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S. G. Prager, K. Kriechbaum, G. Mylonas, G. Rainer, U. Schmidt-Erfurth, DRRG - Diabetic Retinopathy Research Group Vienna; Comparison of Intravitreally Applied Bevacizumab and Triamcinolone on Diabetic Macular Edema. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4262.
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To investigate and compare retinal morphologic and functional changes following intravitreal injections of bevacizumab (Avastin®) or triamcinolone (Volon A®) in patients with clinically significant macular edema secondary to diabetes mellitus.
30 diabetic patients with clinically significant macular edema were included in this prospective, comparative interventional case series. The patients were randomized into two equal groups. One group (15 subjects) received three intravitreal injections of 2.5 mg bevacizumab at 1-month intervals. The other group (15 subjects) received one intravitreal injection of 8 mg triamcinolone, followed by two sham treatments at 1-month intervals. Functional and anatomic results were evaluated each month using ETDRS vision charts and optical coherence tomography (OCT). Reinjections after three months were performed based on OCT measurements of the central retinal thickness (CRT) and based on changes of best corrected visual acuity (BCVA).
Baseline findings were BCVA of 0,28 logarithm of the minimum angle of resolution (logMAR) and CRT of 480 µm in the Bevacizumab group, 0,31 logMAR and 490µm in the Triamcinolone group After the first injection BCVA improved to 0,23 logMAR and 0,22 logMAR respectively.and CRT decreased to 389 µm and 298 µm respectively. After 6 months BCVA changed to 0,21 logMAR and 0,28 logMAR respectively and CRT was 353 µm and 295 µm respectively. After a year BCVA still improved in the Bevacizumab group whereas a loss of BCVA could be observed in the Triamcinolone group. CRT could be maintained at a certain level after repeated injections.
Bevacizumab and Triamcinolone have beneficial effects on reducing CRT in clinically significant DME. However, regarding functional changes Bevacizumab is superior throughout the 12-month observation period. Repeated injections are essential to provide stability or improvement during the first year of DME therapy.
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