Abstract
This prospective study aimed to investigate the effectiveness and safety of intravitreal triamcinolone acetonide (TA) injection in diabetic macular edema unresponsive to an initial argon laser photocoagulation procedure. and methods: Fifty-six eyes of fifty patients were included in this study. All the eyes had refractory and clinically significant diabetic macular edema with a central macular thickness (CMT) greater than 300 microm. All the eyes were injected 4 mg/0.1 ml TA intravitreally. The main outcome parameters were best corrected visual acuity (BCVA) and CMT. Elevation of intraocular pressure (IOP) and other potential complications were monitored carefully. All the patients were followed at least 9 months. Preinjection mean BCVA was 0.128+/-0.11 and statistically significant improvement in BCVA started in the 1st week and was observed during the first 6 months of the follow-up period. BCVA reached 0.289+/-0.19 at the 2nd month and decreased gradually to 0.169+/-0.1 at the 9th month. However, clinically significant improvement after TA injection in BCVA (> or =0.2) was observed in 50%, 67.8%, 67.8%, 28.5%, and 12.5% of the eyes in the 1st, 2nd, 3rd, 6th, and 9th months, respectively. The central macular thickness measured by OCT, which was reduced by 45% at the 3rd month, returned nearly to its initial level at the 9th month. High IOP was observed in 35.7% of eyes and appeared between the 1st week and the 2nd month. Other complications were cataract development and progression (7.1%), pseudoendophthalmitis (3.56%), and bacterial endophthalmitis (1.78%). Intravitreal TA injection is a relatively safe and beneficial therapeutic method for intractable diabetic macular edema. The recurrence of edema warrants reinjections, even though the risk of complication is higher, especially infectious endophthalmitis, which might be devastating. Further studies should be conducted with newer, slow corticosteroid release methods such as intravitreal devices in the treatment of diabetic macular edema.
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