Intravitreal triamcinolone acetonide versus combined intravitreal bevacizumab and dexamethasone in diffuse diabetic macular oedema

Authors


Dr Saumil Sheth, 2/559, Crown Street, Surry Hills, Sydney CBD, NSW 2000, Australia. Email: saumil_sheth@hotmail.com

Abstract

Background:  To compare the efficacy of a single injection of combined intravitreal dexamethasone and bevacizumab (Avastin) with that of intravitreal triamcinolone acetonide in eyes with diffuse cystoid diabetic macular oedema.

Design:  Prospective, non-randomized, masked, interventional case series.

Participants:  Twenty-four eyes of 24 subjects with centre-involved diabetic macular oedema extending over two disc-areas with predominant cystic changes on spectral domain optical coherence tomography were selected.

Methods:  Ten phakic and two pseudophakic, ocular hypertensive eyes received intravitreal dexamethasone and bevacizumab as against 12 pseudophakic, normotensive eyes that received intravitreal triamcinolone acetonide.

Main Outcome Measures:  Change in central macular volume on spectral domain optical coherence tomography and best-corrected visual acuity were measured at 6-week follow-up.

Results:  Baseline data were matched in both groups. Post-injection central macular volume (7.46 ± 0.73 mm3) was significantly lower (P < 0.001) in the intravitreal triamcinolone acetonide group when compared with its pre-injection central macular volume (9.11 ± 1.0 mm3) or when compared with the post-injection central macular volume (P = 0.02) of the intravitreal dexamethasone and bevacizumab group (8.42 ± 1.18 mm3). However, post-injection best-corrected visual acuity between the intravitreal triamcinolone acetonide (0.65 ± 0.15 logMAR) and the intravitreal dexamethasone and bevacizumab groups (0.685 ± 0.15 logMAR) was not significantly different (P = 0.06) at 6 weeks. No significant correlation was noted between change in central macular volume and change in best-corrected visual acuity (r = 0.35, P = 0.07) from the pooled data of both the groups. A fair correlation was noted between change in central macular volume and pre-injection central macular volume (r = 0.55, P = 0.005).

Conclusions:  Intravitreal triamcinolone acetonide may be more effective than intravitreal dexamethasone and bevacizumab in reducing macular volume in patients with diffuse cystoid diabetic macular oedema. A significant reduction in macular volume does not necessarily translate into a correspondingly significant improvement in best-corrected visual acuity.

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