Triamcinolone Acetonide May Prevent Postoperative Diabetic Macular Edema

A recent retrospective study from Zhejiang, China has indicated that triamcinolone acetonide (TA) injections may successfully prevent the onset of diabetic macular edema (DME) after pars plana vitrectomy (PPV), a common postoperative complication in patients with proliferative diabetic retinopathy (PDR).1

Macular edema is a very common complication with many ocular diseases; it manifests as accumulation of fluid in the macula, sometimes diffusely in the central retina or within cysts inside the inner nuclear layer. Edema can result in irreversible tissue damage with death of retinal cells. Most diseases that cause macular edema include dysfunction of the blood-retinal barrier, allowing free passage of vasoactive growth factors and inflammatory cytokines.2

“A better understanding of PV-DME, particularly its incidence and predisposing risk factors, is necessary to estimate the clinical burden and develop a preventative strategy for this complication,” wrote Hang-Tao Zhou, National Clinical Research Center for Ocular Diseases, Wenzhou Medical University, and colleagues. “However, there is little information in the current literature regarding PV-DME.”1

Investigators collected data on patients who underwent PPV from January 2018 to March 2022. Inclusion criteria were ≥3-month follow-up after surgery and gradable optical coherence tomography (OCT) imaging before surgery.1

Patients with silicone oil tamponade, a history of PPV, any intraocular surgery within 3 months prior to and after this PPV, other ocular conditions that could cause macular edema, serious postoperative complications such as neovascular glaucoma and retinal artery occlusion, or a history of penetrating ocular trauma were excluded.1

In total, 365 eyes from 330 patients were included; mean age was 57.3 +/- 10.3 years, and 59.3% of patients were male. Participants were divided into 2 groups according to DME presence prior to surgery. Group A (n = 222) were the patients without preoperative DME, and Group B (n = 143) were those with preoperative DME.1

Patients in Group A who had postoperative DME were on average younger (P = .02), had greater preoperative central retinal thickness (CRT) (P <.001), higher proportion of males (P - .01), higher proportion of intraoperative internal limiting membrane (ILM) peeling (P <.001), higher proportion of intraoperative intravitreal injection (P = .004), and higher proportion of preoperative intravitreal injection of anti-VEGF factors (P = .03). There was no statistical significance found in Group B.1

The team utilized spectral-domain OCT to measure CRT, diffused retinal thickening (DRT), cystoid macular edema (CME), and serous retinal detachment (SRD). Group A saw a cumulative incidence of PV-DME within a 3-month follow-up period was 40.1% (89/222). Of the 89 eyes with PV-DME, 24 eyes (27%) displayed CME alone, 59 eyes (66.2%) showed diffused retinal thickening (DRT) alone, 3 (3.4%) displayed CME and serous retinal detachment (SRD), and 3 (3.4%) showed DRT and SRD.1

Before PPV, Group B saw 63 eyes (44%) displayed CME alone, 61 eyes (42.7%) showed DRT alone, 16 (11.2%) displayed CME and SRD, and 3 (2.1%) showed DRT ad SRD preoperatively. After the operation, 112 eyes (78.3%) retained macular edema within the 3-month follow-up period. Of these, the numbers of CME alone, DRT alone, CME and SRD, DRT and SRD were 35 (31.3%), 63 (56.3%), 11 (9.8%), and 3 (2.7%), respectively.1

Zhou and colleagues indicated that intraoperative intravitreal TA injections effectively prevented PV-DME development. This corresponds with existing literature, which reports that intravitreal TA inection at the end of vitrectomy may inhibit postoperative inflammation and macular edema. Additionally, intraoperative intravitreal TA injections can effectively inhibit inflammatory cytokine production, leukocytosis, and cell-junction protein phosphorylation.1

“In conclusion, PV-DME is a very common postoperative complication in patients with PDR. TA could prevent its formation,” Zhou and colleagues wrote. “Particular attention should be paid to patients with a thicker preoperative CRT and ILM peeling.”1

References

1. Zhou HT, Mei JH, Lin K, et al. Changes of diabetic macular edema post vitrectomy in patients with proliferative diabetic retinopathy. Int J Ophthalmol. 2025;18(5):868-875. Published 2025 May 18. doi:10.18240/ijo.2025.05.12

2. Haydinger CD, Ferreira LB, Williams KA, Smith JR. Mechanisms of macular edema. Front Med (Lausanne). 2023;10:1128811. Published 2023 Mar 7. doi:10.3389/fmed.2023.1128811