Posterior Sub–Tenon’s Capsule Triamcinolone Injection Combined with Focal Laser Photocoagulation for Diabetic Macular Edema
Paper presented at: American Academy of Ophthalmology/European Society of Ophthalmology joint meeting, October, 2004; New Orleans.
Received 25 September 2004; accepted 16 December 2004. published online 09 May 2005.
Purpose
To investigate the efficacy of posterior sub-Tenon’s capsule triamcinolone injection (PSTI) combined with focal laser (FL) photocoagulation in treatment of diffuse clinically significant diabetic macular edema (CSME).
Design
Prospective randomized clinical study.
Participants
Sixty patients with diffuse CSME.
Methods
We randomized the patients who had CSME into 2 treatment groups. A total of 30 eyes received macular focal and grid laser photocoagulation (MP), and the second group of 30 eyes received FL photocoagulation combined with PSTI (FL + PSTI). Clinical and visual evaluations were performed at baseline and 12 and 18 weeks after treatment, and the results were compared by statistical methods.
Mean Outcome Measures
Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity (VA) scores and clinical changes in macular edema.
Results
Before treatment, mean ETDRS VA scores were 45.9±12.7 (mean ± standard deviation [SD]; range, 24–66) in MP (focal + grid laser) and 44.5±12.6 (range, 22–66) in the FL + PSTI group. Early Treatment Diabetic Retinopathy Study scores at 18 weeks were 46.4±14.2 (range, 20–70) after MP and 52.5±17.5 (range, 22–82) after FL + PSTI. Early Treatment Diabetic Retinopathy Study scores significantly improved in eyes that received FL + PSTI (P = 0.0001, paired t test). The FL + PSTI group had an increase of 12.4±7.1 (range, 5–26) ETDRS letters, and the MP group had an increase of 7.8±3.1 (range, 5–15) letters (P = 0.04, unpaired t test). Twelve of 30 (40%) cases in the MP group and 24 of 30 (80%) cases in the FL + PSTI group showed clinical improvement in macular edema according to the stereoscopic evaluation of fundus and fluorescein angiography (P = 0.003).
Conclusion
Posterior sub-Tenon’s capsule application of triamcinolone may improve early visual outcome in diffuse diabetic macular edema when combined with FL photocoagulation.
Department of Ophthalmology, Abant Izzet Baysal University Düzce Medical School, Düzce, Turkey.
Correspondence to Murat Tunc, MD, Inkilap Sokak 19-1, Kizilay—Ankara (06420), Turkey.
Manuscript no. 2004-137.
The authors have no financial interest in any of the materials used in this study.
ABSTRACT