Comparative Efficacy of Intravitreal Triamcinolone and Dexamethasone Intravitreal Implant for Diabetic Macular Edema

Abstract

\n Purpose: To compare the efficacy, adverse effects, and treatment burden of two injectable corticosteroids, triamcinolone acetonide (Kenalog® or Triesence®) and the dexamethasone intravitreal implant (Ozurdex®), for treating diabetic macular edema (DME). Methods: This was a retrospective review at a single tertiary care center. Eyes treated with either intravitreal triamcinolone two mg (IVTA) or the intravitreal dexamethasone 0.7 mg implant for center-involving DME and with follow up of at least six months were included. Main outcomes were visual acuity (VA), intraocular pressure (IOP), IOP medication use, central macular thickness (CMT), and time to next treatment of any kind.Results: There were 24 eyes in the IVTA group and 15 eyes in the dex group. Baseline mean VA was 20/60 (range 20/30-20/800) in the IVTA group and 20/35 (range 20/20-20/100) in the dex group (p=0.0011). Only the subgroup of pseudophakic IVTA patients experienced a statistically significant increase in vision early on (+2 letters at month 1, +3 letters at month three), though not at month six. Mean IOP increased by 2.5 and 0.20 mmHg at month one in the IVTA and dex groups, respectively (p=0.27). Mean CMT decreased by 143 mm with IVTA and 39 mm with dex at month one (p=0.00025). Mean time to next treatment of any kind was 19 weeks for IVTA and 20.3 weeks for dex (p=0.41). Conclusions: Intravitreal triamcinolone and the intravitreal dexamethasone implant both show similar efficacy at reducing DME and its treatment burden, but neither significantly affected visual acuity over six months.