The Effect of Posterior Subtenon Triamcinolone Injection in Panretinal Photocoagulation Induced Visual Dysfunction of Diabetic Retinopathy

Hyung-Bin Hwang; Young-Hoon Park

doi:10.3341/jkos.2009.50.6.864

Journal List > J Korean Ophthalmol Soc > v.50(6) > 1008577

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Hwang and Park: The Effect of Posterior Subtenon Triamcinolone Injection in Panretinal Photocoagulation Induced Visual Dysfunction of Diabetic Retinopathy

Original Article

J Korean Ophthalmol Soc 2009;50(6):864-869.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.6.864

The Effect of Posterior Subtenon Triamcinolone Injection in Panretinal Photocoagulation Induced Visual Dysfunction of Diabetic Retinopathy

Hyung-Bin Hwang, MD, Young-Hoon Park, MD

Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea

Address reprint requests to Young-Hoon Park, MD Department of Ophthalmology, Seoul St. Mary's Hospital, The Catholic University #505 Banpo-dong, Seocho-gu, Seoul 137-701, Korea Tel: 82-2-2258-2846, Fax: 82-2-599-7405, E-mail: parkyh@catholic.ac.kr

Received 1 September 2008 Accepted 2 March 2009

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 evaluate the efficacy of a prophylactic posterior sub-Tenon's capsule injection of Triamcinolone acetonide (TA) against macular edema and visual dysfunction by panretinal photocoagulation (PRP) in patients with severe nonproliferative and proliferative diabetic retinopathy.

Methods

Thirty-eight eyes of 19 patients who have diabetic retinopathy without macular edema and whose retinopathy was bilateral and symmetrical were evaluated. Triamcinolone was injected into the posterior sub-Tenon's capsule in one eye of the patients and nothing was injected in the other eye as a control. Two weeks later, PRP was performed every other week for 4 sessions on both eyes in all patients. The clinical course of visual acuity and macular edema was monitored for up to approximately 6 months after the initial PRP.

Results

There was no statistically significant difference of visual acuity before PRP in the 2 groups (p＞0.05), and there was no macular edema in any patient. For a follow-up period of 6 months, visual dysfunction was more severe in the TA-injected eye than the control. However, the difference was not statistically significant (p＞0.05) throughout the follow-up period except at the 20-week time point. On the other hand, macular edema occurred in 2 eyes (10.5%) of the TA-injected group, and in 4 eyes (21.1%) of the control group. IOP elevation as a complication caused by TA-injection occurred in 2 eyes (10.5%). However, IOP was controlled successfully by anti-glaucomatic eye drops.

Conclusions

Posterior sub-Tenon's capsule injection of Triamcinolone is a safe and effective treatment modality for preventing PRP-induced visual dysfunction and macular edema.

Keywords: Panretinal photocoagulation, Posterior sub-Tenon's, capsule injection of Triamcinolone acetonide

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Figure 1.

Line graph illustrating of the clinical course of logarithm of the minimum angle of resolution (logMAR) visual acuity between the TA-inejcted and control eyes. There was not statistically significant difference between two groups before TA injection and after 2 weeks. TA-injected group shows relatively good vision than control group through the follow-up period. But the difference was not statistically significant (p>0.05) except at 20 weeks follow-up time point (p<0.05). (^* statistically significant difference between the TA-injected and control eyes at the point)

Table 1.

Baseline clinical characteristics of 19 patients

Patients No.	Age (yrs)	Sex	DM^* duration (yrs)	HbA1c (%)	Hypertension	Lens
1	47	M^‡	1.5	9.8	−	P^∏
2	58	F^†	6	7.9	−	P
3	47	F	3	6.9	+	P
4	68	M	5		−	P
5	60	F	15	12.1	−	P
6	63	F	14	11.2	−	IOL^‡
7	65	F	19	7.3	+	IOL
8	62	M	28	6.8	−	P
9	49	F	11		−	P
10	67	F	1	8	−	P
11	54	F	11	13	−	P
12	57	F	12		−	P
13	52	M	6	13.8	−	P
14	67	F	23	8.3	−	IOL
15	64	F	3	6.9	+	P
16	53	M	11	6.1	−	P
17	48	M	2	6.6	−	P
18	66	F	12	10.9	−	P
19	65	F	20		+	P
Mean	58.53		10.71	9.04		
SD^**	7.46		7.78	2.55		
Maximum	68		28	13.8		
Minimum	47		1	6.1		

^* diabetes mellitus

^† female

^‡ intraocular lens

^§ male

^∏ phakic lens

^# standard deviation

^** patient diagnosed with hypertension.

Table 2.

Alteration of visual acuity (logMAR^*) after TA treatment

Patient No.	Triamcinolone Acetonide Injected			Control
Patient No.	−1 week	2 weeks	24 weeks	−1 week	2 weeks	24 weeks
1	0.000	0.222	0.097	0.097	0.097	0.097
2	0.301	0.222	0.301	0.222	0.301	0.222
3	0.000	0.000	0.000	0.000	0.000	0.301
4	0.046	0.097	0.046	0.097	0.046	0.155
5	0.155	0.097	0.097	0.046	0.097	0.398
6	0.155	0.155	0.222	0.155	0.222	0.222
7	0.097	0.155	0.097	0.155	0.097	0.155
8	0.097	0.523	0.155	0.000	0.155	0.222
9	0.699	0.523	1.000	0.523	1.000	0.523
10	0.301	0.523	0.398	0.699	0.398	§
11	0.155	0.222	0.155	0.155	0.155	0.301
12	0.000	0.000	0.000	0.000	0.000	0.000
13	1.222	1.398	1.222	1.398	1.222	1.699
14	0.222	‡	0.046	0.155	‡	0.046
15	0.222	0.222	0.222	0.222	0.222	0.222
16	0.222	0.398	0.301	0.398	0.301	0.155
17	0.222	0.097	0.097	0.222	0.097	0.398
18	0.155	0.097	0.097	0.097	0.097	0.222
19	0.155	0.155	0.155	0.222	0.155	0.222
Mean	0.233	0.284	0.248	0.256	0.259	0.309
SD^†	0.286	0.325	0.324	0.329	0.329	0.369
Maximum	1.222	1.398	1.000	1.398	1.222	1.699
Minimum	0.000	0.000	0.000	0.000	0.000	0.046

^* logarithm of the minimum angle of resolution

^† standand deviation

^‡ patient was not followed

^§ visual acuity was not checked.

Table 3.

Results of treatment and complication

Patient No	Macular edema	Outbreak (weeks)	Complication	Outbreak (weeks)
3	Control eye	20	IOP elevation	2
4	Control eye	20		
5	Control eye	20		
8	TA injected eye	24		
10	−		IOP elevation	2
13	TA injected eye	8 (reinjection at 12 wks)		
17	Control eye	22		

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