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LETTER TO EDITOR
Year : 2006  |  Volume : 54  |  Issue : 4  |  Page : 290

Intravitreal injection of triamcinolone acetonide for diabetic macular edema: Principles and practice


Vitreo Retinal Surgeon, Akansha Apartment, Lalitpur Colony, Gwalior - 474 009, MP, India

Correspondence Address:
Arvind Kumar Dubey
Vitreo Retinal Surgeon, Akansha Apartment, Lalitpur Colony, Gwalior - 474 009, MP
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.27969

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How to cite this article:
Dubey AK. Intravitreal injection of triamcinolone acetonide for diabetic macular edema: Principles and practice. Indian J Ophthalmol 2006;54:290

How to cite this URL:
Dubey AK. Intravitreal injection of triamcinolone acetonide for diabetic macular edema: Principles and practice. Indian J Ophthalmol [serial online] 2006 [cited 2020 Dec 5];54:290. Available from: https://www.ijo.in/text.asp?2006/54/4/290/27969

Dear Editor,

We appreciate the article by Vedantham et al .[1] We would like to draw the attention of the authors to an important use of triamcinolone i.e, during cataract surgery on eyes with treated or untreated diabetic maculopathy. It is an established observation that diabetic maculopathy tends to worsen after cataract surgery, more commonly if not adequately lasered before cataract surgery and if the cataract surgery is not spaced properly, requiring laser in the immediate postcataract surgery period. However, about 28 to 35% of diabetic maculopathy cases worsen following cataract surgery despite adequate laser treatment and stabilization of macular edema before cataract surgery, requiring further laser.

It is possible to do intraoperative laser with the help of laser indirect ophthalmoscope in the above group of cases immediately after removal of cataract but with laser indirect ophthalmoscope it is difficult to do a precise focal or grid laser treatment. In the immediate postoperative period applying a contact lens and doing laser by way of slit lamp delivery is risky both in terms of wound leak and chance of infection. The patient is disappointed if the visual recovery is poor following cataract surgery because of worsening of diabetic macular edema.

We employ a system wherein we give intravitreal injection of triamcinolone in a dose of 4mg contained in 0.1 ml in all diabetics with or without previous macular laser treatment. This totally avoids exacerbation or occurrence of macular edema for a period varying from two to four months. The postoperative period is a happy period for the patients and after two to four months if the edema recurs, a suitable laser treatment is carried out. Release of prostaglandins is the main cause for such postcataract surgery edema and as mentioned by the authors this is one mechanism through which triamcinolone acts to prevent occurrence of such edema.

We have found this as a successful strategy to avoid patient disappointment and also to avoid immediate postoperative laser treatment.



 
  References Top

1.
Vedantham V, Kim R. Intravitreal injection of triamcinolone acetonide for diabetic macular edema: Principles and practice. Indian J Ophthalmol 2006;54:133-7.  Back to cited text no. 1
    



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