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Impressum
Intravitreal Injection of Crystalline Cortisone as Adjunctive Treatment of Proliferative Diabetic Retinopathy
Soefker A., Jonas J. B.
Department of Ophthalmology and Eye Hospital, Faculty of Clinical Medicine Mannheim, Ruprecht-Karls-University Heidelberg
Objective: To report the clinical outcome and complications of
intravitreal injections of crystalline cortisone in patients undergoing
pars plana vitrectomy for treatment of proliferative diabetic retinopathy.
Methods: The prospective interventional case series study included
29 consecutive patients (29 eyes) who underwent pars plana vitrectomy
for treatment of complicated proliferative diabetic retinopathy associated
with central retinal traction detachment. All patients received an intravitreal
injection of 15 -20 mg crystalline triamcinolone acetonide at the end
of surgery, and were operated on by the same surgeon. Mean follow-up time
was 1.4 ± 1.1 months (median, 1 month; 0.30 - 4.9 months).
Results: At the end of the follow-up period, the retina was attached
in 26 (89.7%) of the 29 patients. In three (10.3%) of the 29 patients,
a retinal redetachment had occurred. None of the patients developed iris
neovascularization, and the iris neovascularization present preoperatively
in 12 patients, slightly to markedly regressed in all twelve patients.
Preoperative and postoperative intraocular pressure values (P=0.72) and
blood glucose measurements did not vary significantly. A pseudo-hypopyon
consisting of cortisone crystals in the inferior anterior chamber angle
was detected in one patient and resolved spontaneously within four days.
Conclusion: The present clinical study suggests that intravitreal
injection of crystalline cortisone with most of the vehicle removed seems
to be well tolerated by eyes undergoing pars plana vitrectomy for treatment
of complicated diabetic proliferative retinopathy. In view of the antiphlogistic
and antiproliferative effect of cortisone, future randomized clinical
trails may be indicated to further investigate the role of intravitreal
injection of crystalline cortisone in the treatment of proliferative diabetic
retinopathy.