Abstract
BackgroundTo investigate the efficacy of posterior subtenon methylprednisolone acetate injection in treatment of refractory diffuse clinically significant diabetic macular edema (CSME).MethodsIn a prospective, nonrandomized, interventional case series, 52 eyes were diagnosed with CSME and treated with at least two sessions of laser photocoagulation according to Early Treatment Diabetic Retinopathy Study guidelines. At least 3 months after laser therapy, eyes with a residual central macular thickness were offered posterior subtenon injection of 40 mg methylprednisolone acetate. Main outcome measures were visual acuity, macular thickness and intraocular pressure. Potential complications were monitored, including intraocular pressure response, cataract progression and scleral perforation.ResultsMean baseline visual acuity (in logMAR) improved significantly (p = 0.003) from 0.8 ± 0.36 to 0.6 ± 0.41 at 3 months. Mean foveal thickness decreased from 388 ± 78 μm at baseline to 231 ± 40 μm after 3 months (p < 0.0001). Visual acuity improvement in eyes with CSME with extrafoveal hard exudates was significant (p = 0.0001), but not significant in eyes with CSME with subfoveal hard exudates (p = 0.32). Intraocular pressure increased from 14.7 ± 2.0 mmHg (range, 12–18 mmHg) to a maximum value of 15.9 ± 2.1 mmHg (range, 12–20 mmHg) during the follow-up period. Complications in two eyes developed focal conjunctival necrosis at the site of injection.ConclusionPosterior subtenon methylprednisolone acetate may improve early visual outcome in diffuse diabetic macular edema that fails to respond to conventional laser photocoagulation. Visual acuity improvement in eyes with CSME with extrafoveal hard exudates was significant; and this improvement is depends on location of hard exudates. Further study is needed to assess the long-term efficacy, safety, and retreatment.
Highlights
To investigate the efficacy of posterior subtenon methylprednisolone acetate injection in treatment of refractory diffuse clinically significant diabetic macular edema (CSME)
Group 1 including of 30 eyes having refractory diffuse CSME with extrafoveal hard exudates; and group 2 including of 22 eyes having refractory diffuse
All patients were in the stage of non proliferative diabetic retinopathy (NPDR) and had at least two sessions of MPC
Summary
To investigate the efficacy of posterior subtenon methylprednisolone acetate injection in treatment of refractory diffuse clinically significant diabetic macular edema (CSME). The prevalence of macular edema is directly related to the overall severity of the retinopathy and instruction, ranging from 3% among eyes with mild non proliferative diabetic retin-. The Early Treatment Diabetic Retinopathy Study (EDTRS) showed that laser photocoagulation has significant benefit for the treatment of localized clinically significant macular edema [3]. Substantial subgroups of patients with refractory macular edema prompted interest in other treatment modalities, including pars plana vitrectomy [8], medical therapy with protein kinase C inhibitors [9], intravitreal injection of corticosteroids [9,10,11] or a sustained release intravitreal corticosteroid implant [9]
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