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Intravitreal triamcinolone for diabetic macular edema not responding to bevacizumab therapy

Session Details

Session Title: Quick Fire Free Paper 4

Session Date/Time: Sunday 14/09/2014 | 08:00-10:00

Paper Time: 09:10

Venue: Boulevard B

First Author: : B.Chanana INDIA

Co Author(s): :    V. Kumar              

Abstract Details

Purpose:

To assess the role and safety of a single intravitreal triamcinolone injection (1mg), in cases of diabetic macular edema (DME) not responding to three intravitreal bevacizumab injections, used as primary treatment.

Setting:

University College of Medical Sciences, and Guru-Teg Bahadur Hospital, Delhi, India

Methods:

In this study 14 eyes of 12 patients with clinically significant DME, not responding to three intravitreal bevacizumab injection, were enrolled. Of these, 12 eyes had no response to bevacizumab injections and 2 eyes developed worsening of macular edema following treatment. All eyes received 1 mg of intravitreal triamcinolone acetonide (IVT). Patients were evaluated for changes in central macular thickness on optical coherence tomography and best-corrected visual acuity at 1 month and 3 months.

Results:

The mean central macular thickness (CMT) decreased significantly from 496.29μ ± 148μ at baseline to 227.71μ ± 34.3μ (p=0.003) at 1 month. The response sustained till 3 months with CMT of 222.43μ ± 30.4μ at 3 months (p=0.002). At baseline, the mean best-corrected visual acuity (BCVA) was 1.0 logMAR (20/200). A significant improvement in mean BCVA was observed at 1 month (p=0.002) which further improved at the end of 3 months (p = 0.005). The BCVA was 0.4 logMAR (20/50) at 1 month and 0.3 logMAR (20/40) at 3 months. There were no recurrences of macular edema observed up to 3 months. One patient developed raised intraocular pressure, which was well controlled with medication.

Conclusions:

The pathogenesis of DME is multifactorial. Although anti- vascular endothelial growth factor (anti-VEGF) agents have been proven to be effective in treatment of DME, some cases do not respond to them. This study shows Intravitreal triamcinolone is very beneficial in such cases of DME not responding to bevacizumab. IVT have anti-inflammatory, anti-VEGF and anti-proliferative effects. The complications of IVT can be reduced by reducing the dose to 1mg.

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