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Abstract
Purpose
To investigate the outcomes of the combined therapy of intravitreal bevacizumab (IVB) and posterior sutbtenon triam-conolone acetonide (STTA) injections as compared to single injections of each in patients with diabetic macular edema (DME).
Methods
IVB injection (IVB group), STTA injection (STTA group) and combined therapy injection (combined group) were performed randomly for 90 eyes (83 patients) diagnosed with DME. Changes in central macular thickness (CMT), best corrected visual acuity (BCVA) and intraocular pressure (IOP) were compared among groups prospectively at pre-injection and one, three and six months after injection.
Results
Reduction of CMT and improvement of BCVA were maintained for three months after treatment in all groups, but CMT and BCVA deteriorated at six months after treatment. The combined therapy group revealed significant reductions in CMT and improvement of BCVA (p=0.003, p=0.021, respectively) for the first month compared to the single treatment group. Elevated IOPs were found in three cases and there was no endophthalmitis or retinal detachment.
References
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Figure 1.
Changes in central macular thickness (CMT) after treatments in the three groups. Reduction of CMT was maintained at 3 months after injection in intravitreal bevacizumab (IVB) injection group, subtenon triamcinolone (STTA) injection group, and combined therapy group. CMT increased at 6 months after injection, but final CMT was still significantly lower than initial CMT. Combined therapy revealed significant reduction of CMT compared to other treatments at 1 month after treatment (* p=0.003). There was no difference among groups at 6 months after treatment († p=0.548).
Figure 2.
Changes in visual acuity (Va, LogMAR) after treatments in the three groups. Improvement of CMT was maintained at 3 months after injection in intravitreal bevacizumab (IVB) injection group, subtenon triamcinolone (STTA) injection group, and combined therapy group. Va became worse at 6 months after injections, but final Va was still significantly better than initial Va. Combined therapy revealed significant improvement of Va compared to other treatments at 1 month after treatment (* p= 0.021). There was no difference among groups at 6 months after treatment († p=0.139).
Figure 3.
Comparisons of changes in intraocular pressure (IOP) among groups at each period after treatments. There was no significant difference of changes in IOP among groups at each period.
Table 1.
Characteristics of subjects in three groups
| IVB (30 eyes) | STTA (30 eyes) | Combined (30 eyes) | p-value | |
|---|---|---|---|---|
| Age (years) | 61.6±10.0 | 61.3±10.6 | 58.6±11.1 | 0.463* |
| Gender (M / F) | 16 / 14 | 18 / 12 | 11 / 19 | |
| Hypertension | 8 | 11 | 13 | 0.180† |
| HbA1c (mg/dL) | 6.84±1.03 | 7.54±1.22 | 7.78±1.78 | 0.283* |
| Initial Va‡ | 0.91±0.26 | 0.83±0.32 | 0.94±0.35 | 0.381* |
| Initial CMT§ (μm) | 434.5±154.3 | 425.5±125.8 | 502.9±126.4 | 0.116* |
| Initial IOP∏ (mmHg) | 17.53±5.42 | 18.44±4.81 | 17.72±4.12 | 0.257* |
| IOP∏↑ (≥30 mmHg) | 2 | 0 | 1 | 0.474† |
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