Comparison of Intravitreal Bevacizumab versus Triamcinolone for the Treatment of Diffuse Diabetic Macular Edema

Abstract

Background: Our purpose was to compare the effect of triamcinolone and bevacizumab (Avastin) on the retinal thickness and functional outcome in patients with diabetic macular edema. Methods and Materials: A collective of 32 patients, who had been treated by a single 4.0-mg intravitreal triamcinolone injection (group 1), was matched to 32 patients (‘matched pairs’), who had received 3 injections of 1.25 mg of bevacizumab within 3 months in 4-week intervals (group 2). The outcome variables were changes in best corrected visual acuity (VA) and central retinal thickness 3 months after therapy. Results: Both groups did not differ regarding preoperative VA and central retinal thickness measured by optical coherence tomography. The baseline mean VA was 0.72 ± 0.39 logMAR in group 1 and 0.73 ± 0.39 logMAR in group 2 (p = 0.709). The mean central retinal thickness measured by optical coherence tomography was 548 ± 185 µm in group 1 and 507 ± 192 µm in group 2. While the patients in group 1 experienced a slight increase in VA of on average 0.7 lines following a single triamcinolone injection to a mean of 0.64 ± 0.40 logMAR (p = 0.066) after 3 months, the patients in group 2 showed almost no effect on VA with an average increase of 0.2 lines to a mean VA of 0.72 ± 0.30 logMAR (p = 0.948) following 3 intravitreal injections of bevacizumab. Comparing the effect on VA between both groups no statistically significant difference (p = 0.115) was noted. Concerning decrease in central retinal thickness both therapies were highly effective (p < 0.001 each), again, without statistically significant difference between the groups (p < 0.128). Conclusion: Our data suggest that a single triamcinolone injection may be as effective as a 3 times repeated intravitreal administration of bevacizumab for the treatment of diabetic macular edema. Further prospective trials should be performed.

On the relationship between visual acuity and central retinal (macular) thickness after interventions for macular oedema in diabetics: a review

“…A second level of scrutiny (generally removing case reports, in which the data were not presented in the way defined as suitable et cetera) reduced this further to a total of 140 cohorts reported in 121 different publications, of which only 88 were found to include a full set of data for the planned analyses comparing CMT to VA. The reasons for exclusion were generally because of an incomplete data set (for example, by just reporting percentage changes or the fraction of eyes with a certain range of changes in VA or CMT), leaving 43, nine, 18 and 17 data sets of information for the different interventions (Table ) with some publications yielding more than one set of data …”

Comparison of Intravitreal Bevacizumab Alone or Combined with Triamcinolone versus Triamcinolone in Diabetic Macular Edema: A Randomized Clinical Trial

“…Single IVT (4 mg) was reported to show a more rapid and greater effect, compared with single IVB [17,18], and it was reported that there was no difference between 3 subsequent IVB injections and single IVT (4 mg) on DME [19]. In this study, IVT (2 mg) with/without bevacizumab showed a more pronounced effect on visual acuity and reduction of macular edema, compared with twice IVB within the earlier period (6 weeks, 3 months), and the difference had disappeared at 6 and 12 months.…”

“…Fixed treatment guidelines for DME have not been determined, and the variable combination therapy of intravitreal drugs, such as anti-VEGF or corticosteroid with/without laser photocoagulation, were considered and were tried for the treatment of DME, dependent on the physician. However, comparative studies on DME were limited to analysis of the short-term effects [11,14,17,18,19,20]. …”

Comparison of a single intravitreal injection of bevacizumab versus triamcinolone acetonide as primary treatment for diffuse diabetic macular oedema

“…2009). The clinical effect of a single IVT is comparable to three injections of bevacizumab (Kreutzer et al. 2010).…”