Seven studies, involving 632 DME eyes were included. Four examined the effectiveness of intravitreal triamcinolone acetate injection (IVTA), three examined intravitreal steroids implantation (fluocinolone acetonide implant (FAI) or dexamethasone drug delivery system (DDS)). Two trials were at low risk of bias , one was at median risk of bias , two were at high risk of bias and the remaining two were at unclear risk of bias .
The preponderance of data suggest a beneficial effect from IVTA. Comparing IVTA with controls, the mean difference in visual acuity was - LogMAR (95% CI - to -) at 3 months (based on three trials), - LogMAR (95% CI - to -) at 6 months (two trials), - LogMAR (95% CI - to -) at 9 months (one trial ), and - LogMAR (95% CI - to -) at 24 months (one trial ), all in favor of IVTA. The relative risk ( RR ) for one or more lines improvement in visual acuity was (95% CI to ) at 3 months (two trials), (95% CI to ) at 6 months (one trial ), and (95% CI to ) at 24 months (one trial ), all in favor of IVTA. We did not find evidence for three or more lines improvement in visual acuity. The mean difference in retinal thickness was - um (95% CI - to -) at 3 months (two trials), - um (95% CI - to -) at 6 months (one trial ), - um (95% CI - to -) at 9 months (one trial ), and - um (95% CI - to -) at 24 months (one trial ), all in favor of IVTA. The RR for at least one grade macular edema resolution was (95% CI to ) at 3 months in favor of IVTA (one trial ).
Two trials reported improved clinical outcome when FAI was compared to standard of care. Beneficial effect was also observed in one dexamethasone DDS trial .
Increased intraocular pressure and cataract formation were side effects requiring monitoring and management.
Vision loss from edematous macular conditions remains a significant problem. The mainstay of treatment for these conditions, thermal laser photocoagulation, carries the risk of tissue damage. Furthermore, many conditions are not amenable to laser therapy.
This has led to the advent of intravitreal steroid injection in an attempt to better manage macular edematous conditions and preserve vision. Recent research has demonstrated benefits from this new therapeutic approach and, in time, there should be clear indications as to the proper usage of intravitreal steroid injections for the management of edematous macular diseases.
Dr. Vollmer is an Instructor of Optometry at Nova Southeastern University in Ft. Lauderdale. Dr. Sowka is a Professor of Optometry at Nova Southeastern University. Special acknowledgements also go to Julio Perez, ., and Rena Cappelli, .
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