Comparison of Suprachoroidal Triamcinolone Injection and Modified Grid Laser in Treatment of Refractory Diabetic Macular Edema: Comparison of Suprachoroidal Triamcinolone Injection and Modified Grid Laser

Nouman Aleem; Muhammad Abrar Ahmad; Noor ul Ain; Tayyab Rehman; Hafiz Muhammad Usman Akhtar; Faisal Rashid

doi:10.54393/pjhs.v5i12.2443

Authors

Nouman Aleem Department of Ophthalmology, Services Hospital, Lahore, Pakistan
Muhammad Abrar Ahmad Department of Ophthalmology, District Headquarter Hospital, Toba Tek Singh, Pakistan
Noor ul Ain Department of Ophthalmology, District Headquarter Hospital, Toba Tek Singh, Pakistan
Tayyab Rehman Department of Ophthalmology, Allied Hospital, Faisalabad, Pakistan
Hafiz Muhammad Usman Akhtar Department of Ophthalmology, Bilawal Medical College for Boys, Jamshoro, Pakistan
Faisal Rashid Department of Ophthalmology, Services Institute of Medical Sciences, Lahore, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v5i12.2443

Keywords:

Laser, Macular Edema, Optical Coherence Tomography, Triamcinolone Acetonide, Visual Acuity

Abstract

Diabetic macular edema is the leading cause of blindness in diabetic eye disease. The most important cause of visual impairment is diabetes-induced macular edema also called DME which involves central part of the macula lutea. Objective: To compare the outcome of suprachoroidal triamcinolone injection and modified grid laser in the treatment of refractory diabetic macular edema. Methods: This prospective cohort study was done for 12 months (January 2021 to December 2021) on 56 patients having refractory diabetic macular edema. The technique of non-probability consecutive sampling was used. Patients in Group A received a suprachoroidal injection of 4 mg triamcinolone. Patients in Group B underwent modified grid photocoagulation. After 4 months of treatment, the patients' visual acuity and central macular thickness were assessed again using Snellen's chart and Optical Coherence Tomography (OCT) respectively. Results: After 4 months, the mean BCVA in Group-A was 0.57 + 0.127 and in Group-B was 0.83 + 0.150 (P=0.000) while the mean improvement (change line) was 1.6 + 0.318 and 0.89 + 0.229 (P=0.001), respectively In Group-A, improvement in Central Macular Thickness (CMT) was observed in 24 (85.7%) patients, while in Group-B, improvement in Central Macular Thickness was seen in 17 (60.7%) patients. After 4 months, the mean CMT in Group-A was 302.68 + 14.427 um and in Group-B was 339.71 + 54.821 um (P=0.009) while the mean improvement (change) was 153.89 + 30.902 um and 95.57 + 41.111 um (P=0.024), respectively. Conclusion: Suprachoroidal triamcinolone injection was found to be more effective than modified grid laser in treatment of DME.

References

Hsia NY, Lin CJ, Chen HS, Chang CH, Bair H, Lai CT, et al. Short-Term Outcomes of Refractory Diabetic Macular Edema Switch from Ranibizumab to Dexamethasone Implant and the Influential Factors: A Retrospective Real-World Experience. Frontiers in Medicine. 2021 Apr; 8: 649979. doi: 10.3389/fmed.2021.649979.

Federation ID. IDF Diabetes Atlas 8th Edition. International Diabetes Federation. 2017; (1): 905-911.

Yau JW, Rogers SL, Kawasaki R, Lamoureux EL, Kowalski JW, Bek T, et al. Global Prevalence and Major Risk Factors of Diabetic Retinopathy. Diabetes Care. 2012 Mar; 35(3): 556-64. doi: 10.2337/dc11-1909.

He Y, Ren XJ, Hu BJ, Lam WC, Li XR. A Meta-Analysis of the Effect of a Dexamethasone Intravitreal Implant Versus Intravitreal Anti-Vascular Endothelial Growth Factor Treatment for Diabetic Macular Edema. BMC ophthalmology. 2018 Dec; 18: 1-1. doi: 10.1186/s12886-018-0779-1.

Cosgrove, Benedict. 2020. “8 Risk Factors for Diabetic Macular Edema.” https://www.healthcentral.com/slideshow/dme-risk-factors (December 20, 2024).

Daruich A, Matet A, Moulin A, Kowalczuk L, Nicolas M, Sellam A, et al. Mechanisms of Macular Edema: Beyond the Surface. Progress in Retinal and Eye Research. 2018 Mar; 63: 20-68. doi: 10.1016/j.preteyeres.2017.10.006.

