Primary intravitreal triamcinolone acetonide for diabetic massive macular hard exudates.
OBJECTIVE
To evaluate the efficacy of intravitreal triamcinolone acetonide as treatment for massive macular hard exudates in diabetic patients.


METHODS
The study was a prospective, noncomparative, interventional case series of 12 eyes (12 patients) with massive hard exudates involving the fovea that had no previous focal laser treatment. A single intravitreal injection of 4 mg of triamcinolone acetonide in 0.1 mL was performed. Visual acuity and evolution of hard exudates and fluorescein leakage were assessed. Potential complications were monitored, including ocular hypertension and endophthalmitis.


RESULTS
The follow-up period ranged from 6 to 12 months (mean, 8.25 months). Visual acuity improved significantly at examinations performed 7 days (P = 0.036), 1 month (P = 0.008), 3 months (P = 0.008), and 6 months (P = 0.003) after the injection. Visual acuity improved by at least 2 Snellen lines in 4 patients (33%). However, no eyes with initial visual acuity worse than 20/100 improved to better than 20/100. Foveal hard exudates resolved completely in 6 eyes (50%) and partially in 6 eyes (50%). Fluorescein leakage decreased and a variable proportion of microaneurysms disappeared in all cases. Intraocular pressure elevation occurred in 3 eyes (25%) and was successfully treated by topical medication. No other complications, such as endophthalmitis, were recorded.


CONCLUSIONS
Intravitreal injection of triamcinolone acetonide appears to be beneficial for reducing hard exudates, decreasing fluorescein leakage, and significantly improving visual acuity in patients with diabetic massive hard exudates. Visual improvement may not be important due to profound anatomical impairment caused by hard exudate deposition. Further studies with a larger number of patients are required to assess the long-term efficacy and safety and the need for retreatment.
Khairallah
Moncef
M
Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia. moncef.khairallah@rns.tn
Zeghidi
Hatem
H
Ladjimi
Ahmed
A
Yahia
Salim Ben
SB
Attia
Sonia
S
Zaouali
Sonia
S
Messaoud
Riadh
R
D000328:Adult; D000368:Aged; D002199:Capillary Permeability; D003930:Diabetic Retinopathy / Q000188:drug therapy*; D005122:Exudates and Transudates; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007267:Injections; D008269:Macular Edema / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000009:adverse effects / Q000627:therapeutic use*; D014792:Visual Acuity; D014822:Vitreous Body
D005938:Glucocorticoids; D014222:Triamcinolone Acetonide