Intravitreal Bevacizumab versus Intravitreal Bevacizumab Combined with Posterior Subtenon Triamcinolone Acetonide for Diabetic Macular Edema

Jung Hyun Lee; Hee Young Chung; Kyung Min Lee; Young Sook Park; Joon Hong Sohn; Duck Jin Hwang

doi:10.3341/jkos.2016.57.12.1903

Journal List > J Korean Ophthalmol Soc > v.57(12) > 1010479

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Lee, Chung, Lee, Park, Sohn, and Hwang: Intravitreal Bevacizumab versus Intravitreal Bevacizumab Combined with Posterior Subtenon Triamcinolone Acetonide for Diabetic Macular Edema

Original Article

J Korean Ophthalmol Soc 2016;57(12):1903-1909.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.12.1903

Intravitreal Bevacizumab versus Intravitreal Bevacizumab Combined with Posterior Subtenon Triamcinolone Acetonide for Diabetic Macular Edema

Jung Hyun Lee, MD, Hee Young Chung, MD, Kyung Min Lee, MD, Young Sook Park, MD, Joon Hong Sohn, MD, Duck Jin Hwang, MD

Hangil Eye Hospital, Incheon, Korea

Address reprint requests to Duck Jin Hwang, MD Hangil Eye Hospital, #35 Bupyeong-daero, Bupyeong-gu, Incheon 21388, Korea Tel: 82-32-503-3322, Fax: 82-32-503-0801 E-mail: halleu7@naver.com

Received 4 May 2016 Revised 5 August 2016 Accepted 18 September 2016

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 investigate the outcome of intravitreal bevacizumab (IVB) combined with posterior subtenon triamcinolone acetonide injections compared to IVB injection alone in patients with diabetic macular edema (DME).

Methods

IVB injection (IVB group) and combination therapy injection (combination group) were administered to 35 eyes and 31 eyes, respectively, diagnosed with proliferative diabetic retinopathy combined with DME. Changes in best corrected visual acuity (BCVA), central macular thickness (CMT), total macular volume (TMV), amount of hard exudates and intraocular pressure (IOP) were compared retrospectively between groups prior to injection and 1, 2 and 3 months after injection.

Results

BCVA changes in both groups were only statistically significant at 4 weeks after injection. Reduction of CMT and TMV was maintained for 1 month after treatment in all groups, but CMT and TMV deteriorated 2 months after treatment. No significant differences in BCVA, CMT or TMV were detected between the IVB and combination groups. The amount of hard exudates were only significantly decreased at month 3 in the combination group whereas the amount of hard exudates was not significantly different at 3 months in the IVB group (at baseline 2,899 ± 2,314 pixels vs. at 3 months 2,536 ± 1,981 pixels, p-value = 0.041). IOP showed no significant difference between the groups. Elevated IOP or endophthalmitis were not observed.

Conclusions

In terms of BCVA improvement, subtenon triamcinolone provided no additional benefit on CMT and TMV reduction. However, combination therapy was effective in reducing the amount of hard exudates at 3 months.

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Keywords: Bevacizumab, Diabetic macular edema, Hard exudates, Triamcinolone

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Figure 1.

Measuring the amount of hard exudates with color fundus photography and the Photoshop program. The selected area by the magic wand tool is expressed in pixels by the histogram option.

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Figure 2.

Changes in parameters of both groups during the follow-up after injection. (A) Visual acuity. (B) Spectral domain optical coherence tomography (SD-OCT) measurements of central macular thickness. (C) SD-OCT measurements of total macular volume. (D) Intraocular pressure. IVB = intravitreal bevacizumab.

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Figure 3.

Changes in amount of hard exudates (in pixels) detected by fundus photography and the Photoshop program of both groups during the follow-up after injection. IVB = intravitreal bevacizumab.

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Table 1.

