EVALUATION OF THE EFFECT OF SUPRA-CHOROIDAL TRIAMCINOLONE INJECTION ON REFRACTORY DIABETIC MACULAR EDEMA

Abstract

Background: Diabetic macular edema (DME) is one of the most common causes of visual impairment among patients with diabetic retinopathy and remains a leading contributor to preventable blindness worldwide. Although anti-vascular endothelial growth factor (anti-VEGF) agents have revolutionized its management, a considerable proportion of patients fail to respond adequately to such therapies. Alternative treatment strategies, including targeted corticosteroid delivery through the suprachoroidal route, are gaining interest as potential options for refractory cases.

Objective: To evaluate the outcome of suprachoroidal triamcinolone injection on refractory diabetic macular edema in patients presenting at a tertiary care hospital in Lahore.

Methods: This descriptive study was carried out at Unit 1, Department of Ophthalmology, Services Hospital Lahore, from June to December 2024. A total of 80 patients aged 18–80 years with type 2 diabetes mellitus and refractory DME were enrolled through non-probability convenience sampling. Refractory DME was defined as central foveal thickness (CFT) >250 µm on optical coherence tomography (OCT) with no visual improvement despite six consecutive monthly anti-VEGF injections. Baseline assessment included demographic details, best-corrected visual acuity (BCVA) measured by the Snellen chart, intraocular pressure (IOP) measured by Goldmann applanation tonometry (AT 900, Haag-Streit, USA), and central macular thickness (CMT) measured by OCT. Patients received suprachoroidal triamcinolone injection using a custom-prepared needle. Follow-up evaluations were conducted at one and three months. Data were analyzed using SPSS version 23, with paired t-tests applied to compare baseline and follow-up outcomes. A p-value ≤0.05 was considered statistically significant.

Results: The mean age of patients was 55.26 ± 11.13 years, with an average diabetes duration of 11.27 ± 7.00 years. At baseline, the mean CMT was 650.52 ± 92.91 µm, which decreased to 451.41 ± 73.54 µm at one month and further to 274.51 ± 44.24 µm at three months (p < 0.001). Similarly, mean BCVA improved from 0.87 ± 0.071 logMAR at baseline to 0.67 ± 0.09 logMAR at one month and 0.52 ± 0.09 logMAR at three months (p < 0.001).

Conclusion: Suprachoroidal triamcinolone injection demonstrated significant improvement in both visual acuity and macular thickness, establishing it as an effective and safe therapeutic approach for refractory diabetic macular edema in tertiary care settings.