Outcome of Suprachoroidal Triamcinolone Acetonide in Resistant Diabetic Macular Edema
Resistant Diabetic Macular Edema
DOI:
https://doi.org/10.54393/pjhs.v4i07.932Keywords:
Resistant Diabetic Macular-Edema, HbA1c, Optimally Corrected Visual Acuity, Suprachoroidal Triamcinolone AcetonideAbstract
One of the most frequent cause of central vision deterioration in people with retinopathy due to diabetes is diabetic macular edema. Suprachoroidal injections offer a novel way of delivery for the administration of corticosteroids that may have various benefits. Objective: To observe outcome of triamcinolone acetonide given by suprachoroidal route for the treatment of resistant diabetic macular edema. Methods: A descriptive case series study which was carried out at Department of Ophthalmology, Layton Rahmatullah Benevolant Trust Hospital Multan Road Lahore from July 14, 2021 till Jan 14, 2022. A total of 60 cases meeting selection criteria was taken after taking approval from hospital ethical committee. All injections were given by a single surgeon to avoid any related bias. 30-gauge 1cc insulin syringe was used in all cases. Results: The study included patients aged between 30 and 70 years, and the average age was 52.73 ± 10.99 years. There were 39(65%) male with 21(35%) female cases. The average central subfield thickness before and after one month was 593.62 ± 116.87 µm and 303.55 ± 31.29 µm with statistically significantly less mean central subfield thickness after 1 month, p-value less than 0.001. The mean visual acuity after correction before and after one month was 0.81 ± 0.16 and 0.45 ± 0.03 respectively, with statistically significantly less mean optimally corrected visual acuity after 1 month, p-value less than 0.001. Conclusions: It was found that suprachoroidal triamcinolone acetonide is useful in managing the central subfield and optimally corrected visual acuity in resistant diabetic macular edema.
References
Sorour OA, Levine ES, Baumal CR, Elnahry AG, Braun P, Girgis J, et al. Persistent diabetic macular edema: Definition, incidence, biomarkers and treatment methods. Survey of Ophthalmology. 2022 Nov; 68 (2):147-74. doi: 10.1016/j.survophthal.2022.11.008. DOI: https://doi.org/10.1016/j.survophthal.2022.11.008
Harding JL, Pavkov ME, Magliano DJ, Shaw JE, Gregg EW. Global trends in diabetes complications: a review of current evidence. Diabetologia. 2019 Jan; 62: 3-16. doi: 10.1007/s00125-018-4711-2. DOI: https://doi.org/10.1007/s00125-018-4711-2
Sacconi R, Giuffrè C, Corbelli E, Borrelli E, Querques G, Bandello F. Emerging therapies in the management of macular edema: a review. F1000Research. 2019 Aug; 8: 1000-1413. doi: 10.12688/f1000research.19198.1. DOI: https://doi.org/10.12688/f1000research.19198.1
Sarao V, Veritti D, Maurutto E, Rassu N, Borrelli E, Loewenstein A, et al. Pharmacotherapeutic management of macular edema in diabetic subjects undergoing cataract surgery. Expert Opinion on Pharmacotherapy. 2018 Sep; 19(14): 1551-63. doi: 10.1080/14656566.2018.1516206. DOI: https://doi.org/10.1080/14656566.2018.1516206
Tayyab H, Ahmed CN, Sadiq MA. Efficacy and safety of suprachoroidal triamcinolone acetonide in cases of resistant diabetic macular edema. Pakistan Journal of Medical Sciences. 2020 Jan; 36(2): 42. doi: 10.12669/pjms.36.2.1194. DOI: https://doi.org/10.12669/pjms.36.2.1194
Kim EJ, Lin WV, Rodriguez SM, Chen A, Loya A, Weng CY. Treatment of diabetic macular edema. Current Diabetes Reports. 2019 Sep; 19: 1-0. doi: 10.1007/s11892-019-1188-4. DOI: https://doi.org/10.1007/s11892-019-1188-4
Nalçacı S, Akkın C, Afrashi F. Dexamethasone implant in patients with diabetic macular edema resistant to anti-VEGF therapy. Turkish Journal of Ophthalmology. 2019 Apr; 49(2): 73. doi: 10.4274/tjo.galenos.2018.84665. DOI: https://doi.org/10.4274/tjo.galenos.2018.84665
Chawan-Saad J, Wu M, Wu A, Wu L. Corticosteroids for diabetic macular edema. Taiwan Journal of Ophthalmology. 2019 Oct; 9(4): 233. doi: 10.4103/tjo.tjo_68_19. DOI: https://doi.org/10.4103/tjo.tjo_68_19
