Suprachoroidal versus Intravitreal Triamcinolone Acetonide for the Treatment of Diabetic Macular Edema

Figures & data

Figure 1 Syringe used for suprachoroidal injection.

Figure 2 Injection of TA in the suprachoroidal space using a custom-made syringe.

Figure 3 UBM after SC injection in case no.8 in the 4mg SC group.

Table 1 Baseline Data

		Group I	Group II	Group III	Test Value	P-value	Sig.
Age	Mean±SD	57.67 ± 6.62	57.54 ± 6.33	60.25 ± 6.47	0.681•	0.513	NS
	Range	48–70	47–70	48–70
Gender	Male	4 (33.3%)	2 (15.4%)	2 (16.7%)	1.444*	0.486	NS
	Female	8 (66.7%)	11 (84.6%)	10 (83.3%)
Duration of DM	Mean±SD	14.00 ± 3.72	14.69 ± 6.66	14.00 ± 4.53	0.075•	0.927	NS
	Range	8–20	1–25	4–20
BCVA	Mean ± SD	0.59 ± 0.25	0.73 ± 0.28	0.67 ± 0.15	1.205•	0.310	NS
	Range	0.2–1.1	0.3–1.5	0.5–1
lens status	NSc	10 (66.7%)	7 (46.7%)	7 (46.7%)	7.250*	0.298	NS
	N I	0 (0.0%)	1 (6.7%)	2 (13.3%)
	N II	0 (0.0%)	1 (6.7%)	3 (20.0%)
	N III	0 (0.0%)	0 (0.0%)	0 (0.0%)
	N IV	0 (0.0%)	0 (0.0%)	0 (0.0%)
	Pseudophake	5 (33.3%)	6 (40.0%)	3 (20.0%)
	Aphake	0 (0.0%)	0 (0.0%)	0 (0.0%)
IOP	Mean ± SD	15.20 ± 2.24	16.73 ± 2.69	15.40 ± 2.59	1.652•	0.204	NS
	Range	12–19	12–20	12–19
CMT	Mean ± SD	443.33 ± 112.82	495.80 ± 143.23	425.73 ± 113.47	1.296•	0.284	NS
	Range	316–654	312–779	309–658

Notes: *Chi-square test •: One Way ANOVA test, p-value>0.05 is significant.

Abbreviations: BCVA, best-corrected visual acuity; IOP, intraocular pressure; CMT, central macular thickness; SD, standard deviation; DM, diabetes mellitus; NSc, nuclear sclerosis; NI, II, III, and IV, nuclear cataracts I, II, III, and IV; NS, non-significant.

Table 2 Comparison Between the 3 Groups Regarding BCVA Through the Follow-Up Period

BCVA		Group I	Group II	Group III	Test Value•	P-value	Sig.
1 week	Mean ± SD	0.59 ± 0.24	0.72 ± 0.29	0.66 ± 0.16	1.086	0.347	NS
	Range	0.2–1.1	0.3–1.5	0.4–1
1 month	Mean ± SD	0.54 ± 0.20	0.53 ± 0.26	0.57 ± 0.17	0.121	0.887	NS
	Range	0.3–1	0.2–1.2	0.3–0.8
3 months	Mean ± SD	0.50 ± 0.24	0.55 ± 0.28	0.54 ± 0.24	0.147	0.864	NS
	Range	0–1	0.2–1.2	0.2–1
6 months	Mean ± SD	0.59 ± 0.22	0.55 ± 0.40	0.65 ± 0.22	0.391	0.679	NS
	Range	0.3–1	0–1.4	0.4–1

Note: •: One Way ANOVA test, p-value>0.05 is significant.

Abbreviations: BCVA, best-corrected visual acuity; SD, standard deviation; NS, non-significant.

