Effect of posterior sub-tenon injection of triamcinolone acetonide as ‎an adjunct therapy to intravitreal anti-vascular endothelial growth ‎factor in the management of diabetic macular oedema

Abstract

ABSTRACT Background: to monitor and compare the effect of posterior sub-tenon triamcinolone acetonide injection as an adjunct therapy to intravitreal ranibizumab injection on patients with diabetic macular oedema. Aim of the Work: To assess the effect of combined intravitreal ranibizumab injection, and sub-tenon triamcinolone acetonide injection in the management of diabetic macular oedema. Patients and Methods: Patients with diabetic retinopathy associated with DME (Central macular thickness over 300 um) which are randomly allocated into two groups. In group 1, three monthly doses (0.5 mg) of intravitreal ranibizumab are received. In group 2, the anti-VEGF injection was performed 3times monthly with the sub-tenon steroid injection [triamcinolone acetonide] during the 1st injection. All patients’ best-corrected visual acuity (BCVA), IOP and CMT were followed up for six months. Results: The combined treatment showed improved best-corrected visual acuity from baseline 0.15 ± 0.15 log MAR to 0.46 ± 0.19 log MAR (p 0.001). When comparing the combination treatment with the anti-VEGF treatment alone, recovery of BCVA and CMT was statistically significant (p <0.001‎). Conclusion: sub-tenon triamcinolone addition to the routine anti-VEGF therapy is an effective method for the treatment of diabetic macular oedema not only in rapid and great improvement but also in decreased frequent injections.