INTRAVITREAL INJECTION VERSUS SUBTENON INFUSION OF TRIAMCINOLONE ACETONIDE DURING CATARACT SURGERY IN PATIENTS WITH REFRACTORY DIABETIC MACULAR EDEMA CLECIO TAKATA, MD,* ANDRE MESSIAS, MD, PHD,* MARCO S. FOLGOSA, MD,* LEVY R. LUCENA, MD,* DANIEL R. LUCENA, MD, PHD,* INGRID U. SCOTT, MD, MPH,† RODRIGO JORGE, MD, PHD* Purpose:
Thepurposeofthisstudywastocomparetheeffectivenessofintravitrealinjection (IVT) versus posterior subtenon infusion (STI) of triamcinolone acetonide performed during phacoemulsification cataract surgery in eyes with refractory diffuse diabetic macular edema. Methods: Twenty-four eyes of 24 patients with refractory diffuse diabetic macular edema scheduled to undergo phacoemulsification cataract surgery were randomly assigned to re- ceive either a 4-mg IVT (n 12) or a 40-mg STI (n 12) of triamcinolone acetonide during cataract surgery. Comprehensive ophthalmic evaluation, including best-corrected visual acu- ity, intraocular pressure, and central macular thickness measured with optical coherence tomography, was performed at baseline and at 1, 4, 8 1, 12 2, and 24 2 weeks postoperatively. Results:
Ten patients from the IVT group and 9 patients from the STI group completed the 24-week study visit. Mean baseline best-corrected visual acuity (logarithm of the minimum angle of resolution) was 20/259 and 20/222 in the IVT and STI groups, respec- tively (t 0.41; P 0.3407). A significant improvement in best-corrected visual acuity was observed only in the IVT group at 4 weeks (mean difference standard error, improved to 20/116; P 0.0437), 8 weeks (20/110; P 0.0355), and 12 weeks (20/121; P 0.0471) postoperatively. There was no significant change from baseline in mean intraocular pressure in either group. Mean standard error baseline central macular thickness was 474.1 42.4 m and 490.8 70.8 m in the IVT and STI groups, respectively (t 0.21; P 0.5807). The central macular thickness reductions after surgery at all study follow-up visits were significantly greater in the IVT group than in the STI group (P 0.05). Conclusion:
These data suggest that IVT is more effective than STI of triamcinolone acetonide for the management of refractory diffuse diabetic macular edema in eyes undergoing phacoemulsification. Further investigation of a larger number of patients with longer follow-up is necessary to confirm these findings. RETINA X:1–1, 2010
ARTIGOS ENVIADOS NA AULA 9.