title: Efficacy and safety of postvitrectomy intravitreal triamcinolone therapy for diabetic macular edema.
abstract: OBJECTIVE
  After vitrectomy, diffusion and clearance rates of numerous drugs are increased, leading to a shorter intravitreal half-life. This raises doubts about the efficacy of intravitreal therapies, as retina specialists generally believe that a shorter half-life compromises the drugs' therapeutic effect. We conducted a study to evaluate the functional and anatomical effect of intravitreal triamcinolone acetonide therapy (IVTA) in previously vitrectomized eyes with diabetic macular edema (DME).
  
  
  METHODS
  In this retrospective, multicenter case series study including vitrectomized patients with DME who underwent IVTA injections, central macular thickness (CMT) measured with spectral-domain optical coherence tomography and best-corrected visual acuity (BCVA) in Early Treatment Diabetic Retinopathy Study letters were evaluated after each procedure. All relevant medical data were collected, including previous ophthalmologic treatments and comorbidities.
  
  
  RESULTS
  Twenty vitrectomized eyes of 20 patients, mean age 58.1 years (range 40-72 years), were enrolled in the study. All patients presented DME and received at least one IVTA injection. Mean time between pars plana vitrectomy and IVTA was 12.9 ± 8.7 months. Mean pretreatment and posttreatment CMT was 438.8 ± 90.8 μm and 301.2 ± 76.2 μm, respectively, a difference that reached statistical significance (p&lt;0.001). Mean gain in BCVA letter score was 7.83 ± 14.9 letters after treatment (p = 0.039). Mean intraocular pressure was significantly increased after IVTA (17.2 ± 1.9 mm Hg at baseline vs 21.2 ± 4.59 mm Hg after IVTA, p = 0.002).
  
  
  CONCLUSIONS
  A positive anatomical and functional effect was observed in our cohort. Our results suggest that, despite prior vitrectomy, triamcinolone remains a valid therapeutic approach for eyes with persistent DME. Further prospective randomized studies with larger patient samples are needed to validate this conclusion.
authors.affiliation: Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra, Coimbra - Portugal.
authors.forename: José F
authors.initials: JF
authors.lastname: Costa
authors.affiliation: Department of Ophthalmology, Hospital de Braga - Portugal.
authors.forename: Keissy
authors.initials: K
authors.lastname: Sousa
authors.affiliation: Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra, Coimbra - Portugal.|Association for Innovation and Biomedical Research on Ligh and Image (AIBILI), Coimbra - Portugal.
authors.forename: João P
authors.initials: JP
authors.lastname: Marques
authors.affiliation: Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra, Coimbra - Portugal.
authors.forename: Marco
authors.initials: M
authors.lastname: Marques
authors.affiliation: Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra, Coimbra - Portugal.|Association for Innovation and Biomedical Research on Ligh and Image (AIBILI), Coimbra - Portugal.|Faculty of Medicine of the University of Coimbra (FMUC), Coimbra - Portugal.
authors.forename: Maria Luz
authors.initials: ML
authors.lastname: Cachulo
authors.affiliation: Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra, Coimbra - Portugal.|Association for Innovation and Biomedical Research on Ligh and Image (AIBILI), Coimbra - Portugal.|Faculty of Medicine of the University of Coimbra (FMUC), Coimbra - Portugal.
authors.forename: Rufino
authors.initials: R
authors.lastname: Silva
authors.affiliation: Department of Ophthalmology, Hospital de Braga - Portugal.
authors.forename: Nuno
authors.initials: N
authors.lastname: Gomes
authors.affiliation: Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra, Coimbra - Portugal.|Association for Innovation and Biomedical Research on Ligh and Image (AIBILI), Coimbra - Portugal.|Faculty of Medicine of the University of Coimbra (FMUC), Coimbra - Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Figueira
mesh_terms: D000328:Adult; D000368:Aged; D003930:Diabetic Retinopathy / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007267:Injections; D007429:Intraocular Pressure; D058449:Intravitreal Injections; D008269:Macular Edema / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012160:Retina / Q000503:physiopathology; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014065:Tonometry, Ocular; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000009:adverse effects / Q000627:therapeutic use*; D014792:Visual Acuity; D014821:Vitrectomy; D014822:Vitreous Body
chemical_list: D005938:Glucocorticoids; D014222:Triamcinolone Acetonide