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A prospective randomised trial of different doses of intravitreal triamcinolone for diabetic macular oedema
  1. Dennis S C Lam1,
  2. Carmen K M Chan1,
  3. Shaheeda Mohamed1,
  4. Timothy Y Y Lai1,
  5. Kenneth K W Li2,
  6. Patrick S H Li2,
  7. Chi-Wai Tsang1,
  8. Wai-Man Chan1,
  9. Mahesh P Shanmugam1
  1. 1Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong
  2. 2Department of Ophthalmology, United Christian Hospital, Hong Kong
  1. Correspondence to: Professor D S C Lam Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong; University Eye Center, Hong Kong Eye Hospital, 147K, Argyle Street, Kowloon, Hong Kong; dennislam_pub{at}cuhk.edu.hk

Abstract

Objective: To compare the safety and efficacy of different doses of intravitreal triamcinolone (ivTA) in treating clinically significant diabetic macular oedema (CSMO).

Methods: 63 eyes of 63 patients with CSMO and central foveal thickness (CFT) of ⩾250 μm on optical coherence tomography were randomised to receive 4 mg (n = 23), 6 mg (n = 20) or 8 mg (n = 20) ivTA. Patients were followed up for 6 months, and changes in best-corrected visual acuity (BCVA), optical coherence tomography CFT, standardised change in macular thickness (SCMT), and side effects such as intraocular pressure and cataractogenesis were compared between the three groups.

Results: After ivTA injection, improvements of BCVA and CFT occurred in all groups. The mean BCVA improvement at 6 months was significantly higher for the 8 mg group compared with the 4 mg group, with 9.9 and 3.1 improvement in letters on the Early Treatment of Diabetic Retinopathy Study chart, respectively (p = 0.047). The mean SCMT at 6 months for the 4, 6 and 8 mg groups was 28.7%, 42.3% and 60.5%, respectively (p = 0.06). The proportion of eyes with SCMT ⩾75% at 6 months was higher in the 8 mg group, but the difference failed to reach significance (p = 0.06). Ocular hypertensive responses (>21 mm Hg) occurred in 39%, 30% and 55% of eyes in the 4, 6, and 8 mg groups, respectively (p = 0.27).

Conclusions: Higher doses of ivTA may prolong the duration of visual benefit in diabetic CSMO and seemed to result in more sustained reduction in macular oedema. Further studies are warranted to investigate the optimum dose of ivTA in treating diabetic CSMO.

  • BCVA, best-corrected visual acuity
  • CFT, central foveal thickness
  • CSMO, clinically significant macular oedema
  • ETDRS, Early Treatment of Diabetic Retinopathy Study
  • IOP, intraocular pressure
  • ivTA, intravitreal triamcinolone
  • logMar, logarithm of minimum angle of resolution
  • OCT, optical coherence tomography
  • SCMT, standardised change in macular thickness

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Footnotes

  • Published Online First 13 September 2006

  • Funding: This work was supported in part by the Action for Vision Eye Foundation, Hong Kong (a charitable organisation). The funding organisation did not contribute to the design/execution/data analysis of this study.

  • Competing interests: None.

  • The data in this paper were presented in part at the 2nd International Symposium on Macular Diseases (16–18 December 2004, Bangkok); 2nd SERI ARVO Meeting on Research in Vision and Ophthalmology (16–20 February 2005, Singapore) and the 20th Asia Pacific Academy of Ophthalmology Congress (27–31 March 2005, Kuala Lumpur).

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