Comparing intravitreal triamcinolone acetonide and bevacizumab injections for the treatment of diabetic macular oedema: a randomized double‐blind study

Abstract

ABSTRACT.Purpose: To compare the effect of a single intravitreal injection of triamcinolone acetonide and bevacizumab in reducing macular thickness, which was measured by optical coherence tomography (OCT) in patients with diabetic macular oedema (DMO). Methods: The patients received a single intravitreal injection of 1.25 mg bevacizumab in one randomly selected eye and 4.0 mg triamcinolone acetonide in the contralateral eye. Central foveal thickness measurement (CFT) with OCT was taken at the initial visit and at the 4-week, 12-week and 24-week visits. Results: Eleven patients (22 eyes) were enrolled and statistically analysed. CFT reduced in the eyes treated with triamcinolone and those treated with bevacizumab in weeks 4 and 12 (p < 0.05). At the 24-week follow-up, no significant difference was noted, relative to the initial visit. Comparing the two groups treated with different drugs, a statistically significant difference in CFT in weeks 4 and 12 was noted, with a more significant reduction in triamcinolone-treated eyes (p < 0.05). Regarding visual acuity (VA), patients treated with triamcinolone had improvement in VA at 4-week (p = 0.02) and 12-week follow-up (p = 0.01), while the group treated with bevacizumab had VA improvement at 4 -week follow-up (p = 0.02). Among the eyes treated with triamcinolone, intraocular pressure (IOP) measurement of more than 21 mmHg was found in three eyes (27.3%). Conclusions: Intravitreal triamcinolone proved to be more efficient in reducing DMO, providing longer lasting visual improvement, relative to bevacizumab. Eyes treated with triamcinolone had the highest percentage increase in IOP. Further studies are needed to corroborate these findings.

On the relationship between visual acuity and central retinal (macular) thickness after interventions for macular oedema in diabetics: a review

“…A second level of scrutiny (generally removing case reports, in which the data were not presented in the way defined as suitable et cetera) reduced this further to a total of 140 cohorts reported in 121 different publications, of which only 88 were found to include a full set of data for the planned analyses comparing CMT to VA. The reasons for exclusion were generally because of an incomplete data set (for example, by just reporting percentage changes or the fraction of eyes with a certain range of changes in VA or CMT), leaving 43, nine, 18 and 17 data sets of information for the different interventions (Table ) with some publications yielding more than one set of data …”

“…Specific statements on the use of time‐domain optical coherence tomography method were provided for 76 per cent of the data sets . CMT: central macular thickness.…”

Effectiveness and Safety of Intravitreal Dexamethasone Implant (Ozurdex) in Patients with Diabetic Macular Edema: A Real-World Experience

“…On the other hand, the best treatment sequence and the optimal frequency of administration of these agents remain matters of debate, possibly reflecting increased knowledge about the role of inflammation in the pathophysiology of DME [25], as well as the paucity of direct head-to-head comparisons between VEGF inhibitors and intravitreal corticosteroids [9, 26, 27]. Likewise, no reliable tools are available that allow for optimal patient selection in clinical practice, with response to therapy still considered as the best guide to continued use of a given agent [28].…”

Clinical trials on corticosteroids for diabetic macular edema

“…The therapeutic effect is typically seen within 1 wk and the duration of the effect increased with increasing dosage. However, in many patients re-injections are needed every three to six months as the effect diminishes [18,19,42,44,[53][54][55][56][57] . The Diabetic Retinopathy Clinical Research Network (DRCR) compared 2 doses of IVTA as monotherapy to focal/grid laser photocoagulation in 840 eyes with DME.…”