Intravitreal triamcinolone plus sequential grid laser versus triamcinolone or laser alone for treating diabetic macular edema: six-month outcomes

Ophthalmology. 2007 Dec;114(12):2162-7. doi: 10.1016/j.ophtha.2007.02.006. Epub 2007 Apr 25.

Abstract

Objective: To evaluate the efficacy of sequential intravitreal triamcinolone acetonide (TA) injection followed by grid laser photocoagulation for treating diabetic macular edema (DME).

Design: Prospective, 3-armed, randomized clinical trial.

Participants: One hundred eleven eyes of 111 patients with DME involving the fovea.

Intervention: Patients were randomized to grid laser photocoagulation (37 eyes), 4 mg of intravitreal TA (38 eyes), or 4 mg of intravitreal TA combined with sequential grid laser about 1 month later (36 eyes).

Main outcome measures: Central foveal thickness (CFT) as measured by optical coherence tomography, logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA), and side effect profiles. The 6-month results are reported.

Results: All patients completed 6 months' follow-up. Baseline mean (+/- standard deviation) CFTs were 385+/-100 microm, 396+/-91 microm, and 424+/-108 microm for the laser, intravitreal TA, and combined groups, respectively (P = 0.24). After treatment, significant CFT reductions were noted in both the intravitreal TA and combined groups at all follow-up visits (P<0.01) but not in the laser group. Mean CFT improved significantly to minimums of 267+/-75 microm and 256+/-73 microm for the intravitreal TA and combined groups, respectively, but the difference between the 3 groups was not significant at 6 months. The standardized change in macular thickening at 17 weeks was significantly greater in the combined group versus the intravitreal TA group (P = 0.007), suggesting that combined treatment might prolong the effects of intravitreal TA. Mean baseline logMAR BCVAs were 0.64+/-0.37, 0.72+/-0.34, and 0.69+/-0.34 in the laser, intravitreal TA, and combined groups, respectively (P = 0.67). Best-corrected visual acuity improved significantly at 4 and 9 weeks for the intravitreal TA group but did not change significantly in the other 2 groups. No significant difference in BCVA was observed between the 3 groups at any time point.

Conclusions: Contrary to the results of a recent study, combined treatment of intravitreal TA plus grid laser did not yield better CFT reduction or BCVA improvement at 6 months than intravitreal TA alone. Grid laser alone was significantly worse than the 2 other treatment modalities.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Combined Modality Therapy
  • Diabetic Retinopathy / drug therapy
  • Diabetic Retinopathy / surgery
  • Diabetic Retinopathy / therapy*
  • Female
  • Glucocorticoids / adverse effects
  • Glucocorticoids / therapeutic use*
  • Humans
  • Injections
  • Laser Coagulation / adverse effects
  • Laser Coagulation / methods*
  • Macular Edema / drug therapy
  • Macular Edema / surgery
  • Macular Edema / therapy*
  • Male
  • Middle Aged
  • Prospective Studies
  • Retina / pathology
  • Tomography, Optical Coherence
  • Treatment Outcome
  • Triamcinolone Acetonide / adverse effects
  • Triamcinolone Acetonide / therapeutic use*
  • Visual Acuity
  • Vitreous Body

Substances

  • Glucocorticoids
  • Triamcinolone Acetonide