Intravitreal triamcinolone compared with macular laser grid photocoagulation for the treatment of cystoid macular edema.
OBJECTIVE
To evaluate the outcome of cystoid macular edema (CME) treated with intravitreal injections of triamcinolone acetonide (TA), macular laser grid photocoagulation (MLG), or both (TA+MLG).


METHODS
Prospective, randomized, interventional, parallel, three-arm clinical trial.


METHODS



METHODS
Institutional clinical study.


METHODS
Fifty-six patients (63 eyes) affected by diabetic or retinal vein occlusion CME.


METHODS
Twenty-two eyes received intravitreal injections of 4 mg TA; 21 eyes underwent MLG; and 20 eyes received intravitreal injection of 4 mg TA, and after 3 months, MLG.


METHODS
Best-corrected visual acuity (VA), central macular thickness (CMT) (by optical coherence tomography), and postoperative complications.


RESULTS
Mean follow-up was 9 +/- 2 months (range 6 to 12 months). Baseline VA (logarithm of minimal angle of resolution [logMAR]) and CMT were, respectively, 0.82 +/- 0.19 and 556 +/- 139 microm microns for the TA group, 0.84 +/- 0.15 and 601 +/- 102 microm microns for the MLG group, and 0.83 +/- 0.22 and 573 +/- 106 microm microns for the TA+MLG group (no statistically significant difference among the groups). After the treatment, at 45 days, 3, 6, and 9 months in the TA group, VA had improved (P = .004) by 0.26, 0.25, 0.22, and 0.23 logMAR and CMT had decreased by 37%, 33%, 29%, and 31% (P = < .001). In the MLG group, VA was unchanged although CMT had decreased by 5%, 13%, 14%, and 16% (P = .021). In the TA+MLG group, VA had improved (P = .003) by 0.26, 0.24, 0.19, and 0.20 logMAR, and CMT had decreased by 36%, 34%, 28%, and 29% (P = < .001). The groups receiving triamcinolone had better VA and lower CMT values at all time points (P < .05). A reinjection was performed in eight eyes; intraocular pressure increased in nine eyes (treated with medical therapy), and cataract progressed in one eye. No injection-related complications occurred.


CONCLUSIONS
TA intravitreal injection improves VA and reduces CMT more than MLG, which in triamcinolone-treated eyes does not offer further advantages. Intravitreal TA injection could be used as primary treatment in patients with CME.
Avitabile
Teresio
T
Sezione di Oftalmologia, Dipartimento di Specialità Medico-Chirurgiche, Università di Catania, Catania, Italy. Clinica.Oculistica@mbox.unict.it
Longo
Antonio
A
Reibaldi
Alfredo
A
D000368:Aged; D003131:Combined Modality Therapy; D003930:Diabetic Retinopathy / Q000150:complications; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007267:Injections; D017075:Laser Coagulation; D008269:Macular Edema / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012160:Retina / Q000187:drug effects / Q000473:pathology; D015356:Retinal Artery Occlusion / Q000150:complications; D012170:Retinal Vein Occlusion / Q000150:complications; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*; D014792:Visual Acuity; D014822:Vitreous Body
D005938:Glucocorticoids; D014222:Triamcinolone Acetonide