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Baseline central macular thickness predicts the need for retreatment with intravitreal triamcinolone plus laser photocoagulation for diabetic macular edema

Authors O'Day R, Barthelmes D, Zhu M, Wong TY, McAllister IL, Arnold JJ, Gillies MC

Received 30 April 2013

Accepted for publication 23 May 2013

Published 2 August 2013 Volume 2013:7 Pages 1565—1570


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Roderick O'Day,1 Daniel Barthelmes,1 Meidong Zhu,1 Tien Yin Wong,2,3 Ian L McAllister,4 Jennifer J Arnold,5 Mark C Gillies1

1Clinical Ophthalmology and Eye Health, The University of Sydney, Sydney, NSW, Australia; 2Singapore Eye Research Institute, National University of Singapore, Singapore; 3Center for Eye Research Australia, The University of Melbourne, Melbourne, VIC, Australia; 4Lions Eye Institute, The University of Western Australia, Perth, WA, Australia; 5Marsden Eye Specialists, Sydney, NSW, Australia

Purpose: To identify baseline characteristics that predict the number of treatments with intravitreal triamcinolone acetonide (IVTA) plus laser photocoagulation needed to treat diabetic macular edema over a 2-year period.
Methods: Individual data from 42 eyes of 42 participants treated with IVTA plus laser photocoagulation for diabetic macular edema during a prospective, randomized, double-masked, placebo-controlled trial were used for this post hoc analysis. Baseline characteristics – age, gender, best-corrected visual acuity, glycosylated hemoglobin, phakic status, intraocular pressure, and central macular thickness (CMT) – were correlated with the number of IVTA plus laser treatments received during the 2 years of this study.
Results: The median number of treatments received over the 2-year period was 2.5 (interquartile range 1.0–3.0), with 21 (50%) eyes needing three or more treatments. Eyes that received more IVTA plus laser treatments had a higher mean baseline CMT and eyes with a higher baseline CMT were more likely to receive three or more treatments (odds ratio 5.13, 95% confidence interval 1.75–15.04, P=0.003 per 100 µm increase in CMT). No significant relationship was found between other baseline characteristics and the number of IVTA plus laser treatments received.
Conclusion: Higher baseline CMT was strongly linked with receiving more IVTA plus laser treatments. These patients may be at higher risk of developing dose-dependent steroid-related adverse events, cataract progression, and intraocular pressure rise.

Keywords: diabetic macular edema, intravitreal triamcinolone, central macular thickness

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