Abstract

Comparison of Safety and Efficacy of Grid Laser Versus Combination of Sequential Intravitreal Triamcinolone Acetonide and Grid Laser in Treatment of Diabetic Macular Oedema - Randomized Open Label Study, Bangalore, Karnataka

Author(s): Shashidhar S.1, Sachin M. Kasbe2, Adhar V. Nayak3, Shivakumar D.4

 BACKGROUND
The reported prevalence of diabetic retinopathy in diabetics is around 40 %.
Diabetic macular oedema (DME) is defined as macular thickening resulting from
diabetic retinopathy, due to leakage from micro aneurysms, or from a diffuse
leakage of hyper permeable capillaries. Intravitreal injection of triamcinolone
acetonide (IVTA) has gained considerable interest and clinical use because it often
has beneficial effect on retinal thickening in DME. The synergistic action of IVTA
and laser photocoagulation might increase and prolong the beneficial effects of
IVTA in reducing ME. Hence the need for a study to compare efficacies of grid
laser, and combination of sequential IVTA and grid laser in treating patients with
DME. We wanted to evaluate functional and morphological outcome of grid laser
versus combination of sequential intravitreal triamcinolone acetonide and grid
laser in treatment of diabetic macular oedema.
METHODS
The study included 62 eyes with DME. There were 31 eyes which received grid
laser photocoagulation (group 1) and 31 eyes which received grid laser
photocoagulation following IVTA (group 2) and visual acuity, CMT on OCT was
compared at baseline and after day 1, 1st week, 4th week and 12th week.
Outcome and comparative efficacies were evaluated.
RESULTS
Our study shows reduced macular thickness and improved visual acuity in group
2 compared to group 1 in all follow ups. On intragroup analysis, we found a
significant reduction in CMT in both groups at 1 week, 4 weeks and 12 weeks as
compared to baseline. In our study we also compared CMT between group 1 and
group 2 which did not show significant difference at baseline. But, difference in
CMT from baseline at each follow up which is at 1 week, 4 weeks and 12 weeks
between two groups showed more reduction in CMT in group 2 compared to group
1.
CONCLUSIONS
There was a significant reduction in CMT in all the follow ups of both groups, but
group 2 had more reduction in CMT compared to group 1. The synergistic action
of IVTA and laser photocoagulation might increase and prolong the beneficial
effect of IVTA in reducing ME. This study found evidence of synergistic effects of
IVTA and laser photocoagulation in DME in terms of improving visual acuity and
in reducing CMT compared to grid laser alone and should be tried as a modality of
treatment in DME.