Three-Year Follow-up of a Randomized Trial Comparing Focal/Grid Photocoagulation and Intravitreal Triamcinolone for Diabetic Macular Edema

Abstract

Objective: To report 3-year outcomes of patients who participated in a randomized trial evaluating 1 mg and 4 mg doses of preservative-free intravitreal triamcinolone compared with focal/grid photocoagulation for treatment of diabetic macular edema (DME). Methods: Eyes with DME and visual acuity 20/40 to 20/320 were randomly assigned to focal/grid photocoagulation, 1 mg triamcinolone, or 4 mg triamcinolone. At the conclusion of the trial, 3-year follow up was available for 306 eyes. Results: Between two and three years, more eyes in all treatment groups improved than worsened. Change in visual acuity letter score from baseline to 3 years was +5 in the laser group and 0 in each triamcinolone group. The cumulative probability of cataract surgery by three years was 31%, 46%, and 83% in the laser, 1 mg, and 4 mg groups, respectively. Conclusions: Results in the subset of the randomized subjects who completed 3-year follow up are consistent with the previously published 2 year results, and do not indicate a long-term benefit of intravitreal triamcinolone relative to focal/grid photocoagulation for patients with DME similar to those studied in this clinical trial. Most eyes receiving 4 mg triamcinolone as given in this study are likely to require cataract surgery.