolone acetonide

MeSH Terms

Antibodies, Monoclonal, Humanized
Cataract
Endophthalmitis
Eye
Humans
Intraocular Pressure
Macular Edema
Retinal Detachment
Retinaldehyde
Retrospective Studies
Triamcinolone
Triamcinolone Acetonide
Visual Acuity
Bevacizumab
Antibodies, Monoclonal, Humanized
Retinaldehyde
Triamcinolone
Triamcinolone Acetonide

Figure

• 

  Figure 1. Changes in central macular thickness (CMT) and best-corrected visual acuity (BCVA) of eyes with diabetic macular edema (DME) after posterior sub-Tenon triamcinolone acetonide (TA) 40 mg (1 ml) injection. (A, B, C) Horizontal optical coherence tomography (OCT) scan of a 67-year-old patient with recurrent DME despite 3 repeated intravitreal bevacizumab (IVB) injections. (A) At baseline, OCT showed cystoid macular edema with intraretinal cystoid spaces with 735 μ m of CMT and BCVA was 20/200. (B) Three months after TA injection, OCT showed complete resolution of intraretinal cystoid spaces with 244 μ m of CMT and BCVA improved to 20/50. (C) Six months after TA injection, CMT increased to 560 μ m and BCVA decreased to 20/100.

• 

  Figure 2. Changes in central macular thickness (CMT) and best-corrected visual acuity (BCVA) of eyes with diabetic macular edema (DME) after posterior sub-Tenon triamcinolone acetonide (TA) 40 mg (1 ml) injection. (A, B C) Horizontal optical coherence tomography (OCT) scan of a 64-year-old patient with recurrent DME despite 3 repeated intravitreal bevacizumab (IVB) injections. (A) At baseline, OCT showed serous retinal detachment with low subretinal reflectivity with 545 μ m of CMT and BCVA was 20/125. (B) Three months after TA injection, OCT showed nearly complete resolution of subretinal fluid with 242 μ m of CMT and BCVA improved to 20/80. (C) Six months after TA injection, CMT increased to 431 μ m and BCVA decreased to 20/125.

Reference

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