Intravitreal Triamcinolone Acetonide for Diabetic Macular Edema Refractory to Intravitreal Ranibizumab. Nine-month Results

The Purpose of this study was to evaluate the efficacy of IVTA as rescue therapy in patients with DME refractory to intravitreal ranibizumab. This is a prospective interventional non-comparative study that included diabetic patients with persistent CSME and associated visual loss despite previous treatment with intravitreal ranibizumab. Main outcome measures were improvement of BCVA 3 Snellen lines and improvement of macular central subfield thickness 250 μ on OCT. Eligible patients received IVTA injection in a concentration of 4 mg in 0.1 ml. Follow-up period was 9 months. Statistical analysis was performed using analysis of variance (F-test) “ANOV". Statistical significance of measured data was set at significant (p < 0.05).The study recruited 50 eyes of 50 patients. Mean baseline macular central subfield thickness was 552.3 μ. Mean BCVA improved by > 5 Snellen lines to reach 20/40 at 1 month follow-up. This improvement was maintained through the 9-month visit. Mean macular central subfield thickness was 314, 308, 307, and 306 μ at 1, 3, 6, and 9 months, respectively. Steroid-induced rise in the IOP was detected in 88% of patients at the 1month visit. Mean IOP value at subsequent visits was 14 mmHg. At the 9-month visit 16%, 38%, and 18% of patients still relied upon 1, 2, and 3 anti-glaucoma drops, respectively. Eight patients (16%) required filtering surgery. No other ocular complications were detected. In conclusion, IVTA is an effective salvage treatment for DME that is refractory to ranibizumab. Its complications do not seem to be prohibitive given its therapeutic potential.