Basic characteristics according to treatment group

	IVB group	Combination group	p-value
Eyes	35	31
Age (years)	53.9 ± 9.1	51.7 ± 7.9	0.275^*
Male:Female	27:8	18:13	0.058^†
Right:Left	17:18	14:17	0.807^†
Duration of diabetes (years)	9.3 ± 7.2	7.11 ± 6.2	0.316^*
Hypertension (yes:no)	18:17	10:21	0.082^*
Visual acuity (log MAR)	0.40 ± 0.27	0.37 ± 0.19	0.091^*
Intraocular pressure (mm Hg)	17.5 ± 3.6	15.7 ± 3.7	0.124^*
Central macular thickness (μ m)	367.0 ± 113.6	415.9 ± 157.8	0.262^*
Total macular volume (mm³)	1.06 ± 0.08	1.19 ± 0.04	0.165^*
Amount of hard exudates (pixels)	2,394 ± 1,989	2899 ± 2,314	0.235^*

Values are presented as mean ± SD unless otherwise indicated. IVB group = intravitreal bevacizumab injections in diabetic macular edema; Combination group = combined therapy with intravitreal bevacizumab and subtenon triamcinolone acetonide injection in diabetic macular edema.

^* p-value of values et each follow-up period in intravitreal bevacizumab injection group and intravitreal bevacizumab combined with subtenon triamcinolone injection group, Mann-Whitney U-test

^† p-value of values et each follow-up period in intravitreal bevacizumab injection group and intravitreal bevacizumab combined with subtenon triamcinolone injection group, Pearson's chi-square test.

Table 2.

Treatment effect in each group

		IVB grou		Combination group
		Mean ± SD	p-value^*	Mean ± SD	p-value^†	p-value^‡
Visual acuity (log MAR)	At baseline	0.40 ± 0.27		0.37 ± 0.19		0.291
	1 month	0.34 ± 0.22	0.030	0.24 ± 0.22	0.024	0.124
	2 months	0.36 ± 0.23	0.916	0.25 ± 0.19	0.306	0.077
	3 months	0.39 ± 0.28	0.854	0.30 ± 0.21	0.285	0.153
Central macular thickness (μm)	At baseline	367.0 ± 113		415.9 ± 157		0.262
	1 month	265 ± 104	<0.001	302 ± 144	0.001	0.223
	2 months	337 ± 129	0.196	338 ± 194	0.066	0.982
	3 months	394 ± 130	0.410	454 ± 221	0.953	0.344
Total macular volume (mm³)	At baseline	1.06 ± 0.08		1.19 ± 0.04		0.165
	1 month	0.95 ± 0.09	0.003	1.04 ± 0.10	0.010	0.211
	2 months	0.93 ± 0.10	0.059	1.04 ± 0.12	0.068	0.351
	3 months	0.99 ± 0.14	0.790	1.15 ± 0.09	0.590	0.245
Amount of hard exudates (pixels)	At baseline	2,394 ± 1,989		2,899 ± 2,314		0.235
	1 month	2,400 ± 1,998	0.871	2,930 ± 2,015	0.865	0.278
	2 months	2,389 ± 1,994	0.899	2,837 ± 2,020	0.217	0.343
	3 months	2,379 ± 2,030	0.968	2,536 ± 1,981	0.041	0.608
Intraocular pressure (mm Hg)	At baseline	16.2 ± 3.5		15.3 ± 2.8		0.164
	1 month	16.3 ± 4.1	0.879	15.6 ± 3.2	0.812	0.491
	2 months	15.7 ± 3.9	0.535	15.6 ± 2.9	0.815	0.172
	3 months	16.5 ± 4.4	0.689	15.4 ± 3.3	0.977	0.173

^* p-value of values at each follow-up period comparing to baseline values in intravitreal bevacizumab injection group, Wilcoxon matched-pairs signed ranks test

^† p-value of values at each follow-up period comparing to baseline values in intravitreal bevacizumab combined with subtenon triamcinolone injection group, Wilcoxon matched-pairs signed ranks test

^‡ p-value of values et each follow-up period in intravitreal bevacizumab injection group and intravitreal bevacizumab combined with subtenon triamcinolone injection group, Mann-Whitney U-test.

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