Korean J Ophthalmol.  2006 Sep;20(3):156-161. 10.3341/kjo.2006.20.3.156.

Intravitreal Triamcinolone Reinjection for Refractory Diabetic Macular Edema

• Ramezani A
• Ahmadieh H
• Tabatabaei H

• KMID: 754572
• DOI: http://doi.org/10.3341/kjo.2006.20.3.156

Abstract

PURPOSE: To evaluate the effect of intravitreal triamcinolone acetonide (IVT) reinjection on clinical and optical coherence tomographic features in refractory diabetic macular edema. METHODS: In a prospective interventional case series, all IVT treated patients enrolled in a previous clinical trial were recalled to have a new ophthalmologic examination and optical coherence tomography (OCT) performed. Eyes found suitable for reinjection received 4 mg IVT. Complete clinical examination and OCT were repeated at 2 and 4 months post-injection. The changes were statistically analyzed using a paired t test and were compared to the results of the first injections. RESULTS: Of all returning patients, 12 cases with complete records were considered candidates for reinjection. Visual acuity (VA) changes were not significant after the first and second interventions, although there was a relative improvement (0.14 logMAR) 2 months after the first injection. Reductions of central macular thickness (CMT) were 43+/-69 micrometer, and 40+/-69 micrometer after the first injection and 27+/-48 micrometer, 49+/-58 micrometer after the reinjection at 2 and 4 months, respectively. None of the mentioned changes was significant. After the second injection, however, intraocular pressure was elevated at both 2 and 4 months (3.6 and 2.4 mmHg respectively, P<0.05). Two months after the first administration, intraocular pressure was found to be raised significantly (5.58 mmHg, P=0.001). CONCLUSIONS: The transient beneficial effects of IVT on diabetic macular edema are not repeated with second injections. However, IVT-related ocular hypertension is more persistent after reinjection.

Keyword

Diabetic macular edema; Intravitreal triamcinolone; Intraocular pressure; Macular thickness; Reinjection

MeSH Terms

Vitreous Body
Visual Acuity
Triamcinolone/*administration & dosage
Treatment Outcome
Tomography, Optical Coherence
Time Factors
Retreatment
Prospective Studies
Male
Macular Edema, Cystoid/*drug therapy/etiology/pathology
Intraocular Pressure
Injections
Humans
Glucocorticoids/*administration & dosage
Follow-Up Studies
Female
Diabetic Retinopathy/*complications/pathology

Figure

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  Fig. 1 Mean visual acuity (SD) before, 2, 4 and about 10 months after the first intravitreal triamcinolone injection.

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  Fig. 2 Mean central macular thickness before, 2, 4 and about 10 months after the first intravitreal triamcinolone injection.

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  Fig. 3 Mean intraocular pressure before, 2, 4 and about 10 months after the first intravitreal triamcinolone injection.

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  Fig. 4 Visual acuity changes (SD) after the first and the second injections.

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  Fig. 5 Central macular thickness changes after the first and the second injections.

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  Fig. 6 Intraocular pressure changes after the first and the second njections.

Reference

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