title: Comparative study of vitrectomy versus intravitreous triamcinolone for diabetic macular edema on randomized paired-eyes.
abstract: BACKGROUND
  The present study was performed to compare the effects of pars plana vitrectomy (PPV) and single intravitreaous triamcinolone acetonide (IVTA) on diabetic macular edema (DME) in paired eyes.
  
  
  METHODS
  Prospective comparative study on randomized paired-eyes was carried out at two hospitals. Forty eyes of 20 patients with bilateral DME were included. One randomly-selected eye was treated with PPV (PPV group), and the other eye was treated with IVTA (4 mg, IVTA group). The central macular thickness (CMT) measured by optical coherence tomography (OCT) and best-corrected visual acuity (BCVA) were monitored for 12 months after treatment. Changes from baseline and differences between groups were analyzed using a mixed model.
  
  
  RESULTS
  At 1 and 3 months, CMT decreased significantly in the IVTA group compared to baseline (p < 0.0001 both), but CMT then increased gradually and no significant difference was found at 12 months (p = 0.90). In the PPV group, CMT decreased continuously and reached a significant level at 12 months (p < 0.0001). CMT of the IVTA group was significantly less than that of the PPV group at 1 month (p = 0.009); however, there was no significant difference at 3 months. Conversely, CMT was significantly less in the PPV group than in the IVTA group at 12 months (p = 0.0003). The changes of BCVA paralleled those of CMT, but no significant difference was detected between baseline BCVA and any time point.
  
  
  CONCLUSIONS
  Despite the short-term improvement, DME recurred 6 months after IVTA, while it remained resolved after PPV. Although this study did not reveal a significant change of BCVA with either treatment, PPV resolved DME more effectively than IVTA at 1 year.
authors.affiliation: Department of Ophthalmology Faculty of Medicine, Kagoshima University Graduate School of Medicine and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan.
authors.forename: Norihito
authors.initials: N
authors.lastname: Doi
authors.forename: Taiji
authors.initials: T
authors.lastname: Sakamoto
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Sonoda
authors.forename: Miho
authors.initials: M
authors.lastname: Yasuda
authors.forename: Koji
authors.initials: K
authors.lastname: Yonemoto
authors.forename: Noboru
authors.initials: N
authors.lastname: Arimura
authors.forename: Eisuke
authors.initials: E
authors.lastname: Uchino
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Ishibashi
mesh_terms: D000328:Adult; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003930:Diabetic Retinopathy / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D058449:Intravitreal Injections; D008269:Macular Edema / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D006442:Glycated Hemoglobin; D014222:Triamcinolone Acetonide; C517652:hemoglobin A1c protein, human