Intravitreal triamcinolone plus sequential grid laser versus triamcinolone or laser alone for treating diabetic macular edema: six-month outcomes.
OBJECTIVE
To evaluate the efficacy of sequential intravitreal triamcinolone acetonide (TA) injection followed by grid laser photocoagulation for treating diabetic macular edema (DME).


METHODS
Prospective, 3-armed, randomized clinical trial.


METHODS
One hundred eleven eyes of 111 patients with DME involving the fovea.


METHODS
Patients were randomized to grid laser photocoagulation (37 eyes), 4 mg of intravitreal TA (38 eyes), or 4 mg of intravitreal TA combined with sequential grid laser about 1 month later (36 eyes).


METHODS
Central foveal thickness (CFT) as measured by optical coherence tomography, logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA), and side effect profiles. The 6-month results are reported.


RESULTS
All patients completed 6 months' follow-up. Baseline mean (+/- standard deviation) CFTs were 385+/-100 microm, 396+/-91 microm, and 424+/-108 microm for the laser, intravitreal TA, and combined groups, respectively (P = 0.24). After treatment, significant CFT reductions were noted in both the intravitreal TA and combined groups at all follow-up visits (P<0.01) but not in the laser group. Mean CFT improved significantly to minimums of 267+/-75 microm and 256+/-73 microm for the intravitreal TA and combined groups, respectively, but the difference between the 3 groups was not significant at 6 months. The standardized change in macular thickening at 17 weeks was significantly greater in the combined group versus the intravitreal TA group (P = 0.007), suggesting that combined treatment might prolong the effects of intravitreal TA. Mean baseline logMAR BCVAs were 0.64+/-0.37, 0.72+/-0.34, and 0.69+/-0.34 in the laser, intravitreal TA, and combined groups, respectively (P = 0.67). Best-corrected visual acuity improved significantly at 4 and 9 weeks for the intravitreal TA group but did not change significantly in the other 2 groups. No significant difference in BCVA was observed between the 3 groups at any time point.


CONCLUSIONS
Contrary to the results of a recent study, combined treatment of intravitreal TA plus grid laser did not yield better CFT reduction or BCVA improvement at 6 months than intravitreal TA alone. Grid laser alone was significantly worse than the 2 other treatment modalities.
Lam
Dennis S C
DS
Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong, Hong Kong, China. dennislam_pub@cuhk.edu.hk
Chan
Carmen K M
CK
Mohamed
Shaheeda
S
Lai
Timothy Y Y
TY
Lee
Vincent Y W
VY
Liu
David T L
DT
Li
Kenneth K W
KK
Li
Patrick S H
PS
Shanmugam
Mahesh P
MP
D000368:Aged; D003131:Combined Modality Therapy; D003930:Diabetic Retinopathy / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007267:Injections; D017075:Laser Coagulation / Q000009:adverse effects / Q000379:methods*; D008269:Macular Edema / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012160:Retina / Q000473:pathology; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000009:adverse effects / Q000627:therapeutic use*; D014792:Visual Acuity; D014822:Vitreous Body
D005938:Glucocorticoids; D014222:Triamcinolone Acetonide