• Online Features  This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citing articles on HighWire  • Citing articles on Web of Science (9)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Diabetic Retinopathy  • Ophthalmological Procedures, Other  • Randomized Controlled Trial  • Drug Therapy  • Drug Therapy, Other  • Alert me on articles by topic  Social Bookmarking   What's this?

Neil M. Bressler, MD; Allison R. Edwards, MS; Roy W. Beck, MD, PhD; Christina J. Flaxel, MD; Adam R. Glassman, MS; Michael S. Ip, MD; Craig Kollman, PhD; Baruch D. Kuppermann, MD; Thomas W. Stone, MD; for the Diabetic Retinopathy Clinical Research Network

Arch Ophthalmol. 2009;127(12):1566-1571.

Objective  To compare the effect of intravitreal triamcinolone acetonide with focal/grid photocoagulation on the progression of diabetic retinopathy.

Methods  We performed an exploratory analysis of participants with diabetic macular edema randomly assigned to receive laser therapy or intravitreal triamcinolone acetonide (1 or 4 mg). Fundus photographs were obtained at baseline and 1, 2, and 3 years. The main outcome measure was progression to proliferative diabetic retinopathy or worsening of 2 or more severity levels on reading-center masked assessment of 7-field fundus photographs, plus additional eyes that received panretinal photocoagulation or had a vitreous hemorrhage.

Results  From July 15, 2004, through May 5, 2006, 840 eyes from 693 participants were enrolled in the study and randomly assigned to receive laser therapy (n = 330), 1 mg of triamcinolone acetonide (n = 256), or 4 mg of triamcinolone acetonide (n = 254). The cumulative probability of progression of retinopathy at 2 years was 31% (laser group), 29% (1-mg group), and 21% (4-mg group) (P = .64 in the 1-mg group and .005 in the 4-mg group compared with the laser group). These differences appeared to be sustained at 3 years.

Conclusions  Intravitreal triamcinolone acetonide (4 mg) appeared to reduce the risk of progression of diabetic retinopathy. Given the exploratory nature of this analysis and because intravitreal triamcinolone adverse effects include cataract formation and glaucoma, use of this treatment merely to reduce the rates of progression of proliferative diabetic retinopathy or worsening of the level of diabetic retinopathy does not seem warranted at this time.

Author Affiliations: Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland (Dr Bressler); Jaeb Center for Health Research, Tampa, Florida (Ms Edwards, Drs Beck and Kollman, and Mr Glassman); Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland (Dr Flaxel); Fundus Photograph Reading Center, Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison (Dr Ip); Department of Ophthalmology, University of California, Irvine (Dr Kuppermann); and Retina and Vitreous Associates of Kentucky, Lexington (Dr Stone).

CiteULike    Connotea    Delicious    Digg    Facebook    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

Intravitreal Corticosteroids for Diabetic Retinopathy Prevention
William E. Smiddy
Arch Ophthalmol. 2009;127(12):1672-1673.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Comparability of Digital Photography with the ETDRS Film Protocol for Evaluation of Diabetic Retinopathy Severity
Li et al.
IOVS 2011;52:4717-4725.
ABSTRACT | FULL TEXT  

Intravitreal Corticosteroids for Diabetic Retinopathy Prevention
Smiddy
Arch Ophthalmol 2009;127:1672-1673.
FULL TEXT