Comparison of intravitreal bevacizumab, intravitreal triamcinolone acetonide, and macular grid augmentation in refractory diffuse diabetic macular edema: A prospective, randomized study

Abstract

Background:In spite of laser being the gold standard treatment for Diabetic Macular edema (DME), some patients do not respond to laser. Various treatment modalities are being tried in the management of refractory diffuse DME (DDME).Purpose:To compare the efficacy of intravitreal bevacizumab (IVB), intravitreal triamcinolone acetonide (IVTA), and macular grid augmentation in the management of refractory DDME.Settings and Design:Prospective randomized study in a tertiary eye care center.Materials and Methods:Sixty patients with refractory DDME were randomly assigned to three groups: Group 1 received IVB (1.25 mg/0.05 ml), Group 2 received IVTA (4 mg/0.1ml), and Group 3 underwent laser augmentation. Primary outcome measures were best corrected visual acuity (BCVA) and central macular thickness (CMT) at the end of 6 months.Statistics:Analysis was performed using SPSS 14.0Results:Group 1 and 2 showed significant improvement in mean BCVA from 20/160 at baseline to 20/80 and from 20/125 to 20/63, respectively, at 6 months (P < 0.05). These groups also showed a significant reduction in the mean CMT from 457 ± 151 μ at baseline to 316 ± 136 μ and from 394 ± 61 μ to 261 ± 85 μ, respectively, at 6 months (P < 0.05). Group 3 showed only small improvement in mean BCVA from 20/100 to 20/80 (P = 1.0) while mean CMT increased from 358 ± 89 μ at baseline to 395 ± 127 μ at 6 months (P = 0.191). Eight (40%) eyes in Group 2 had intraocular pressure (IOP) rise and 10 (50%) eyes developed cataract.Conclusions:Both IVB and IVTA may be effective in the treatment of refractory DDME compared with macular grid augmentation. IVTA may be associated with side effects such as IOP rise and cataract formation.

Management of Refractory Diabetic Macular Edema: A Review Article

“…Azad et al enrolled 60 patients with refractory DME into their prospective study. 48 They defined refractory DME as persistent DME with CMT>250 µm after at least 2 sessions of laser photocoagulation. Patients were randomized into 3 groups: group 1 included patients treated with 1.25 mg intravitreal bevacizumab, group 2 included patients treated with 4 mg intravitreal triamcinolone acetonide, and group 3 included patients who underwent macular laser photocoagulation.…”

Overview of Ocular Anti-Vascular Endothelial Growth Factor Therapy in the Management of Diabetic Eye Complications

“…In a similar randomized, prospective study ( 30 ) with 60 participants, 1.25 mg IVB injection, 4 mg IVTA, and macular grid augmentation treatments were compared with follow-up measurements at 1, 3, and 6 months. Results demonstrated clinical benefits and visual acuity improvements for both IVB and IVTA treatments.…”