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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.
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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).
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).
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).
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.
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.
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).
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 |
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