Irfan Karamat, Asad Aslam Khan, Nasir Chuadhry, Haroon Tayyab.
Refractory Diabetic Macular Edema in Phakic Patients Looking for Answer.
Pak J Ophthalmol Jan ;34(1):9-14.

Purpose: To evaluate the efficacy of intra-vitreal triamcinolone acetate (TA) in the treatment of macular edema secondary to diabetes mellitus, not responding to intra-vitreal bevacizumab injection. Study Design: Quasi experimental study. Place and Duration of study: Study was conducted in Mayo hospital. Study duration was six months from 1st January to 30th June 2017. Material and Methods: Our study was prospective case series, which included 14 patients having diabetes and refractory diabetic macular edema, with history of 3 ? 8 injections of intra-vitreal bevacizumab. Patients included in the study underwent phacoemulsification along with intra-vitreal injection of triamcinolone acetate in a single sitting. Best corrected visual acuity (BCVA) and central macular thickness (CMT) was documented pre-op and post-op at 1, 4, 8 and 16 weeks. Results: Mean age of study population was 44.5 ± 4.94 years. Out of 14 patients, 11 (78.6%) patients were males and 3 (21.4%) were females. Results showed that 12 patients (85.7%) had improvement in BCVA, one patient (7.1%) had no improvement in BCVA while one patient (7.1%) had decrease in visual acuity from 0.2 Log MAR to 0.1 Log MAR. 12 (85.7%) patients showed decrease in CMT, while 2 (14.2%) showed increase in CMT. Only 1 (7%) patient showed increase in IOP which was outside normal limits. Conclusion: Intra-vitreal triamcinolone, when given in an appropriate dose is an effective treatment of refractory macular edema. Cataract extraction can reduce steroid related complications; improve compliance and produce better visual outcome.

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