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      Intravitreal triamcinolone plus sequential grid laser versus triamcinolone or laser alone for treating diabetic macular edema: six-month outcomes.


      Aged, Combined Modality Therapy, Diabetic Retinopathy, drug therapy, surgery, therapy, Female, Glucocorticoids, adverse effects, therapeutic use, Humans, Injections, Laser Coagulation, methods, Macular Edema, Male, Middle Aged, Prospective Studies, Retina, pathology, Tomography, Optical Coherence, Treatment Outcome, Triamcinolone Acetonide, Visual Acuity, Vitreous Body

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          To evaluate the efficacy of sequential intravitreal triamcinolone acetonide (TA) injection followed by grid laser photocoagulation for treating diabetic macular edema (DME). Prospective, 3-armed, randomized clinical trial. One hundred eleven eyes of 111 patients with DME involving the fovea. Patients were randomized to grid laser photocoagulation (37 eyes), 4 mg of intravitreal TA (38 eyes), or 4 mg of intravitreal TA combined with sequential grid laser about 1 month later (36 eyes). Central foveal thickness (CFT) as measured by optical coherence tomography, logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA), and side effect profiles. The 6-month results are reported. All patients completed 6 months' follow-up. Baseline mean (+/- standard deviation) CFTs were 385+/-100 microm, 396+/-91 microm, and 424+/-108 microm for the laser, intravitreal TA, and combined groups, respectively (P = 0.24). After treatment, significant CFT reductions were noted in both the intravitreal TA and combined groups at all follow-up visits (P<0.01) but not in the laser group. Mean CFT improved significantly to minimums of 267+/-75 microm and 256+/-73 microm for the intravitreal TA and combined groups, respectively, but the difference between the 3 groups was not significant at 6 months. The standardized change in macular thickening at 17 weeks was significantly greater in the combined group versus the intravitreal TA group (P = 0.007), suggesting that combined treatment might prolong the effects of intravitreal TA. Mean baseline logMAR BCVAs were 0.64+/-0.37, 0.72+/-0.34, and 0.69+/-0.34 in the laser, intravitreal TA, and combined groups, respectively (P = 0.67). Best-corrected visual acuity improved significantly at 4 and 9 weeks for the intravitreal TA group but did not change significantly in the other 2 groups. No significant difference in BCVA was observed between the 3 groups at any time point. Contrary to the results of a recent study, combined treatment of intravitreal TA plus grid laser did not yield better CFT reduction or BCVA improvement at 6 months than intravitreal TA alone. Grid laser alone was significantly worse than the 2 other treatment modalities.

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