Sonoda S, Sakamoto T, Yamashita T, Otsuka H, Shirasawa M, Kakiuchi N, et al. Effect of intravitreal triamcinolone acetonide or bevacizumab on choroidal thickness in eyes with diabetic macular edema. Investigative Ophthalmology & Visual Science. 2014 Jun; 55(6): 3979-85. doi: 10.1167/iovs.14-14188. DOI: https://doi.org/10.1167/iovs.14-14188
Campochiaro PA, Wykoff CC, Brown DM, Boyer DS, Barakat M, Taraborelli D, et al. Suprachoroidal triamcinolone acetonide for retinal vein occlusion: results of the tanzanite study. Ophthalmology Retina. 2018 Apr; 2(4): 320-8. doi: 10.1016/j.oret.2017.07.013. DOI: https://doi.org/10.1016/j.oret.2017.07.013
Grover DA, Li T, Chong CC. Intravitreal steroids for macular edema in diabetes. Cochrane Database of Systematic Reviews. 2008 Jan; (1): 1-29. doi: 10.1002/14651858.CD005656.pub2. DOI: https://doi.org/10.1002/14651858.CD005656.pub2
Hussain RM and Ciulla TA. Treatment strategies for refractory diabetic macular edema: switching anti-VEGF treatments, adopting corticosteroid-based treatments, and combination therapy. Expert Opinion on Biological Therapy. 2016 Mar; 16(3): 365-74. doi: 10.1517/14712598.2016.1131265. DOI: https://doi.org/10.1517/14712598.2016.1131265
Dhoot DS, Pieramici DJ, Nasir M, Castellarin AA, Couvillion S, See RF, et al. Residual edema evaluation with ranibizumab 0.5 mg and 2.0 mg formulations for diabetic macular edema (REEF study). Eye. 2015 Apr; 29(4): 534-41. doi: 10.1038/eye.2014.338. DOI: https://doi.org/10.1038/eye.2014.338
Ahmadieh H, Ramezani A, Shoeibi N, Bijanzadeh B, Tabatabaei A, Azarmina M, et al. Intravitreal bevacizumab with or without triamcinolone for refractory diabetic macular edema; a placebo-controlled, randomized clinical trial. Graefe's Archive for Clinical and Experimental Ophthalmology. 2008 Apr; 246: 483-9. doi: 10.1007/s00417-007-0688-0. DOI: https://doi.org/10.1007/s00417-007-0688-0
Al Rashaed S and Arevalo JF. Combined therapy for diabetic macular edema. Middle East African Journal of Ophthalmology. 2013 Oct; 20(4): 315. doi: 10.4103/0974-9233.120014. DOI: https://doi.org/10.4103/0974-9233.120014
Patel SR, Lin AS, Edelhauser HF, Prausnitz MR. Suprachoroidal drug delivery to the back of the eye using hollow microneedles. Pharmaceutical Research. 2011 Jan; 28: 166-76. doi: 10.1007/s11095-010-0271-y. DOI: https://doi.org/10.1007/s11095-010-0271-y
Emami-Naeini P and Yiu G. Medical and surgical applications for the suprachoroidal space. International Ophthalmology Clinics. 2019 Jan; 59(1): 195. doi: 10.1097/IIO.0000000000000251. DOI: https://doi.org/10.1097/IIO.0000000000000251
Jahangir T, Riaz S, Amjad A. Evaluation of the Effect of Suprachoroidal Triamcinolone Injection on Refractory Diabetic Macular Edema. Pakistan Journal of Ophthalmology. 2021 May; 37(3): 262-8. doi: 10.36351/pjo.v37i3.1171. DOI: https://doi.org/10.36351/pjo.v37i3.1171
Yousef MS, Abd Elhafez YA, Farag MH. Assessment of suprachoroidal injection of triamcinolone acetonide in cases of diabetic macular edema. International Journal of Medical Arts. 2021 Apr; 3(2): 1384-9. doi: 10.21608/ijma.2021.55079.1230. DOI: https://doi.org/10.21608/ijma.2021.55079.1230
Rai UD, Young SA, Thrimawithana TR, Abdelkader H, Alani AW, Pierscionek B, et al. The suprachoroidal pathway: a new drug delivery route to the back of the eye. Drug Discovery Today. 2015 Apr; 20(4): 491-5. doi: 10.1016/j.drudis.2014.10.010. DOI: https://doi.org/10.1016/j.drudis.2014.10.010
Seiler GS, Salmon JH, Mantuo R, Feingold S, Dayton PA, Gilger BC. Effect and distribution of contrast medium after injection into the anterior suprachoroidal space in ex vivo eyes. Investigative Ophthalmology & Visual Science. 2011 Jul; 52(8): 5730-6. doi: 10.1167/iovs.11-7525. DOI: https://doi.org/10.1167/iovs.11-7525
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Pakistan Journal of Health Sciences
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access journal and all the published articles / items are distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. For comments