A Randomized Trial Comparing Suprachoroidal and Intravitreal Injection of Triamcinolone Acetonide in Refractory Diabetic Macular Edema due to Epiretinal Membrane.

Ahmed Abdelshafy Tabl,Mohamed Anany Elsayed,Tarek Tawfik Soliman,Marwa Abdelshafy Tabl,Alessandro Meduri

doi:10.1155/2022/7947710

Abstract

Purpose To compare the efficacy and safety of suprachoroidal and intravitreal injection of triamcinolone acetonide in pseudophakic patients with refractory diabetic macular edema (DME) due to epiretinal membrane (ERM). Study Design. This study is a randomized clinical trial (RCT). Participants. Twenty-three nonvitrectomized pseudophakic eyes of 23 subjects (9 M and 14 F with mean age: 54.8 years) with refractory DME due to ERM. Methods The eyes were randomized to suprachoroidal triamcinolone acetonide injection 4 mg/0.1 ml (SCTA) (n = 13 eyes) or intravitreal triamcinolone acetonide 4 mg/0.1 ml (IVTA) (n = 10 eyes) and were evaluated at baseline and 1 and 3 months after injection to assess outcome measures. Main Outcome Measures. Changes in best-corrected visual acuity (BCVA) (primary outcome), central foveal thickness (CFT) by optical coherence tomography (OCT), and intraocular pressure (IOP) measurement (secondary). Results Baseline median BCVA (logMAR) was 1.0 (range 0.8–1.0) in both groups, improved within the SCTA group to 0.8 on the 1st and 3rd months, while in the IVTA group, median BCVA changed to 0.8 and 0.9 on the 1st and 3rd months, respectively. No significant differences were noted between groups regarding BCVA at baseline (P=0.927), and 1st (P=0.605) and 3rd months (P=0.313). Regarding mean CFT, no significant differences were observed at baseline (P=0.353) and at the first month (P=0.214) between both groups, while at the third month, CFT was significantly higher in the IVTA group (385 um) than in the SCTA group (323 um) (P=0.028). Mean IOP was significantly higher in the IVTA group (15 mmHg) on 1st month than in the SCTA group (12 mmHg) (P=0.011); after 3rd month, IOP was significantly higher within the IVTA group (18 mmHg) than SCTA (14 mmHg) (P=0.028). No significant difference was noted between both groups at baseline IOP (P=0.435). Conclusions Both SCTA and IVTA are effective in reduction of CFT and improvement of patients' visual acuity, but with a higher recurrence rate and rise in IOP after IVTA when compared to SCTA. Both treatments have temporary effects with the possibility of recurrence of DME and the need for retreatment.

Highlights

Diabetic macular edema (DME) is the most common ocular complication of diabetes that may cause serious vision problems
Our objective was to compare efficacy and safety of suprachoroidal and intravitreal injection of triamcinolone acetonide in the pseudophakic eyes with refractory diabetic macular edema due to epiretinal membrane with no vitreomacular traction. In this randomized clinical trial, twenty-three pseudophakic eyes diagnosed as refractory DME due to ERM were enrolled in the retina clinic at Ophthalmology Department, Benha University Hospital, Egypt, and Ebsar Eye Center, Benha, Egypt, from February 2020 to April 2021
intraocular pressure (IOP) was measured by Goldmann applanation tonometry (AT 900, Haag-Streit Inc., the USA). e diagnosis of diabetic retinopathy and macular edema was made with slit-lamp using auxiliary +90D lens and fundus fluorescein angiography, central foveal thickness, and presence of ERM by optical coherence tomography (OCT) (Optovue, Fremont, CA 94538, the USA)

Summary

Introduction

Diabetic macular edema (DME) is the most common ocular complication of diabetes that may cause serious vision problems. E treatment of refractory DME due to ERM is still controversial; on the other hand, anteroposterior tractions as vitreomacular traction (VMT) or proliferative preretinal membranes usually require pars-plana vitrectomy with or without peeling of internal limiting membrane (ILM) [7, 10] Corticosteroids have both anti-inflammatory and angiostatic effects, they have been used in the form of intravitreal injections or implants as a second-line therapy in the treatment of DME due to their side effects as cataract progression and ocular hypertension, in refractory DME due to ERM corticosteroids therapy is considered the first line of treatment due to their effect on various inflammatory mediators [11]. Our objective was to compare efficacy and safety of suprachoroidal and intravitreal injection of triamcinolone acetonide in the pseudophakic eyes with refractory diabetic macular edema due to epiretinal membrane with no vitreomacular traction

Methods

Results

SCTA group IVTA group

Additional Points