If this is not your name, click here.
| | If this is not your name, click here. | | |
| | Contact Us | Order Now | Journals | Bookstore | Register a colleague | | |
| |  Triamcinolone Shows No Synergistic Effect When Added to Laser Photocoagulation for Diabetic Macular Oedema: Presented at RC2009 By Cameron Johnston NEW YORK -- October 12, 2009 -- Pretreating patients who have diabetic macular oedema with intravitreal triamcinolone (IVTA) prior to laser photocoagulation does not have any meaningful benefit over laser therapy alone, according to a study presented here at the Retina Congress (RC) 2009. A prospective, double-masked, placebo-controlled trial was conducted to answer whether there would be any benefit to pretreating patients with IVTA before laser photocoagulation. Previous studies had shown conflicting results. The study results were presented on October 2 by Mark C. Gillies, MD, Department of Ophthalmology, University of Sydney, Sydney, Australia. For the study, 42 patients were given either placebo, or a single 4-mg injection of IVTA 6 weeks prior to laser treatment. The patients were matched for demographic background and disease characteristics, all were long-term diabetics, and all had reasonably well-controlled blood sugars. Six months after undergoing the laser photocoagulation, 43% of patients in the IVTA arm and 38% in the placebo arm (18/42 and 16/42, respectively) gained at least 5 letters (LogMAR) in visual acuity. And while central macular thickness was reduced more in patients who received IVTA, compared with those receiving the placebo, this difference was barely significant (P = .016). The added IVTA did not make a difference as to whether the patients would require further treatments after 6 months either. Fifty-six percent of patients in the treatment arm and 53% of patients in the placebo arm required additional treatments. This was not significant (P = .727). There was a difference with respect to side effects, however. One patient receiving IVTA developed culture negative endophthalmitis, but 19/42 eyes (45%) developed elevated intraocular pressure (IOP) compared with only 7/42 in the laser-alone arm (17%). This was not entirely surprising, Dr. Gillies commented, since extreme spikes in IOP are a well-documented side effect of intravitreal steroid use. None of the eyes experienced a gain of >1 point in cataract severity. Although the 6-month data was disappointing, preliminary data from 24 months did not offer a lot more promise. There were no meaningful differences in the number of patients needing re-treatments, nor were the significant differences in changes in retinal thickness. In fact, the only measurement that showed any kind of noteworthy improvement was that 15 patients (39%) treated with IVTA plus laser had an improvement of 10 or more letters (LogMAR) compared with 7 patients (19%) who were treated with laser only. Even so, this difference was not statistically significant. Dr. Gillies said that overall, this study was disappointing since it did not demonstrate any kind of short-term synergistic effect of pretreating patients with IVTA. The slight improvement in visual acuity was not sufficient to outweigh the increased risk of elevated IOP and subsequent damage to the optic disc and the optic nerve head, he concluded. The 2009 Retina Congress is a combined meeting of the American Society of Retina Specialists, the Macula Society, and the Retina Society. [Presentation title: Effect of Intravitreal Triamcinolone on Outcomes of Laser Photocoagulation for Diabetic Macular Edema: 6-Month Data From a Randomized Controlled Trial]
|
