Prophylactic Kenalog at Phaco for Diabetic Macular Edema
March 3, 2009
I came across this article that discusses diabetic macular edema after phaco. Lately, I have been injecting Kenalog after I finish my phaco in patients with diabetic maculopathy who I have treated with laser. Nothing is more frustrating than loss of vision due to worsening CSME after phaco. I have to figure the benefits far outweigh the risks. For sure, I inject those patients who I couldn’t treat or treat adequately pre-op due to the cataract, as those patients will surely deteriorate. But again, even in stable dry maculas, I am injecting. For patients with BDR without any edema, I am not injecting.
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2 Responses to “Prophylactic Kenalog at Phaco for Diabetic Macular Edema”
thanks dr wong for your input.
of course, i appreciate the risks of kenalog. i just feel that the benefits outweigh it. no question that control of edema pre-op is ideal. as you probably know, there was a good article that demonstrated that focal gives beter long term control c/w kenalog which gave better short-term. so in my hands, i like to do focal first, then if there is little/insufficient rersponse, do kenalog, then follow up with more focal as the edema subsides from the kenalog. i never do kenaolg alone, as per the article.
and again, at phaco, if the macula received any focal, i inject kenaolg. i dont do kenaolg at phaco on virgin bdr eyes, unless, of course, focal was precluded from the cataract.
I work in the same group as a high volume cataract surgeon. I agree with your treatment. We usually try intravitreal injections of Kenalog in the less compliant patients with macular edema that is not amenable to focal laser. In general, I think most retina people would still prefer control of the macular edema before cataract surgery. Kenalog also may tend to have some funky late affects with IOP down the road.
