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M. Shimura, T. Nakazawa, K. Yasuda, T. Shiono, T. Iida, T. Sakamoto, K. Nishida; Comparative Therapy Evaluation of Intravitreal Bevacizumab and Triamcinolone Acetonide on Persistent Diffuse Diabetic Macular Edema. Invest. Ophthalmol. Vis. Sci. 2008;49(13):3513. doi: https://doi.org/.
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To compare the effect of intravitreal injection of bevacizumab, an anti-VEGF antibody, with that of triamcinolone acetonide (TA), a corticosteroid for reduction of diabetic macular edema (DME)
Prospective, comparative interventional case series. Twenty-eight eyes of 14 patients with bilateral DME participated in this study. In each patient, one eye received intravitreal injection of 4 mg TA and the other eye received 1.25 mg bevacizumab. The clinical course of best corrected visual acuity (VA) with logMAR chart and averaged foveal thickness (FT) using optical coherence tomography was monitored for up to 24 weeks after the injection. The procedures conformed to the tenets of the Declaration of Helsinki.
Before the injection, FT and VA were 522.3 ± 91.3 µm and 0.64 ± 0.28 in the TA-injected eye, and 527.6 ± 78.8 µm and 0.61 ± 0.18 in the bevacizumab-injected eye, respectively; there was no significant difference between the eyes. One week after the injection, both eyes showed significant regression of macular edema. The TA-injected eye (342.6 ± 85.5 µm and 0.33 ± 0.21) showed significantly better results than the bevacizumab-injected eye (397.6 ± 103.0 µm and 0.37 ± 0.17). However, both eyes showed the recurrence of macular edema with time, even at 24 weeks. TA (410.4 ± 82.4 µm and 0.47 ± 0.25) kept better results than bevacizumab (501.6 ± 92.5 µm and 0.61 ± 0.17).
With the generally used-concentration, intravitreal injection of TA brought better results of reducing DME than that of bevacizumab, suggesting that the pathogenesis of DME is not only due to VEGF-dependency, but is also due to corticosteroid-dependent mechanisms.
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