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”

  1. Randall Wong on March 6th, 2009 10:05 am

    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.

  2. Dr. Weitzner on March 6th, 2009 11:30 am

    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.

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