Intravitreal Bevacizumab versus Combined Bevacizumab-Triamcinolone versus Macular Laser Photocoagulation in Diabetic Macular Edema

Faghihi, Hooshang; Roohipoor, Ramak; Mohammadi, Saeed; Hojat-Jalali, K.; Mirshahi, Ahmad; Lashay, Alireza; Piri, Niloofar; Faghihi, Shahin

doi:10.1177/112067210801800614

Cited by 89 publications

(74 citation statements)

References 52 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…No difference in visual acuity or macular thickness after treatment between single IVB and IVB combined with IVT was reported, and it was suggested that there is no additive effect on IVT over single bevacizumab [11,15,22,23]. In contrast, Faghihi et al [20] also compared single IVB with IVB/IVT in treatment-naïve eyes, like our study population, and they reported that a combination with IVT had a longer and greater effect on DME and may reduce the initial frequency of injections. In addition, Ahmadieh et al [14] compared 3 subsequent IVB injections and single IVB with IVT.…”

Section: Discussionmentioning

confidence: 99%

“…Fixed treatment guidelines for DME have not been determined, and the variable combination therapy of intravitreal drugs, such as anti-VEGF or corticosteroid with/without laser photocoagulation, were considered and were tried for the treatment of DME, dependent on the physician. However, comparative studies on DME were limited to analysis of the short-term effects [11,14,17,18,19,20]. …”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of Intravitreal Bevacizumab Alone or Combined with Triamcinolone versus Triamcinolone in Diabetic Macular Edema: A Randomized Clinical Trial

Lim

Lee

Shin³

2011

Ophthalmologica

View full text Add to dashboard Cite

Purpose: To compare the effect of an intravitreal injection of bevacizumab alone (IVB) or combined with triamcinolone (IVB/IVT) versus triamcinolone (IVT) in patients with diabetic macular edema (DME). Methods: In this randomized three-arm clinical trial, eligible eyes were assigned randomly to one of the three study arms: the IVB group, 2 injections of 1.25 mg of bevacizumab with 6-week intervals; the IVB/IVT group, 1.25 mg of IVB with 2 mg of IVT, and the IVT group, 2 mg of IVT. The clinical course of best-corrected visual acuity and central macular thickness by optical coherence tomography was monitored for up to 12 months after the initial injection. Results: One hundred eleven eyes of 105 patients with DME completed 12 months of follow-up. The IVB/IVT group and the IVT group showed better visual acuity and reduced central macular thickness at 6 weeks and 3 months, compared with the IVB group (p = 0.041, p = 0.02 at 6 weeks; p = 0.045, p = 0.043 at 3 months, respectively). However, no significant difference in visual acuity and central macular thickness was observed between the three groups at 12 months (p = 0.088, p = 0.132, respectively). The frequency of retreatment was lower in the IVB/IVT and IVT groups during the 12-month period (p < 0.001). No significant differences in visual acuity or central macular thickness were observed between the IVB/IVT and IVT groups during the follow-up. Conclusion: IVB/IVT and IVT showed more pronounced effects during the earlier postinjection period. However, levels of visual acuity or central macular thickness at 12 months were comparable in the three study groups. No beneficial effect of the combination injection was observed.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of Intravitreal Bevacizumab Alone or Combined with Triamcinolone versus Triamcinolone in Diabetic Macular Edema: A Randomized Clinical Trial

Lim

Lee

Shin³

2011

Ophthalmologica

View full text Add to dashboard Cite

show abstract

“…In a threearm randomised trial, bevacizumab was compared with combination bevacizumab/triamcinolone and macular laser photocoagulation. After 16 weeks of follow-up, combination therapy for these patients provided a longer period of BCVA and CMT improvement [104].…”

Section: Combination Therapymentioning

confidence: 99%

Diabetic macular oedema: pathophysiology, management challenges and treatment resistance

