Triamcinolone Acetonide in the Treatment of Diabetic Macular Edema

Reported by Joelle Escoffery, PhD

Conventional treatment for diabetic macular edema (DME) is laser photocoagulation applied in either a focal or grid fashion. There are a variety of new options available for the treatment of DME, including steroid therapy. Intravitreal triamcinolone injection has been shown to reduce macular thickness and improve visual acuity relatively quickly (approximately 2 weeks). Research has demonstrated that this approach is more effective among patients with cystoid edema. This approach, however, is associated with a number of complications, including the presence of floaters, increased intraocular pressure, acceleration of cataract, and endopthalmitis. Because of the numerous complications, other approaches have been examined. One strategy, a combination of laser photocoagulation and posterior subtenon steroid injection, has been showing improved efficacy with reduced complications. Similar to the intravitreal injection, combined laser and subtenon steroid injection has been shown to improve visual acuity at 3 weeks that worsened at 3 months. This approach, however, was not associated with an increase in intraocular pressure. Overall, this approach has a rapid onset, fewer complications than intravitreous injections, and is cost effective.