Clinical Observation Of Posterior Subtenon Triamcinolone Acetonide For Diffuse Macular Edema

ObjectiveDiabetic macular edema(DME)is one of the major causes of decreased visual acuity in diabetic individuals.Triamcinolone acetonide(TA)is one of the synthesized steroids which is effective to relieve imflammation,inhibit the development of proliferative vitroretinopathy,reduce neovascularization,and treat macular edema associated with various diseases.Intravitreal TA(IVT)is widely used to treat macular edema.However,many complications were reported for IVT treatment as well. Therefore,it is important to find a safer and more effective technique for the treatment of DME.Our study is to evaluate the clinical consequences of posterior subtenon (PSTT)and IVT injection in DME refratory to conventional grid laser photocoagulation.MethodsThirty-nine cases(42 Eyes)with clinical significant DME refratory to grid laser phtotcoagulation(at least 3 months)were assessed for the inclusion in the study and randomly divided into 2 groups.The PSTT group received 20mg/0.5ml TA and the IVT group received 4mg/0.1ml TA injection.Complete ophthalmic examination with best-corrected visual acuity(BCVA),optic coherence tomography(OCT)and intraocular pressure(IOP)were performed before and in the 1^st,2^nd,and 3^rdmonths of the treatment.ResultsIn the PSTT group,the mean best-corrected visual acuity(BCVA)were 0.10±0.06, 0.14±0.07,0.21±0.09 and 0.24±0.11 before and after treatment for 1m,2m and 3m, respectively.The mean central foveal thickness were found to be decreased from 447.0±63.9μm to 287.9±53.51μm during the treatment(P＜0.01).In the IVT group,the mean BCVA were 0.09±0.05,0.13±0.06,0.20±0.09 and 0.22±0.10 before and after treatment for 1m,2m and 3m,respectively.The mean central foveal thickness were decreased from 493.9±121.8μm to 285.5±67.4μm after treatment for 3 months(P＜0.01). The BCVA during the treatment in both groups was significant increased compared to that of pretreatment(P＜0.01).There was no significant difference with respect to the decrease in the central foveal thickness and increase in the visual acuity between the PSTT group and the IVT group.Significant IOP increase was found in 13.6%of the PSTT group and in 30 of the IVT group.There was one case of pseudomonas endophthalmitis in the IVT group.ConclusionBoth PSTT and IVT injections caused a significant increase in visual acuity and a decrease in central foveal thickness,especially in the short term.Although the effect was more pronounced in the IVT group,the PSTT injection also seemed to be a safe and effective technique for the treatment of DME.