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Posterior sub-Tenon's capsule injection of triamcinolone acetonide prevents panretinal photocoagulation-induced visual dysfunction in patients with severe diabetic retinopathy and good vision.

Shimura M, Yasuda K, Shiono T

Department of Ophthalmology, NTT East Japan Tohoku Hospital, Sendai, Miyagi, Japan. masahiko@oph.med.tohoku.ac.jp

PURPOSE: To evaluate prospectively the efficacy of a single sub-Tenon's capsule injection of triamcinolone acetonide (TA) against panretinal photocoagulation (PRP)-induced macular thickening and visual disturbance in patients with severe diabetic retinopathy and good vision. DESIGN: Prospective, comparative, interventional case series. PARTICIPANTS: Twenty eyes of 10 patients with severe nonproliferative diabetic retinopathy or non-high-risk proliferative diabetic retinopathy whose visual acuity was 20/40 or better (<0.3 in logarithm of the minimum angle of resolution [logMAR] acuity) before the PRP, whose retinopathy was bilateral and symmetrical. The averaged parafoveal retinal thickness was more than 300 microm, leading to a worse visual prognosis after PRP. INTERVENTION: Sub-Tenon's capsule injection of 20 mg TA. MAIN OUTCOME MEASURES: Best-corrected visual acuity (BCVA) with logMAR chart and averaged foveal thickness (FT) using the retinal mapping program of optical coherence tomography. METHODS: In all patients, PRP was performed every other week for 4 sessions on both eyes, and 1 week before PRP; 1 eye received the TA injection, and the other eye served as a control. The clinical course of BCVA and FT was monitored for up to 24 weeks after beginning PRP. RESULTS: Before TA injection, BCVA and FT were 0.055+/-0.072 and 235.5+/-37.5 microm in the TA-injected eye and 0.065+/-0.071 and 233.7+/-39.8 microm in the control eye, respectively; there was no significant difference between eyes. After the TA injection, FT in the TA-injected eyes was significantly decreased. During and after the PRP, FT in the control eye increased dramatically and reached 312.0+/-68.2 microm at 24 weeks, which was significantly different from that in the TA-injected eyes (235.3+/-38.6 microm at 24 weeks). Best-corrected visual acuity in the control eye decreased with time to 0.24+/-0.13; in contrast, and BCVA in the TA-injected eye was good (to 0.085+/-0.11) . CONCLUSIONS: As a pretreatment for PRP, a single sub-Tenon's capsule injection of TA has beneficial effects for preventing PRP-induced foveal thickening and visual dysfunction in patients with severe diabetic retinopathy and good vision.

Published 3 March 2006 in Ophthalmology, 113(3): 381-7.
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