A Randomized Trial Comparing Suprachoroidal and Intravitreal Injection of Triamcinolone Acetonide in Refractory Diabetic Macular Edema due to Epiretinal Membrane

Abstract

Purpose. To compare the efficacy and safety of suprachoroidal and intravitreal injection of triamcinolone acetonide in pseudophakic patients with refractory diabetic macular edema (DME) due to epiretinal membrane (ERM). Study Design. This study is a randomized clinical trial (RCT). Participants. Twenty-three nonvitrectomized pseudophakic eyes of 23 subjects (9 M and 14 F with mean age: 54.8 years) with refractory DME due to ERM. Methods. The eyes were randomized to suprachoroidal triamcinolone acetonide injection 4 mg/0.1 ml (SCTA) (n = 13 eyes) or intravitreal triamcinolone acetonide 4 mg/0.1 ml (IVTA) (n = 10 eyes) and were evaluated at baseline and 1 and 3 months after injection to assess outcome measures. Main Outcome Measures. Changes in best-corrected visual acuity (BCVA) (primary outcome), central foveal thickness (CFT) by optical coherence tomography (OCT), and intraocular pressure (IOP) measurement (secondary). Results. Baseline median BCVA (logMAR) was 1.0 (range 0.8–1.0) in both groups, improved within the SCTA group to 0.8 on the 1st and 3rd months, while in the IVTA group, median BCVA changed to 0.8 and 0.9 on the 1st and 3rd months, respectively. No significant differences were noted between groups regarding BCVA at baseline ( P = 0.927 ), and 1st ( P = 0.605 ) and 3rd months ( P = 0.313 ). Regarding mean CFT, no significant differences were observed at baseline ( P = 0.353 ) and at the first month ( P = 0.214 ) between both groups, while at the third month, CFT was significantly higher in the IVTA group (385 um) than in the SCTA group (323 um) ( P = 0.028 ). Mean IOP was significantly higher in the IVTA group (15 mmHg) on 1st month than in the SCTA group (12 mmHg) ( P = 0.011 ); after 3rd month, IOP was significantly higher within the IVTA group (18 mmHg) than SCTA (14 mmHg) ( P = 0.028 ). No significant difference was noted between both groups at baseline IOP ( P = 0.435 ). Conclusions. Both SCTA and IVTA are effective in reduction of CFT and improvement of patients’ visual acuity, but with a higher recurrence rate and rise in IOP after IVTA when compared to SCTA. Both treatments have temporary effects with the possibility of recurrence of DME and the need for retreatment.

Comparison between Two Doses of Suprachoroidal Triamcinolone Acetonide among Cases of Resistant Diabetic Macular Edema

“…Effects of TA were studied in this research only at 4mg4 mg/0.1 ml of dosage. 21 In contrast to our study, Zakaria et al, divided his patients into three groups. Among these, one group was administered TA (2mg dosage) by intravitreal injection whereas the other two groups received 2mg and 4 mg of drug by suprachoroidal injection.…”

Suprachoroidal triamcinolone acetonide injection: a novel therapy for serous retinal detachment due to Vogt-Koyanagi Harada disease

“…Localized subconjunctival hemorrhage was noted in one eye (16.6%), no inadvertent intravitreal injection had been occurred, and only one patient (16.6%) reported a localized pain immediately after injection which was controlled by systemic pain killer, our results are consistent with recent publications used the same injection technique. 21,22 Nazari et al reviewed the OCT of 12 eyes (6 patients) with acute VKH and observed that the height of the subretinal fluid in the OCT was correlated with visual acuity, the height of the subretinal fluid in the initial presentation did not correlate with resolution time and final visual acuity. 23 These results are similar to our study, but we find that SCTA helped our patients to gain rapid visual improvement, reduced the dosage of systemic steroids and earlier tapering of steroids as all patients tapered systemic steroids within 3 months from recruitment.…”

“…Localized subconjunctival hemorrhage was noted in one eye (16.6%), no inadvertent intravitreal injection had been occurred, and only one patient (16.6%) reported a localized pain immediately after injection which was controlled by systemic pain killer, our results are consistent with recent publications used the same injection technique. 21,22…”

Effect of suprachoroidal triamcinolone on intraocular pressure: a systematic review and meta-analysis

“…Abdelshafy Tabl et al .’s study was the only study conducted solely in patients with refractory diabetic macular oedema due to epiretinal membrane, and they found a decrease in IOP 1 month after injection. 19 Ateeq et al on the other hand noted a statistically significant rise in IOP at 1 month as well as 3 months post-injection. 20 However, there was consensus regarding there being no statistically significant rise in IOP at 6 months post-injection.…”