EFFICACY OF SUPRACHOROIDAL TRIAMCINOLONE ACETONIDE INJECTION IN THE TREATMENT OF RESISTANT DIABETIC MACULAR EDEMA

SS BUTT; RN IQBAL; S SIDDIQ; K WAHEED; T JAVED

doi:10.54112/bcsrj.v2023i1.202

Authors

SS BUTT Department of ophthalmology, Mughal Eye Hospital Trust Lahore, Pakistan
RN IQBAL Department of ophthalmology, Eye Unit 1, Services Institute of Medical Sciences (SIMS) Lahore, Pakistan
S SIDDIQ Department of ophthalmology, Eye Unit 1, Services Institute of Medical Sciences (SIMS) Lahore, Pakistan
K WAHEED Department of ophthalmology, Eye Unit 1, Services Institute of Medical Sciences (SIMS) Lahore, Pakistan
T JAVED Department of ophthalmology, PICS, Lahore, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2023i1.202

Keywords:

Suprachoroidal Injection, Triamcinolone Acetonide, Resistant Diabetic Macular Edema

Abstract

This study aimed to assess the efficacy of suprachoroidal TA injection for treating diabetic macular edema resistant to anti-VEGF agents. A prospective study was conducted in Ophthalmology Department Service Hospital, Lahore, from December 2020 to December 2021. A total of 60 patients were included in the study. Suprachoroidal TA injection 4 mg/0.1 mL was given after diagnosing resistant DME. The injection was administered every 3 months during the follow-up period (12 months) if intraretinal cysts, intraretinal or subretinal fluid persisted and CMT remained > 250 µm. The primary endpoint was CMT reduction and BCVA improvement after 12 months of injection. The secondary endpoint was assessing the safety of TA injection. The mean CMT at baseline was 478.6±170.1 µm, and after 12 months, it was 230.1 ± 47.5 µm. This decrease was statistically significant (P< .001). The mean BCVA at baseline was 1.194±0.1; after 12 months, it was 0.75±0.2 (P<.001). After one month of injection, IOP reached the maximum value (13.2±0.4 mmHg) compared to the baseline (12.32±0.1mmHg). It gradually declined with the use of topical beta blockers and reached baseline value at 3rd month, and glaucoma surgery was not needed in any patient. Suprachoroidal TA injection effectively treats resistant DMA and leads to SCVA improvement and CMT reduction.

Downloads

Download data is not yet available.

References

Blinder, K. J., Dugel, P. U., Chen, S., Jumper, J. M., Walt, J. G., Hollander, D. A., and Scott, L. C. (2017). Anti-VEGF treatment of diabetic macular edema in clinical practice: effectiveness and patterns of use (ECHO Study Report 1). Clinical ophthalmology (Auckland, NZ) 11, 393.

Campochiaro, P. A., Wykoff, C. C., Brown, D. M., Boyer, D. S., Barakat, M., Taraborelli, D., Noronha, G., and Group, T. S. (2018). Suprachoroidal triamcinolone acetonide for retinal vein occlusion: results of the tanzanite study. Ophthalmology Retina 2, 320-328.

Eski Yucel, O., Birinci, H., and Sullu, Y. (2019). Outcome and predictors for 2-year visual acuity in eyes with diabetic macular edema treated with Ranibizumab. Journal of Ocular Pharmacology and Therapeutics 35, 229-234.

Fraser-Bell, S., Kang, H. K., Mitchell, P., Arnold, J. J., Tainton, J., and Simonyi, S. (2023). Dexamethasone intravitreal implant in treatment-naïve diabetic macular oedema: findings from the prospective, multicentre, AUSSIEDEX study. British Journal of Ophthalmology 107, 72-78.

Goldstein, D. A., Do, D., Noronha, G., Kissner, J. M., Srivastava, S. K., and Nguyen, Q. D. (2016). Suprachoroidal corticosteroid administration: a novel route for local treatment of noninfectious uveitis. Translational vision science & technology 5, 14-14.

