MAY 23, 2011
The authors of this randomized, double masked, placebo-controlled clinical trial found that pre-treating diabetic macular edema (DME) with intravitreal triamcinolone (IVTA) before laser treatment did not reduce the necessity for further treatment six months later. However, the 24-month results from this study show a positive benefit for combined therapy. At 24 months, IVTA plus laser resulted in a doubling of vision improvement by ≥10 letters compared with laser alone. But the authors warn IVTA eyes are more likely to experience cataract and elevated IOP.
Researchers randomly assigned 84 eyes of 54 participants to receive intravitreal IVTA plus laser or laser treatment alone.
Primary endpoint data, improvement of ≥10 logMAR letters, were available for 84.5 percent of eyes at 24 months, with last visual acuity observation carried forward for the remaining eyes. At 24 months, 36 percent of eyes in the combination group achieved the primary endpoint compared with 17 percent of eyes treated with laser alone. There was no difference in the mean central macular thickness or mean logMAR visual acuity between the groups. At least one retreatment was required in the second year of the study in 69 percent of IVTA plus laser-treated eyes compared with 45 percent of laser-only eyes (P = 0.187).
There were expected adverse effects of cataract and raised IOP in the IVTA group. Cataracts were removed from 61 percent of phakic IVTA plus laser-treated eyes compared with none in the laser-only group. Treatment for elevated IOP was required in 64 percent of the IVTA plus laser eyes compared with 24 percent of laser-only eyes.
These results are consistent with those recently reported by the Diabetic Retinopathy Clinical Research network, in which pseudophakic eyes that received IVTA did better than those that received laser alone.
The authors conclude that IVTA can be a useful adjunct to laser treatment for management of certain eyes with DME, but that adverse effects may be a concern.