| Purposes: Macular edema is a major cause of visual acuity loss in patients with diabetic retinopathy. The apoptosis of photoreceptors is the important mechanism of visual loss resulted from macular edema. Current therapies for macular edema include medicine aimed in relieving macular edema, photocoagulation and vitrectomy. However, until now there is no proven effective treatment for patients with macular edema from diabetic retinopathy . Triamcinolone acetonide (TA) is one of artificially synthesized steroids which has strong effect to relieve imflammation, and has little toxic effects. It can be injected into the vitreous cavity directly. Intravitreal injection of TA is widely used to treat macular edema associated with various diseases. In this study we used this methodand panretinal photocoagulation to treat DME, and to observe it's efficacy and safety. Optical coherence tomography (OCT), fundus fluorescein angiography (FFA), ophthalmic routine examination including ophthalmoscopy, slit lamps and intraocular pressure (IOP) measurement were performed to document the results.Methods: This study included fifty eyes of thirsty-one patients with DME. Each eye received one injection of 4mg/0.1ml into the vitreous and panretinal photocoagulation. Evaluation methods include visual acuity, OCT, IOP, ophthalmoscopy, slit lamps and so on.Results: Mean best-corrected visual acuity (BCVA) was 0.21±0.14 before treatment. One month after injection it improved to 0.45±0.24, which was significantly better than that at baseline(P﹤0.01). At the three months follow-up , BCVA improved continuously to 0.5±0.25, which was significantly better compared to that before treatment. Compared to one month follow-up, the patients whose vision continued to improve occupy 54%. At the six months follow-up BCVA was 0.39±0.17, which was significantly better than that at baseline.The mean baseline central macular thickness (CMT) as measured by optical coherence tomography (OCT) was 533.46±187.5μm. One month after injection they decreased significantly to 240.44±67.88μm, and at the three months follow-up to 203.52±72.43μm. While six Months after injection they increased to 265.48±120.48μm. The CMT at one month after injection had an significantly decline compared to baseline, and at three months follow-up time points it was significantly better compared to that at one month follow-up time points. However at six months follow-up the CMT increased again, but they were still fewer than the baseline.An intraocular pressure (IOP) rise to values higher than 21mmHg was observed in 19(38%) eyes. Elevation of IOP occurred at one week after the injection was 20%, at three months after the injection was 12%, at six months after the injection was 3%. In all but one eye, IOP could be lowered to the normal range with topical medicine. One eye developed refractory ocular hypertension to intravitreal injection of TA. Selective laser trabeculoplasty (SLT) had to be performed in emergency to avoid optic nerve damage and allowed to successfully control the IOP follow-up.13 (26%) eyes experience recurrence of macular edema after injection. Excipient left in 2(4%) eyes because that it was not completely cleaned out before injection. There were 2(4%) eyes of pseudoendophthalmitis after 2 days of the injection of TA. There were 2(4%) eyes of progression of cataract and 1(2%) eyes of vitreous haemorrhage after the injection of TA.Intravitreal triamcinolone and panretinal photocoagulation seems to be an effective treatment for DME, resulting in a marked reduction in macular thickness and improved vision in most eyes treated for at least 3 months after the injection with a significant but manageable adverse event profile. However, further studies are required to demonstrate its long-term efficacy.
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