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To evaluate the efficacy of the 4 mg triamcinolone acetonide injection into the vitreous in patients with diabetic macular edema not responding to the laser treatment after one-year follow-up.In a prospective study, 20 eyes with diffuse diabetic macular edema, not responding to the previous laser treatment were evaluated. The group consists of 20 patients; the mean age was 61.5 (29-76) years. The mean duration of diabetes was 14.5 (2-28) years. Twelve patients (60%) were treated by means of insulin, and eight patients (40%) by means of oral agents; the blood levels of glucose ranged between 3.2 - 22 mmol/L. In all patients, the treatment by means of intravitreal injection of triamcinolone started at least 3 months after the previous unsuccessful laser therapy of the macular region. Before the application, and at 1, 3, 6, 9 and 12 months after the application the visual acuity at the EDCRS optotypes was examined, the intraocular pressure was measured, the macula was examined by means of biomicroscopy, the photography of the fundus was performed by the funduscamera, and the macular thickness and its volume were measured by means of optic coherence tomography. The intravitreal injection of 4 mg of triamcinolone was performed on the outpatient's basis under aseptic circumstances at the operation theatre.The starting best-corrected visual acuity was 0.17 +/- 0.09 and after 12 months it improved to 0.22 +/- 0.14. During the 12 months follow-up period, the visual acuity improved in 11 eyes (55%), stabilized in 5 eyes (25%) and decreased in 4 eyes (20%). The improvement of the visual acuity was significant in all follow-up controls. In the first month p = 0.001, in the 12th month p = 0.038. The macular thickness decreased from the mean value 506.2 +/- 91.4 microm (range, 389 -719) in the beginning of the study, to the mean 362.4 +/- 92.6 microm (range, 211 - 569) after 12 months. During the follow-up period of twelve months, the macular thickness reduced in 18 eyes (90%), and increased in 2 eyes (10%). The decrease of the macular thickness is significant in all follow-up controls. In the 1st, 3rd, and 6th months, p0.0005, in the 9th and 12th months, p = 0.001. The correlation coefficient between the best-corrected visual acuity and the macular thickness is -0,467, and the probability (p= 0.038) is statistically significant. In 6 patients, the intravitreal injection of triamcinolone was repeated, and in one of them twice.The intravitreal injection of triamcinolone reduces the macular thickness and improves the visual acuity in patients with diabetic macular edema, in whom the laser treatment did not established the improvement. The best effectiveness is observed in the first three months after the application. After 12 months, we observed the reduction of the macular thickness in 90% of patients, and improvement of the visual acuity in 55% of patients. In some cases, it is necessary to repeat the application of triamcinolone to keep its effect.

The aim of the study was to evaluate the effect of the intravitreal administration of triamcinolon acetonide depending on patients' HbAlc and blood pressure levels. The presence of edema, its resorption, and the duration of the edema free macula during the follow-up period were evaluated.A total of 80 eyes of 68 patients with persistent diabetic macular edema after grid laser photocoagulation were included in the study. The follow-up period of each eye was 6 months. The group of patients was divided into four subgroups according to the blood pressure levels (up to 120/80 mm Hg, 120/80-140/90 mm Hg, 140/90-180/110 mm Hg, and higher than 180/110 mm Hg) and into two subgroups according to the HbA1c levels (up to 6% and above 6%). The dose of 4 mg (0.1 ml) of triamcinolon acetonide suspension (TRIAM INJEKT) was used in the standard transconjuctival intravitreal injection. The site of injection was located superotemporaly 4 mm behind the limbus.The cystoid edema resolved in all eyes treated in the study. The patients with excellent controlled blood pressure maintained the edema free macula during the whole follow-up period. The patients with poorly controlled blood pressure experienced recurrence of the edema during follow up period. The HbAlc level did not influence the effect of the intravitreal triamcinolon administration.The results achieved in the study allow us to identify more accurately the patients, who may profit from the intravitreal triamcinolone injection.

The treatment of CTS (carpal tunnel syndrome) with Kenalog 40 is reported in 184 hands. Its effect is evaluated 1 week, 1 and 3 mos after the first and the second injections, respectively. As stated in the wrist, the effect occurred well and rapidly, though being temporary. It lasted more than 3 mos in about 57% of cases. No expressed difference between injection effects was stated in both DML-normal-and-pathologic and SCT-related subjects. Another finding consisted in that there was no significant difference in effects between the first and the second injections in any of observance intervals in either normal or DML pathologic subjects. Authors recommend to repeat injections immediately in relapsing disorders. Of relatively high occurrence were both the normal EMG and DML findings in subjects with long-term SCT symptoms. The lesser number of patients (cases of muscular atrophy with serious EMG changes) is directly admitted to surgery. The majority of patients is treated well with injections, and surgery is presumed only when conservative treatment becomes inefficient.