Effectiveness of Suprachoroidal Triamcinolone Acetonide at Reducing Central Subfield Thickness in Diabetic Macular Edema, A Descriptive Case Series
DOI:
https://doi.org/10.21649/akemu.v30i4.5524Keywords:
Diabetic macular edema, suprachoroidal,, triamcinolone acetonideAbstract
Background: Injection of corticosteroids into suprachoroidal space enables therapeutic drug levels to be attained in retina and choroid while minimizing them in anterior chamber. This helps deliver a higher drug concentration in posterior chamber whilst minimizing the potential side effects of conventional intravitreal steroid therapy, like cataract formation and increased intraocular pressure.
Objectives: To assess effectiveness of Suprachoroidal Triamcinolone Acetonide (SCTA) injection at reducing central subfield thickness in individuals suffering from diabetic macular edema (DME).
Methods: A Descriptive case series study was carried out at Department of Ophthalmology, Lahore General Hospital, Lahore from 1st July 2021 to 31st December 2021. A total of 150 treatment naive patients with DME, age range from 18-70 years and any gender, were selected. We excluded those patients that had history of uveitis, intraocular surgery, cataract, macular ischemia, and ocular hypertension or those with macular edema secondary to any other pathology. They were observed for three months after getting a SCAT injection. They were examined at one week, one month and third month. At the end of three months, the outcome measure was a change in central subfield thickness (CST) from the baseline.
Results: The patients in our study had age ranging from 18 to 70 years with a mean of 51.10 ± 9.53 years. Most of the patients 114 (76.0%) had ages between 46 to 70 years. Out of these 150 individuals, 77 (51.33%) were males and 73 (48.67%) were females. Mean pre-injection CST was 299.76 ± 13.72µm and after 3 months, it reduced to 250.49 ± 17.82 µm. Using paired t-test, the difference was found to be statistically significant with a p-value of 0.0001.
Conclusion: Our study concludes that SCTA injection is clinically and statistically effective at reducing central subfield thickness in treatment naive patients with DME, with no adverse consequences. Further studies assessing BCVA, with longer follow-up can potentiate the observation at hand.
References
Kropp M, Golubnitschaja O, Mazurakova A, Lenka Koklesova, Nafiseh Sargheini, Steve K, et al. Diabetic retinopathy as the leading cause of blindness and early predictor of cascading complications—risks and mitigation. EPMA J. 2023;14(1):21–42.
Chitturi SP, Venkatesh R, Mangla R, Parmar Y, Sangoram R, Yadav NK,et al. REal-world treatment outcomes after delayed intRavitreal therapy in center-involving diabetic macular edema – RETORT study. PubMed Central. 2023;9(1):1-8.
Ramzan B, Hassali A, Hashmi F, Saleem F, Gardezi S, Hussain I, et al. Impact of diabetes-related knowledge and medication adherence on quality of life among type 2 diabetes patients in a tertiary health facility in Multan, Pakistan. Trop. J. Pharm. 2022;21(4):871–7
Elnahry AG, Abdel-Kader AA, Habib AE, Elnahry GA, Raafat KA, Elrakhawy K. Review on Recent Trials Evaluating the Effect of Intravitreal Injections of Anti-VEGF Agents on the Macular Perfusion of Diabetic Patients with Diabetic Macular Edema. Rev Recent Clin Trials. 2020;15(3):188–98.
Shaikh K, Ahmed N , Kazi U , Zia A , Aziz MZ. Comparison between Suprachoroidal Triamcinolone and Intravitreal Triamcinolone Acetonide in patients of resistant Diabetic Macular Edema. Pak J Ophthalmol. 2023;39(1): 14-19.
Muya L, Kansara V, Cavet ME, Ciulla T. Suprachoroidal Injection of Triamcinolone Acetonide Suspension: Ocular Pharmacokinetics and Distribution in Rabbits Demonstrates High and Durable Levels in the Chorioretina. J Ocul Pharmacol Ther. 2022;38(6):459–467.
