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PURPOSE: To evaluate the outcome of cystoid macular edema (CME) treated with intravitreal injections of triamcinolone acetonide (TA), macular laser grid photocoagulation (MLG), or both (TA+ MLG).DESIGN: Prospective, randomized, interventional, parallel, three-arm clinical trial. METHODS: setting: Institutional clinical study. patients: Fifty-six patients (63 eyes) affected by diabetic or retinal vein occlusion CME. procedures: Twenty-two eyes received intravitreal injections of 4 mg TA; 21 eyes underwent MLG; and 20 eyes received intravitreal injection of 4 mg TA, and after 3 months, MLG. main outcome measures: Best-corrected visual acuity (VA), central macular thickness (CMT) (by optical coherence tomography), and postoperative complications. RESULTS: Mean follow-up was 9± 2 months (range 6 to 12 months). Baseline VA (logarithm of minimal angle of resolution [logMAR]) and CMT were, respectively, 0.82± 0.19 and 556± 139 μ m microns for the TA group, 0.84 ± 0.15 and 601 ± 102 μ m microns for the MLG group, and 0.83 ± 0.22 and 573 ± 106 μ m microns for the TA+ MLG group (no statistically significant difference among the groups). After the treatment, at 45 days, 3, 6, and 9 months in the TA group, VA had improved (P=.004) by 0.26, 0.25, 0.22, and 0.23 logMAR and CMT had decreased by 37% , 33% , 29% , and 31% (P≤ .001). In the MLG group, VA was unchanged although CMT had decreased by 5% , 13% , 14% , and 16% (P=.021). In the TA+ MLG group, VA had improved (P=.003) by 0.26, 0.24, 0.19, and 0.20 logMAR, and CMT had decreased by 36% , 34% , 28% , and 29% (P≤ .001). The groups receiving triamcinolone had better VA and lower CMT values at all time points (P< .05). A reinjection was performed in eight eyes; intraocular pressure increased in nine eyes (treated with medical therapy), and cataract progressed in one eye. No injection-related complications occurred. CONCLUSIONS: TA intravitreal injection improves VA and reduces CMT more than MLG, which in triamcinolone-treated eyes does not offer further advantages. Intravitreal TA injection could be used as primary treatment in patients with CME.
PURPOSE: To evaluate the outcome of cystoid macular edema (CME) treated with intravitreal injections of triamcinolone acetonide (TA), macular laser grid photocoagulation (MLG), or both (TA + MLG). DESI: Prospective, randomized, interventional, parallel, three METHODS: setting: Institutional clinical study. patients: Fifty-six patients (63 eyes) affected by diabetic or retinal vein occlusion CME. procedures: Twenty-two eyes received intravitreal injections of 4 mg TA; 21 eyes underwent MLG ; and 20 eyes received intravitreal injection of 4 mg TA, and after 3 months, MLG. main outcome measures: Best-corrected visual acuity (VA), central macular thickness (CMT) (by optical coherence tomography), and postoperative complications. : Mean follow-up was 9 ± 2 months (range 6 to 12 months). Baseline VA (logarithm of minimal angle of resolution [logMAR]) and CMT were, respectively, 0.82 ± 0.19 and 556 ± 139 microns for the TA group, 0.84 ± 0.15 and 601 ± 102 μm microns for the MLG group, and 0.83 ± 0.22 and 573 ± 106 μm for the TA + MLG group (no significant significant difference among the groups). After the treatment, at 45 days, 3, 6, and 9 months in the TA In the MLG group, VA had improved (P = .004) by 0.26, 0.25, 0.22, and 0.23 logMAR and CMT had decreased by 37%, 33%, 29%, and 31% VA was unchanged while CMT had decreased by 5%, 13%, 14%, and 16% (P = .021). In the TA + MLG group, VA had improved (P = .003) by 0.26, 0.24, 0.19, and 0.20 logMAR, and CMT decreased decreased by 36%, 34%, 28%, and 29% (P≤ .001). The groups receiving triamcinolone had better VA and lower CMT values at all time points (P <.05). A reinjection was performed in eight eyes; intraocular pressure increased in nine eyes (treated with medical therapy), and cataract progressed in one eye. No injection-related topics occurred. CONCLUSIONS: TA intravitreal injection improves VA and reduces CMT more than MLG, which in triamcinolo ne-treated eyes does not offer further advantages. Intravitreal TA injection could be used as primary treatment in patients with CME.