Deferred intravitreal triamcinolone in diabetic eyes after phacoemulsification.

Purpose: Evaluation of diabetic macular edema (DME) after phacoemulsification by optical coherence tomography (OCT) and the use of deferred intravitreal triamcinolone acetonide (IVTA) as a therapy.

Methods: This was an institutional, nonrandomized, retrospective study. Within a period of 18 months, 5,684 eyes underwent phacoemulsification in our department, 1,634 of which were diabetic. Eight weeks after surgery, 55 out of 1,634 diabetic eyes that had undergone phacoemulsification developed DME and were treated with a 3.2 mg IVTA injection. The mean best-corrected visual acuity (BCVA) and mean central macular thickness (CMT) were measured before and after phacoemulsification and 3 months after IVTA.

Results: The mean BCVA at baseline, after phacoemulsification, and 3 months after deferred IVTA was 49.0±17.7, 53.7±17.4, and 66.36±20.66, respectively. The mean CMT for the same endpoints was 268.9±76.3, 554.6±137.8, and 275.0±76.3 μm, respectively. Eyes were subdivided into 2 subgroups: eyes with a previous history of DME and eyes with de novo DME. Three months after deferred IVTA, there was a statistically significant difference between these 2 subgroups in BCVA (P<0.001) and in CMT (P=0.002). The OCT features before and after IVTA defined 2 subgroups of DME, with respect to cyst color and symmetry and OS/IS line integrity after IVTA.

Conclusions: Our data suggest that DME progresses after uncomplicated phacoemulsification in diabetic eyes and that IVTA is an appropriate therapeutic tool. The response to IVTA treatment depends on previous history of DME and its OCT profile.