Pretreatment of posterior subtenon injection of triamcinolone acetonide has beneficial effects for grid pattern photocoagulation against diffuse diabetic macular oedema

• Published in: British journal of ophthalmology 2007-04, Vol.91 (4), p.449-454
• Main Authors: Shimura, Masahiko, Nakazawa, Toru, Yasuda, Kanako, Shiono, Takashi, Nishida, Kohji
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Cholesterol; Clinical Science - Extended Report; Combined Modality Therapy; DDME; Diabetes; Diabetes. Impaired glucose tolerance; Diabetic retinopathy; Diabetic Retinopathy - drug therapy; Diabetic Retinopathy - physiopathology; Diabetic Retinopathy - surgery; diffuse diabetic macular oedema; early treatment diabetic retinopathy study; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; ETDRS; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Fovea Centralis - pathology; foveal thickness; G-PC; Glucocorticoids - therapeutic use; grid pattern photocoagulation; haemoglobin A1c; HbA1c; Humans; Hypertension; Injections; intravenous fluorescein angiography; IVFA; Laser Coagulation; Lasers; logarithm of the minimum angle of resolution; logMAR; Macular degeneration; Macular Edema - drug therapy; Macular Edema - physiopathology; Macular Edema - surgery; Male; mean deviation; Medical sciences; Middle Aged; Miscellaneous; non-proliferative diabetic retinopathy; NPDR; OCT; Ophthalmology; optical coherence tomography; PDR; Pilot Projects; proliferative diabetic retinopathy; Prospective Studies; Studies; Treatment Outcome; triamcinolone acetonide; Triamcinolone Acetonide - therapeutic use; visual acuity; Visual Acuity - drug effects; Visual Field Tests - methods
• ISSN: 0007-1161; 1468-2079
• DOI: 10.1136/bjo.2006.106336

Aim: To prospectively evaluate the efficacy of subtenon injection of triamcinolone acetonide (TA) before laser grid pattern photocoagulation (G-PC) for the treatment of diffuse diabetic macular oedema (DDME). Methods: 42 eyes of 37 consecutive patients with DDME were studied. 1 week before G-PC, 21 eyes received TA subtenon injection, and the other eyes served as control. The clinical course of visual acuity (VA) and foveal thickness (FT) was monitored for up to 24 weeks after G-PC. Mean deviation (MD) of perimetry with 30-2 program on Humphrey Perimeter (Zeiss-Humphrey, Dublin, California, USA) was also measured. The average laser intensity was recorded. Results: After TA injection, FT and VA were improved, and subsequent G-PC maintained the improvement for up to 24 weeks without recurrence of diffuse diabetic macular oedema. In contrast, G-PC without TA injection induced transient worsening of FT and VA, then both were gradually improved. At 24 weeks after G-PC, MD in the TA-injected eyes was better than those in control. The required laser intensity in TA-injected eyes was less than that for control. Conclusion: Subtenon injection of TA prior to G-PC allows for treatment with a lower intensity of laser spots and also prevents the decrease in central visual field sensitivity, all of which have clinical advantages for G-PC.