Bahrami

Zhu

Hong³

et al. 2016

Diabetologia

View full text Add to dashboard Cite

Diabetic macular oedema (DMO) is the leading cause of vision loss in patients living with diabetes. DMO results from hyperglycaemia-induced activation of pathways that lead to oxidative stress and release of cytokines, impairing the inner and outer blood-retinal barriers. Improved understanding of the pathophysiological mechanisms leading to DMO have led to the development of effective therapies, including vitreoretinal surgery, laser photocoagulation, intravitreal anti-vascular endothelial growth factor drugs and corticosteroids. Advances in imaging, including fluorescein angiography and optical coherence tomography, have also enhanced diagnosis and management of the condition. Despite these advances, there remain patients who do not respond completely to therapy, reflecting the complex pathophysiology of DMO. These patients may be considered treatment-resistant. In this review, we summarise the pathophysiology of DMO, as well as the available treatments and their mechanism of action. Additionally, we focus on treatment-resistant disease and review the literature on potential options for managing this complication of diabetes.

show abstract

“…[134][135][136][137] Ahmadieh et al 134 evaluated bevacizumab alone in comparison to bevacizumab and triamcinolone, and determined that there was no further improvement with the combination compared with bevacizumab alone. Sohelian et al 135,136 compared combination of 1.25 mg bevacizumab and 2 mg triamcinolone with bevacizumab alone and laser photocoagulation alone.…”

Section: Clinical Evidencementioning

confidence: 99%

A review of therapies for diabetic macular oedema and rationale for combination therapy

Amoaku

Saker

Stewart

2015

Eye

View full text Add to dashboard Cite

Diabetic macular oedema (DMO) is responsible for significant visual impairment in diabetic patients. The primary cause of DMO is fluid leakage resulting from increased vascular permeability through contributory anatomical and biochemical changes. These include endothelial cell (EC) death or dysfunction, pericyte loss or dysfunction, thickened basement membrane, loss or dysfunction of glial cells, and loss/change of EC Glycocalyx. The molecular changes include increased reactive oxygen species, pro-inflammatory changes: advanced glycation end products, intracellular adhesion molecule-1, Complement 5-9 deposition and cytokines, which result in increased paracellular permeability, tight junction disruption, and increased transcellular permeability. Laser photocoagulation has been the mainstay of treatment until recently when pharmacological treatments were introduced. The current treatments for DMO target reducing vascular leak in the macula once it has occurred, they do not attempt to treat the underlying pathology. These pharmacological treatments are aimed at antagonising vascular endothelial growth factor (VEGF) or non-VEGF inflammatory pathways, and include intravitreal injections of anti-VEGFs (ranibizumab, aflibercept or bevacizumab) or steroids (fluocinolone, dexamethasone or triamcinolone) as single therapies. The available evidence suggests that each individual treatment modality in DMO does not result in a completely dry macula in most cases. The ideal treatment for DMO should improve vision and improve morphological changes in the macular (eg, reduce macular oedema) for a significant duration, reduced adverse events, reduced treatment burden and costs, and be well tolerated by patients. This review evaluates the individual treatments available as monotherapies, and discusses the rationale and potential for combination therapy in DMO.

show abstract

Intravitreal Bevacizumab versus Combined Bevacizumab-Triamcinolone versus Macular Laser Photocoagulation in Diabetic Macular Edema

Cited by 89 publications

References 52 publications

Comparison of Intravitreal Bevacizumab Alone or Combined with Triamcinolone versus Triamcinolone in Diabetic Macular Edema: A Randomized Clinical Trial

Comparison of Intravitreal Bevacizumab Alone or Combined with Triamcinolone versus Triamcinolone in Diabetic Macular Edema: A Randomized Clinical Trial

Diabetic macular oedema: pathophysiology, management challenges and treatment resistance

A review of therapies for diabetic macular oedema and rationale for combination therapy

Contact Info

Product

Resources

About