Petrovic N, Todorovic D, Sarenac Vulovic T, Sreckovic S, Zivic F, Risimic D. Combined Treatment of Persistent Diabetic Macular Edema with Aflibercept and Triamcinolone Acetonide in Pseudophakic Eyes. Medicina. 2023;59(5):982.
Merani R, Hunyor AP. Endophthalmitis following intravitreal anti-vascular endothelial growth factor (VEGF) injection: a comprehensive review. Int J Retina Vitreous. 2015;1(1):9.
Wykoff, C. C., Khurana, R. N., Lampen, S. I. R., Noronha, G., Brown, D. M., Ou, W. C., et al. (2018). Suprachoroidal Triamcinolone Acetonide for Diabetic Macular Edema. Ophthalmology Retina, 2018;2(8):874–877.
Chiang B, Jung JH, Prausnitz MR. The suprachoroidal space as a route of administration to the posterior segment of the eye. Adv Drug Deliv Rev. 2018;126(1):58-66
Wan CR, Muya L, Kansara V, Ciulla TA. Suprachoroidal Delivery of Small Molecules, Nanoparticles, Gene and Cell Therapies for Ocular Diseases. Pharmaceutics. 2021;13(2):288.
Aceves-Franco LA, Sanchez-Aguilar OE, Barragan-Arias AR, Ponce-Gallegos MA, Navarro-Partida J, Santos A. The Evolution of Triamcinolone Acetonide Therapeutic Use in Retinal Diseases: From Off-Label Intravitreal Injection to Advanced Nano-Drug Delivery Systems. Biomedicines. 2023;11(7):1901.
Tatsumi T, Oshitari T, Baba T, Takatsuna Y, Yamamoto S. Effects of Switching from Anti-VEGF Treatment to Triamcinolone Acetonide in Eyes with Refractory Macular Edema Associated with Diabetic Retinopathy or Retinal Vein Occlusion. Biomed Res Int. 2020;2020(1):4529850.
Campochiaro PA, Wykoff CC, Brown DM, Boyer DS, Barakat M, Taraborelli D, et al. Tanzanite Study Group. Suprachoroidal Triamcinolone Acetonide for Retinal Vein Occlusion:Results of the Tanzanite Study. Ophthalmol Retina. 2018;2(4):320–328.
Behar-Cohen F. Recent advances in slow and sustained drug release for retina drug delivery. Expert Opin Drug Deliv. 2019;16(7):679–686.
Yeh S, Kurup SK, Wang RC, Foster CS, Noronha G, Nguyen QD, Do DV: Suprachoroidal injection of triamcinolone acetonide, CLS-TA, for macular edema due to noninfectious uveitis: a randomized, phase 2 study (DOGWOOD). Retina. 2019;39:1880-8.
Yeh S, Khurana RN, Shah M, Henry CR, Wang RC, Kissner JM, et al. Efficacy and Safety of Suprachoroidal CLS-TA for Macular Edema Secondary to Noninfectious Uveitis: Phase 3 Randomized Trial. Ophthalmology. 2020 ;127(7):948-955.
Jahangir T, Riaz S, Amjad A. Evaluation of the Effect of Suprachoroidal Triamcinolone Injection on Refractory Diabetic Macular Edema. Pak J Ophthalmol. 2021; 37 (3): 267-273.
Tayyab H, Ahmed CN, Sadiq MAA. Efficacy and safety of suprachoroidal triamcinolone acetonide in cases of resistant diabetic macular edema. Pak J Med Sci. 2020;36(2):42-47.
Ghoraba HH, Leila M, Elgouhary SM, Elgemai EEM, Abdelfattah HM, Ghoraba HH, et al. Safety of high-dose intravitreal triamcinolone acetonide as low-cost alternative to anti-vascular endothelial growth factor agents in lower-middle-income countries. Clin Ophthalmol. 2018;12(1):2383-2391
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Annals of King Edward Medical University

This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access journal and all the published articles / items are distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. For comments publications@kemu.edu.pk