Cataract Surgery Combined with Intravitreal Injection of Triamcinolone Acetonide for Diabetic Macular Edema
DOI:
https://doi.org/10.48560/rspo.33086Keywords:
Cataract Extraction, Diabetic Retinopathy, Glucocorticoids/therapeutic use, Intravitreal Injections, Macular Edema, Triamcinolone Acetonide/therapeutic useAbstract
INTRODUCTION: Diabetic macular edema (DME) is the main cause of visual impairment in diabetic patients. Further, cataract formation is known to be accelerated in these patients. DME exacerbation after cataract extraction surgery is common, leading to a poorer visual outcome. Intravitreal triamcinolone acetonide (IVTA) has been used to treat macular edema from a variety of causes and when used at time of phacoemulsification surgery may treat or prevent this complication. This study aims to evaluate functional and anatomical outcomes of combined phacoemulsification and IVTA in eyes with concomitant or previous DME and cataract.METHODS: Retrospective cohort study of the diabetic patients with cataract and concomitant DME or history of previous DME, undergoing phacoemulsification surgery combined with IVTA. The cases included were divided into two groups: group I, eyes with DME at surgery time; and group II, eyes without DME in the last 3 months before surgery, but with previous records of DME.
RESULTS: The mean age of our patients was 69.83 ± 6.99 years. 108 eyes of 98 patients (69 eyes in group I and 39 eyes in group II) were included in the study. In group I, the mean best corrected visual acuity (BCVA), at baseline was 0.67 ± 0.33 logMAR and 1-month after the procedure was 0.41 ± 0.31 logMAR, a statistically significant increase (p<0.001). Central macular thickness (CMT) decreased significantly in the first month (p<0.001). A clinically significant increase (≥20%) of CMT was verified in 6 cases (8.70%). Nine cases (13.04%) developed transient ocular hypertension. In group II, the mean BCVA at baseline was 0.62 ± 0.34 logMAR and 1-month after the procedure was 0.32 ± 0.34 logMAR, with a statistically significant increase (p<0.001). CMT decreased significantly in the first month (p<0.001). A clinically significant increase (≥20%) of CMT was verified in only 2 cases (5.13%). Six cases (15.38%) developed transient ocular hypertension.
CONCLUSION: Diabetic patients have an increased risk of developing central DME after phacoemulsification surgery, especially if previous DME history is present. Our study highlights IVTA in cataract surgery as a safe and effective tool to treat and prevent DME development.
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Gaudric A, Massin-Korobelnik P. Maculopathie diabétique: classification, épidémiologie, évolution spontanée, traitement. Diabete Metab. 1993;19:422-9.
Wilson CA, Berkowitz BA, Sato Y, Ando N, Handa JT, de Juan E Jr. Treatment with intravitreal steroid reduces blood–retinal barrier breakdown due to retinal photocoagulation. Arch Ophthalmol.1992;110:1155–115.
Hamilton AM. Epidemiology of diabetic retinopathy. In: Management of Diabetic Retinopathy. London: BMJ Publishing Group: 1996.
Squirrell D, Bhola R, Bush J, Winder S, Talbot JF. A prospective, case controlled study of the natural history of diabetic retinopathy and maculopathy after uncomplicated phacoemulsification cataract surgery in patients with type 2 diabetes. r J Ophthalmol. 2002;86:565-71. doi: 10.1136/bjo.86.5.565.
Diabetes Retinopathy Clinical Research Network. A randomized trial evaluating intravitreal bevacizumab or laser therapy for diabetic macular edema involving the center of the macula in eyes with vitrectomy-pseudophakia (Protocol P). Invest Ophthalmol Vis Sci. 2015;56:5520-8.
Giansanti F, Bitossi A, Giacomelli G, Virgili G, Pieretti G, Giuntoli M, et al. Evaluation of macular thickness after uncomplicated cataract surgery using optical coherence tomography. Eur J Ophthalmol. 2013;23:751-6. doi: 10.5301/ejo.5000280.
Bresnick GH. Diabetic maculopathy. A critical review highlighting diffuse macular edema. Ophthalmology. 1983;90:1301-17. doi: 10.1016/s0161-6420(83)34388-8.
Antcliff RJ, Spalton DJ, Stanford MR, Graham EM, Ffytche TJ, Marshall J. Intravitreal triamcinolone for uveitic cystoid macular edema: an optical coherence tomography study. Ophthalmology. 2001;108:765-72. doi: 10.1016/s0161-6420(00)00658-8.
Stern AL, Taylor DM, Dalburg LA, Cosentino RT. Pseudophakic cystoid maculopathy: a study of 50 cases. Ophthalmology. 1981;88:942-6. doi: 10.1016/s0161-6420(81)80009-7.
Suckling RD, Maslin KF. Pseudophakic cystoid macular oedema and its treatment with local steroids. Aust N Z J Ophthalmol. 1988;16:353-9. doi: 10.1111/j.1442-9071.1988.tb01241.x.
