Intravitreal Triamcinolone For Refractory Diabetic Clinically Significant Macular Oedema

Abstract

Objective: To determine long term effects on final visual outcome, macular fluorescein leakage
and intraocular pressure after intravitreal injection of triamcinolone for treating refractory diabetic
clinically significant macular oedema (CSMO).
Material & Methods: Patients with CSMO of more than 12 months duration, diagnosed
according to ETDRS criteria were recruited. All patients had at least two or more macular grid
laser treatment with the more recent laser at least 3 months prior to the injection. Patients with
CSMO and active proliferative disease, vein occlusions and macular ischemia were excluded.
Patients with pre-existing significant cataract or glaucoma were also not considered.
Triamcinolone, 4mg was injected through the pars-plana, infrotemporally using a 27 guage
needle. The response to the treatment was monitored at 1 month, 3 months and 6 months. Visual
acuity was assessed by LogMAR units, Fluorescein leakage by measuring the area of late phase
of digital fluorescein angiogram and intraocular pressure by Goldman's applanation tonometry.
Results: Fourteen eyes of 13 patients were included in the study. The mean age was 68 years.
All patients had an average of 2.4 previous sessions of grid laser treatment for CSMO. The mean
visual acuity improved from 0.54 LogMAR units prior to the injection to 0.43, 0.40 and 0.37
LogMAR units at 1,3 and 6 months post-injection. This showed a statistically significant p-values
of 0.042, 0.013 and 0.002 respectively. The mean intraocular pressure (IOP) increased from a
pre-injection value of 16.57 to 19.42, 22.07 and 21.50 at 1,3 and 6 months post injection
respectively. The p-value for this rise in IOP was also statistically significant at 0.035, 0.005 and
0.000 respectively. Evaluated subjectively in a masked fashion, macular post injection fluorescein
angiograms of all 14 eyes (100%) were graded to show less leakage than on the pre-injection
angiograms in at 1, 3 and 6 months visits. No injection site related complications were noted. No
patient had a repeat injection.
Conclusion: Intravitreal triamcinolone has shown visually and anatomically encouraging
results for the treatment of diabetic macular oedema that fails to respond to conventional laser
photocoagulation. Raised intraocular pressure is a concern but longer follow up is needed to
asses the efficacy and safety as well as need for re-treatment