Sacconi R, Giuffrè C, Corbelli E, Borrelli E, Querques G, Bandello F. Emerging Therapies in the Management of Macular Edema: A Review. F1000 Research. 2019; 8. doi: 10.12688/f1000research.19198.1.

Vidal PL, de Moura J, Díaz M, Novo J, Ortega M. Diabetic Macular Edema Characterization and Visualization Using Optical Coherence Tomography Images. Applied Sciences. 2020 Oct; 10(21): 7718. doi: 10.3390/app10217718.

Torabi H. Management of Refractory Diabetic Macular Edema: A Review Article. International Journal of Medical Reviews. 2018 Mar; 5(1): 27-34. doi: 10.29252/IJMR-050105.

Zakaria YG, Salman AG, Said AM, Abdelatif MK. Suprachoroidal Versus Intravitreal Triamcinolone Acetonide for the Treatment of Diabetic Macular Edema. Clinical Ophthalmology. 2022 Mar: 733-46. doi: 10.2147/OPTH.S351853.

Park YG, Kim EY, Roh YJ. Laser‐Based Strategies to Treat Diabetic Macular Edema: History and New Promising Therapies. Journal of Ophthalmology. 2014; 2014(1): 769213. doi: 10.1155/2014/769213.

Kuroiwa DA, Malerbi FK, Regatieri CV. New Insights in Resistant Diabetic Macular Edema. Ophthalmologica. 2021 Dec; 244(6): 485-494. doi: 10.1159/000516614.

Fazel F, Malekahmadi M, Feizi A, Oliya B, Tavakoli M, Fazel M. Suprachoroidal Injection of Triamcinolone Acetonide Plus Intravitreal Bevacizumab in Diabetic Macular Edema: A Randomized Pilot Trial. BMC Ophthalmology. 2023 Jan; 23(1): 40. doi: 10.1186/s12886-023-02790-y.

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): 1384-1389. doi: 10.21608/ijma.2021.55079.1230.

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.

Khanzada MA, Ahmed M, Mirza AA, Mari GK, Mahmood MA. Results of Intravitreal Bevacizumab as an Adjunct to mETDRS Grid Laser in Diabetic Macular Edema. Pakistan Journal of Ophthalmology. 2021; 37(1). doi: 10.36351/pjo.v37i1.1135.

Abdelshafy Tabl A, Tawfik Soliman T, Anany Elsayed M, Abdelshafy Tabl M. A Randomized Trial Comparing Suprachoroidal and Intravitreal Injection of Triamcinolone Acetonide in Refractory Diabetic Macular Edema Due to Epiretinal Membrane. Journal of Ophthalmology. 2022; 2022(1): 7947710. doi: 10.1155/2022/7947710.

Munir MS, Rehman R, Nazir S, Sharif N, Chaudhari MZ, Saleem S. Visual Outcome After Suprachoroidal Injection of Triamcinolone Acetate in Cystoid Macular Edema of Different Pathology. Pakistan Journal of Medical & Health Sciences. 2022 May; 16(05):164-164. doi: 10.53350/pjmhs22165164.

Tufan HA, Özdek Ş, Hasanreisoğlu B. Comparison of Intravitreal Triamcinolone Treatment and Intravitreal Triamcinolone with Grid Laser Treatment in Patients with Diffuse Diabetic Macular Edema. Balkan Medical Journal. 2012 Jun; 2012(2): 166-169. doi: 10.5152/balkanmedj.2012.008.

Jonas JB, Söfker A. Intraocular Injection of Crystalline Cortisone as Adjunctive Treatment of Diabetic Macular Edema. American Journal of Ophthalmology. 2001 Sep; 132(3): 425-427. doi: 10.1016/S0002-9394(01)01010-8.

Martidis A, Duker JS, Greenberg PB, Rogers AH, Puliafito CA, Reichel E, et al. Intravitreal Iriamcinolone for Refractory Diabetic Macular Edema. Ophthalmology. 2002 May; 109(5): 920-927. doi: 10.1016/S0161-6420(02)00975-2.

Aslam M, Nazir T, Haq RI, Asghar A, Nadeem S, Obaid N. Efficacy of Suprachoroidal Versus Intravitreal Triamcinolone Acetonide in Refractory Macular Edema; A Quasi-experimental study. Pakistan Armed Forces Medical Journal. 2024 Oct; 74(5): 1365. doi: 10.51253/pafmj.v74i5.10818.