Comparison of Intravitreal Dexamethasone Implant and Posterior Subtenon Triamcinolone Injection in the Treatment of Diabetic Macular Edema in Vitrectomized Eyes

Abstract

PURPOSE: To compare posterior subtenon triamcinolone (PSTA) application and intravitreal dexamethasone phosphate (DEX) implant in the treatment of diabetic macular edema (DME) in vitrectomized eyes. METHODS: This retrospective study included 64 (48.12 %) patients who received PSTA and 69 (51.88 %) patients who received DEX implants in DME treatment after vitrectomy. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were analyzed before injection, at 1, 3 and 6 months after injection. The post-injection values were statistically compared with the pre-injection value. RESULTS: All post-injection CMT values in both groups were lower than the pre-injection value. (p< 0.05 for all) There were statistically significant increases in all post-injection BCVAs of the DEX group and post-injection 1-month BCVA of the PSTA group. (p< 0.05 for all) However, there was no significant difference in BCVA values of the PSTA group at 3 and 6 months after injection. (p> 0.05 for both) There was no statistically significant difference in all post-injection IOP values of the PSTA group. (p> 0.05 for all) However, significant increases in IOP were observed in the DEX group at 1 and 3 months after injection. (p<0.05 and p=0.02 respectively) The number of additional injections between the 3rd and 6th months after the initial injection was statistically higher in the PSTA group. (p= 0.006) CONCLUSION: Both intravitreal DEX and PSTA administration are effective in the treatment of DME after vitrectomy. However, visual improvement persisted longer, and the need for additional injections was less in patients who received DEX.

The Evolution of Triamcinolone Acetonide Therapeutic Use in Retinal Diseases: From Off-Label Intravitreal Injection to Advanced Nano-Drug Delivery Systems

“…In a retrospective study, posterior subtenon triamcinolone (PSTA) injection for the treatment of DME in vitrectomized eyes was demonstrated to lower central macular thickness (CMT) and increase best-corrected visual acuity (BCVA) [79]. Additionally, the efficacy and safety of suprachoroidal and intravitreal injections of triamcinolone acetonide in pseudophakic patients with refractory DME caused due to epiretinal membrane (ERM) were compared in a randomized clinical trial.…”

Commentary: Posterior subtenon triamcinolone - The unsung hero for managing various ocular disorders

“…A recent study noted that both PST and intravitreal dexamethasone implant (Ozurdex®, Allergan) was effective in treating DME in vitrectomized eyes, though the effect persisted longer and the need for repeat injections was less with dexamethasone implant. [ 6 ] Advantages of PST include easy availability, ease of doing the procedure in the outdoor patient department, low cost, and time-tested efficacy. PST may also work in refractory CME due to various causes, including DME and RVO.…”