The effects of intravitreal triamcinolone acetonide in diabetic macular edema refractory to anti-VEGF treatment

Purpose To investigate the efficacy and safety of primary intravitreal triamcinolone acetonide (IVTA) in eyes affected by diabetic macular edema (DME) refractory to anti-vascular endothelial growth factor (VEGF) therapy. Study design Retrospective observational study Methods The medical records of patients who attended our clinic from March 2013 to September 2018 with refractory macular were reviewed. We included the patients who were injected at least one IVTA and completed 6 months of observation. Best-corrected Snellen visual acuity (VA), central macular thickness (CMT), intraocular pressure (IOP), and adverse events (AEs) were examined at baseline and at 1 month, 2 months, 3 months, and 6 months. Results Sixty-four eyes of 54 subjects were included. The mean VA was improved significantly at all time points compared to pre-treatment ( P < 0.0001), with the greatest mean improvement at 1 month (0.3 logMAR). The reduction in mean CMT was also significant at all follow-up examinations compared to baseline ( P < 0.0001), with the greatest decrease at 1 month (113.68 ± 53.78 μm). A poorer VA before injection was a factor that influenced visual gain 1 month post treatment (0.247 logMAR units/unit increase in baseline VA, P = 0.006). The most common AE associated with IVTA treatment was elevated IOP (11 eyes), observed significantly more often after IVTA injections containing a preservative (25.8%) than after those that were preservative-free (9.1%) ( P = 0.033). Conclusion IVTA injection can be an alternative steroid treatment for DME refractory to anti-VEGF therapy.