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Posterior Subtenon Injection of Triamcinalone Acetonide for Cystoid ...

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clinics and improves patient’s compliance with this<br />

therapy.<br />

Marco (17) reported a significant rise in IOP from<br />

the baseline measurements in eyes with diffuse<br />

diabetic macular edema after four weeks <strong>of</strong> PSTI. In<br />

our study, a significant rise in IOP from the baseline<br />

was noted in two eyes after the first week <strong>of</strong> PSTI.<br />

These eyes were treated with antiglaucoma drugs <strong>for</strong><br />

a short time period (5.5 month).<br />

Other possible complications <strong>of</strong> posterior<br />

subtenon corticosteroid injection include ptosis,<br />

cataract <strong>for</strong>mation, inadvertent globe per<strong>for</strong>ation. (15)<br />

Conclusion<br />

PSTI <strong>of</strong> 40mg TA through a superotemporal<br />

approach appears to be safe and effective <strong>for</strong> shortterm<br />

management <strong>of</strong> diabetic CME.<br />

References<br />

1. Moss SE, Klein R, Klein BEK. The incidence <strong>of</strong><br />

visual loss in a diabetic population. Ophthalmology<br />

1988; 95: 1340-8.<br />

2. MacMeel JW, Trempe CL, Franks EB. Diabetic<br />

Maculopathy. Trans Am Acad Ophthalmol<br />

Otolaryngol 1977; 83: 476-87.<br />

3. Quinn CJ. <strong>Cystoid</strong> macular edema. Optom Clin<br />

1996; 5(1):111-30.<br />

4. Karacorlu M, Ozdemir H, Karacorlu S, et al.<br />

Intravitreal triamcinolone as a primary therapy in<br />

diabetic macular oedema. Eye. 2005; 19:382–386.<br />

5. Massin P, Audren F, Haouchine B, et al.<br />

Intravitreal triamcinolone acetonide <strong>for</strong> diabetic<br />

diffuse macular edema: preliminary results <strong>of</strong> a<br />

prospective controlled trial. Ophthalmology 2004;<br />

111:218–224.<br />

6. Jonas JB, Akkoyun I, Kreissig I, et al. Diffuse<br />

diabetic macular oedema treated by intravitreal<br />

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study. Br J Ophthalmol 2005; 89:321-<br />

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7. Jonas JB, Degenring RF, Kreissig I, et al.<br />

Intraocular pressure elevation after intravitreal<br />

triamcinolone acetonide injection. Ophthalmology<br />

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elevation after intravitreal triamcinolone acetonide<br />

injection. Korean J Ophthalmol 2005; 19:122-7.<br />

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endophthalmitis following intravitreal<br />

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retrobulbar triamcinolone infusion <strong>for</strong> diffuse<br />

macular edema. Graefes Arch Clin Exp Ophthalmol<br />

2004; 242:444–445.<br />

11. Cardillo JA, Melo LA Jr, Costa RA, et al.<br />

Comparison <strong>of</strong> intravitreal versus posterior sub-<br />

Tenon's capsule injection <strong>of</strong> triamcinolone<br />

acetonide <strong>for</strong> diffuse diabetic macular edema.<br />

Ophthalmology 2005 Sep; 112(9):1557-63.<br />

12. Geroski DH, Edelhauser HF. Transscleral drug<br />

delivery <strong>for</strong> posterior segment disease. Adv Drug<br />

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409X(01)00193-4.<br />

13. Choi YJ, Oh IK, Oh JR, Huh K. Intravitreal<br />

versus posterior subtenon injection <strong>of</strong><br />

triamcinalone acetonide <strong>for</strong> diabetic macular<br />

edema. Korean J Ophthalmol 2006 Dec; 20(4):205-<br />

9.<br />

14. Thomas ER, Wang J, Ege E, et al. Intravitreal<br />

triamcinolone acetonide concentration after<br />

subtenon injection. Am J Ophthalmol 2006 Nov;<br />

142(5):860-1.<br />

15. Bakri SJ, Kaiser PK. <strong>Posterior</strong> subtenon<br />

triamcinolone acetonide <strong>for</strong> refractory diabetic<br />

macular edema. Am J Ophthalmol 2005;139:290–<br />

294<br />

16. Entezari M, Ahmadieh H, Dehghan MH, et al.<br />

<strong>Posterior</strong> sub-tenon triamcinolone <strong>for</strong> refractory<br />

diabetic macular edema: a randomized clinical trial.<br />

Eur J Ophthalmol 2005 Nov-Dec; 15(6):746-50.<br />

17. Bonini-Filho MA, Jorge R, Barbosa JC, et al.<br />

Intravitreal injection versus sub-tenon’s infusion <strong>of</strong><br />

triamcinolone acetonide <strong>for</strong> refractory diabetic<br />

macular edema: A randomized clinical trial.<br />

Investigative Ophthalmology and Visual Science<br />

2005; 46:3845-3849<br />

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triamcinalone acetonide into the posterior subtenon<br />

capsule <strong>for</strong> treatment <strong>of</strong> diabetic macular<br />

edema. Retina 2007 Jul-Aug; 27(6):764-9.<br />

19. Wada M, Ogata N, Minamino K, et al. Trans-<br />

Tenon’s retrobulbar injection <strong>of</strong> triamcinalone<br />

acetonide <strong>for</strong> diffuse diabetic macular edema. Jpn J<br />

Ophthalmol 2005 Nov-Dec; 49(6):509-15.<br />

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al. Macular thickening and visual acuity<br />

measurement in patients with cystoid macular<br />

edema. Ophthalmology 1987 Sep; 94(9):1134-9.<br />

21. Cellini M, Pazzaglia A, Zamparini E, et al.<br />

Intravitreal vs. subtenon triamcinolone acetonide<br />

<strong>for</strong> the treatment <strong>of</strong> diabetic cystoid macular<br />

edema. Ophthalmol 2008; 8: 1-7.<br />

64<br />

JOURNAL OF THE ROYAL MEDICAL SERVICES<br />

Vol. 17 No. 1 March 2010

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