Abstract
Purpose: To evaluate efficacy and safety of combined intravitreal triamcinolone acetonide (IVTA) injection plus panretinal photocoagulation (PRP) in comparison with PRP in proliferative diabetic retinopathy (PDR). Methods: 38 eyes of nineteen patients with PDR were enrolled. One eye of each patient was randomly selected to undergo IVTA injection one week prior to PRP session (IVTA eye), and contralateral eye treated with PRP alone (control eye). Patients were followed at 1, 4 and 6 months after treatment. Main outcome measures included change in logarithm of the minimum angle of resolution best-corrected visual acuity (logMAR BCVA), central macular thickness (CMT) and complications. Results: Mean baseline logMAR BCVA was 0.41±0.36 (IVTA eyes) and 0.36±0.30 (control eyes). At 6 months, Mean change of visual acuity to logMAR BCVA was - 0.054±0.114 (IVTA eyes) and 0.053±0.145 (control eyes) (p=0.02). Mean baseline CMT was 274.5±61.7 µm (IVTA eyes) and 246.7±74.7 µm (control eyes). Injected eyes showed significant reduction in mean CMT at all visits. However, there was no significant difference for CMT between IVTA and control eyes at all visits. Significant reduction of CMT in IVTA eyes was observed at 1 month from 319.2±79.1 to 260.5±78.5 (p=0.024). At 6 months, CMT reduction was still significant in IVTA eyes as compared with baseline values (p=0.048). In control eyes, CMT was not significantly reduced at 1 and 6 months of treatment. Conclusions: IVTA injection is a relatively safe method which might have prophylactic role against visual acuity exacerbation and macular edema secondary to PRP in PDR eyes.
Highlights
Diabetic retinopathy is a leading cause of visual loss in developed countries [1]
Based on guidelines presented by the Early Treatment of Diabetic Retinopathy Study group (EDTRS) and the Diabetic Retinopathy Study (DRS), panretinal photocoagulation (PRP) is an effective treatment for proliferative diabetic retinopathy (PDR) to prevent vision loss or progression of retinopathy [2,3]
There was no significant difference between injected and control eyes with respect to baseline measurements such as best-corrected visual acuity (BCVA), intraocular Pressure (IOP) and central macular thickness (CMT)
Summary
Diabetic retinopathy is a leading cause of visual loss in developed countries [1]. Based on guidelines presented by the Early Treatment of Diabetic Retinopathy Study group (EDTRS) and the Diabetic Retinopathy Study (DRS), panretinal photocoagulation (PRP) is an effective treatment for proliferative diabetic retinopathy (PDR) to prevent vision loss or progression of retinopathy [2,3]. Panretinal photocoagulation (PRP) should be performed as the treatment of choice in proliferative diabetic retinopathy (PDR). Visual deterioration after PRP due to worsening or precipitation of macular edema (early treatment diabetic retinopathy study research group 1991) is not uncommon which is usually temporary but it may persist for months. Previous studies have shown that 25% to 43% of eyes with proliferative diabetic retinopathy treated with PRP developed macular edema and visual disturbance [7,8]. Several studies have suggested post laser release of inflammatory factors, leukocyte accumulation in the non photocoagulated posterior pole and up-regulation of angiogenic factors as possible mechanisms in the development of macular edema [9]. The present study was designed to evaluate protective effects of IVTA against macular edema as a probable cause of visual acuity deterioration after PRP in PDR patients
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