Use of intravitreal triamcinolone and laser photocoagulation for the treatment of diffuse diabetic macular edema / Tratamento do edema macular difuso do diabético com triancinolona intravítrea e fotocoagulação com laser de argônio

AUTOR(ES)
DATA DE PUBLICAÇÃO

2008

RESUMO

INTRODUCTION: The diffuse macular edema is an important cause of visual impairment in diabetic subjects. Laser photocoagulation is the main treatment for this disorder, however, it is not effective in a large number of patients. In this study, we evaluated the efficacy of intravitreal use of triamcinolone acetonide combined with laser photocoagulation for the treatment of diffuse diabetic macular edema and we compare it with either laser alone or intra-vitreal triancinolone. METHODS: In this study, performed between june 2005 and september 2006, we studied 30 well controlled diabetic patients with diffuse macular edema. These patients were randomly divided into the following treatment groups: (1) macular grid photocoagulation; (2) intravitreal injection of 4 mg of triamcinolone acetonide; (3) combination of the two previous therapies. Follow up was scheduled at predetermined intervals of one day, one week and monthly until completion of six months. The following parameters were analyzed: LogMAR best corrected visual acuity; central macular thickness and total macular volume measured by ocular coherence tomography; and intraocular pressure assessed by Goldmans tonometer. RESULTS: Grid photocoagulation did not significantly reduce the central macular thickness (p=0,0862) or the total macular volume (p=0,11). On the other side, this reduction was significant and statistically similar in the others two groups (p<0,001). All groups improved the mean visual acuity (p=0,003), however, the group that received the association treatment had a higher percentage of patients gaining 10 or more letters at the fourth and fifth month of follow up (p=0,026; p=0,034). A rise in 5 or more mmHg in intraocular pressure was observed in 12 patients; half of them was in the triamcinolone group and the other half was in the group that received combined therapies (p<0,001). These cases with elevated intraocular pressure were well controlled with timolol maleate 0,5% drops. CONCLUSION: The simultaneous use of photocoagulation and intravitreal triamcinolone provided a higher gain of visual lines than the isolated use of each treatment. The laser photocoagulation was the only therapy that did not significantly reduce the macular volume and the macular thickness, however, it was also the only one that did not present cases of ocular hypertension during follow up.

ASSUNTO(S)

diabetic retinopathy diabetes mellitus fotocoagulação visual acuity edema light coagulation vision disorders edema acuidade visual diabetes mellitus transtornos da visão triancinolona acetonida triamcinolone acetonide complicações do diabetes diabetes complications retinopatia diabética

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