Intravitreal triamcinolone, laser ineffective for long-term DME treatment

Zdenek Gregor, MD, advised against using intravitreal triamcinolone or lasers for the long-term treatment of DME.

PARIS — Patients treated with intravitreal triamcinolone or a laser for persistent diabetic macular edema showed “no statistically significant improvement from baseline” at the 1–year follow-up, said Zdenek Gregor, MD, here at the French Society of Ophthalmology meeting.

At a joint session between the association and the European Society of Ophthalmology, Dr. Gregor said that patients experienced an initial improvement in best corrected visual acuity (BCVA) and a reduction of macular thickness. However, by 1 year, results returned to near baseline and there was no statistically significant improvement in either group, he said.

“The results … were inconclusive or rather negative. Those patients who received intravitreal triamcinolone as well as those who received further laser treatments had very little change in vision from baseline to 12 months,” Dr. Gregor said.

The trial enrolled 43 patients in the triamcinolone arm and 45 in the laser portion. Of the patients, 35 in the triamcinolone portion and 39 in the laser group were pseudophakic.

Baseline BCVA was 55 letters in the intravitreal triamcinolone group and 53 letters in the laser group, Dr. Gregor said. At 1 year, BCVA letter score was 53 letters in the triamcinolone group and 56 letters in the laser group. Mean retinal thickness was 320 µm in the intravitreal triamcinolone group against 333 µm in the laser group.

“We quite evenly spread patients who had intravitreal triamcinolone as well as those who had continuing laser treatments,” Dr. Gregor said. “These were more or less equally matched as far as age, sex, type of diabetes type of retinopathy and a high number of patients who had cataract surgery.”

Macular volume was 8.3 µl in the intravitreal triamcinolone group compared with 8.8 µl in the laser group. In the intravitreal triamcinolone group one patient developed infective endophthalmitis, and 19 out of 43 patients required topical medication for raised IOP. None required surgery, Dr. Gregor said.

“Intravitreal triamcinolone up to 1 year did not improve BCVA, did not reduce macular thickness or volume, and possibly caused a slight reduction both in thickness and in vision initially,” Dr. Gregor said. “Intravitreal triamcinolone is unlikely to improve visual acuity in any lasting fashion.”