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Study: Laser therapy more effective at 2 years than triamcinolone for DME patients

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Among most patients with diabetic macular edema, laser therapy appears to yield better long-term visual and anatomical results with fewer side effects than either of two dosing regimens of preservative-free triamcinolone, a randomized study suggests.

Michael S. Ip, MD, and colleagues at 88 U.S. eye care centers compared 2-year safety and efficacy outcomes for 840 eyes of 693 patients with foveal DME who received either one of two dosing regimens of preservative-free intravitreal triamcinolone or focal/grid photocoagulation. Specifically, 330 eyes received laser therapy, 256 eyes received 1 mg of intravitreal triamcinolone, and 254 eyes received 4 mg of intravitreal triamcinolone. Subsequently, re-treatment was administered for persistent or new edema in 4-month intervals.

At 4 months, patients in the 4-mg triamcinolone group had achieved a better mean visual acuity than patients in the 1-mg triamcinolone group (P = .001) and the laser treatment group (P < .001); however, the investigators found no significant differences between the groups at 1 year.

At 16 months and thereafter until 2 year final follow-up, patients in the laser treatment group had achieved a better mean visual acuity than patients in the 1-mg triamcinolone group (P = .02) and in the 4-mg triamcinolone group (P = .002).

"Optical coherence tomography results generally paralleled the visual acuity results," the authors said.

IOP had increased by 10 mm Hg or more in 4% of eyes in the laser treatment group, 16% of eyes in the 1-mg triamcinolone group and 33% of eyes in the 4-mg triamcinolone group.

Cataract surgery was performed in 13%, 23% and 51% of eyes in the three treatment groups, respectively; however, variances in visual acuity between the groups did not appear to be caused solely by cataract formation, according to the study, published online ahead of print in Ophthalmology.

"The results of this study ... support that focal/grid photocoagulation currently should be the benchmark against which other treatments are compared in clinical trials of DME," the authors said.