Combined Laser and Intravitreal Triamcinolone for Proliferative Diabetic Retinopathy and Macular Edema: One-year Results of a Randomized Clinical Trial

• Published in: American journal of ophthalmology 2009-02, Vol.147 (2), p.291-297.e2
• Main Authors: Maia, Otacilio O, Takahashi, Beatriz S, Costa, Rogerio A, Scott, Ingrid U, Takahashi, Walter Y
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Cataracts; Clinical trials; Colleges & universities; Combined Modality Therapy; Diabetes Mellitus, Type 2 - complications; Diabetes. Impaired glucose tolerance; Diabetic retinopathy; Diabetic Retinopathy - physiopathology; Diabetic Retinopathy - therapy; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Eye surgery; Female; Glucocorticoids - therapeutic use; Glycated Hemoglobin A - analysis; Hemorrhage; Hospitals; Humans; Injections; Laser Coagulation - methods; Lasers; Macular degeneration; Macular Edema - physiopathology; Macular Edema - therapy; Male; Medical sciences; Middle Aged; Miscellaneous; Nitric oxide; Ophthalmology; Retina - pathology; Retinopathies; Standard deviation; Tomography, Optical Coherence; Treatment Outcome; Triamcinolone Acetonide - therapeutic use; Visual Acuity - physiology; Vitreous Body
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2008.08.024

Purpose To evaluate laser combined with intravitreal triamcinolone acetonide (IVTA) for the management of patients with proliferative diabetic retinopathy (PDR) and clinically significant macular edema (CSME). Design Randomized clinical trial. Methods settings: Single center. study population: Twenty-two patients with bilateral treatment-naïve moderate PDR and CSME. intervention: Laser (panretinal and macular) photocoagulation was performed in each eye, followed by IVTA in one randomly assigned eye. Best-corrected visual acuity (BCVA), fundus photography, and optical coherence tomography were performed at baseline and at months 1, 3, 6, 9, and 12. main outcome measures: Changes in BCVA, central macular thickness (CMT), and total macular volume (TMV). Results The mean logarithm of the minimal angle of resolution (logMAR) BCVA improved significantly, and mean CMT and TMV were significantly reduced in the IVTA group compared with the laser-only group (controls) at all study follow-up visits ( P < .001). The mean logMAR BCVA (Snellen equivalent) was 0.44 (20/50−2 ) for the IVTA group and 0.38 (20/50+1 ) for the controls at baseline, and 0.12 (20/25−1 ) for the IVTA group and 0.32 (20/40−1 ) for the controls at 12 months ( P < .001). The mean CMT and TMV were, respectively, 360 μm and 8.59 mm 3 for the IVTA group and 331 μm and 8.44 mm 3 for the controls at baseline, and 236 μm and 7.32 mm 3 for the IVTA group and 266 μm and 7.78 mm 3 for the controls at 12 months ( P < .001). Conclusions The combination of laser photocoagulation with IVTA was associated with improved BCVA and decreased CMT and TMV when compared with laser photocoagulation alone for the treatment of moderate PDR with CSME.