title: Intravitreal vs. subtenon triamcinolone acetonide for the treatment of diabetic cystoid macular edema.
abstract: BACKGROUND
  To assess the efficacy of the intravitreal (IVT) injection of Triamcinolone Acetonide (TA) as compared to posterior subtenon (SBT) capsule injection for the treatment of cystoid diabetic macular edema.
  
  
  METHODS
  Fourteen patients with type II diabetes mellitus and on insulin treatment, presenting diffuse cystoid macular edema were recruited. Before TA injection all focal lakes were treated by laser photocoagulation. In the same patients one eye was assigned to 4 mg IVT injection of TA and the fellow eye was then treated with 40 mg SBT injection of TA. Before and one, three and six months after treatment we measured visual acuity with ETDRS chart as well as thickness of the macula with optical coherence tomography (OCT) and intraocular pressure (IOP).
  
  
  RESULTS
  The eyes treated with an IVT injection displayed significant improvement in visual acuity, both after one (0.491 +/- 0.070; p < 0.001) and three months (0.500 +/- 0.089; p < 0.001) of treatment. Significant improvement was displayed also in eyes treated with an SBT injection, again after one (0.455 +/- 0.069; p < 0.001) and three months (0.427 +/- 0.065; p < 0.001). The difference between an IVT injection (0.809 +/- 0.083) and SBT injection (0.460 +/- 0.072) becomes significant six months after the treatment (p < 0.001). Macular thickness of the eyes treated with IVT injection was significantly reduced both after one (222.7 +/- 13.4 microm; p < 0.001) and after three months (228.1 +/- 10.6 microm; p < 0.001) of treatment. The eyes treated with SBT injection displayed significant improvement after one (220.1 +/- 15.1 microm; p < 0.001) and after three months (231.3 +/- 10.9 microm; p < 0.001). The difference between the eyes treated with IVT injection (385.2 +/- 11.3 microm) and those treated with SBT injection (235.4 +/- 8.7 microm) becomes significant six months after the treatment (p < 0.001). Intraocular pressure of the eyes treated with IVT injection significantly increased after one month (17.7 +/- 1.1 mm/Hg; p < 0.020), three (18.2 +/- 1.2 mm/Hg; p < 0.003) and six month (18.1 +/- 1.3 mm/Hg; p < 0.007) when compared to baseline value (16.1 +/- 1.402 mm/Hg). In the SBT injection eyes we didn't display a significant increase of intraocular pressure after one (16.4 +/- 1.2 mm/Hg; p < 0.450), three (16.3 +/- 1.1 mm/Hg; p < 0.630) and six months (16.2 +/- 1.1 mm/Hg; p < 0.720) when compared to baseline value (16.2 +/- 1.3 mm/Hg).
  
  
  CONCLUSIONS
  The parabulbar subtenon approach can be considered a valid alternative to the intravitreal injection.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN67086909.
authors: Department of Surgery and Transplant A, Valsalva, Ophthalmology Service (Chief: Prof, E,C, Campos), University of Bologna, Italy. mauro.cellini@unibo.it
authors: Mauro
authors: M
authors: Cellini
authors: Alberto
authors: A
authors: Pazzaglia
authors: Eugenio
authors: E
authors: Zamparini
authors: Pietro
authors: P
authors: Leonetti
authors: Emilio C
authors: EC
authors: Campos
mesh_terms: D003238:Connective Tissue; D003930:Diabetic Retinopathy / Q000150:complications*; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007267:Injections; D008266:Macula Lutea / Q000473:pathology; D008269:Macular Edema / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*; D014822:Vitreous Body
chemical_list: D005938:Glucocorticoids; D014222:Triamcinolone Acetonide