Dosage dependency of intravitreal triamcinolone acetonide as treatment for diabetic macular oedema

Abstract

Aim: To evaluate the effect of different doses of intravitreal triamcinolone acetonide on diffuse diabetic macular oedema. Methods: The prospective, randomised, double masked, clinical interventional study included 27 eyes (27 patients) with diffuse diabetic macular oedema. They were randomly divided into three study groups receiving an intravitreal injection of filtered triamcinolone acetonide of about 2 mg (n = 8 eyes), 5 mg (n = 10), or 13 mg (n = 9), respectively. Dosage measurement was performed before filtration. Mean follow up was 6.6 (SD 2.4) months (3-12 months). Main outcome measures were visual acuity and intraocular pressure. Results: Maximal increase in visual acuity was significantly (p = 0.046; 95% CI: 0.032 to 2.99; r = 0.38) correlated with the dosage of intravitreal triamcinolone acetonide. Additionally, the duration of the effect of intravitreal triamcinolone acetonide increased significantly with the dosage of intravitreal triamcinolone acetonide (r = 0.45; p = 0.014). Increase in intraocular pressure during follow up was statistically not significantly associated with the dosage used (p = 0.77). Conclusions: In patients with diffuse diabetic macular oedema receiving intravitreal triamcinolone acetonide, treatment response may last longer and be more pronounced with a dosage of 13 mg than in lower doses of 5 mg or 2 mg. Triamcinolone acetonide induced increase in intraocular pressure may not be markedly associated with the dosage used.

A prospective randomised trial of different doses of intravitreal triamcinolone for diabetic macular oedema

“…The visual improvement in the 4 mg group began to disappear after 4 weeks, whereas the BCVA of the 8 mg group continued to improve until 26 weeks, indicating a prolonged treatment effect with higher doses of ivTA. These findings are consistent with the findings by Spandau et al, 15 in which a higher dose of ivTA resulted in more prolonged visual improvement. In terms of the proportion of patients with a BCVA gain of at least 15 ETDRS letters at 6 months, there was also a trend towards greater benefit with 8 mg ivTA, although it failed to reach statistical significance.…”

The effects and safety of intravitreal triamcinolone injections in the treatment of diabetic macular edema

“…14 In making this decision it was important that increases in intraocular pressure induced by triamcinolone acetonide are reported not to be markedly dependent on the dosage used. 15 Furthermore, in research on rat retinas, the potential retinal toxicity of triamcinolone acetonide administered in high doses was not evident, in contrast to the effects of other steroids. 16 Apart from a decrease in central retinal thickness, the patients in the current treatment group showed significant improvements in BCVA for distant and near vision after IVTA.…”

Clinical trials on corticosteroids for diabetic macular edema

“…Many clinical trials have been conducted to evaluate the efficacy of IVTA therapy for DME [18][19][20][21][22][23][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52] . IVTA has shown significant improvements in diabetic macular edema and visual acuity in the short term and found to be transient.…”