Department of Ophthalmology, First Affiliated Hospital of Harbin Medical University, Harbin, China.
Curr Eye Res. 2012 Dec;37(12):1136-47. doi: 10.3109/02713683.2012.705412. Epub 2012 Jul 13.
To compare the efficacy of intravitreal (IV) triamcinolone acetonide (IVTA) versus subtenon (ST) triamcinolone acetonide (STTA) injection for the treatment of diabetic macular edema (DME).
Searches for randomized clinical trials published between 1 January 1950 and 15 March 2011 were conducted using PubMed, MEDLINE, EMBASE, and the Cochrane Library included in the present meta-analysis are five randomized controlled trials, each with a minimum follow-up of 3 mo. All included studies evaluated the efficacy of TA for the treatment of refractory DME, and compared IVTA with STTA by measuring visual acuity (VA), central macular thickness (CMT), and intraocular pressure (IOP).
One mo post-injection, treatment with IVTA had significantly improved VA (MD, -0.14 logMAR; 95% CI = -0.16 to -0.13) and reduced CMT (MD = -174.02 μm; 95% CI = -249.97 to -98.08) compared with STTA. At 3 mo post-injection, treatment with IVTA had significantly improved VA (MD = -0.07 logMAR; 95% CI = -0.09 to -0.05) and reduced CMT (MD = -119.46 μm; 95% CI = -176.55 to -62.36) compared with STTA. The benefits of either treatment were no longer significant at 6 mo, and patients had to be retreated. Compared with STTA, IVTA injections produced no difference in IOPs at 1 mo, higher IOPs at 3 mo, and lower IOP values at 6 months
Within 3 mo, IVTA is more effective than is STTA in improving VA and reducing CMT in patients with refractory DME. However, the benefits of either regimen were no longer evident at 6 mo.
比较玻璃体内（IV）曲安奈德（IVTA）与经结膜下（ST）曲安奈德（STTA）注射治疗糖尿病黄斑水肿（DME）的疗效。
本荟萃分析纳入了 5 项随机对照试验，均为至少 3 个月的随访，检索 1950 年 1 月 1 日至 2011 年 3 月 15 日期间发表的随机临床试验，使用 PubMed、MEDLINE、EMBASE 和 Cochrane Library。所有纳入的研究均评估了 TA 治疗难治性 DME 的疗效，并通过测量视力（VA）、黄斑中心厚度（CMT）和眼压（IOP）比较 IVTA 与 STTA。
注射后 1 个月，IVTA 治疗组的 VA（MD，-0.14 logMAR；95%CI=-0.16 至-0.13）和 CMT（MD=-174.02 μm；95%CI=-249.97 至-98.08）明显改善，优于 STTA 治疗组。注射后 3 个月，IVTA 治疗组的 VA（MD=-0.07 logMAR；95%CI=-0.09 至-0.05）和 CMT（MD=-119.46 μm；95%CI=-176.55 至-62.36）明显改善，优于 STTA 治疗组。但在 6 个月时，两种治疗方法的疗效均不再显著，且患者需要再次治疗。与 STTA 相比，IVTA 注射在 1 个月时眼压无差异，在 3 个月时眼压升高，而在 6 个月时眼压降低。
在 3 个月内，IVTA 改善 VA 和降低 CMT 的效果优于 STTA，但在 6 个月时，两种方案的疗效均不再明显。
