Intravitreal Versus Subtenon Injections of Triamcinolone Acetonide for Diabetic Macular Edema

Soon Jae Kwon; Jae Pil Shin; Si Yeol Kim

doi:10.3341/jkos.2008.49.1.81

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Kwon, Shin, and Kim: Intravitreal Versus Subtenon Injections of Triamcinolone Acetonide for Diabetic Macular Edema

Original Article

J Korean Ophthalmol Soc 2008;49(1):81-90.

Published online: 3 August 2008

DOI: https://doi.org/10.3341/jkos.2008.49.1.81

Intravitreal Versus Subtenon Injections of Triamcinolone Acetonide for Diabetic Macular Edema

Soon Jae Kwon, M.D., Jae Pil Shin, M.D., Si Yeol Kim, M.D.

Department of Ophthalmology, Kyungpook National University College of Medicine, Daegu, Korea

Address reprint requests to Si Yeol Kim. M.D. Department of Ophthalmology, Kyungpook National University, School of Medicine #50 Samduk-2ga, Jung-gu, Daegu 700-721, Korea Tel: 82-53-420-5813, Fax: 82-53-426-6552, E-mail: kimsy@knu.ac.kr

Received 22 January 2007 Accepted 4 September 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To retrospectively evaluate the clinical effect of intravitreal (IVT) and posterior subtenon (PSTT) triamcinolone acetonide (TA) injection in diabetic macular edema.

Methods

Fifty eyes of 43 patients with diabetic macular edema (DME) were included. Twenty-two eyes in the IVT group received 4 mg/0.1 ml intravitreal TA injections and 26 eyes in the PSTT group received 40 mg/1.0 ml subtenon TA injections. LogMAR visual acuity and intraocular pressure (IOP) were measured and, using OCT, central macular thickness (CMT) and total macular volume (TMV) were also measured before and 1, 3, and 6 months postoperatively.

Results

Both groups showed significant decreases in the mean CMT and TMV. The mean CMT in the IVT group was significantly thinner than that of the PSTT group 1 month postoperatively. The percentage reduction in CMT and TMV were also greater in the IVT group than the PSTT group 1 month postoperatively. Both groups showed significant improvements in mean visual acuity, with no significant difference between the two groups. However, at 1-month postoperative improvement in visual acuity was significantly greater in the IVT group than the PSTT group. The mean IOP in the IVT group was also greater than that in the PSTT 1 month postoperatively.

Conclusions

Both injections caused a significant increase in visual acuity and a decrease in CMT and TMV. The effect was more pronounced in the IVT group. However, the PSTT injection also appeared to be a safe and effective technique for the treatment of DME.

Keywords: Diabetic macular edema, Intravitreal injection, Posterior subtenon injection, Triamcinolone acetonide

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Figure 1.

Temporal changes of mean central macular thickness (CMT) in intravitreal TA injection (IVT) and subtenon TA injection (PSTT) groups.

Figure 2.

Temporal changes of mean total macular volume (TMV) in intravitreal TA injection (IVT) and subtenon TA injection (PSTT) groups.

Figure 3.

Comparison of mean percentage reduction in central macular thickness and total macular volume between intravitreal TA injection (IVT) and subtenon TA injection (PSTT) groups.

Figure 4.

Temporal changes of mean visual acuity (logMAR) in intravitreal TA injection (IVT) and subtenon TA injection (PSTT) groups.

Table 1.

Patient characteristics in the IVT^* and PSTT^† injection group

Characteristics	IVT^* group	PSTT^† Group	p value
No. of eyes	24	26
No. of patients (male)	23	25
Age (years)	58.17±8.51	59.65±7.93	0.566
Male (female)	10 (14)	10 (16)	0.817
Left eye (right)	11 (13)	16 (10)	0.266
Duration of diabetes (years)	13.21±7.34	13.08±6.54	0.884
Hypertension	6	8	0.65
Previous PRP^‡			0.23
no treatment	7	8
post-PRP^‡ state	15	14
PRP^‡ during study	2	4
Previous FLP^§	2	1	0.211
Lens status			0.119
Phakic	17	23
pseudophakic	7	3
ETDRS^∏ grade			0.729
PDR^#	15	15
NPDR^**	9	11

IVT^* : Intravitreal triamcinolone injection,

PSTT^†: Posterior subtenon triamcinolone injection.

PRP^‡: Panretinal photocoagulation,

FLP^§ : Focal laser photocoagulation.

ETDRS^∏ : Early treatment diabetic retinopathy study,

PDR^# : Proliferative diabetic retinopathy.

NPDR^** : Non-proliferative diabetic retinopathy.

Table 2.

Comparison of central macular thickness (CMT) and total macular volume (TMV) between IVT^* and PSTT^† injection group (mean±SD)

	IVT^* group	PSTT^† group	p value
CMT (µm)
Preoperative	497.3±206.8	466.3±126.1	0.79
Post-op 1 month	305.7±141.3	409.3±128.3	0.038^†
3 months	295.8±132.8	354.3±138.4	0.12
6 months	441.3±130.5	401.2±143.0	0.38
TMV (mm³)
Preoperative	4.46±1.32	4.07±0.77	0.38
Post-op 1 month	3.32±0.83	3.87±0.96	0.15
3 months	3.40±0.77	3.44±0.91	0.8
6 months	4.17±1.16	3.68±0.96	0.19

IVT^*: Intravitreal triamcinolone injection,

PSTT^†: Posterior subtenon triamcinolone injection.

^‡ : Statistically significant (p<0.05).

Table 3.

Comparison of logMAR^‡ visual acuity and improvement in logMAR^‡ visual acuity between IVT^* and PSTT^† injection group (mean±SD)

	IVT^* group	PSTT^† group	p value
Visual acuity
Preoperative	0.929±0.299	0.796±0.321	0.106
Post-op 1 month	0.721±0.301	0.677±0.313	0.799
3 months	0.783±0.350	0.644±0.347	0.223
6 months	0.929±0.366	0.765±0.310	0.313
Improvement in visual acuity
Post-op 1 month	-0.208	-0.119	0.02^§
3 months	-0.161	-0.16	0.913
6 months	-0.043	-0.106	0.452

IVT^* : Intravitreal triamcinolone injection,

PSTT^†: Posterior subtenon triamcinolone injection.

logMAR^‡: logarithm of minimal angle of resolution.

^§ : Statistically significant (p<0.05).

Table 4.

Comparison of IOP^‡ and percentage increase in IOP^‡ between IVT^* and PSTT^† injection group (mean±SD).

	IVT^* group	PSTT^† group	p value
IOP^‡(mmHg)
Preoperative	17.7±2.8	18.4±2.8	0.23
Post-op 1 day	17.5±3.3	18.3±2.4	0.3
1 week	18.5±4.0	18.9±2.7	0.95
1 month	21.7±5.1	18.8±3.2	0.045^§
3 months	20.3±3.7	19.0±2.8	0.27
6 months	19.6±3.7	18.8±2.8	0.76
Percentage increase in IOP^‡(%)
Post-op 1 day	-0.3±17.6	-1.9±17.6	0.652
1 week	7.7±22.0	4.8±16.6	0.623
1 month	24.7±34.1	3.8±15.7	0.023^§
3 months	17.5±22.8	2.8±13.4	0.048^§
6 months	12.9±17.9	2.0±13.6	0.082

IVT^* : Intravitreal triamcinolone injection,

PSTT^†: Posterior subtenon triamcinolone injection.

IOP^‡: Intraocular pressure.

^§ : Statistically significant (p<0.05).

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