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How to improve the long term efficacy?
The treatment of diffuse diabetic macular oedema (DMO) has significantly improved in recent years: intravitreal triamcinolone acetonide (IVTA) has been shown to improve visual acuity (VA)1,2 and reduce central macular thickness (CMT) more effectively than laser treatment.3 IVTA is associated with a low incidence of surgical complications but with some side effects (increase in intraocular pressure, cataract development).
Since diabetes is a chronic disease, the long term efficacy of the treatment is fundamental. Unfortunately, recurrence of DMO after IVTA injection is a common finding; after a rapid decrease in CMT and a phase of stability, a relapse can occur after 3–6 months with the more common dosage of 4 mg3–7 and after 7–9 months with a higher dosage (20 mg).8 Recurrence can be treated with re-injection of IVTA (up to three to four re-injections have been reported),5 but unlimited repetition of IVTA injection cannot be offered to our patients, because it implies additional surgical risks and complications.
In the paper published in this issue of the BJO (p 1137), Chan and associates report the outcome after repeated injections of IVTA in patients with diffuse DMO who were good responders at the …