Three-year follow-up of a randomized trial comparing focal/grid photocoagulation and intravitreal triamcinolone for diabetic macular edema

Abstract

Objective: To report 3-year outcomes of patients who participated in a randomized trial evaluating 1-mg and 4-mg doses of preservative-free intravitreal triamcinolone compared with focal/grid photocoagulation for treatment of diabetic macular edema.

Methods: Eyes with diabetic macular edema and visual acuities of 20/40 to 20/320 were randomly assigned to focal/grid photocoagulation or 1 mg or 4 mg of triamcinolone. At the conclusion of the trial, 3-year follow-up data were available in 306 eyes.

Results: Between 2 years (time of the primary outcome) and 3 years, more eyes improved than worsened in all 3 treatment groups. Change in visual acuity letter score from baseline to 3 years was +5 in the laser group and 0 in each triamcinolone group. The cumulative probability of cataract surgery by 3 years was 31%, 46%, and 83% in the laser and 1-mg and 4-mg triamcinolone groups, respectively. Intraocular pressure increased by more than 10 mm Hg at any visit in 4%, 18%, and 33% of eyes, respectively.

Conclusions: Results in a subset of randomized subjects who completed the 3-year follow-up are consistent with previously published 2-year results and do not indicate a long-term benefit of intravitreal triamcinolone relative to focal/grid photocoagulation in patients with diabetic macular edema similar to those studied in this clinical trial. Most eyes receiving 4 mg of triamcinolone as given in this study are likely to require cataract surgery.

Trial registration: clinicaltrials.gov Identifier: NCT00367133.

Figures

Figure 1

Mean visual acuity at each visit according to treatment group. Figure 1A: Includes all available data from all randomized eyes. Figure 1B: Includes all available data from the cohort of eyes that completed the 3 year visit.

Figure 1

Mean visual acuity at each visit according to treatment group. Figure 1A: Includes all available data from all randomized eyes. Figure 1B: Includes all available data from the cohort of eyes that completed the 3 year visit.

Figure 2

Cumulative probability of cataract surgery for all eyes phakic at baseline. The “# eyes at risk” indicates the number of eyes still in follow up at the beginning of the interval.