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DIABETIC RETINOPATHY:
Triamcinolone reduces macular edema when laser photocoagulation fails.





June 3, 2002.

BY Sonia Nichols,
Diabetes Week.




When laser photocoagulation isn't successful for treating diabetic macular edema, triamcinolone may do the trick, according to a multicenter research team in the U.S.


Diabetic macular edema arises as a result of diabetic retinopathy, a diabetes complication affecting the vessels of the retina that is associated with vascular leakage. While laser photocoagulation is a method commonly used for treating it, the eyes of some patients may be unresponsive to therapy. Medical collaborators at several eye institutes in the U.S. are now recommending that in cases where laser photocoagulation is ineffective, follow-up with triamcinolone might work. The team used triamcinolone to treat 16 of such eyes that had initially been treated twice with laser photocoagulation, but suffered treatment failure.


"Eyes with a residual macular thickness of more than 300 (micro)m (normal 200 (micro)m) and visual loss from baseline were offered intravitreal injection of 4 mg triamcinolone acetonide," said Adam Martidis of the Wills Eye Hospital in Philadelphia, Pennsylvania.


Martidis, and collaborators at the New England Eye Center of Boston, Massachusetts, and the Bascom Palmer Eye Institute of Miami, Florida, followed the patients for changes in visual acuity and macular thickening for several months after the treatment was rendered. Half of the 16 patients ultimately completed 6 months or more of follow-up.


Tests for visual acuity showed that at months 1, 3, and 6 of follow-up, average improvements were detected at 2.4, 2.4, and 1.3 Snellen lines, respectively, Martidis and coauthors said (Intravitreal triamcinolone for refractory diabetic macular edema, Ophthalmology, May 2002;920-927).


"The central macular thickness as measured by optical coherence tomography (OCT) decreased by 55%, 57.5%, and 38%, respectively, over these same intervals from an initial pretreatment mean of 540.3 (micro)m (plusmn 96.3 (micro)m)," they noted.


Excess intraocular pressure, evident in five patients at the first month follow-up visit, was only present in one patient after 6 months, and only one patient experienced cataract progression during the evaluation period.


"Reinjection was performed in 3 of 8 eyes after 6 months because of recurrence of macular edema," Martidis and colleagues remarked.


Although further evaluation of the therapy is needed in larger studies, given a low incidence of complications and the therapeutic benefits observed, investigators said triamcinolone shows promise for treating patients with diabetic macular edema that is refractive to laser photocoagulation.


The corresponding author for this study is Jay S. Duker, 750 Washington Street, Box 450, Boston, MA 02115, USA.


Key points reported in this study include:


*In some instances, the eyes of some patients with diabetic macular edema fail to respond to laser photocoagulation therapy


*Intravitreal injections of triamcinolone improved visual acuity and reduced macular thickening in eyes not responsive to laser photocoagulation


*Intravitreal triamcinolone therapy may be a viable alternative to laser photocoagulation for treating diabetic macular edema






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