Exploratory Analysis of Diabetic Retinopathy Progression Through 3 Years in a Randomized Clinical Trial That Compares Intravitreal Triamcinolone Acetonide With Focal/Grid Photocoagulation | Diabetic Retinopathy | JAMA Ophthalmology | JAMA Network
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Clinical Sciences
December 14, 2009

Exploratory Analysis of Diabetic Retinopathy Progression Through 3 Years in a Randomized Clinical Trial That Compares Intravitreal Triamcinolone Acetonide With Focal/Grid Photocoagulation

Author Affiliations

Author Affiliations: Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland (Dr Bressler); Jaeb Center for Health Research, Tampa, Florida (Ms Edwards, Drs Beck and Kollman, and Mr Glassman); Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland (Dr Flaxel); Fundus Photograph Reading Center, Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison (Dr Ip); Department of Ophthalmology, University of California, Irvine (Dr Kuppermann); and Retina and Vitreous Associates of Kentucky, Lexington (Dr Stone).

Arch Ophthalmol. 2009;127(12):1566-1571. doi:10.1001/archophthalmol.2009.308
Abstract

Objective  To compare the effect of intravitreal triamcinolone acetonide with focal/grid photocoagulation on the progression of diabetic retinopathy.

Methods  We performed an exploratory analysis of participants with diabetic macular edema randomly assigned to receive laser therapy or intravitreal triamcinolone acetonide (1 or 4 mg). Fundus photographs were obtained at baseline and 1, 2, and 3 years. The main outcome measure was progression to proliferative diabetic retinopathy or worsening of 2 or more severity levels on reading-center masked assessment of 7-field fundus photographs, plus additional eyes that received panretinal photocoagulation or had a vitreous hemorrhage.

Results  From July 15, 2004, through May 5, 2006, 840 eyes from 693 participants were enrolled in the study and randomly assigned to receive laser therapy (n = 330), 1 mg of triamcinolone acetonide (n = 256), or 4 mg of triamcinolone acetonide (n = 254). The cumulative probability of progression of retinopathy at 2 years was 31% (laser group), 29% (1-mg group), and 21% (4-mg group) (P = .64 in the 1-mg group and .005 in the 4-mg group compared with the laser group). These differences appeared to be sustained at 3 years.

Conclusions  Intravitreal triamcinolone acetonide (4 mg) appeared to reduce the risk of progression of diabetic retinopathy. Given the exploratory nature of this analysis and because intravitreal triamcinolone adverse effects include cataract formation and glaucoma, use of this treatment merely to reduce the rates of progression of proliferative diabetic retinopathy or worsening of the level of diabetic retinopathy does not seem warranted at this time.

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