I’ve been writing alot about all the neat new treatments for diabetic macular edema, but what do we use, today, in the office?
Diabetic macular edema, aka clinically significant macular edema (CSME), has long been treated using focal photocoagulation (laser treatment). The idea is to treat the area of swelling with laser, causing either decreased leakage of the blood vessels, or, increased absorption of the fluid by the tissue underneath the retina. This has been moderately successful, with an 80% of either stability or improvement in vision.
We have been talking about the latest developments including intraocular injection of Avastin or intravitreal steroids. The new Ozurdex® implant may also be helpful in treating this condition. Neither the Avastin® nor the intravitreal steroids are indicated for CSME, but have been used off – label.
Subtenon’s injection of triamcinolone acetonide (steroid) has also been a safe alternative to intravitreal injection. In this case, the steroid triamcinolone, is injected beneath the clear outer coverings of the eye. The steroid forms a depot of drug that may last for months. Technically, the injection is outside the eye and is thus deemed less invasive and safer.
Many of my patients that receive sub-tenon’s injections do quite well. Many of my patients respond well and get improved vision. There are few complications and the chance of intraocular infection is avoided. Complications can include ptosis (droopy lid), eye penetration with the needle and raised increased intraocular pressure. If the sub-tenon’s injections don’t work, then I feel it may be worthwhile trying intraocular injections.
Randall V. Wong, M.D.
Retina Specialist, Ophthalmologist