Intravitreal triamcinolone versus laser photocoagulation for persistent diabetic macular oedema

Abstract

Backgrounds/Aims: To determine if repeated intravitreal triamcinolone improves best corrected visual acuity at 1 year compared to conventional laser therapy for persistent diabetic macular oedema.

Methods: 88 eyes with persistent clinically significant macular oedema, after at least one prior laser photocoagulation were included in this prospective randomised controlled trial. 43 patients were randomised to 4mg intravitreal triamcinolone (TA) and 45 to laser photocoagulation. The primary endpoint was the proportion of patients who improved by 15 Early Treatment of Diabetic Retinopathy Study (ETDRS) letters at 12 months in TA vs. laser groups. Secondary endpoints were the change in mean best corrected visual acuity, difference in macular thickness and macular volume and adverse event reporting in particular elevated intraocular pressure at 12 months.

Results: Improvement in ≥ 15 ETDRS letters occurred in 2 of 42 patients in the TA group (4.8%) and in 5 of 41 (12.2%) patients in the laser group (P = 0.265). At baseline, the mean ETDRS scores at baseline were 54.4 letters in the TA group and 53.0 letters in the laser group. At 12 months, these were 54.5 and 54.6 respectively. Optical coherence tomography showed a reduction in central macular thickness of 82.0 μm with TA and 62.3 μm with laser at 12 months. There was 1 case of sterile endophthalmitis. 22 out of 43 patients in the triamcinolone group required ocular antihypertensives.

Conclusion: This study did not show a benefit from intravitreal triamcinolone over conventional laser therapy for patients with chronic diabetic macular oedema