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Special considerations needed for pseudophakic patients with DME

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KAANAPALI, Hawaii — Intravitreal triamcinolone with prompt focal/grid laser may be equally as effective as ranibizumab in improving visual acuity and reducing retinal thickening in pseudophakic eyes, but there are other important factors to consider, according to a speaker here.

"This really is a paradigm shift of how we think we are going to approach patients with foveal-involved diabetic macular edema," Susan B. Bressler, MD, said at the Retina 2011 meeting.

Dr. Bressler presented findings from two subgroup analyses of a recent Diabetic Retinopathy Clinical Research Network study that is examining the use of Lucentis (ranibizumab, Genentech) plus prompt or deferred laser vs. triamcinolone plus prompt laser for treating diabetic macular edema.

Results of the protocol B analysis demonstrated that pseudophakic eyes at baseline treated with intravitreal triamcinolone compared to focal/grid laser did not have superior outcomes, whereas in protocol I, intravitreal triamcinolone with prompt focal/grid laser appeared more effective than laser alone, Dr. Bressler said.

This discrepancy may have resulted from factors such as characteristic differences between the two cohorts, she said.

Overall, using steroid with focal/grid laser in pseudophakic eyes might be equally effective at reducing retinal thickness and improving visual acuity and may require fewer injections (three steroid injections vs. eight to nine ranibizumab injections), according to Dr. Bressler.

"However, in ... those assigned to triamcinolone plus laser, nearly 50% had a pressure issue, meaning a rise in pressure of 10 mm Hg, or a pressure of greater than 30, or the need to be put on medication," Dr. Bressler said. "So, no matter what, there's a one in two chance, if you use that approach, you will be dealing with glaucoma."

• Disclosure: Dr. Bressler receives institutional research grants from Genentech, Novartis and Bausch + Lomb.

Hawaiian Eye and Retina 2012 will be held January 15-20 at the Grand Wailea Resort & Spa in Maui. Learn more at OSNHawaiianEye.com or RetinaMeeting.com.