Efficacy and Safety of Intravitreal Injection Ranibizumab versus Triamcinolone Acetonide in Diabetic Macular Oedema - A Prospective Randomized Study, Gorakhpur, Uttar Pradesh

Abstract

BACKGROUND Diabetic macular oedema is a sight threatening complication of diabetic retinopathy. Vascular endothelial growth factor (VEGF) plays an important role in developing diabetic macular oedema. There are many treatment options available for diabetic macular oedema such as laser therapy, intravitreal injectable medications like anti-VEGF and steroids. This study intends to compare the efficacy and safety of intravitreal injection Ranibizumab (anti-VEGF) and Triamcinolone acetonide (steroid) in diabetic macular oedema. METHODS This is a prospective randomized study conducted among 42 patients ≥ 18 years of age with diabetic macular oedema presenting to outpatient department in a tertiary care centre in Gorakhpur, UP, conducted from November 2019 – December 2020. 42 participating patients were divided into 2 groups, A and B with 21 patients in each group. Group A treated with intravitreal injection Ranibizumab (0.05 ml ; 0.50 mg) and group B treated with intravitreal injection Triamcinolone acetonide (4 mg in 0.1 ml). All patients were followed-up at 2 week and 4 week after injection for best corrected visual acuity, intraocular pressure, foveal and para-foveal thickness. Optical coherence tomography was performed for measuring foveal and para-foveal thickness. RESULTS The mean age group being 56.48 years in group A and 58.63 years in group B with 12 male and 9 female patients in group A and 10 male and 11 female patients in group B with no dropout during study period. Both injections were equally effective in reducing foveal and para-foveal thickness and improving best corrected visual acuity. Intraocular pressure (IOP) was stable in Ranibizumab treated group but Triamcinolone treated group showed raised IOP in few patients, required anti-glaucoma medications. CONCLUSIONS Both treatment types had good efficacy in reducing foveal and para-foveal thickness and thus improving best corrected visual acuity, but intravitreal Ranibizumab is safer and well tolerated along with good efficacy in patients with diabetic macular oedema. KEYWORDS Best Corrected Visual Acuity, Diabetic Macular Oedema, Foveal and Para-Foveal Thickness, Intravitreal Ranibizumab, Intravitreal Triamcinolone Acetonide