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• W2078911110 abstract "Although previous studies have demonstrated that intravitreal antivascular endothelial growth factor (VEGF) is an effective treatment for diabetic macular oedema (DME), the effects of this therapy are limited in some cases. We evaluated the short-term efficacy of intravitreal triamcinolone acetonide (TA) for treating DME that is resistant to intravitreal bevacizumab injection. This retrospective study included 20 eyes from 20 patients (13 males and seven females) with recent onset (duration < 3 months) DME that resistant to (<150 μm reduction in central foveal thickness (CFT) or CFT >300 μm after treatment) two or more consecutive intravitreal bevacizumab injections. Eyes with thick vitreomacular adhesion or vitreomacular traction were excluded from the study. The CFT was measured based on optical coherence tomography (Spectral OCT/SLO®; OTI Ophthalmic Technologies Inc., Miami, FL, USA) image. It was defined as the distance between the internal limiting membrane and upper edge of retinal pigment epithelium at the fovea. The mean patient age was 58.4 ± 11.7 years (range, 33–77). The included eyes were previously treated with a mean of 2.3 ± 0.4 (range, 2–3) intravitreal bevacizumab injections. The TA injection (4 mg/0.1 ml) was administered, on average, 5.4 ± 1.4 weeks (range, 4–8) after the last bevacizumab injection. Eyes exhibiting a decrease in CFT of ≥150 μm or CFT ≤250 μm at 1 month after TA injection were classified as the responsive group. The remaining eyes were classified as the poorly responsive group. Baseline characteristics were compared between the two groups (Table 1). The mean best-corrected visual acuity (BCVA) before TA injection, 1 and 3 months after TA injection, was 0.52 ± 0.26 (Snellen equivalent = 20/66), 0.41 ± 0.22 (20/51) and 0.46 ± 0.24 (20/57), respectively. BCVA differed significantly among the three time-points (p = 0.008, repeated-measures analysis of variances). The BCVA before TA injection was significantly different from that measured at 1 month after TA injection (p = 0.008) but not from that measured at 3 months after TA injection (p = 0.240). When compared to the value before TA injection, visual acuity had improved by 1–2 lines in eight eyes (40.0%) and by ≥2 lines in three eyes (15.0%) at 1 month after TA injection. At 3 months, visual acuity had improved by 1–2 lines in five eyes (25.0%) and by ≥2 lines in three eyes (15.0%). At 3 months, a deterioration in visual acuity of >3 lines was not noted in any of the included eyes. Mean CFT before TA injection, 1 month and 3 months after TA injection, was 482.2 ± 125.1 μm, 300.8 ± 122.8 μm and 343.0 ± 131.6 μm, respectively. CFT differed significantly among the three time-points (p < 0.001). CFT before TA injection was significantly different from that measured at 1 and 3 months after intravitreal TA (p = 0.001 and p = 0.005, respectively). CFT ≤250 μm was achieved in eight eyes (40.0%) and six eyes (30.0%) at 1 and 3 months after TA injection, respectively. In four eyes (20.0%), intraocular pressure increased to levels >21 mmHg. These eyes were successfully treated with topical antiglaucoma medication. Mild cataract progression was noted in one of eight phakic eyes. Intravitreal TA is an effective treatment modality for DME (Jonas et al. 2003; Audren et al. 2006). TA suppresses VEGF as well as other cytokines, whereas the effects of anti-VEGF therapies are primarily associated with VEGF (Shimura et al. 2008; Sohn et al. 2011). This difference in the mechanism of action of each treatment modality suggests that some anti-VEGF-resistant DMEs may benefit from TA therapy. Although the potential role of intravitreal TA in this condition has been suggested (Thomas et al. 2013), the efficacy of intravitreal TA in anti-VEGF-resistant DME has not yet been analysed in a case series. In our small case series, significant improvements in BCVA as well as significant decreases in CFT were noted 1 month after intravitreal TA injection in eyes with bevacizumab-resistant DME. However, increases in CFT and deteriorations in BCVA were noted in some eyes between 1 and 3 months after TA injection. As a result, BCVA at 3 months after TA injection was not significantly different when compared with the values measured before TA injection. Although the overall improvement in visual acuity was limited, BCVA improvements of ≥2 lines were maintained up to 3 months in 15% of the eyes. This result suggests that intravitreal TA has a valid short-term effect in some patients with DME that is resistant to bevacizumab. Considering the mean number of anti-VEGF injections before TA injection was only 2.4, it is possible that our results may not be valid for DMEs resistant to a greater number of anti-VEGF injections. Further studies investigating the efficacy of repeated TA injections or combined anti-VEGF plus TA treatment may help to establish the optimal treatment strategy in this condition." @default.
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• W2078911110 date "2014-07-10" @default.
• W2078911110 modified "2023-09-27" @default.
• W2078911110 title "Short-term efficacy of intravitreal triamcinolone acetonide for bevacizumab-resistant diabetic macular oedema" @default.
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• W2078911110 doi "https://doi.org/10.1111/aos.12504" @default.
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