title: Repeated intravitreal high-dosage injections of triamcinolone acetonide for diffuse diabetic macular edema.
abstract: OBJECTIVE
  To report the results of repeated intravitreal injections of triamcinolone acetonide for treatment of diffuse diabetic macular edema.
  
  
  METHODS
  Retrospective interventional comparative study.
  
  
  METHODS
  The investigation included a study group (the responders) of 19 patients (22 eyes) with diffuse diabetic macular edema, who showed an improvement in visual acuity after an intravitreal injection of approximately 20 mg triamcinolone acetonide, and who received a second intravitreal injection 10.0+/-3.8 months after the first injection. A control group consisted of 31 patients with diffuse diabetic macular edema without treatment during follow-up.
  
  
  METHODS
  Intravitreal injection of approximately 20 mg triamcinolone acetonide.
  
  
  METHODS
  Visual acuity and intraocular pressure.
  
  
  RESULTS
  Follow-up after the second injection was 9.1+/-4.9 months. Four patients received a third injection at 9.7+/-3.7 months after the second injection, with a follow-up after the third injection that was at 7.9+/-11.5 months. After the second and third injections, visual acuity increased significantly (P = 0.002 and P = 0.068, respectively) by 1.8+/-2.1 and 4.0+/-2.6 Snellen lines, respectively. Eleven eyes (50%) showed an improvement in visual acuity by at least 2 Snellen lines after the second injection, and 3 patients (75%) experienced a gain in visual acuity by at least 2 Snellen lines after the third injection. Intraocular pressure increased significantly (P<0.01) after each injection, and returned to baseline values before each reinjection. Visual acuity improvement (P>0.05) and intraocular pressure rise did not differ significantly (P>0.55) between the various injections. Improvement in visual acuity and rise of intraocular pressure lasted approximately 6 to 8 months after each injection.
  
  
  CONCLUSIONS
  Intravitreal injection of approximately 20 mg triamcinolone acetonide may repeatedly lead to an improvement in visual acuity and a rise of intraocular pressure in patients with diffuse diabetic macular edema. The duration of the effect after each injection is approximately 6 to 8 months. Tachyphylaxis in visual acuity or intraocular pressure outcomes were not observed.
authors.affiliation: Department of Ophthalmology, Faculty of Clinical Medicine Mannheim of the University Heidelberg, Mannheim, Germany. Jost.Jonas@ma.augen.uni-heidelberg.de
authors.forename: Jost B
authors.initials: JB
authors.lastname: Jonas
authors.forename: Ulrich H
authors.initials: UH
authors.lastname: Spandau
authors.forename: Bernd A
authors.initials: BA
authors.lastname: Kamppeter
authors.forename: Urs
authors.initials: U
authors.lastname: Vossmerbaeumer
authors.forename: Björn
authors.initials: B
authors.lastname: Harder
authors.forename: Gangolf
authors.initials: G
authors.lastname: Sauder
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003930:Diabetic Retinopathy / Q000188:drug therapy*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007267:Injections; D007429:Intraocular Pressure; D008269:Macular Edema / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D019233:Retreatment; D012189:Retrospective Studies; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*; D014792:Visual Acuity; D014822:Vitreous Body
chemical_list: D005938:Glucocorticoids; D014222:Triamcinolone Acetonide