Evaluation of the Effect of Suprachoroidal Triamcinolone Injection on Refractory Diabetic Macular Edema

Abstract

Purpose: To assess the safety and efficacy of supra choroidal triamcinolone injection (SCT) in cases of refractory diabetic macular oedema.
 Study Design: Interventional case series.
 Place and Duration of Study: Lahore General Hospital, Lahore, from July to December 2019.
 Methods: A total of 22 eyes of patients above 18 years of age, with either Type-1 or Type-2 diabetes mellitus and treatment resistant central Diabetic Macular Edema (DME) of 320 um or more (measured on Zeiss Cirrus HD-OCT) and Best Corrected Visual Acuity (BCVA) of less than or equal to 20/40 were included in the study. BCVA, Intra Ocular Pressure (IOP) and Central Subfield Thickness (CST) was recorded. After Supra-Choroidal triamcinolone (SCTA), patients were followed up at one and three months and same clinical parameters were recorded and the results were analysed.
 Results: out of 22 patients, 10 (45.45%) were males and 12 (54.54%) were females. Mean pre injection CST was 615.5 ± 200.28 um and Log MAR BCVA was 0.9 ± 0.20. Mean post injection CST at one and three months was 302.45 ± 52.45 and 301.66 ± 55.82 um. Mean post injection Log MAR BCVA at one and three months was 0.52 ± 0.3 and 0.40 ± 0.22. The results were statistically significant for pre and post injection CST at both one and three months (p-value < 0.00001). Pre and post injection BCVA was also statistically significant (p-value < 0.05).
 Conclusion: CST is a safe and effective means to reduce refractory diabetic macular edema and improve OCT macular thickness.
 Key Words: Diabetic macular edema, Suprachoroidal Triamcinolone, Central sub-field thickness.

Comparison between Suprachoroidal Triamcinolone and Intravitreal Triamcinolone Acetonide in patients of resistant Diabetic Macular Edema

“…17 Local data also support that supra-choroidal drug administration as a safe and effective route of TA injection in cases of resistant diabetic macular edema. 24 Limitations of present study are small sample size and shorter duration of follow-up. Further studies are obligatory to explore the longstanding effectiveness of SCI of TA in cases of resistant DME.…”

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

“… 8 Most other studies included in this meta-analysis all noted a rise in IOP 1 and 3 months after injecting suprachoroidal triamcinolone but interestingly, this rise was not statistically significant and was associated with a p -value >0.05. 9 – 10 , 22 – 26 The exceptions to this were the studies by Abdelshafy Tabl et al and Ateeq et al . 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.…”

A combination of suprachoroidal injection of triamcinolone using a custom-made needle and intravitreal Ziv-aflibercept every eight weeks to manage naïve/denovo central DME: a single-center retrospective case series

“…Several studies have shown the efficacy and safety of utilizing suprachoroidal triamcinolone acetonide injection for DME. For example, in an interventional case series [ 28 ], 22 eyes with refractory DME were evaluated. Those eyes were managed with a suprachoroidal injection of triamcinolone acetonide, followed up for three months, and it was concluded that suprachoroidal injection of triamcinolone acetonide for refractory DME is safe and effective.…”