Table 3 Comparison Between the 3 Groups Regarding the Difference in BCVA from Presentation to 1, 3, and 6 Months

BCVA		Group I	Group II	Group III	Test Value^‡	P-value	Sig.
Difference from presentation to 1 month	Mean ± SD	−0.09 ± 0.09	−0.19 ± 0.10	−0.10 ± 0.09	7.396	0.025	S
	Range	−0.2–0.1	−0.3–0	−0.3–0
Difference from presentation to 3 months	Mean ± SD	−0.09 ± 0.12	−0.18 ± 0.11	−0.13 ± 0.14	3.542	0.170	NS
	Range	−0.3–0.1	−0.3–0	−0.4–0.2
Difference from presentation to 6 months	Mean ± SD	−0.01 ± 0.12	−0.14 ± 0.21	−0.02 ± 0.14	3.021	0.221	NS
	Range	−0.2–0.2	−0.6–0.1	−0.3–0.2

Note: ^‡Kruskal Wallis test.

Abbreviations: BCVA, best-corrected visual acuity; SD, standard deviation; NS, non-significant; S, significant.

Table 4 Follow-Up of BCVA in Each of the 3 Groups Throughout the Follow-Up Period

BCVA		At Presentation	1 Week	1 Month	3 Month	6 Month	Test Value*	P-value	Sig.
Group I	Mean±SD	0.59±0.25	0.59±0.24	0.54±0.20	0.50±0.24	0.59±0.22	5.978	0.006	HS
	Range	0.2–1.1	0.2–1.1	0.3–1	0–1	0.3–1
	P-value	–	1.00	0.004	0.012	1.00
Group II	Mean±SD	0.73 ± 0.28	0.72 ± 0.29	0.53 ± 0.26	0.55 ± 0.28	0.55 ± 0.40	11.324	0.001	HS
	Range	0.3–1.5	0.3–1.5	0.2–1.2	0.2–1.2	0–1.4
	P-value	–	1.00	0.0	0.002	0.401
Group III	Mean±SD	0.67±0.15	0.66±0.16	0.57±0.17	0.54±0.24	0.65±0.22	5.457	0.007	HS
	Range	0.5–1	0.4–1	0.3–0.8	0.2–1	0.4–1
	P-value	–	1.00	0.009	0.088	1.00

Note: *Repeated Measure ANOVA test.

Abbreviations: BCVA, best-corrected visual acuity; SD, standard deviation; HS, highly significant, p-value>0.05 is significant.

Figure 4 Chart showing the change of BCVA throughout the follow-up period in the 3 groups (logMAR).

Table 5 Comparison Between the 3 Groups Regarding CMT Through the Follow-Up Period

CMT		Group I	Group II	Group III	Test Value•	P-value	Sig.
1 month	Mean ± SD	294.00 ± 52.69	335.00 ± 82.62	344.71 ± 102.29	1.334	0.276	NS
	Range	206–410	231–524	230–571
3 months	Mean ± SD	401.80 ± 120.82	346.00 ± 86.88	376.47 ± 104.14	1.065	0.354	NS
	Range	293–655	236–559	210–561
6 months	Mean ± SD	474.36 ± 139.20	402.91±154.56	445.27 ± 134.01	0.785	0.464	NS
	Range	313–763	279–653	215–646

Note: •: One Way ANOVA test, p-value>0.05 is significant.

Abbreviations: CMT, central macular thickness; SD, standard deviation; NS, non-significant.

Table 6 Follow-Up of CMT Throughout the Follow-Up Period in the 3 Groups

		At Presentation	1 Month	3 Month	6 Month	Test Value	P-value	Sig.
Group I	Mean±SD	443.33±112.82	294.00±52.69	401.80±120.82	474.36±139.20	8.847•	0.000	HS
	Range	316–654	206–410	293–655	313–763
	P-value	–	0.005	0.691	1.00
Group II	Mean±SD	495.80±143.23	335.00±82.62	346.00±86.88	402.91±154.56	9.062•	0.001	HS
	Range	312–779	231–524	236–559	279–653
	P-value	–	0.008	0.013	0.714
Group III	Mean±SD	425.73±113.47	344.71±102.29	376.47±104.14	445.27±134.01	13.665•	0.000	HS
	Range	309–658	230–571	210–561	215–646
	P-value	–	0.001	0.345	0.991

Note: •: Repeated Measure ANOVA test.

