Effect of Intravitreal Triamcinolone Acetonide or Bevacizumab on Choroidal Thickness in Eyes With Diabetic Macular Edema

Abstract

Citation: Sonoda S, Sakamoto T, Yamashita T, et al. Effect of intravitreal triamcinolone acetonide or bevacizumab on choroidal thickness in eyes with diabetic macular edema. Invest Ophthalmol Vis Sci. 2014;55:3979-3985. PURPOSE.We evaluated the effect of intravitreal triamcinolone acetonide (IVTA) or intravitreal bevacizumab (IVB) on subfoveal choroidal thickness (SFCT) in eyes with diabetic macular edema (DME). METHODS.In this prospective, randomized, interventional comparative study, 51 DME eyes of 51 patients were randomized to receive either IVTA or IVB. The central macular thickness (CMT) and SFCT were determined by optical coherence tomography at 24 hours, 7 days, and 4, 8, and 12 weeks. The SFCT at 1500 and 3000 lm nasal or temporal to the central fovea also was measured. The values obtained before were compared to those obtained 12 weeks after the injections. RESULTS.The eyes were randomly assigned to the IVTA (25 eyes) and IVB (26 eyes) groups. The SFCT was reduced significantly in the IVTA group from 24 hours to 12 weeks. The average 6 SD of the SFCT expressed as the ratio to baseline thickness decreased to 94.8% 6 5.6% (P < 0.01) at 24 hours after IVTA and remained unchanged up to 12 weeks (91.8% 6 10.5%, P < 0.01, Wilcoxon signed-rank test). In the IVB group, no significant difference was found in the SFCT after IVB for 12 weeks. The CMT decreased significantly in both groups from 24 hours to 4 weeks; however, the decrease was not significant at 8 weeks or later in the IVB group.CONCLUSIONS. The decrease in choroidal thickness in eyes with DME after IVTA suggests that the choroidal pathology in diabetic retinopathy might be due to steroid-sensitive factors rather than vascular endothelial growth factor. (www.umin.ac.jp/ctr number, clinical trials number UMIN000009854.)

Effect of intravitreal dexamethasone implant on retinal and choroidal thickness in refractory diabetic macular oedema after multiple anti-VEGF injections

“…Other recent studies reported similar results showing that despite reduction of the DMO after intravitreal triamcinolone, significant improvement of vision was not achieved. 16 Because of the chronic nature of DMO in our study, eyes may have already sustained chronic and irreversible microstructural damage to photoreceptors, and this may have caused a limitation on the improvement of visual acuity. Perhaps, it may be more effective to perform IVD injection at an early stage before imposing burdens of multiple anti-VEGF injections on patients and it may lead to concurrent improvement of visual acuity along with morphological improvement of DMO before eyes sustain chronic damage to the photoreceptors in the macula.…”

“…21,22 Regarding the effect of specific treatment on subfoveal CT, a recent study showed that intravitreal triamcinolone injection caused significant reduction of subfoveal CT, whereas such reduction was not observed in those receiving intravitreal anti-VEGF injections. 16 However, another recent study by Yiu et al 23 showed significant decrease of subfoveal CT after multiple anti-VEGF injections. In their study, however, the decrease of subfoveal CT after anti-VEGF injection was not associated with either the number of injections, changes in BCVA, or CFT.…”

“…Previous treatment with multiple injections of anti-VEGF agents, before IVD, might have exerted potential influence on the measurement of CT, but the potential effect of anti-VEGF on subfoveal CT may be minimal in eyes with DMO, as shown in previous studies. 16 Also, as IVD's therapeutic effect may not last for the expected 6 months, patients may benefit from additional IVD injection at sometime around 4-5 months, but this was not investigated in our study. The definition of refractory DMO may vary among different studies and it is not a universal term.…”

“…[13][14][15] Recent studies have revealed mixed results of either increased or decreased CT relating to disease severity or response to treatments for DMO. 14,16 Although the clinical implication of changes in CT and its exact role in the pathophysiology of DMO remains undetermined, it would be clinically meaningful to study the changes of the choroid and evaluate the potential role of subfoveal CT as a biomarker for treatment response after IVD as many previous studies have implicated choroidal changes and its potential role in the pathophysiology of DMO. [17][18][19] Thus, we hypothesized that DMO resistant to repeated anti-VEGF therapy would show a favorable response to IVD and that the subfoveal CT in DMO would show meaningful changes in response to IVD treatment.…”

Corticosteroids for the Treatment of Diabetic Macular Edema

“…A randomized, prospective trial found that IVTA was associated with a sustained reduction of choroidal thickness in patients with DME; the choroidal thickness remained unchanged after IVB [69]. Color Doppler imaging of ocular hemodynamics after IVTA and IVB found that the end diastolic volume decreases in the ophthalmic artery and posterior ciliary arteries after IVTA while peak systolic velocity and end diastolic volume decrease significantly in the ophthalmic artery after IVB [70].…”