Intravitreal triamcinolone versus laser photocoagulation as a primary treatment for diabetic macular oedema - a comparative pilot study

Abstract

BackgroundDiabetic macular oedema is the leading causes of blindness. Laser photocoagulation reduces the risk of visual loss. However recurrences are common and despite laser treatment, patients with diabetic macular oedema experienced progressive loss of vision. Stabilization of the blood retinal barrier introduces a rationale for intravitreal triamcinolone treatment in diabetic macular oedema. This study is intended to compare the best corrected visual acuity (BCVA) and the macular oedema index (MEI) at 3 month of primary treatment for diabetic macular oedema between intravitreal triamcinolone acetonide (IVTA) and laser photocoagulation.MethodsThis comparative pilot study consists of 40 diabetic patients with diabetic macular oedema. The patients were randomized into two groups using envelope technique sampling procedure. Treatment for diabetic macular oedema was based on the printed envelope technique selected for every patient. Twenty patients were assigned for IVTA group (one injection of IVTA) and another 20 patients for LASER group (one laser session). Main outcome measures were mean BCVA and mean MEI at three months post treatment. The MEI was quantified using Heidelberg Retinal Tomography II.ResultsThe mean difference for BCVA at baseline [IVTA: 0.935 (0.223), LASER: 0.795 (0.315)] and at three months post treatment [IVTA: 0.405 (0.224), LASER: 0.525 (0.289)] between IVTA and LASER group was not statistically significant (p = 0.113 and p = 0.151 respectively). The mean difference for MEI at baseline [IVTA: 2.539 (0.914), LASER: 2.139 (0.577)] and at three months post treatment [IVTA: 1.753 (0.614), LASER: 1.711 (0.472)] between IVTA and LASER group was also not statistically significant (p = 0.106 and p = 0.811 respectively).ConclusionsIVTA demonstrates good outcome comparable to laser photocoagulation as a primary treatment for diabetic macular oedema at three months post treatment.Trial RegistrationISRCTN05040192 (http://www.controlled-trial.com)

Effect of intravitreal Triamcinolone (2mg) on diabetic macular oedema in the pseudophakic patient as primary treatment

“…On third postoperative month follow up visit there were six eyes (30%) with visual acuity 6/18 or better, nine eyes (45 %) with visual acuity 6/24-6/36 and 5 eyes (25 %) had visual acuity 6/60 or less. In Noralili (Norlaili et al, 2011) study only (30%) of eyes had visual acuity 6/18 and better after three months while in this study we had (44%) of eyes with visual acuity 6/18 or better after three months and (48%) after six months. In Noralili (Norlaili et al, 2011) (25 %) had visual acuity 6/60 or less after three months of injection while in this study only (24%) of eyes had visual acuity of 6/60 or less after three months and six months.…”

“…In Noralili (Norlaili et al, 2011) study only (30%) of eyes had visual acuity 6/18 and better after three months while in this study we had (44%) of eyes with visual acuity 6/18 or better after three months and (48%) after six months. In Noralili (Norlaili et al, 2011) (25 %) had visual acuity 6/60 or less after three months of injection while in this study only (24%) of eyes had visual acuity of 6/60 or less after three months and six months. Visual outcome in this study after three months was better than visual outcome in Noralili (Norlaili et al, 2011).…”

“…However, (Lamds et al, 2007) Published a comparison between 4 and 8mg dose of intravitreal Triamcinolone and showed that the higher dose had a more sustained effect on both visual acuity and central macular thickness. Noralili (Norlaili et al, 2011) study 20 eyes of 20 patients received intravitreal injection of Triamcinolone in a single dose of 4 mg/0. 1ml as a primary treatment and visual acuity was measured preoperatively.…”

Macular Laser Grid Alone Versus Combined With Intravitreal Triamcinolone Plus Bevacizumab for Diabetic Macular Edema

“…10,11 This is supposed to be the first study comparing MLG alone and combined with IVTA + IVB for treatment of diffuse DME as our knowledge. 17,18 , IVB vs IVTA + IVB 19 , IVB vs IVTA + MLG20, IVB vs MLG 21 and IVB vs IVB + MLG 22 . There was modest correlation between CMT and visual acuity after focal laser treatment for DME.…”

Intravitreal Triamcinolone Acetonide in the Treatment of Ophthalmic Inflammatory Diseases with Macular Edema: A Meta-Analysis Study

“…A total of 8 studies met the inclusion criteria and were finally included in this review for quantitative analysis. 13,[28][29][30][31][32][33][34] The main characteristics of the studies reviewed are outlined in Table 1. Five studies 28-32 were conducted on patients with DME and one 13 on patients with cystoid macular edema secondary to both diabetic and retinal vein occlusion, all treated with either intravitreal TA or laser photocoagulation as standard of care (Table 1).…”