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[Triamcinolone in the treatment of the diabetic macular edema--one-year results].

AIM
To evaluate the efficacy of the 4 mg triamcinolone acetonide injection into the vitreous in patients with diabetic macular edema not responding to the laser treatment after one-year follow-up.


PATIENTS AND METHODS
In a prospective study, 20 eyes with diffuse diabetic macular edema, not responding to the previous laser treatment were evaluated. The group consists of 20 patients; the mean age was 61.5 (29-76) years. The mean duration of diabetes was 14.5 (2-28) years. Twelve patients (60%) were treated by means of insulin, and eight patients (40%) by means of oral agents; the blood levels of glucose ranged between 3.2 - 22 mmol/L. In all patients, the treatment by means of intravitreal injection of triamcinolone started at least 3 months after the previous unsuccessful laser therapy of the macular region. Before the application, and at 1, 3, 6, 9 and 12 months after the application the visual acuity at the EDCRS optotypes was examined, the intraocular pressure was measured, the macula was examined by means of biomicroscopy, the photography of the fundus was performed by the funduscamera, and the macular thickness and its volume were measured by means of optic coherence tomography. The intravitreal injection of 4 mg of triamcinolone was performed on the outpatient's basis under aseptic circumstances at the operation theatre.


RESULTS
The starting best-corrected visual acuity was 0.17 +/- 0.09 and after 12 months it improved to 0.22 +/- 0.14. During the 12 months follow-up period, the visual acuity improved in 11 eyes (55%), stabilized in 5 eyes (25%) and decreased in 4 eyes (20%). The improvement of the visual acuity was significant in all follow-up controls. In the first month p = 0.001, in the 12th month p = 0.038. The macular thickness decreased from the mean value 506.2 +/- 91.4 microm (range, 389 -719) in the beginning of the study, to the mean 362.4 +/- 92.6 microm (range, 211 - 569) after 12 months. During the follow-up period of twelve months, the macular thickness reduced in 18 eyes (90%), and increased in 2 eyes (10%). The decrease of the macular thickness is significant in all follow-up controls. In the 1st, 3rd, and 6th months, p < 0.0005, in the 9th and 12th months, p = 0.001. The correlation coefficient between the best-corrected visual acuity and the macular thickness is -0,467, and the probability (p= 0.038) is statistically significant. In 6 patients, the intravitreal injection of triamcinolone was repeated, and in one of them twice.


CONCLUSION
The intravitreal injection of triamcinolone reduces the macular thickness and improves the visual acuity in patients with diabetic macular edema, in whom the laser treatment did not established the improvement. The best effectiveness is observed in the first three months after the application. After 12 months, we observed the reduction of the macular thickness in 90% of patients, and improvement of the visual acuity in 55% of patients. In some cases, it is necessary to repeat the application of triamcinolone to keep its effect.