Intravitreal Injection of Triamcinolone
An emerging treatment for diabetic macular edema
- Michael S. Ip, MD
- From the Department of Ophthalmology and Visual Sciences, University of Wisconsin Medical School, Madison, Wisconsin
- Address correspondence and reprint requests to Michael S. Ip, MD, Department of Ophthalmology and Visual Sciences, University of Wisconsin Medical School, F4/336 Clinical Science Center, 600 Highland Ave., Madison, WI 53792. E-mail: msip{at}wisc.edu
- DCCT, Diabetes Control and Complications Trial
- ETDRS, Early Treatment Diabetic Retinopathy Study
- VEGF, vascular endothelial growth factor
Editor’s comment: From time to time, treatments for diabetes and its complications are promulgated, which seem to have sufficient nonrandomized clinical data to support their consideration for use in our patients. Rather than wait for randomized clinical trials to be published (and in some cases, this is unlikely to occur), descriptions of these treatments, their effectiveness, and their side effects will be published in Diabetes Care as a Commentary. In many situations, these therapeutic approaches would only be considered after more conventional therapy has been ineffective. Intraocular injections of glucocorticoids for macular edema fit these criteria.
Diabetic retinopathy is a major cause of visual impairment in the U.S. (1–3). Diabetic macular edema is a manifestation of diabetic retinopathy that produces loss of central vision and is commonly diagnosed by ophthalmologists. The Wisconsin Epidemiologic Study of Diabetic Retinopathy estimated that after 15 years of known diabetes, the prevalence of diabetic macular edema is ∼20% in patients with type 1 diabetes, 25% in patients with type 2 diabetes who are taking insulin, and 14% in patients with type 2 diabetes who do not take insulin (1).
Diabetic macular edema, because of the frequency with which it is seen, is a condition that has considerable public health importance. Currently, the only demonstrated means to reduce the risk of vision loss from diabetic macular edema are intensive glycemic control, as demonstrated by the Diabetes Control and Complications Trial (DCCT) (4) and the U.K. Prospective Diabetes Study (5), and laser photocoagulation, as demonstrated by the Early Treatment Diabetic Retinopathy Study (ETDRS) (6).
In the DCCT, intensive glucose control reduced the risk of onset of diabetic macular edema by 23% compared with conventional treatment. Long-term follow-up of patients in the DCCT show a sustained effect of intensive glucose control, with a 58% …
