Posterior Sub–Tenon’s Capsule Injection of Triamcinolone Acetonide Prevents Panretinal Photocoagulation-Induced Visual Dysfunction in Patients with Severe Diabetic Retinopathy and Good Vision
Received 16 May 2005; accepted 11 October 2005. published online 03 February 2006.
Purpose
To evaluate prospectively the efficacy of a single sub–Tenon’s capsule injection of triamcinolone acetonide (TA) against panretinal photocoagulation (PRP)-induced macular thickening and visual disturbance in patients with severe diabetic retinopathy and good vision.
Design
Prospective, comparative, interventional case series.
Participants
Twenty eyes of 10 patients with severe nonproliferative diabetic retinopathy or non–high-risk proliferative diabetic retinopathy whose visual acuity was 20/40 or better (<0.3 in logarithm of the minimum angle of resolution [logMAR] acuity) before the PRP, whose retinopathy was bilateral and symmetrical. The averaged parafoveal retinal thickness was more than 300 μm, leading to a worse visual prognosis after PRP.
Intervention
Sub–Tenon’s capsule injection of 20 mg TA.
Main Outcome Measures
Best-corrected visual acuity (BCVA) with logMAR chart and averaged foveal thickness (FT) using the retinal mapping program of optical coherence tomography.
Methods
In all patients, PRP was performed every other week for 4 sessions on both eyes, and 1 week before PRP; 1 eye received the TA injection, and the other eye served as a control. The clinical course of BCVA and FT was monitored for up to 24 weeks after beginning PRP.
Results
Before TA injection, BCVA and FT were 0.055±0.072 and 235.5±37.5 μm in the TA-injected eye and 0.065±0.071 and 233.7±39.8 μm in the control eye, respectively; there was no significant difference between eyes. After the TA injection, FT in the TA-injected eyes was significantly decreased. During and after the PRP, FT in the control eye increased dramatically and reached 312.0±68.2 μm at 24 weeks, which was significantly different from that in the TA-injected eyes (235.3±38.6 μm at 24 weeks). Best-corrected visual acuity in the control eye decreased with time to 0.24±0.13; in contrast, and BCVA in the TA-injected eye was good (to 0.085±0.11) .
Conclusions
As a pretreatment for PRP, a single sub–Tenon’s capsule injection of TA has beneficial effects for preventing PRP-induced foveal thickening and visual dysfunction in patients with severe diabetic retinopathy and good vision.
1Department of Ophthalmology, NTT East Japan Tohoku Hospital, Sendai, Japan
Correspondence to: Masahiko Shimura, MD, PhD, Department of Ophthalmology, NTT East Japan Tohoku Hospital, 2-29-1, Yamato, Wakabayashi, Sendai, Miyagi 984-8560, Japan
ABSTRACT