Reinjection of Intravitreal Triamcinolone for Refractory Diabetic Macular Edema

To evaluate the effect of intravitreal triamcinolone acetonide (IVT) reinjection on clinical and optical coherence tomographic (OCT) features in refractory diabetic macular edema (DME). In an interventional case series, all IVT-treated patients enrolled in a previous clinical trial (45 subjects), were recalled for performing a new ophthalmologic examination and OCT. Suitable eyes for reinjection received 4 mg IVT. Complete ophthalmologic examination and OCT were performed after two and four months. From 45 recalled patients, 23 were included for the new study (51.1% response rate). Of these, only 12 cases were considered as candidates for reinjection. Visual acuity (VA) changes were not significant in the reinjected eyes after both the first and the second interventions, although there was a relative improvement (0.14 logMAR) at two months after the first injection. Central macular thickness (CMT) was reduced by 27 and 49  two and four months after the reinjection and 43 and 40 m at two and four months after the first injection. None of the mentioned changes was significant. IOP elevation was significant two and four months after the second injection (3.6 and 2.4 mmHg, respectively, P<0.05). However, it was significant (5.58 mmHg, P=0.001) only two months after the first injection. The transient beneficial effects of IVT on refractory DME are not repeated with second injections. However, IVT-related ocular hypertension is more persistent after reinjection.