Comparison of Intravitreal Bevacizumab Alone Injection and Intravitreal Combination Low-Dose Bevacizumab-Triamcinolone Injection or Diabetic Macular Edema

Byoung Seon Kim; In Young Chung; Jong Moon Park; Yong Seop Han

doi:10.3341/jkos.2014.55.8.1155

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Kim, Chung, Park, and Han: Comparison of Intravitreal Bevacizumab Alone Injection and Intravitreal Combination Low-Dose Bevacizumab-Triamcinolone Injection or Diabetic Macular Edema

Original Article

J Korean Ophthalmol Soc 2014;55(8):1155-1161.

Published online: 31 August 2014

DOI: https://doi.org/10.3341/jkos.2014.55.8.1155

Comparison of Intravitreal Bevacizumab Alone Injection and Intravitreal Combination Low-Dose Bevacizumab-Triamcinolone Injection or Diabetic Macular Edema

Byoung Seon Kim, MD¹, In Young Chung, MD, PhD^1,², Jong Moon Park, MD, PhD^1,², Yong Seop Han, MD, PhD^1,²

¹Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea

²Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea

Address reprint requests to Yong Seop Han, MD, PhD, Department of Ophthalmology, Gyeongsang National University Hospital, #79 Gangnam-ro, Jinju 660-702, Korea, Tel: 82-55-750-8864, Fax: 82-55-750-4158, E-mail: medcabin@hanmail.net

Received 26 October 2013 Revised 23 January 2014 Accepted 7 July 2014

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 report the effects and intraocular pressure results of intravitreal bevacizumab alone injection compared with intravitreal low-dose bevacizumab combined with low-dose triamcinolone injection in patients with diabetic macular edema.

Methods

In total, 40 eyes of 40 patients diagnosed with diabetic macular edema were evaluated. Of these, 20 eyes of 20 patients were injected with intravitreal bevacizumab (1.25 mg/0.05 mL) and 20 eyes of 20 patients were injected with low-dose bevacizumab (0.625 mg/0.025 mL) combined with low-dose triamcinolone (1 mg/0.025 mL). The best corrected visual acuity (BCVA), central macular thickness, and intraocular pressure of treated eyes were measured before injection and at 1 month, 2 months, and 3 months after injection.

Results

In both the intravitreal bevacizumab and the low-dose bevacizumab combined with low-dose triamcinolone groups, BCVA increased significantly at 1 month, 2 months, and 3 months after injection (p< 0.05). In addition, in both groups, neither intraocular pressure (IOP) nor central macular thickness increased significantly at 1 month, 2 months, or 3 months after injection (p > 0.05). The BCVA, IOP, and central macular thickness (CMT) at 1 month, 2 months, and 3 months after injection showed no significant differences between the intravitreal bevacizumab group and the low-dose bevacizumab combined with low-dose triamcinolone group (p > 0.05).

Conclusions

The BCVA of both groups increased significantly, and the CMT of both groups decreased significantly in patients with diabetic macular edema. The injection of low-dose intravitreal bevacizumab combined with low-dose intravitreal triamcinolone may be useful for the treatment of diabetic macular edema.

Keywords: Diabetic macular edema, Intravitreal bevacizumab injection, Intravitreal triamcinolone injection

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Figure 1.

Mean changes in best corrected visual acuity (BCVA) (log MAR) after injection. IVB = intravitreal bevacizumab injection; IVTA = intravitreal triamcinolone injection.

Figure 2.

Mean changes in intraocular pressure (IOP) (mm Hg) after injection. IVB = intravitreal bevacizumab injection; IVTA = intravitreal triamcinolone injection.

Figure 3.

Mean changes in central macular thickness (μm) after injection. CMT = central macular thickness; IVB = intravitreal bevacizumab injection; IVTA = intravitreal triamcinolone injection.

Table 1.

Characteristics of patients

Variable	IVB (n = 20)	IVB + IVTA (n = 20)
Age (years)	60.48 ± 8.25	62.82 ± 9.80
Sex
Male	12	11
Female	8	9
Lens
Phakic	12	10
Pseudophakic	8	10
Diabetic retinopathy
NPDR	7	6
PDR	13	14

Values are presented as mean ± SD.

IVB = intravitreal bevacizumab injection; IVTA = intravitreal triamcinolen injection; NPDR = non proliferative diabetic retinopathy; PDR = proliferative diabetic retinopathy.

Table 2.

Best corrected visual acuity (BCVA), IOP and central macular thickness before injection

	IVB (n = 20)	IVB + IVTA (n = 20)	p-value
BCVA (log MAR)	0.78 ± 0.14	0.81 ± 0.22	0.852
IOP (mm Hg)	17.05 ± 0.25	16.53 ± 0.58	0.695
Central macular thickness (μm)	565.28 ± 80.65	612.53 ± 100.52	0.652

Values are presented as mean ± SD.

IOP = intraocular pressure; IVB = intravitreal bevacizumab injection; IVTA = intravitreal triamcinolone injection.

Table 3.

Mean changes in best corrected visual acuity (BCVA), IOP and central macular thickness after injection

	Base line	1 month	2 months	3 months
IVB
BCVA (log MAR)	0.78 ± 0.14	0.59 ± 0.12	0.62 ± 0.08	0.67 ± 0.21
p-value		0.018	0.029	0.042
IOP (mm Hg)	17.05 ± 0.25	18.02 ± 0.38	18.58 ± 0.95	17.85 ± 0.85
p-value		0.525	0.625	0.453
CMT (μm)	565.28 ± 80.65	325.94 ± 110.35	351.20 ± 87.25	486.62 ± 50.25
p-value		0.011	0.027	0.039
IVB + IVTA
BCVA (log MAR)	0.81 ± 0.18	0.68 ± 0.08	0.72 ± 0.13	0.75 ± 0.18
p-value		0.025	0.052	0.253
IOP	16.53 ± 0.58	17.59 ± 0.59	18.28 ± 0.52	17.92 ± 0.82
p-value		0.538	0.632	0.423
CMT (μm)	612.53 ± 100.52	390.94 ± 98.35	423.50 ± 103.25	522.72 ± 80.27
p-value		0.022	0.039	0.042

Values are presented as mean ± SD.

IOP = intraocular pressure; CMT = central macular thickness; IVB = intravitreal bevacizumab injection; IVTA = intravitreal triamcinolone injection.

Table 4.

Mean changes in best corrected visual acuity (BCVA), IOP, central macular thickness (CMT) (?m) change after injection

	1 month	2 months	3 months
BCVA (log MAR)
IVB	0.59 ± 0.12	0.62 ± 0.08	0.67 ± 0.21
IVB + IVTA	0.68 ± 0.08	0.72 ± 0.13	0.75 ± 0.18
p-value	0.525	0.193	0.685
IOP (mm Hg)
IVB	18.02 ± 0.38	18.58 ± 0.95	17.85 ± 0.85
IVB + IVTA	17.59 ± 0.59	18.28 ± 0.52	17.92 ± 0.82
p-value	0.125	0.693	0.385
CMT change (μm)
IVB	239.34 ± 50.95	214.18 ± 87.50	78.67 ± 10.15
IVB + IVTA	247.59 ± 40.55	189.23 ± 20.50	89.81 ± 50.12
p-value	0.564	0.281	0.326

Values are presented as mean ± SD; CMT change (μm): central macular thickness of base line - central macular thickness after intravitreal injection.

IOP = intraocular pressure; IVB = intravitreal bevacizumab injection; IVTA = intravitreal triamcinolone injection.

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