Intravitreal triamcinolone acetonide injection for treatment of refractory diabetic macular edema: a systematic review.
OBJECTIVE
To compare intravitreal triamcinolone acetonide (IVTA) injection versus no treatment or sub-Tenon triamcinolone acetonide (STTA) injection in improving visual acuity (VA) of patients with refractory diabetic macular edema (DME; unresponsive to focal laser therapy).


CONCLUSIONS
Diabetic macular edema is the leading cause of visual loss in diabetic retinopathy. Laser therapy has been the standard of care for patients with persistent or progressive disease. More recently, it has been suggested that IVTA injection may improve VA. METHODS AND LITERATURE REVIEWED: The following databases were searched: Medline (1950-September Week 2 2008), The Cochrane Library (Issue 3, 2008), and the TRIP Database (up to September 1, 2008), using no language or other limits. Randomized controlled trials were included that consisted of patients with refractory DME, those comparing IVTA injection with no treatment or STTA injection, those reporting VA outcomes, and those having a minimum follow-up of 3 months.


RESULTS
In the 4 randomized clinical trials comparing IVTA injection with placebo or no treatment, IVTA injection demonstrated greater improvement in VA at 3 months, but the benefit was no longer significant at 6 months. Those who received IVTA injection had significantly higher IOP at 3 months and at 6 months. In the 2 randomized clinical trials comparing IVTA injection with STTA injection, IVTA injection demonstrated greater improvement in VA at 3 months, but not at 6 months. Intravitreal triamcinolone acetonide injection demonstrated no difference in IOP at 3 months or at 6 months.


CONCLUSIONS
Intravitreal triamcinolone acetonide injection is effective in improving VA in patients with refractory DME in the short-term, but the benefits do not seem to persist in the long-term.


BACKGROUND
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
The Dartmouth Institute for Health Policy and Clinical Practice, 30 Lafayette Street, Hanover, NH 03766, USA.
Taygan
T
Yilmaz
Christopher D
CD
Weaver
Micheal J
MJ
Gallagher
Miguel
M
Cordero-Coma
Rene A
RA
Cervantes-Castaneda
Dino
D
Klisovic
Alejandro J
AJ
Lavaque
Robin J
RJ
Larson
D000368:Aged; D016208:Databases, Factual; D003930:Diabetic Retinopathy / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007267:Injections; D007429:Intraocular Pressure; D008269:Macular Edema / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage* / Q000009:adverse effects; D014792:Visual Acuity / Q000502:physiology; D014822:Vitreous Body
D005938:Glucocorticoids; D014222:Triamcinolone Acetonide