Zakaria Yousra Gamal, Salman Abdelrahman Gaber, Said Azza Mohamed Ahmed, Abdelatif Mona Kamal
Ophthalmology Department, Ain Shams University, Cairo, Egypt.
Clin Ophthalmol. 2022 Mar 11;16:733-746. doi: 10.2147/OPTH.S351853. eCollection 2022.
This article aims to compare between intravitreal (IV) and suprachoroidal (SC) triamcinolone acetonide (TA) injection for the treatment of diabetic macular edema (DME) in terms of improvement in both best-corrected visual acuity (BCVA) and central macular thickness (CMT), and development of complications (intraocular pressure (IOP) rise and cataract progression), and to identify the efficient dose of TA using the SC route.
This prospective interventional randomized comparative study included 45 eyes of 32 patients, randomly divided into three groups, group I received 4 mg/0.1 mL intravitreal TA (IVTA), group II received 4 mg/0.1 mL suprachoroidal TA (SCTA), and group III received 2mg/0.1 mL SCTA. Patients were followed up for 6 months.
At 1 month, a maximum reduction in CMT (147.33 ± 110.97 µm, 160.80 ± 98.25 µm and 65.64 ± 46.19 µm in groups I, II, and III, respectively) was observed, which was associated with the greatest improvement of BCVA (0.09 ± 0.09, 0.19 ± 0.10 and 0.10 ± 0.09 logMAR lines) in groups I, II, and III, respectively. At 3 months, CMT started to increase, and reduction was not statistically significant compared to baseline, except in group II (4 mg SCTA group) (149.80 ± 106.57 µm with P-value = 0.013). At 6 months, CMT and BCVA returned close to baseline except for group II which had a sustained reduction of 60.16 µm from baseline. Regarding steroid-related complications, IOP elevation of 10 mmHg or more was noted in 1 eye (6.7%), 2 eyes (13.3%), and 1 eye in groups I, II, and III, respectively. Three phakic eyes per group showed cataract progression.
SCTA is a safe and effective route for the treatment of DME, which has comparable effects to IVTA, and may even last longer.
本文旨在比较玻璃体内（IV）注射和脉络膜上腔（SC）注射曲安奈德（TA）治疗糖尿病性黄斑水肿（DME）在最佳矫正视力（BCVA）和中心黄斑厚度（CMT）改善方面的效果，以及并发症（眼压（IOP）升高和白内障进展）的发生情况，并确定SC途径使用TA的有效剂量。
这项前瞻性干预随机对照研究纳入了32例患者的45只眼，随机分为三组，第一组接受4mg/0.1mL玻璃体内TA（IVTA），第二组接受4mg/0.1mL脉络膜上腔TA（SCTA），第三组接受2mg/0.1mL SCTA。对患者进行了6个月的随访。
在1个月时，观察到CMT最大程度降低（第一组、第二组和第三组分别为147.33±110.97μm、160.80±98.25μm和65.64±46.19μm），这分别与第一组、第二组和第三组BCVA的最大改善（分别为0.09±0.09、0.19±0.10和0.10±0.09 logMAR行）相关。在3个月时，CMT开始增加，与基线相比降低无统计学意义，但第二组（4mg SCTA组）除外（149.80±106.57μm，P值=0.013）。在6个月时，CMT和BCVA除第二组外均恢复至接近基线水平，第二组较基线持续降低60.16μm。关于类固醇相关并发症，第一组、第二组和第三组分别有1只眼（6.7%）、2只眼（13.3%）和1只眼眼压升高10mmHg或更多。每组有3只晶状体眼出现白内障进展。
SCTA是治疗DME的一种安全有效的途径，其效果与IVTA相当，甚至可能持续时间更长。
