Retrobulbar Injection Of Triam Cinolone Acetonide Associated With Macular Grid Photocoagulation For Macular Edema In Diabetic Retinopathy

Objective:To evaluate the efficacy and security of retrobulbar injection with triamcinolone acetonide (TA) on diabetic macular edema. Methods:Eight eyes of80patients with clinically significant macular edema (CSME) in diabetic retinopathy were divided into2groups. The combined treatment group eyes were subjected to a macular grid laser photocoagulation on2weeks after retrobulbar injection with TA. The control group eyes underwent only a macular grid laser photocoagulation. All patients were taken general eye examination, intraocular pressure (IOP), fundus fluorescein angiography (FFA) and optical coherence tomography (OCT). The combined treatment group40affected eyes of40cases with clinically significant macular edema (CSME) in diabetic retinopathy were subjected to a macular grid laser photocoagulation2weeks after retrobulbar injection with20mg TA (0.2ml). The average follow-up duration was3months. The post-treatment visual acuity, IOP, fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) were observed and recorded on2weeks,1months and3months respectively. The control group40affected eyes of40cases with clinically significant macular edema (CSME) in diabetic retinopathy were only subjected to a macular grid laser photocoagulation. The average follow-up duration was3months. The post-treatment visual acuity, IOP, fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) were observed and recorded on2weeks,1months and3months respectively. Both groups were compared with repared to the changes in visual acuity, IOP and thickness of retinal macular fovea at2weeks,1months and3months after treatment. Results:All the combined treatment group40affected eyes of40eyes had improved visual acuity. The mean visual acuity was improved to0.417+0.191, 0.457±0.218and0.456±0.221respectively. The result of FFA showed decrease of fluorescein leakage. Edema disappeared completely in3eyes (7.5%), partially in24eyes (60%), unchanged in13eyes (32.5%). During follow-up, intraocular pressure of all patients was in the normal range. All the combined treatment group40affected eyes of40eyes had reduced thickness of retinal macular fovea. The mean retinal thickness of macular fovea was reduced to304.17±41.730um,294.25±41.421um and296.05±41.756um respectively. All the control group40affected eyes of40cases had improved visual acuity, too. The mean visual acuity was improved to0.343±0.209,0.343±0.199and0.342±0.204respectively. The result of FFA showed decrease of fluorescein leakage. Edema disappeared completely in0eyes (0.00%), partially in12eyes (30%), unchanged in28eyes (70%). The IOP measured at3months show no significant difference with pre-treatment IOP. During follow-up, intraocular pressure of all patients was in the normal range. All the control group40affected eyes of40eyes had reduced thickness of retinal macular fovea. The mean retinal thickness of macular fovea was reduced to312.45±39.990um,309.90±38.865um and311.20±38.738um respectively. The visual, IOP and thickness of retinal macular fovea acuities were not significantly different between the2groups at baseline and at time after treatment. The bleeding of injection section was observed in4eyes, and no such complications as retrobulbar hemorrhage, endophthalmitis or cataract occurred in all the affected eyes. Conclusions:Retrobulbar injection of triamcinolone acetonide (TA) associated with macular grid laser photocoagulation for treatment of diabetic macular edema are one of effective measures and better security, but its long-term efficacy and safety needs further evaluation. Retrobulbar injection of triamcinolone acetonide (TA) combined with macular grid laser photocoagulation and simple macular grid laser photocoagulation for the treatment of clinical significance in the patients with diabetic macular edema were no significant difference in vision improvement and retinal thickness of macular fovea reduction.