Journal List > J Korean Ophthalmol Soc > v.50(8) > 1008332

Se, Jun, and Hyung: Comparison of Effects of Intravitreal Triamcinolone and Bevacizumab in the Treatment of Diabetic Macular Edema

Abstract

Purpose:

To compare the effect of an intravitreal injection of triamcinolone acetonide with bevacizumab in the treatment of diabetic macular edema (DME).

Methods:

For this study, the medical records of patients with diabetic macular edema, who received intravitreal triamcinolone injection (IVTA) or intravitreal bevacizumab injection (IVB), were reviewed. Best corrected visual acuity (BCVA), central macular thickness (CMT) and total macular volume (TMV) were evaluated before injection and at 1 week, 1 month, 2 months, 3 months, and 6 months after injection. The adverse events, such as increased intraocular pressure, and progression of cataract, were also reviewed.

Results:

A total of 72 eyes from 72 patients, (IVTA: 40 eyes, IVB: 32 eyes) were included in this study. In the IVTA group, BCVA improved significantly at 1 week after injection and was maintained until 3 months after injection. In the IVB group, BCVA improved significantly at 1 week after injection and was maintained until 2 months after injection. In the IVTA group, CMT and TMV decreased significantly at 1 week after injection and were maintained until 3 months after injection, while in the IVB group CMT and TMV were maintained until 2 months after injection. The IVTA group showed significantly better results in visual improvement, CMT and TMV reduction compared to the results of the IVB group, from 1 month to 3 months after injection. In the IVTA group, intraocular pressure increased to more than 25 mmHg in 12.5% of patients during the follow-up period.

Conclusions:

While the functional and anatomical improvements are achieved by both IVTA and IVB for diabetic macular edema, the effect of IVTA is more prominent with longer duration than IVB.

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Figure 1.
Change in best corrected visual acuity (BCVA, logMAR) after intravitreal bevacizumab (IVB) and tri-amcinolone injections (IVTA)at follow-up visits. denotes statistically significant change from baseline at each visit within group (p<0.05). ∗∗ denotes statistically significant difference between two groups at each follow-up visit (p<0.05).
jkos-50-1190f1.tif
Figure 2.
Change in central macular thickness (CMT, µm) after intravitreal bevacizumab (IVB) and triamcinolone injections (IVTA) at follow-up visits. denotes statistically significant change from baseline at each visit within group (p<0.05). ∗∗ denotes statistically sig-nificant difference between two groups at each follow− up visit (p<0.05).
jkos-50-1190f2.tif
Figure 3.
Change in total macular volume (TMV, mm3) after intravitreal bevacizumab (IVB) and triamcinolone injections (IVTA) at follow-up visits. denotes sta-tistically significant change from baseline at each visit within-group (p<0.05). ∗∗ denotes statistically signi-ficant difference between two groups at each follow-up visit (p<0.05).
jkos-50-1190f3.tif
Figure 4.
The proportion of patients losing (−3 lines ~-1 line), maintaining (−1 line~+1 line), or gaining (+1~+3) best corrected visual acuity (BCVA) at 3 months. indicates a statistically significant difference between the two groups.
jkos-50-1190f4.tif
Figure 5.
The proportion of patients losing (−3 lines ~-1 line), maintaining (−1 line~+1 line), or gaining (+1~+3) best corrected visual acuity (BCVA) at 6 months. There was no statistically significant difference between the two groups.
jkos-50-1190f5.tif
Figure 6.
Change in intraocular pressure (IOP, mm Hg) after intravitreal bevacizumab (IVB) and triamcinolone injections (IVTA) at follow-up visits. denotes statis-tically significant change from baseline at each visit within group (p<0.05). ∗∗ denotes statistically significant difference between the two groups at each visit (p<0.05).
jkos-50-1190f6.tif
Table 1.
Baseline characteristics
  IVTA group IVB group p value
Number of eyes 40 32  
Systemic      
  Age (years) 59.2 61.1 0.317
  Female (%) 37.5 40.6 0.215
  Duration of DM (years) 13.07 12.81 0.271
  HbA1c (%) 6.89 7.02 0.485
  Systolic BP (mmHg) 142 144 0.571
  Diastolic BP (mmHg) 92 88 0.436
Ocular      
  BCVA (logMAR) 0.64 0.67 0.512
  IOP (mmHg) 15.41 16.25 0.516
  CMT (µm) 500.86 484.06 0.183
Type of DME§     0.532
  Sponge 22 15  
  Cystoid 18 17  
  serous RD 0 0  

BCVA=best corrected visual acuity

IOP=intraocular pressure

CMT=central macular thickness

§ DME=diabetic macular edema

RD=retinal detachment.

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