Intravitreal triamcinolone, commonly marketed as Kenalog (Bristol-Myers Squibb), does not offer long-term benefit when used to treat patients with diabetic macular edema (DME), according to a study in the March issue of Archives of Ophthalmology.1
The study also suggests that many of the patients who received intravitreal triamcinolone are likely to require cataract surgery.
The researchers randomly assigned 693 patients with DME to a focal/grid photocoagulation, 1mg triamcinolone or 4mg triamcinolone treatment group.
The researchers found that patients given 4mg of triamcinolone had an initial positive effect on retinal thickening and visual acuity at four months. But then this benefit diminished.
By the three-year follow-up, patients who had received laser treatment experienced an average improvement of +5 in visual acuity letter score, but patients in either triamcinolone group showed no improvement. Also, 83% of patients who received 4mg of triamcinolone required cataract surgery at follow-up, compared with 46% who received 1mg of triamcinolone and 31% who received laser treatment.
Intravitreal triamcinolone gained widespread popularity in 2002 when Adam Martidis, M.D., and associates demonstrated a significant improvement in visual acuity in a group of diabetic retinopathy patients who had recalcitrant macular edema, despite already undergoing at least two laser treatments, says Mark Dunbar, O.D., director of optometric services at Bascom Palmer Eye Institute in Miami.2
Since then, intravitreal Kenalog has been used extensively for a number of conditions associated with macular edema, including retinal vein occlusions, cystoid macular edema and post-inflammatory disease. After experiencing such good success with intravitreal Kenalog, some investigators have begun questioning the value of conventional laserthe current standard of care for DME, Dr. Dunbar says. However, this latest study should put some of those questions to rest.
So, does this mean that there is no value in treating DME patients with intravitreal triamcinolone?
I dont believe that is the case, Dr. Dunbar says. Clearly, there is still value in intravitreal Kenalog, but not as the primary treatment for DME. Much like those patients in Dr. Martidis original study, there are patients who will have such extensive macular edema that laser alone will not be enoughthese are the patients who will probably still benefit the most from intravitreal Kenalog.
1. The Diabetic Retinopathy Clinical Research Network (DRCR.net), Beck RW, Edwards AR, et al. Three-year follow-up of a randomized trial comparing focal/grid photocoagulation and intravitreal triamcinolone for diabetic macular edema. Arch Ophthalmol 2009 Mar;127(3):245-51.
2. Martidis A, Duker JS, Greenberg PB, et al. Intravitreal triamcinolone for refractory diabetic macular edema. Ophthalmology 2002 May;109(5):920-7.