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Abstract
Purpose
To compare the effect of single intravitreal injection of triamcinolone acetonide and bevacizumab for the treatment of diabetic macular edema by optical coherence tomography (OCT) patterns.
Methods
We classified diabetic macular edema by three OCT patterns: Type 1, diffuse retinal thickening; Type 2, increased retinal thickness associated with the presence of intraretinal cystoid spaces (cystoid spaces with horizontal diameter ＞300 μ m); and Type 3, serous macular detachment. According to this classification, 84 eyes of 42 patients with bilateral diabetic macular edema by the same OCT pattern participated in this study. In each patient, one eye was treated with a single intravitreal injection of bevacizumab 1.25 mg/0.05 ml (IVBI group) and the other eye with a single intravitreal injection of 4 mg/0.1 ml triamcinolone (IVTI group). A comprehensive ophthalmic examination was performed at baseline and at one, three and six months after treatment. Main outcome measures included best corrected visual acuity (logMAR) and central macular thickness measured with OCT.
Results
In Type 1, central macular thickness (CMT) reduced significantly in the IVBI group at one month. In Type 2, mean BCVA and CMT improved significantly in the IVTA group at one and three months and in the IVBI group at one month following treatment. In Type 3, CMT reduced significantly in both groups at one, three and six months. However, BCVA did not significantly increase in either group at one, three or six months after treatment.
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Figure 1.
The classification of diabetic macular edema on optical coherent tomographic images. (A) Diffuse thickening of the retina with homogeneous optical reflectivity on the whole layer (Type 1). (B) Macular edema with cystoid lesion that shows increased lower refrectivity in the retinal layer (Type 2). (C) Subretinal fluid accumulation with foveolar detachment without vitreoretinal traction (Type 3).
Figure 2.
Mean visual acuity change on both groups in the type 1 DME after intravitreal injection DME=Diabetic macular edema; IVTI=Intravitreal triamcinolone acetonide injection group; IVBI=Intravitreal bevacizumab injection group.
Figure 3.
Mean visual acuitv change on both groups in the type 2 DME after intravitreal injection DME=Diabetic macular edema; IVTI=Intravitreal triamcinolone acetonide injection group; IVBI=Intravitreal bevacizumab injection group.
Figure 4.
Mean visual acuitv change on both groups in the type 3 DME after intravitreal injection DME=Diabetic macular edema; IVTI=Intravitreal triamcinolone acetonide injection group; IVBI=Intravitreal bevacizumab injection group.
Table 1.
Clinical characteristics of patients
| Characteristic |
Type 1 |
Type 2 |
Type 3 |
|||
|---|---|---|---|---|---|---|
| IVTI† | IVBI‡ | IVTI† | IVBI‡ | IVTI† | IVBI‡ | |
| Age(years) | | | | | | |
| Mean ± SD | 60.0±14.4 | 57.7±13.8 | 61.2±9.7 | |||
| Range | 33 to 77 | 28 to 76 | 34 to 71 | |||
| Number of patients | 11 | 12 | 8 | |||
| Men | 6 | 5 | 3 | |||
| Women | 5 | 7 | 5 | |||
| Number of eyes | 22 | 24 | 16 | |||
| DM duration (years) | 13.4±9.6 | 12.6±2.8 | 10.8±6.3 | |||
| History of PRP(eyes) | 8 | 14 | 8 | |||
| DR status | | | | | | |
| Severe NPDR: number (eyes) | 8 (16) | 6 (12) | 4 (8) | |||
| PDR: number (eyes) | 3 (6) | 6 (12) | 4 (8) | |||
| Cataract Operation history | | | | | | |
| Phakic (eyes) | 8 | 8 | 10 | 10 | 7 | 7 |
| Pseudophakic (eyes) | 3 | 3 | 2 | 2 | 1 | 1 |
Table 2.
Best corrected visual acuity preoperative and postoperative 1, 3 and 6 months
| Types of DME | Intravitreal injection | Pre-operative BCVA (LogMAR) | Postoperative (1 Month) | p-value | Postoperative (3 Month) | p-value | Postoperative (6 Month) | p-value |
|---|---|---|---|---|---|---|---|---|
| Type 1 | IVTI†1 | 0.36±0.19 | 0.33±0.18 | 0.590 | 0.34±0.22 | 0.798 | 0.35±0.31 | 0.502 |
| | IVBI‡ | 0.38±0.27 | 0.32±0.23 | 0.303 | 0.36±0.31 | 0.502 | 0.39±0.23 | 0.673 |
| Type 2 | IVTI† | 0.80±0.53 | 0.52±0.34 | 0.007 | 0.54±0.26 | 0.041 | 0.74±0.41 | 0.646 |
| | IVBI‡ | 0.77±0.53 | 0.53±0.43 | 0.005 | 0.58±0.38 | 0.332 | 0.72±0.49 | 0.859 |
| Type 3 | IVTI† | 0.91±0.33 | 0.76±0.22 | 0.172 | 0.87±0.34 | 0.518 | 0.83±0.30 | 0.144 |
| | IVBI‡ | 1.14±0.36 | 0.91±0.30 | 0.006 | 1.04±0.27 | 0.357 | 1.00±0.27 | 0.141 |
Table 3.
Mean foveal thickness preoperative and postoperative 1, 3 and 6 months
| Types of DME | Intravitreal injection | Pre-operative (μm) | Postoperative (1 Month) | p-value | Postoperative (3 Month) | p-value | Postoperative (6 Month) | p-value |
|---|---|---|---|---|---|---|---|---|
| Type 1 | IVTI† | 241±35 | 208±27 | 0.091 | 218±24 | 0.450 | 240±39 | 0.374 |
| | IVBI‡ | 248±39 | 212±50 | 0.047 | 236±29 | 0.150 | 261±39 | 0.625 |
| Type 2 | IVTI† | 447±81 | 243±76 | 0.002 | 361±67 | 0.003 | 421±78 | 0.221 |
| | IVBI‡ | 473±82 | 323±72 | 0.009 | 412±56 | 0.285 | 431±61 | 0.131 |
| Type 3 | IVTI† | 594±139 | 284±80 | 0.028 | 421±79 | 0.028 | 519±135 | 0.018 |
| | IVBI‡ | 555±96 | 276±42 | 0.012 | 469±96 | 0.025 | 483±67 | 0.028 |
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