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R. J. Lowe, S. E. Mansour; Comparison of Intravitreal Bevacizumab and Triamcinolone for the Treatment of Diabetic Macular Edema. Invest. Ophthalmol. Vis. Sci. 2008;49(13):1564.
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Few studies have compared the efficacy of intravitreal bevacizumab (IVB) to intravitreal triamcinolone (IVT) in the treatment of diabetic macular edema (DME). The aim of this study was to compare change in central macular thickness (CMT), Snellen best-corrected visual acuity (BCVA) and intraocular pressure (IOP) between eyes who have received IVB or IVT for DME.
A retrospective analysis of 26 eyes (22 patients) receiving IVB and 15 eyes (12 patients) receiving IVT from an academic medical center and affiliated private clinics from January 1, 2006 to October 31, 2007 was performed. Patients with DME were included if they had not received any previous intravitreal injections of the examined drug. BCVA, IOP and CMT obtained by optical coherence tomography (OCT) were measured at time of injection and at subsequent follow-ups. BCVA was converted to logMAR visual acuity (VA) scale. Variables and their change from time of injection to follow-up were statistically compared between the IVB and IVT groups using a paired student’s t-test.
Patient demographics included 40% male, 60% female and an average age of 60.5 ± 11.8 years in the IVB group. The IVT group had 60% male, 40% female and an average age of 59.9 ± 7.3 years. Patients with nonproliferative diabetic retinopathy (DR) at the time of injection in the IVB and IVT groups were 50% and 73%, respectively. Patients with proliferative DR at the time of injection in the IVB and IVT groups were 50% and 27%, respectively. Follow-up time for the IVB and IVT groups were 40 ± 19 days and 47 ± 18 days (p ≤ 0.24), respectively. Pre and post CMT for the IVB group were 320 ± 130 µm and 298 ± 108 µm (p ≤ 0.52), respectively (mean change in CMT = -32 ± 56 µm). Pre and post CMT for the IVT group were 449 ± 149 µm and 278 ± 66 µm (p ≤ 0.0003), respectively (mean change in CMT = -170 ± 141 µm). Comparison of the IVB mean CMT change vs IVT was statistically significant (p ≤ 0.00013). Pre and post logMAR VA for the IVB group were 0.69 ± 0.47 and 0.69 ± 0.58 (p ≤ 0.99), respectively (mean change in logMAR VA = 0.00 ± 0.63). Pre and post logMAR VA for the IVT group were 0.54 ± 0.28 and 0.50 ± 0.29 (p ≤ 0.72), respectively (mean change in logMAR VA = -0.04 ± 0.21). Mean changes in IOP were -0.11 ± 3.7 mmHg (IVB) and +1.9 ± 2.7 mmHg (IVT). Comparisons of the mean logMAR VA and IOP change between the IVB and IVT groups were not statistically significant (p ≤ 0.81 and p ≤ 0.11, respectively).
The use of intravitreal triamcinolone may reduce central macular thickness to a greater extent than intravitreal bevacizumab. This may occur despite a lack of a statistically significant change in the visual acuity.
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