Intravitreal bevacizumab vs intravitreal triamcinolone combined with macular laser grid for diffuse diabetic macular oedema

Abstract

Objective To evaluate the 12-month clinical outcome of patients with persistent nonischaemic diffuse diabetic macular oedema (DME) treated with intravitreal bevacizumab (IVB) or with intravitreal injection of triamcinolone combined with macular laser grid (IVTA-MLG) from September 2005 to February 2008. Methods Retrospective interventional comparative study. Best-corrected visual acuity (BCVA, ETDRS LogMAR scale) and foveal thickness (FT) at optical coherence tomography (OCT) were obtained at baseline and during 12 months after first treatment. Re-treatment was based on clinical or OCT-based evidence of persistent macular oedema or deterioration in visual acuity. Results Forty-three eyes (32 patients) with DME were treated with IVB. Ninety-six eyes (52 patients) with DME were treated with combined laser grid treatment and intravitreal triamcinolone. At baseline, mean BCVA and FT were 0.92 ± 0.34 LogMAR and 372 ± 22 lm in the IVTA-MLG group, and 1.07 ± 0.49 LogMAR and 423 ± 33 lm in the IVB group, respectively. At 1-and 3-month visits, BCVA and FT had significantly improved in both groups. After 6 and 12 months, the IVB group experienced a statistically significant improvement in visual acuity (0.83±0.21 LogMAR, Po0.001 at 6 months; BCVA 0.86 ± 0.24 LogMAR, Po0.001 at 12 months) and FT (248 ± 18 lm, Po0.001 at 6 months; 262 ± 28 lm, P ¼ 0.001 at 12 months) when compared with baseline, whereas the IVTA-MLG group did not show statistically significant improvement in vision and FT. An increase in intraocular pressure (IOP) was present in 10 of 96 (10.4%) eyes treated with IVTA-MLG, and in two cases it was resistant to topical treatment. No significant side effects were reported in the IVB group. Conclusions At 6 and 12 months after first treatment for chronic DME IVB provided significant improvement of BCVA and FT, whereas improvement after IVTA-MLG was not significant. Increased IOP occurred in 10.4% of patients who received IVTA, with two patients requiring trabeculectomy.

The effect of intravitreal bevacizumab on ocular blood flow in diabetic retinopathy and branch retinal vein occlusion as measured by laser speckle flowgraphy

“…Our study, in which we analyzed the results of only a single injection, broadly agrees with existing reports showing that IVB leads to a significant improvement in FT and BCVA in patients with BRVOME 5,9. Some earlier papers also found a similar improvement in patients with DME,28–30 but our study contradicts such findings. The exact reason for this discrepancy is unclear, but it may be related to differences in injection times and follow-up periods, pre-IVB BCVA, differences in the demographics of the DME patients, or the small number of participants in this study.…”

Comparison between Intravitreal Triamcinolone with Grid Laser Photocoagulation versus Bevacizumab with Grid Laser Photocoagulation Combinations for Branch Retinal Vein Occlusion

“…The combination of IVT injection with GLP and the combination of intravitreal bevacizumab (IVB) injection with GLP have been proposed and have obtained positive outcomes [16, 17]. In the literature the efficacy of IVB monotherapy versus IVT combination with GLP in the treatment of diffuse diabetic macular edema was studied [18]. However, a literature search (from PubMed and MEDLINE search) revealed that there was no study that compared the combinations of IVT with GLP and IVB with GLP for the treatment of ME secondary to BRVO.…”

Macular Laser Grid Alone Versus Combined With Intravitreal Triamcinolone Plus Bevacizumab for Diabetic Macular Edema

“…[27][28][29] The most frequent adverse effects with corticosteroids are cataract formation and elevation of IOP. 20,30 No side effects (cataract or increase in IOP) were recorded in the MLG group, whereas cataract formation and intraocular pressure increase (> 21 mm Hg) was reported in 13.3 % of eyes treated with MLG + IVTA + IVB group. Several retrospective studies support the local and systemic safety of intravitreal anti-VEGF 12,31 .…”