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Laser Treatment May Improve Long-Term Vision in Diabetics

Focal/grid photocoagulation more effective for diabetic macular edema

MONDAY, Aug. 4 (HealthDay News) -- In patients with diabetic macular edema, treatment with focal/grid photocoagulation may provide a better long-term response and fewer side effects than treatment with preservative-free intravitreal triamcinolone, according to a report published online July 28 in Ophthalmology.

Michael S. Ip, M.D., of the Jaeb Center for Health Research in Tampa, Fla., and colleagues randomized patients with diabetic macular edema to focal/grid photocoagulation (n=330), 1-mg intravitreal triamcinolone (n=256), or 4-mg intravitreal triamcinolone (n=254), and persistent or new edema was re-treated at four-month intervals. Visual acuity, the primary outcome measure, was evaluated at two years.

The researchers report that visual acuity was significantly better in the 4-mg triamcinolone group compared to either the laser group or the 1-mg triamcinolone group, but no significant differences remained after one year of treatment. From the 16-month visit through two years, mean visual acuity was significantly better in the laser group compared to the triamcinolone groups, they note. The investigators also found that intraocular pressure increased from baseline by 10 mm Hg or more in 4 percent of the focal/grid photocoagulation group, and 16 percent and 33 percent of eyes in the 1-mg and 4-mg dose groups of preservative-free intravitreal triamcinolone, respectively. Cataract surgery was least common in the focal/grid photocoagulation group, the report indicates.

"Over a two-year period, focal/grid photocoagulation is more effective and has fewer side effects than 1-mg or 4-mg doses of preservative-free intravitreal triamcinolone for most patients with diabetic macular edema who have characteristics similar to the cohort in this clinical trial," the authors conclude. "The results of this study also support that focal/grid photocoagulation currently should be the benchmark against which other treatments are compared in clinical trials of diabetic macular edema."

Allergan, Inc., provided the triamcinolone and topical antibiotics for the study.

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