Comparison of Combination Posterior Sub-Tenon Triamcinolone and Modified Grid Laser Treatment with Intravitreal Triamcinolone Treatment in Patients with Diffuse Diabetic Macular Edema
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Purpose: To compare the efficacy of posterior sub-Tenon’s capsule triamcinolone acetonide injection combined with modified grid macular photocoagulation (PSTI+MP) with intravitreal triamcinolone acetonide (IVTA) injection in the treatment of diffuse diabetic macular edema (DME). Materials and Methods: Forty eyes of 33 patients with diffuse DME were randomly allocated into either PSTI+MP (20 eyes) or IVTA (20 eyes). Best corrected visual acuity (VA) and foveal thickness were measured. Results: The ETDRS scores at baseline were 25.2±13.6 (mean±SD) letters in the PSTI+ MP group, whereas 21.7±16.3 letters in the IVTA group. The ETDRS scores improved by 33.2±15.9, 34.7±16.6 and 30.9 ±19.0 letters in the PSTI + MP group whereas by 30.9±15.4, 30.1±17.9 and 31.5±15.0 letters in the IVTA group at 1, 3, and 6 months after the treatments, respectively. The VA improved significantly at 1 month and 3 months after both treatments (all p<0.02, paired t-test). The VA improvements were no longer significant at 6 months in either group. There were no statistically significant differences at any time points between the 2 groups (all p>0.05, Student’s t-test). The foveal thicknesses at baseline and 1, 3, and 6 months after the treatments were 382.8±148.3, 309.1±131.3, 319.3±93.3, 340.4±123.5μm (mean±SD) in the PSTI+MP group vs. 369.1±123.1, 241.4 ±52.3, 277.5±137.4, 290.2±127.9μm in the IVTA group, respectively. Pairwise comparisons revealed significant decrease in foveal thickness at 1 month (p=0.01, paired t-test) for the PSTI+MP group, and at both 1 month (p<0.001) and 3 months (p=0.016) for the IVTA group. There were no statistically significant differences at any time points between the 2 groups (all p>0.05, Student’s t-test). In contrast to the PSTI+MP group, where no complications were noted, the elevation of intra-ocular pressure in 3 of 20 eyes (15%) and a significant increase in average cataract grading were observed in the IVTA group. Conclusion: PSTI+MP treatment provides significant improvement of vision in patients with diffuse DME over 3 months, and achieves outcomes comparable to those after IVTA treatment, however, with fewer complications.
Abstract
Purpose: To compare the efficacy of posterior sub-Tenon’s capsule triamcinolone acetonide injection combined with modified grid macular photocoagulation (PSTI+MP) with intravitreal triamcinolone acetonide (IVTA) injection in the treatment of diffuse diabetic macular edema (DME). Materials and Methods: Forty eyes of 33 patients with diffuse DME were randomly allocated into either PSTI+MP (20 eyes) or IVTA (20 eyes). Best corrected visual acuity (VA) and foveal thickness were measured. Results: The ETDRS scores at baseline were 25.2±13.6 (mean±SD) letters in the PSTI+ MP group, whereas 21.7±16.3 letters in the IVTA group. The ETDRS scores improved by 33.2±15.9, 34.7±16.6 and 30.9 ±19.0 letters in the PSTI + MP group whereas by 30.9±15.4, 30.1±17.9 and 31.5±15.0 letters in the IVTA group at 1, 3, and 6 months after the treatments, respectively. The VA improved significantly at 1 month and 3 months after both treatments (all p<0.02, paired t-test). The VA improvements were no longer significant at 6 months in either group. There were no statistically significant differences at any time points between the 2 groups (all p>0.05, Student’s t-test). The foveal thicknesses at baseline and 1, 3, and 6 months after the treatments were 382.8±148.3, 309.1±131.3, 319.3±93.3, 340.4±123.5μm (mean±SD) in the PSTI+MP group vs. 369.1±123.1, 241.4 ±52.3, 277.5±137.4, 290.2±127.9μm in the IVTA group, respectively. Pairwise comparisons revealed significant decrease in foveal thickness at 1 month (p=0.01, paired t-test) for the PSTI+MP group, and at both 1 month (p<0.001) and 3 months (p=0.016) for the IVTA group. There were no statistically significant differences at any time points between the 2 groups (all p>0.05, Student’s t-test). In contrast to the PSTI+MP group, where no complications were noted, the elevation of intra-ocular pressure in 3 of 20 eyes (15%) and a significant increase in average cataract grading were observed in the IVTA group. Conclusion: PSTI+MP treatment provides significant improvement of vision in patients with diffuse DME over 3 months, and achieves outcomes comparable to those after IVTA treatment, however, with fewer complications.
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