Haider, M. A., Usman, N., Buksh, H. M., and Jabran, A. (2023). Treatment Outcomes of Suprachoroidal Triamcinolone Injection in Refractory Diabetic Macular Edema. Pakistan Journal of Ophthalmology 39.

He, Y., Ren, X.-j., Hu, B.-j., Lam, W.-C., and Li, X.-r. (2018). A meta-analysis of the effect of a dexamethasone intravitreal implant versus intravitreal anti-vascular endothelial growth factor treatment for diabetic macular edema. BMC ophthalmology 18, 1-11.

Kansara, V. S., Hancock, S. E., Muya, L. W., and Ciulla, T. A. (2022). Suprachoroidal delivery enables targeting, localization and durability of small molecule suspensions. Journal of Controlled Release 349, 1045-1051.

Korobelnik, J.-F., Lu, C., Katz, T. A., Dhoot, D. S., Loewenstein, A., Arnold, J., and Staurenghi, G. (2019). Effect of baseline subretinal fluid on treatment outcomes in VIVID-DME and VISTA-DME studies. Ophthalmology Retina 3, 663-669.

Kuppermann, B. D., Parrag, I., Louka, D., Fischer, H., Mackey, G., Muirhead, B. B., Hicks, E. A., Sheardown, H., and Naimark, W. (2019). Pharmacokinetics and Pharmacodynamics of a Novel Dexamethasone Intravitreal Implant. Investigative Ophthalmology & Visual Science 60, 1702-1702.

Marashi, A., and Zazo, A. (2022). A manually made needle for treating Pseudophakic cystoid macular edema by injecting triamcinolone acetonide in the suprachoroidal space: a case report. American Journal of Ophthalmology Case Reports 25, 101254.

Markan, A., Agarwal, A., Arora, A., Bazgain, K., Rana, V., and Gupta, V. (2020). Novel imaging biomarkers in diabetic retinopathy and diabetic macular edema. Therapeutic Advances in Ophthalmology 12, 2515841420950513.

Nawar, A. E. (2022). Effectiveness of Suprachoroidal Injection of Triamcinolone Acetonide in Resistant Diabetic Macular Edema Using a Modified Microneedle. Clinical Ophthalmology, 3821-3831.

Oli, A., and Waikar, S. (2021). Modified inexpensive needle for suprachoroidal triamcinolone acetonide injections in pseudophakic cystoid macular edema. Indian Journal of Ophthalmology 69, 765.

Schmidt-Erfurth, U., Garcia-Arumi, J., Bandello, F., Berg, K., Chakravarthy, U., Gerendas, B. S., Jonas, J., Larsen, M., Tadayoni, R., and Loewenstein, A. (2017). Guidelines for the management of diabetic macular edema by the European Society of Retina Specialists (EURETINA). Ophthalmologica 237, 185-222.

Tayyab, H., Ahmed, C. N., and Sadiq, M. A. A. (2020). Efficacy and safety of suprachoroidal triamcinolone acetonide in cases of resistant diabetic macular edema. Pakistan Journal of Medical Sciences 36, 42.

Vujosevic, S., Torresin, T., Berton, M., Bini, S., Convento, E., and Midena, E. (2017). Diabetic macular edema with and without subfoveal neuroretinal detachment: two different morphologic and functional entities. American journal of ophthalmology 181, 149-155.

Yeh, S., Kurup, S. K., Wang, R. C., Foster, C. S., Noronha, G., Nguyen, Q. D., Do, D. V., and Team, D. S. (2019). Suprachoroidal injection of triamcinolone acetonide, CLS-TA, for macular edema due to noninfectious uveitis: a randomized, phase 2 study (DOGWOOD). Retina 39, 1880-1888.

Zafar, U., Ali, Z., Naz, S., Iftikhar, A., Khaliq, S., and Lone, K. (2021). Serum uric acid in relation with insulin resistance associated indices in metabolic syndrome and healthy subjects----an observational study. Pakistan Journal of Medical and Health Sciences 15, 816-9.