Abbreviations: CMT, central macular thickness; SD, standard deviation; HS, highly significant.

Table 7 Comparison Between the 3 Groups Regarding the Difference in CMT from Presentation to 1, 3, and 6 Months

CMT		Group I	Group II	Group III	Test Value^‡	P-value	Sig.
Difference From presentation to 1 month	Mean ± SD	−147.33 ± 110.97	−160.80 ± 98.25	−65.64 ± 46.19	7.240	0.027	S
	Range	−370 – −15	−346 – −18	−179 – 3
Difference From presentation to 3 months	Mean ± SD	−41.53 ± 147.19	−149.80 ± 106.57	−49.27 ± 81.53	8.052	0.018	S
	Range	−309 – 316	−354 – −11	−244 – 29
Difference From presentation to 6 months	Mean ± SD	23.36 ± 115.32	−60.18 ± 117.09	19.53 ± 86.29	3.727	0.155	NS
	Range	−152 – 243	−283 – 131	−135 – 153

Note: ^‡Kruskal Wallis test.

Abbreviations: CMT, central macular thickness; SD, standard deviation; NS, non-significant; S, significant.

Figure 5 Radial OCT images of eye no.14 in group I ((A) At presentation, (B) 1 month after injection, (C) 3 months after injection, (D) 6 months after injection).

Figure 6 Radial OCT images of eye no.5 in group II ((A) At presentation, (B) 1 month after injection, (C) 3 months after injection, (D) 6 months after injection).

Figure 7 Radial OCT images of eye no.2 in group III ((A) At presentation, (B) 1 month after injection, (C) 3 months after injection, (D) 6 months after injection).

Figure 8 Chart showing the change of CMT throughout the follow-up period in the 3 groups (µm).

Table 8 Comparison Between the 3 Groups Regarding IOP Through the Follow-Up Period

IOP After Injection		Group I	Group II	Group III	Test Value•	P-value	Sig.
1 week	Mean ± SD	15.60 ± 2.13	17.40 ± 3.87	16.60 ± 2.06	1.540	0.226	NS
	Range	13–20	13–29	14–20
1 month	Mean ± SD	17.25 ± 3.25	18.67 ± 5.47	19.00 ± 3.23	0.620	0.543	NS
	Range	12–22	12–32	14–24
3 month	Mean ± SD	16.13 ± 2.47	18.47 ± 4.53	16.93 ± 1.98	2.068	0.139	NS
	Range	12–20	14–33	14–20
6 month	Mean ± SD	14.93 ± 1.54	16.00 ± 2.53	16.47 ± 2.00	2.178	0.128	NS
	Range	13–18	12–20	14–21

Note: •: Repeated Measure ANOVA test, p-value>0.05 is significant.

Abbreviations: IOP, intraocular pressure; SD, standard deviation; NS, non-significant.

Table 9 Follow-Up of IOP in Each of the 3 Groups Throughout the Follow-Up Period

IOP		At Presentation	1 Week	1 Month	3 Month	6 Month	Test Value•	P-value	Sig.
Group I	Mean±SD	15.20±2.24	15.60±2.13	17.25±3.25	16.13±2.47	14.93±1.54	2.502	0.116	NS
	Range	12–19	13–20	12–22	12–20	13–18
Group II	Mean±SD	16.73±2.69	17.40±3.87	18.67±5.47	18.47±4.53	16.00±2.53	1.175	0.333	NS
	Range	12–20	13–29	12–32	14–33	12–20
Group III	Mean±SD	15.40±2.59	16.60±2.06	19.00±3.23	16.93±1.98	16.47±2.00	6.623	0.003	HS
	Range	12–19	14–20	14–24	14–20	14–21
	P-value	–	0.218	0.041	0.660	1.00

Note: •: Repeated measure ANOVA test, p-value>0.05 is significant.

Abbreviations: IOP, intraocular pressure; SD, standard deviation; NS, non-significant; HS, highly significant.

Figure 9 Chart showing the change of IOP throughout the follow-up period in the 3 groups (mmHg).