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Originally published In Press as doi:10.1167/iovs.08-2518 on December 30, 2008
 (Investigative Ophthalmology and Visual Science. 2009;50:2391-2397.)
© 2009 by The Association for Research in Vision and Ophthalmology, Inc.
doi:10.1167/iovs.08-2518
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Posterior Juxtascleral Infusion of Modified Triamcinolone Acetonide Formulation for Refractory Diabetic Macular Edema: One-Year Follow-Up

Daniele Veritti,1 Paolo Lanzetta,1 Laura Perissin,2 and Francesco Bandello1

1From the Departments of Ophthalmology and 2Biomedical Sciences and Technologies, University of Udine, Udine, Italy.

PURPOSE. To evaluate prospectively the efficacy and safety of posterior juxtascleral infusion of a new formulation of triamcinolone acetonide for refractory diffuse diabetic macular edema.

METHODS. This was an interventional case series. Twenty-two consecutive eyes of 18 patients with refractory diffuse diabetic macular edema were included in the study. Each patient underwent a complete ophthalmic examination, including optical coherence tomography (OCT) and digital fluorescein angiography (FA). All patients received a suspension of 40 mg triamcinolone acetonide, 20 mg sodium chondroitin sulfate, and 15 mg sodium hyaluronate (1.5 mL), delivered posteriorly through a conjunctival and Tenon’s incision. All patients completed the 1-year follow-up.

RESULTS. On average, studied eyes received 1.5 treatments. Mean preoperative foveal thickness (±SD) and visual acuity (±SD) were 474.2 ± 136.6 µm and 0.6 ± 0.37 logarithm of the minimum angle of resolution (logMAR), respectively. The central foveal thickness was significantly reduced from baseline at every follow-up visit (P < 0.001). Mean (±SD) reductions in macular thickness were 136 ± 108 µm at 1 week and 128 ± 122 µm after 1 year of follow-up. Mean (±SD) improvement in visual acuity at 12 months was 0.15 ± 0.21 logMAR (P = 0.008). Visual acuity improvement of one or more lines and three or more lines were observed in 14 (63.6%) and 6 (27.3%) eyes, respectively. Seven eyes (31.8%) required topical treatment due to a significant intraocular pressure increase.

CONCLUSIONS. Posterior juxtascleral infusion of a new formulation of triamcinolone acetonide is an effective treatment for diffuse diabetic macular edema unresponsive to conventional grid laser photocoagulation. A randomized, larger study is warranted.






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