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      Suprachoroidal versus Intravitreal Triamcinolone Acetonide for the Treatment of Diabetic Macular Edema

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          Abstract

          Purpose

          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.

          Patients and Methods

          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.

          Results

          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.

          Conclusion

          SCTA is a safe and effective route for the treatment of DME, which has comparable effects to IVTA, and may even last longer.

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          Most cited references23

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          WITHDRAWN: Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the International Diabetes Federation Diabetes Atlas, 9th edition

          To provide global estimates of diabetes prevalence for 2019 and projections for 2030 and 2045.
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            Treatment techniques and clinical guidelines for photocoagulation of diabetic macular edema. Early Treatment Diabetic Retinopathy Study Report Number 2. Early Treatment Diabetic Retinopathy Study Research Group.

            The Early Treatment Diabetic Retinopathy Study (ETDRS) has recently shown that argon laser photocoagulation treatment is beneficial in reducing the risk of visual loss from clinically significant diabetic macular edema. The ETDRS treatment consisted of a combination of focal treatment to individual-leaking microaneurysms and grid treatment to areas of diffuse leakage and capillary nonperfusion. These techniques are described in detail, and the concepts of "clinically significant macular edema" and "treatable lesions" are defined. Guidelines for the application of ETDRS findings to clinical practice are discussed.
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              Classification of diabetic retinopathy and diabetic macular edema.

              The global incidence and prevalence of diabetes mellitus (DM) have reached epidemic proportions. Estimates indicate that more than 360 million people will be affected by DM by 2030. All of these individuals will be at risk of developing diabetic retinopathy (DR). It is extremely important to categorize, classify and stage the severity of DR in order to establish adequate therapy. With proper management more than 90% of cases of visual loss can be prevented. The purpose of the current paper is to review the classification of DR with a special emphasis on the International Clinical Disease Severity Scale for DR. This new classification is simple to use, easy to remember and based on scientific evidence. It does not require specialized examinations such as optical coherence tomography or fluorescein angiography. It is based on clinical examination and applying the Early Treatment of Diabetic Retinopathy Study 4:2:1 rule.
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                Author and article information

                Journal
                Clin Ophthalmol
                Clin Ophthalmol
                opth
                Clinical Ophthalmology (Auckland, N.Z.)
                Dove
                1177-5467
                1177-5483
                11 March 2022
                2022
                : 16
                : 733-746
                Affiliations
                [1 ]Ophthalmology Department, Ain Shams University , Cairo, Egypt
                Author notes
                Correspondence: Yousra Gamal Zakaria, Ophthalmology Department, Ain Shams University , Ramses Street, Abbassiya, Cairo, 11517, Egypt, Tel +21006799302, Email yosragamalselim@gmail.com
                Article
                351853
                10.2147/OPTH.S351853
                8923681
                35300032
                abf66705-8ae3-4604-b25f-be12c1ea21b4
                © 2022 Zakaria et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 10 December 2021
                : 09 February 2022
                Page count
                Figures: 9, Tables: 27, References: 23, Pages: 14
                Categories
                Original Research

                Ophthalmology & Optometry
                suprachoroidal space,diabetic macular edema,triamcinolone acetonide,intravitreal

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