Jonas JB, Kreissig I, Söfker A, Degenring RF. Intravitreal injection of triamcinolone for diffuse diabetic macular edema. Arch Ophthalmol. 2003;121:57-61.
Wingate RJ, Beaumont PE. Intravitreal triamcinolone and elevated intraocular pressure. Aust N Z J Ophthalmol. 1999;27:431-2. doi: 10.1046/j.1440-1606.1999.00238.x
Jonas JB, Kreissig I, Degenring R. Intraocular pressure after intravitreal injection of triamcinolone acetonide. Br J Ophthalmol. 2003;87:24-7. doi: 10.1136/bjo.87.1.24.
Bakri SJ, Beer PM. The effect of intravitreal triamcinolone acetonide on intraocular pressure. Ophthalmic Surg Lasers Imaging. 2003;34:386-90
Early Treatment Diabetic Retinopathy Study Research Group. Treatment techniques and clinical guidelines for diabetic macular edema. Ophthalmology. 1991;98:765-72.
Grover D, Li TJ, Chong CC. Intravitreal steroids for macular edema in diabetes. Cochrane Database Syst Rev. 2008:CD005656. doi: 10.1002/14651858.CD005656.pub2. Up- date in: Cochrane Database Syst Rev. 2020;11:CD005656.
Zhang XL, Chen J, Zhang RJ, Wang WJ, Zhou Q, Qin XY. Intravitreal triamcinolone versus intravitreal bevacizumab for diabetic macular edema: a meta-analysis. Int J Ophthalmol. 2013;6:546-52. doi: 10.3980/j.issn.2222-3959.2013.04.26.
Ozkiris A. Intravitreal bevacizumab (Avastin) for primary treatment of diabetic oedema. Eye. 2009;23:616-20. doi: 10.1038/eye.2008.40.
Arvello JF, Guerra JF, Mercado HQ, Sanchez JG, Wu L, Maia M, et al. Primary intravitreal bevacizumab (Avastin) for diabetic macular oedema: results from the Pan-American Collaborative Retina Study Group at 6-month follow-up. Ophthalmology. 2007;114:743-50.
Kandasamy R, Constantinou M, Rogers SL, Sandhu SS, Wickremasinghe S, Al-Qureshi S, et al. Prospective randomised clinical trial of intravitreal bevacizumab versus triamcinolone in eyes with diabetic macular oedema undergoing cataract surgery: 6-month results. Br J Ophthalmol. 2019;103:1753-8. doi: 10.1136/bjophthalmol-2018-313437.
Diabetic Retinopathy Clinical Research Network Authors/Writing Committee; Bressler SB, Baker CW, Almukhtar T, Bressler NM, Edwards PA, et al. Pilot study of individuals with diabetic macular edema undergoing cataract surgery. JAMA Ophthalmol. 2014;132:224-6. doi: 10.1001/jamaophthalmol.2013.6209.
Lam DS, Chan CK, Mohamed S, Lai TY, Lee VY, Lai WW, et al. Phacoemulsification with intravitreal triamcinolone in patients with cataract and coexisting diabetic macular oedema: a 6-month prospective pilot study. Eye. 2005;19:885-90. doi: 10.1038/sj.eye.6701686.
Kaiser PK, Moisseiev E. The role of anti-vascular endothelial growth factor agents in the management of diabetic macular edema. Saudi J Ophthalmol. 2015;29:209-14.
Takata C, Messias A, Folgosa MS, Lucena LR, Lucena DR, Scott IU, et al. Intravitreal injection versus subtenon infusion of triamcinolone acetonide during cataract surgery in patients with refractory diabetic macular edema. Retina. 2010;30:562-9. doi: 10.1097/IAE.0b013e3181c969b4.
Ciardella AP, Klancnik J, Schiff W, Barile G, Langton K, Chang S. Intravitreal triamcinolone for the treatment of refractory diabetic macular oedema with hard exudates: an optical coherence tomography study. Br J Ophthalmol. 2004;88:1131-6. doi: 10.1136/bjo.2004.041707.
Wielders LH, Schouten JS, Winkens B, van den Biggelaar FJ, Veldhuizen CA, Murta JC, et al. Randomized controlled European multicenter trial on the prevention of cystoid macular edema after cataract surgery in diabetics: ESCRS PREMED Study Report 2. J Cataract Refract Surg. 2018;44:836-47.
Massin P, Audren F, Haouchine B, Erginay A, Bergmann JF, Benosman R, et al. Intravitreal triamcinolone acetonide for
diabetic diffuse macular edema: preliminary results of a prospective controlled trial. Ophthalmology. 2004;111:218-24; discussion 224-5. doi: 10.1016/j.ophtha.2003.05.037.
Tewari HK, Sony P, Chawla R, Garg SP, Venkatesh P. Prospective evaluation of intravitreal triamcinolone acetonide injection in macular edema associated with retinal vascular disorders. Eur J Ophthalmol. 2005;15:619-26. doi: 10.1177/112067210501500513.
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