Acta Biomedica Scientia

INTRAVITREAL AUTOLOGOUS PLASMIN VS. TRIAMCINOLONE ACETONIDE FOR DIABETIC MACULAR EDEMA: A COMPARATIVE STUDY

Dr. Sheshadri Vishnu Mahajan1*, Dr. Bankar Mahima Suhas2, Dr. Devi Bharathi

Diabetic macular edema, intravitreal autologous plasmin, triamcinolone acetonide, central macular thickness.

The study aims to compare the efficacy and safety of intravitreal autologous plasmin (IAP) injections with triamcinolone acetonide (TA) injections in the treatment of diffuse diabetic macular edema (DME). The research evaluates improvements in central macular thickness (CMT), best-corrected visual acuity (BCVA), and intraocular pressure (IOP) over a six-month follow-up period. Methods: A prospective, comparative study was conducted at Swamy Vivekananda Institute of Medical Sciences, Tiruchengode, Tamil Nadu, India, and Indira Medical College and Hospitals, Chennai, Tamil Nadu, India, involving 100 patients with bilateral DME. Participants were randomly assigned to receive either intravitreal 4 mg TA injections or IAP injections, prepared using autologous blood-derived plasmin. Ophthalmic evaluations, including OCT, fluorescein angiography, Goldmann applanation tonometry, and BCVA assessment, were performed at baseline, 1 month, 3 months, and 6 months post-injection. Statistical analysis was conducted using SPSS software, with Wilcoxon ranksum tests applied for comparisons. A p-value ? 0.05 was considered statistically significant. Results: Both treatment groups demonstrated a significant reduction in CMT (P<0.05) and improvement in BCVA (P<0.05) at 1 month post-injection, followed by a gradual decline in efficacy over six months. The IAP group showed a more sustained reduction in CMT (P<0.05) at six months compared to the TA group, indicating a longer-lasting therapeutic effect. BCVA improvements were similar between the groups initially but showed greater preservation in the IAP group at six months. IOP was significantly elevated in the TA group at 3 and 6 months (P<0.05), whereas no significant changes in IOP were observed in the IAP group. Conclusion: Both intravitreal TA and IAP injections were effective in reducing CMT and improving BCVA in patients with diffuse DME. However, IAP provided a more sustained reduction in macular thickness and was associated with fewer adverse effects on IOP. The findings suggest that IAP may be a safer alternative to TA, particularly for patients at risk of steroid-induced IOP elevation. Further long-term studies are needed to evaluate the durability of these effects and the potential need for repeat injections