Resorption of the Diabetic Cystoid Macular Edema after Intravitreal Triamcinolon Acetonide Injection Depending on Compensation of Diabetes and Systemic Hypertension
Authors:
Š. Rusňák; H. Fidranská; Š. Belfínová; D. Frdlíková; Š. Kozlerová
Authors‘ workplace:
Oční klinika LF UK a FN, Plzeň, přednosta doc. MUDr. Renata Říčařová, CSc.
Published in:
Čes. a slov. Oftal., 64, 2008, No. 1, p. 26-29
Overview
Purpose:
The aim of the study was to evaluate the effect of the intravitreal administration of triamcinolon acetonide depending on patients’ HbA1c and blood pressure levels. The presence of edema, its resorption, and the duration of the edema free macula during the follow-up period were evaluated.
Methods:
A total of 80 eyes of 68 patients with persistent diabetic macular edema after grid laser photocoagulation were included in the study. The follow-up period of each eye was 6 months.
The group of patients was divided into four subgroups according to the blood pressure levels (up to 120/80 mm Hg, 120/80–140/90 mm Hg, 140/90–180/110 mm Hg, and higher than 180/110 mm Hg) and into two subgroups according to the HbA1c levels (up to 6 % and above 6 %).
The dose of 4 mg (0.1 ml) of triamcinolon acetonide suspension (TRIAM INJEKT) was used in the standard transconjuctival intravitreal injection. The site of injection was located superotemporaly 4 mm behind the limbus.
Results:
The cystoid edema resolved in all eyes treated in the study. The patients with excellent controlled blood pressure maintained the edema free macula during the whole follow-up period. The patients with poorly controlled blood pressure experienced recurrence of the edema during follow up period. The HbA1c level did not influence the effect of the intravitreal triamcinolon administration.
Conclusion:
The results achieved in the study allow us to identify more accurately the patients, who may profit from the intravitreal triamcinolone injection.
Key words:
cystoid macular edema, intravitreal triamcinolone injection, blood pressure levels
Sources
1. Early Treatment Diabetic Retinopathy Study Research Group. Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study Report Number 1. Arch. Ophthalmol., 103, 1985: 1796-1806
2. Gilies, M. C., Simpson, J, M , Billson, F. A. et al.: Safety of an intravitreal injection of triamcinolone: results from a randomised clinical trial. Arch. Ophthalmol., 122, 2004: 336-340
3. Chan, C. K. M., Mohamed, S., Shanmugam, M. P. et al.: Decreasing efficacy of repeated intravitreal triamcinolone injections in diabetic macular oedema. Br. J. Ophthalmol., 90, 2006: 1137-114
4. Jonas, J. B., Hayler, J. K., Sofker, A.et al.: Intravitreal injection of crystalline cortisone as adjunctive treatment of proliferative diabetic retinopathy. Am. J. Ophthalmol., 131, 2001: 468-471
5. Jonas, J. B., Sofker, A.: Intraocullar injection of crystalline cortisone as adjunctive treatment of diabetic macular edema. Am. J. Ophthalmol., 132, 2001: 425-427
6. Jonas, J. B., Harder, B., Kamppeter, B. A.: Inter-eye difference in diabetic macular edema after unilateral intravitreal injection of triamcinolon acetonide. Am. J. Ophthalmol., 138, 2004: 970-977
7. Jonas, J. B.: Intraocular availability of triamcinolon acetonide after intravitreal injection. Am. J. Ophthalmol., 137, 2004: 560-562
8. Jonas, J. B., Akkoyun, I, Kreissig, I. et al.: Diffuse diabetic macular oedema treated by intravitreal triamcinolon acetonide: a comparative, non-randomised study. Br. J. Ophthalmol., 89, 2005: 321-326
9. Lee, C. M., Olk, R. J.: Modified grid laser photocoaguation for diffuse diabetic macular edema. Long-term visual results. Ophthalmology, 98, 1991: 1594-1602
10. Machemer, R., Sugita, G., Tano, Y.: Treatment of intraocular proliferations with intravitreal steroids. Trans. Am. Ophthalmol. Soc., 77, 1979: 171-180
11. Martidis, A., Duker, J. S., Greenberg, P. B. et al.: Intravitreal triamcinolone for refractory diabetic macular edema. Ophthalmology, 109, 2002: 920-927
12. Mc Donald, H. R, Schatz, H.:. Grid photocoagulation for diffuse macular edema. Retina, 5, 1985: 65-72
13. Park, C. H., Jaffe, G. J., Fekrat, S.: Intravitreal triamcinolone acetonide in eyes with cystoid macular edema associated with central retinal vein occlusion. Am. J. Ophthalmol., 136, 2003: 419-425
14. Spandau, U. H. M., Derse, M., Schmitz-Valckenberg, P. et al.: Dosage dependency of intravitreal triamcinolone acetonide as treatment for diabetic macular edema. Br. J. Ophthalmol., 89, 2005: 999-1003
15. Vernon, S. A.: Intravitreal triamcinolone therapy for diabetic macular oedema. Br. J. Ophthalmol., 89, 2005: 931-933
16. Young, S., Larkin, G., Branley, M. S. et al.: Safety and efficacy of intravitreal triamcinolone for cystoid macular oedema in uveitis. Clin. Experiment. Ophthalmol., 29, 2001: 2-6
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Czech and Slovak Ophthalmology
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