Role ofintravitreal triamcinolone acetonide on macula in diabetic patients without maculopathy undergoing cataract surgery

Abstract

Diabetic macular edema (DME) is a major cause of central visual loss in diabetic patients. It has been well established by many authors that DME after cataract surgery can cause difficult visual improvement Cataract is another well-recognised ocular complication of diabetes and it has been estimated that up to 20% of all cataract surgeries are performed on diabetics. Phacoemulsification (phaco) is one of the most widely used cataract surgery techniques nowadays. But, the presence of maculopathy at the time of surgery has been suggested to be a risk factor for poorer visual outcome. Some previous studies suggested that 22% of diabetic patients develop increases >30% in central retinal thickness measured by optical coherence tomography (OCT) after uncomplicated phacoemulsification. The aim of the study was to compare central macular thickness between diabetic patients undergoing phaco surgery and diabetic patients undergoing phaco surgery with intravitreal triamcinolone acetonide injection and assess efficacy of triamcinolone acetonide in prevention against postphaco macular edema in diabetic patients. The study included 20 eyes of 18 diabetic patients underwent cataract surgery due to visually significant cataract divided into two groups: Control group(10 eyes): they underwent micro incision cataract surgery (MICS) and PC IOL only without any other intervention. Injected group(10 eyes):they underwent micro incision cataract surgery (MICS) and PC IOL and intravitreal triamcinolone acetonide (4mg/0.1ml) injection in the same session. All operations were done at the ophthalmology department in Ain Shams University hospital between 10/ 2014 and 8/ 2015. Our study revealed that CMT increased after phaco surgery by about 30% of preoperative value in the first month postoperatively then decreased gradually in the control group while no comparable increase occurred in the injected group but this difference was not reflected by difference in the BCVA in both groups. So, there is no benefit from prophylactic use of intravitreal triamiconolone aceteniode with phaco surgery in diabetic patients not suffering from maculopathy.