Treatment of Diabetic Macular Edema: A Comparative Study

Yong Jun Lee; Kyung Seek Choi; Sung Jin Lee

doi:10.3341/jkos.2010.51.6.849

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Lee, Choi, and Lee: Treatment of Diabetic Macular Edema: A Comparative Study

Original Article

J Korean Ophthalmol Soc 2010;51(6):849-859.

Published online: 3 August 2010

DOI: https://doi.org/10.3341/jkos.2010.51.6.849

Treatment of Diabetic Macular Edema: A Comparative Study

Yong Jun Lee, MD, Kyung Seek Choi, MD, PhD, Sung Jin Lee, MD, PhD

Department of Ophthalmology, Soonchunhyang University College of Medicine, Seoul, Korea

Address reprint requests to Kyung Seek Choi, MD Department of Ophthalmology, Soonchunhyang University Hospital #657 Hannam-dong, Yongsan-gu, Seoul 140-743, Korea. TEL: 82-2-709-9354, FAX: 82-2-798-7797, E-mail: ckseek@hosp.sch.ac.kr

Received 18 January 2010 Accepted 23 March 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare the effect and complications of treatments for diabetic macular edema.

Methods

Literature review using the Korean medical database and the Korean Ophthalmological Society database was performed. Studies used consisted of patients with diabetic macular edema, comparing intravitreal triamcinolone acetonide (IVTA) injection with posterior subtenon triamcinolone acetonide (STTA) injection or intravitreal bevacizumab (IVB) injection, according to visual acuity (VA) outcomes, central macular thickness (CMT), and intraocular pressure (IOP) at 1, 3, and 6 months.

Results

I n the three studies comparing IVTA injection with STTA injection, IVTA injection demonstrated greater improvement in VA at 1 month and CMT at 6 months. The patients who received IVTA injection had significantly higher IOP at 3 months. In the three studies comparing IVTA injection with IVB injection, IVTA injection demonstrated greater improvement in VA at 3 months and CMT at 6 months.

Conclusions

The functional and anatomical improvements are achieved by IVTA injection, STTA injection, and IVB injection for diabetic macular edema, and the effect of IVTA injection is more prominent than other injection types with longer duration.

Keywords: Diabetic macular edema, Intravitreal injection, Posterior subtenon injection, Triamcinolone acetonide, Bevacizumab

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Figure 1.

Diagram showing the pooled summary estimates of visual acuity (logarithm of the minimum angle of resolution units). IVTA=intravitreal triamcinolone acetonide injection; STTA=sub-tenon’s triamcinolone acetonide injection; CI=confidence interval; Chi²=chi-square statistic; df=degrees of freedom; P=p value; I²=I-square heterogeneity statistic; Z=Z-statistic.

Figure 2.

Diagram showing the pooled summary estimates of central macular thickness (micrometers). IVTA=intravitreal triamcinolone acetonide injection; STTA=sub-tenon’s triamcinolone acetonide injection; CI=confidence interval; Chi²=chi-square statistic; df=degrees of freedom; P=p value; I²=I-square heterogeneity statistic; Z=Z-statistic.

Figure 3.

Diagram showing the pooled summary estimates of intraocular pressure (millimeters of mercury). IVTA= intravitreal triamcinolone acetonide injection; STTA=sub-tenon’s triamcinolone acetonide injection; CI=confidence interval; Chi²=chi-square statistic; df=degrees of freedom; P=p value; I²=I-square heterogeneity statistic; Z=Z-statistic.

Figure 4.

Diagram showing the pooled summary estimates of visual acuity (logarithm of the minimum angle of resolution units). IVTA=intravitreal triamcinolone acetonide injection; IVB=intravitreal bevacizumab injection; CI=confidence interval; Chi²=chi-square statistic; df=degrees of freedom; P=p value; I²=I-square heterogeneity statistic; Z=Z-statistic.

Figure 5.

Diagram showing the pooled summary estimates of central macular thickness (micrometers). IVTA=intravitreal triamcinolone acetonide injection; IVB=intravitreal bevacizumab injection; CI=confidence interval; Chi²= chi-square statistic; df=degrees of freedom; P=p value; I²=I-square heterogeneity statistic; Z=Z-statistic.

Figure 6.

Diagram showing the pooled summary estimates of intraocular pressure (millimeters of mercury). IVTA= intravitreal triamcinolone acetonide injection; IVB=intravitreal bevacizumab injection; CI=confidence interval; Chi²=chi-square statistic; df=degrees of freedom; P=p value; I²=I-square heterogeneity statistic; Z=Z-statistic.

Table 1.

Characteristics of the 7 included studies

Author (year)	Exposure	Dose	Patient (n)	Eye (n)	Mean age (years)	Sex (%, male)
Choi et al (2006)¹⁴	IVTA^*	4 mg	60	30	60.7	33.3%
	STTA^†	40 mg		30
Hwang et al (2007)¹⁸	IVTA	4 mg	29	15	59.6	65.5%
	IVTA+STTA	4 mg+20 mg		14
Kwon et al (2008)¹⁵	IVTA	4 mg	43	24	58.9	41.9%
	STTA	40 mg		26
Chang et al (2008)¹⁹	IVTA	4 mg	69	45	57.0	50%
	IVTA+IVB^‡	2 mg+1.25 mg		24
Lee et al (2009)¹⁶	IVTA	4 mg	51	28	61.4	47.1%
	IVB	1.25 mg		23
Oh et al (2009)¹⁷	IVTA	4 mg	72	40	60.1	61.1%
	IVB	1.25 mg		32
Kim et al (2009)¹³	IVTA	4 mg	113	30	60.5	54%
	STTA	40 mg		30
	IVB	1.25 mg		30
	IVB+STTA	1.25 mg+40 mg		30

^* IVTA=intravitreal triamcinolone acetonide injection;

^† STTA=sub-tenon’s triamcinolone acetonide injection;

^‡ IVB=intravitreal bevacizumab injection.

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