Intravitreal triamcinolone acetonide as an adjuvant therapy to panretinal photocoagulation for proliferative retinopathy with high risk characteristics in type 1 diabetes: case report with 22 weeks follow-up.
OBJECTIVE
To describe a new treatment protocol to deliver panretinal photocoagulation that may avoid further deterioration of vision in patients with type 1 diabetes mellitus with proliferative retinopathy with high risk characteristics for severe visual loss and cystoid macular oedema.


METHODS
Fundus photography, measurement of foveal thickness with optical coherence tomography and best corrected visual acuity (BCVA) determined by Snellen and ETDRS charts were measured before and after treatment in a 28-year-old man.


RESULTS
Over 9 weeks, BCVA improved from 0.05 to 0.25 and the number of letters read at 2 metres from four to 39 after panretinal photocoagulation and adjuvant intravitreal triamcinolone injection under intraconal anaesthesia. Foveal thickness decreased from 691 microm to 239 microm and cysts disappeared by 15 weeks. By 22 weeks, foveal thickness had increased to 282 microm and small cysts had reappeared, but BCVA remained at 0.2 and the number of letters read at 30.


CONCLUSIONS
Proliferative retinopathy regressed, cystoid macular oedema disappeared and vision improved after panretinal photocoagulation and adjuvant intravitreal triamcinolone acetonide injection under intraconal anaesthesia. This represents a feasible option in cases where pain during laser treatment and impairment of vision afterwards due to cystoid macular oedema result in poor compliance with standard laser treatment under topical anaesthesia.
Kytö
Janne P
JP
Department of Ophthalmology, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland.
Angerman
Susanne
S
Lumiste
Evelyn
E
Paloheimo
Markku
M
Summanen
Paula A
PA
D000328:Adult; D000772:Anesthesia, Local; D003131:Combined Modality Therapy; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D003930:Diabetic Retinopathy / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007267:Injections; D017075:Laser Coagulation; D008269:Macular Edema / Q000188:drug therapy / Q000601:surgery / Q000628:therapy; D008297:Male; D041623:Tomography, Optical Coherence; D014222:Triamcinolone Acetonide / Q000008:administration & dosage / Q000627:therapeutic use*; D014786:Vision Disorders / Q000188:drug therapy / Q000601:surgery / Q000628:therapy; D014792:Visual Acuity; D014822:Vitreous Body
D005938:Glucocorticoids; D014222:Triamcinolone Acetonide