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| |  ARVO: Triamcinolone Injections Slightly Better than Vitrectomy for Treating Macular Oedema, but Benefit Short-Lived By Earl R. Nichols FT. LAUDERDALE, FL -- May 3, 2005 -- Patients with diffuse diabetic macular oedema (DME) who undergo intravitreal injections of triamcinolone acetonide may have a better response than those who have a vitrectomy. However, say researchers who compared the two approaches, triamcinolone injections have to be repeated more often than vitrectomy and this may limit the effectiveness of the treatment. In a presentation here May 2nd at the Association for Research in Vision and Ophthalmology annual meeting, Susanne Binder, MD, chair, department of ophthalmology, Rudolf Foundation Hospital, Vienna, Austria, said in an interview that while DME has traditionally been treated with argon laser photocoagulation, this procedure does not restore vision, bet merely arrests the progression of the disease. Laser photocoagulation also leaves the patient with some degree of permanent and irreversible vision loss, Dr. Binder said. With vitrectomy, the entire vitreous body of the eye is removed and replaced with a Ringer's saline solution. Triamcinolone treatment entails injecting 4 mg of the steroid into the vitreous body. Dr. Binder and colleagues studied 25 eyes that underwent vitrectomy and 22 eyes that received triamcinolone injections. Optical coherence tomography, reading acuity and visual acuity using the Early Treatment of Diabetic Retinopathy Study (ETDRS) score were measured at baseline, and at 1 and 3 months of follow-up. At 3 months, there was relatively little difference between the two treatments in terms of the measurements taken. Patients receiving triamcinolone had a greater stabilisation of ETDRS score (100% vs. 84%). Both groups experienced more or less the same degree of improvement on reading acuity, with 92% in the injection group and 91% in the vitrectomy group showing stabilisation or improvement. The decrease in retinal thickness was significantly greater in the triamcinolone arm than in the vitrectomy arm (232 microns vs. 62 microns). There was a slight but important increase in retinal thickness in the triamcinolone group during the 3-month follow-up period, and this continued until at least the 6th month of follow-up. Dr. Binder said he believes the treatment benefit is fairly short-lived. That is not to say that triamcinolone injections could not be repeated, he said, but other studies have shown that the second treatment results in less retinal thinning than does the first treatment, she cautioned. Another limitation of triamcinolone is that the steroid is known to cause significant spikes in intraocular pressure (IOP) and, although all patients in the injection group received timolol immediately after the injection and this controlled the increase in IOP, it does represent another complication with the injection treatment, Dr. Binder said. Given that many people with diabetic macular oedema are older and have glaucoma or elevated IOP, this would limit its use in that population, she said. Overall, both groups showed a high rate of postoperative functional improvement or stabilisation and a significant decrease in retinal thickness. Over the course of 3 months, triamcinolone treated patients had a greater visual acuity OCT measurements on ETDRS, but the change in reading acuity was more or less equal between groups. Larger studies, perhaps over a longer follow-up period, are required to determine whether there are other differences between these two procedures, Dr. Binder concluded.
[Presentation title: Vitrectomy Versus Intravitreal Triamcinolone in Eyes With Persistent Diffuse Diabetic Macular Edema - a Prospective Trial. Poster 1453/B222]
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