La progressione della retinopatia diabetica, e in particolar modo la comparsa di neovascolarizzazione retinica del disco o periferica, può portare a un’importante e significativa riduzione della funzionalità visiva, conseguenza di complicanze emorragiche e/o retiniche.
Studi multicentrici randomizzati hanno evidenziato come il controllo metabolico e glicemico riduca il rischio d’insorgenza di retinopatia proliferativa.
Inoltre, “Early Treatement Diabetic Retinopathy Study” ha dimostrato che il trattamento laser panfotocoagulativo riduce significativamente il rischio di perdita visiva negli occhi sottoposti a terapia.
Scopo dello studio è eseguire una valutazione in termini di progressione della retinopatia diabetica, comparando il trattamento con triamcinolone intravitreale rispetto alla terapia laser focale/griglia.
Sono stati esaminati 840 occhi di 693 pazienti inclusi nello studio a ricevere in modo randomizzato, terapia laser, 1-mg o 4-mg di triamcinolone intravitreale. La probabilità di progressione della retinopatia a 2 anni di follow-up è del 31% (gruppo laser), 29% (1-mg triamcinolone) e 21% (4-mg triamcinolone).
Allo stato attuale tale evidenza, considerata anche alla luce delle più frequenti complicanze steroidi-correlate (cataratta e ipertensione oculare), necessita di ulteriori studi.


Archives of Ophthalmology Exploratory analysis of diabetic retinopathy progression through 3 years in a randomized clinical trial that compares intravitreal triamcinolone acetonide with focal/grid photocoagulation

Bressler NM, Edwards AR, Beck RW, Flaxel CJ, et al.

Archives of Ophthalmology
2009;127:1566-1571.


Objective To compare the effect of intravitreal triamcinolone acetonide with focal/grid photocoagulation on the progression of diabetic retinopathy.

Methods We performed an exploratory analysis of participants with diabetic macular edema randomly assigned to receive laser therapy or intravitreal triamcinolone acetonide (1 or 4 mg). Fundus photographs were obtained at baseline and 1, 2, and 3 years. The main outcome measure was progression to proliferative diabetic retinopathy or worsening of 2 or more severity levels on reading-center masked assessment of 7-field fundus photographs, plus additional eyes that received panretinal photocoagulation or had a vitreous hemorrhage.

Results From July 15, 2004, through May 5, 2006, 840 eyes from 693 participants were enrolled in the study and randomly assigned to receive laser therapy (n = 330), 1 mg of triamcinolone acetonide (n = 256), or 4 mg of triamcinolone acetonide (n = 254). The cumulative probability of progression of retinopathy at 2 years was 31% (laser group), 29% (1-mg group), and 21% (4-mg group) (P = .64 in the 1-mg group and .005 in the 4-mg group compared with the laser group). These differences appeared to be sustained at 3 years.

Conclusions Intravitreal triamcinolone acetonide (4 mg) appeared to reduce the risk of progression of diabetic retinopathy. Given the exploratory nature of this analysis and because intravitreal triamcinolone adverse effects include cataract formation and glaucoma, use of this treatment merely to reduce the rates of progression of proliferative diabetic retinopathy or worsening of the level of diabetic retinopathy does not seem warranted at this time.