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Intravitreal steroids for macular edema in diabetes

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Intravitreal steroids for macular edema in diabetes

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21.10.2013 • Sonuncu dəyişiklik 21.10.2013
Editors

Steroids placed inside the eye by either intravitreal injection or surgical implantation improve visual outcomes in eyes with persistent or refractory diabetic macular edema. Elevation of intraocular pressure and cataract progression occur in treated eyes and require monitoring and management.

A Cochrane review included 7 studies with a total of 632 diabetic macular edema (DME) eyes. 4 studies examined the effectiveness of intravitreal triamcinolone acetate injection (IVTA), 3 examined intravitreal steroids implantation (fluocinolone acetonide implant (FAI) or dexamethasone drug delivery system (DDS)). The preponderance of data suggest a beneficial effect from IVTA. The average improvement in visual acuity was 7.5 letters more (-0.15 LogMAR; 95% CI -0.21 to -0.09; 3 studies) in the IVTA treated eyes than in those treated with other therapies at three months, 11.5 letters more (-0.23 LogMAR; 95% CI -0.33 to -0.13; 2 studies) at six months, 14.5 letters more (-0.29 LogMAR; 95% CI -0.47 to -0.11; 1 study) at nine months, and 5.7 letters more (-0.11 LogMAR; 95% CI -0.20 to -0.03; 1 study) at 24 months. Improved clinical outcomes were also reported in FAI and dexamethasone DDS trials. The studies focused on chronic or refractory DME and it is not known whether intravitreal steroids therapy could be of value in other stages of DME, especially the earlier stages either as standalone therapy or in combination with other therapies, such as laser photocoagulation. Increased intraocular pressure and cataract formation were side effects requiring monitoring and management.

Ədəbiyyat

  1. Grover D, Li TJ, Chong CC. Intravitreal steroids for macular edema in diabetes. Cochrane Database Syst Rev 2008 Jan 23;(1):CD005656.