Sequential posterior subtenon injection of triamcinolone acetonide with macular grid/focal photocoagulation for clinically significant diabetic macular edema

PurposeTo evaluate the efficacy of sequential posterior subtenon triamcinolone acetonide (PSTA) injection with macular grid/focal laser photocoagulation for clinically significant diabetic macular edema (CSME).MethodsProspective, interventional clinical trial. Between July 2007 and March 2008, 41 eyes of 32 patients (17 males and 15 females) with Type II diabetes mellitus and diffuse clinically significant macular edema according to the Early Treatment Diabetic Retinopathy Study criteria were recruited. PSTA was used as the first line of treatment, followed by macular focal/grid photocoagulation 2 weeks later. In patients with persistent macular edema, a second dose of PSTA followed by additional focal laser treatment was administered 8–10 weeks later.ResultsBest-corrected visual acuity (BCVA) calculated as logarithm of the minimum angle of resolution (logMAR) unit showed significant improvement both after 3 weeks (0.79 ± 0.27, p = 0.001) and after 6 months (0.77 ± 0.29, p = 0.001) in comparison with the baseline values 0.92 ± 0.24. Central macular thickness (CMT) was significantly reduced both after 3 weeks (336.2 ± 125.8 μm, p = 0.001) and after 6 months (342.2 ± 127.2 μm, p = 0.001) in comparison with the baseline values 437.1 ± 186.5 μm. Total macular volume (TMV) was also significantly reduced both after 3 weeks (10.2 ± 1.8 mm3, p < 0.05) and after 6 months (10.3 ± 2.0 mm3, p < 0.05) in comparison with the baseline values 11.9 ± 2.1 mm3. There were no significant differences in BCVA, CMT, and TMV between 3 weeks and 6 months posttreatment.ConclusionOne or two sessions of sequential PSTA injection and macular grid/focal photocoagulation may improve or stabilize visual acuity, CMT, and TMV for at least 6 months in patients with CSME.