Intravitreal Triamcinolone for Treatment of Refractory Diabetic Macular Edema

To determine if intravitreal injection of triamcinolone acetonide is safe and effective in the treatment of diabetic macular edema unresponsive to prior laser photocoagulation. Fifty-four eyes of 38 patients with clinically significant macular edema which had received at least two sessions of laser photocoagulation according to Early Treatment Diabetic Retinopathy Study guidelines were enrolled in this study. At least four months after laser therapy; eyes with residual central macular thickness (CMT) greater than 250 µm on optical coherence tomography (OCT) and visual loss from baseline were offered intravitreal injection of 4 mg triamcinolone acetonide. Visual and anatomic responses as well as complications related to the injection procedure and corticosteroid medication were observed. Mean baseline best corrected visual acuity (BCVA) and CMT were 0.77±0.5 LogMAR and 443±138 µm, respectively. All patients completed one month of follow up and 39 of 54 eyes (72.2%) completed 6 months of follow up. Mean BCVA was 0.64±0.45, 0.56±0.48, and 0.79±0.55 LogMAR at months 1, 3, and 6, respectively. Central macular thickness measured by OCT decreased by 39% and 23.5%, at the third and sixth month visits, respectively. Intraocular pressure exceeded 21 mmHg in 36.3% of the eyes. Cataract progression was noted in 12.8% of phakic eyes. Intravitreal triamcinolone seems a promising therapeutic method for diabetic macular edema refractory to conventional laser photocoagulation without any significant complication, however the effect seems to be temporary. Further studies are warranted to assess the long-term efficacy and safety and also the need for retreatment.