Triple therapy of vitrectomy, intravitreal triamcinolone, and macular laser photocoagulation for intractable diabetic macular edema.
OBJECTIVE
To evaluate the effect of a sequentially combined triple therapy on intractable diabetic macular edema (DME).


METHODS
Prospective, interventional case series.


METHODS
Twenty-four eyes from 24 subjects, diagnosed with intractable DME of nontractional origin, were subjected to vitrectomy. Intravitreal triamcinolone acetonide injection and macular laser photocoagulation were conducted sequentially at one and 14 days after vitrectomy. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were recorded before surgery and at three, six, and 12 months after triple therapy.


RESULTS
The mean (+/- standard deviation [SD]) logarithm of the minimum angle of resolution BCVAs before and three, six, and 12 months after the triple therapy were 0.88 +/- 0.37, 0.55 +/- 0.33, 0.56 +/- 0.27, and 0.48 +/- 0.28, respectively. The mean (+/- SD) CMTs before and three, six, and 12 months after the triple therapy were 514 +/- 187 microm, 253 +/- 138 microm, 219 +/- 95 microm, and 197 +/- 91 microm, respectively. The changes in both BCVA and CMT at three, six, and 12 months from baseline were statistically significant (P < .003). The major adverse events after triple therapy were development of nuclear sclerotic cataracts (eight among 12 phakic eyes) and elevation of intraocular pressure (eight among 24 eyes).


CONCLUSIONS
The triple therapy may facilitate early recovery of vision and may improve the long-term outcomes in some patients with DME refractory to conventional monotherapy.
Kang
Se Woong
SW
Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. swkang@smc.samsung.co.kr
Park
Sung Chul
SC
Cho
Hee Yoon
HY
Kang
Jae Hoon
JH
D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D003930:Diabetic Retinopathy / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007267:Injections; D017075:Laser Coagulation / Q000009:adverse effects / Q000379:methods*; D008266:Macula Lutea / Q000473:pathology; D008269:Macular Edema / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage* / Q000009:adverse effects; D014792:Visual Acuity; D014821:Vitrectomy / Q000009:adverse effects / Q000379:methods*; D014822:Vitreous Body
D005938:Glucocorticoids; D014222:Triamcinolone Acetonide