Pretreatment with intravitreal triamcinolone before laser for diabetic macular
edema: 6-month results of a randomized, placebo-controlled trial.
Author(s): Gillies MC, McAllister IL, Zhu M, Wong W, Louis D, Arnold JJ, Wong TY.
Affiliation(s): Save Sight Institute, Department of Clinical Ophthalmology, The University of
Sydney, Sydney Eye Hospitals, Sydney, NSW, Australia. mark@eye.usyd.edu.au
Publication date & source: 2010, Invest Ophthalmol Vis Sci. , 51(5):2322-8
PURPOSE: To determine whether pretreatment with intravitreal triamcinolone
acetonide (IVTA) before laser photocoagulation is effective in eyes with diabetic
macular edema (DME).
METHODS: The study was a prospective, double-masked, placebo-controlled, clinical
trial of eyes with DME and impaired vision (or=5 letters after 6 months. Secondary
outcomes were necessity of further treatment, change in central macular
thickness, and incidence of adverse events.
RESULTS: Eighty-four eyes of 54 participants were entered into the study, with
6-month data available for 81 (96%) of 84 eyes. Improvement of >or=5 logMAR
letters was similar in eyes treated with IVTA before laser as placebo (18/42
[43%] IVTA vs. 16/34 [38%] laser alone; P = 0.807), as were retreatment rates at
6 months (22 [56%] IVTA vs. 21 [53%] laser alone; P = 0.727). Mean central
macular thickness decreased by 50 microm (95% confidence interval, 10-96 microm)
more in the IVTA treatment group than in the laser-alone group after 6 months (P
= 0.016). Glaucoma therapy was necessary more frequently in IVTA-treated eyes
than in those treated with laser alone (19/42 [45%] vs. 7/42 [17%]; P = 0.005).
CONCLUSIONS: Visual results and the need for further laser treatment at 6 months
were no better in the IVTA group than in the laser-alone group, despite a better
anatomic outcome reflected by reduction in mean central macular thickness. This
study found no evidence of a synergistic effect of IVTA and laser
photocoagulation for DME. (ClinicalTrials.gov number, NCT00148265).
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