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Intravitreal Triamcinolone versus Bevacizumab for treatment of Refractory Diabetic Macular Edema (IBEME Study)
  1. Letícia Paccola (leticiapaccola{at}yahoo.com.br),
  2. Rogerio A Costa (roger.retina{at}globo.com),
  3. Marco S Folgosa (msfolgosa{at}yahoo.com.br),
  4. José C Barbosa (jcbarbosa{at}fcav.unesp.br),
  5. Ingrid U Scott (iscott{at}psu.edu),
  6. Rodrigo Jorge (rjorge{at}fmrp.usp.br)
  1. School of Medicine of Ribeirão Preto, Brazil
  2. U.D.A.T. – Retina Diagnostic & Treatment Division, Hospital de Olhos de Araraquara, Araraquara, Brazil
  3. School of Medicine of Ribeirão Preto, Brazil
  4. Exact Sciences Department, São Paulo State University, Brazil
  5. Departments of Ophthalmology and Public Health Sciences, Penn State College of Medicine, Hershey, United States
  6. School of Medicine of Ribeirão Preto, Brazil

    Abstract

    Background/Aims: To compare the morphological and visual acuity outcomes associated with a single intravitreal injection of triamcinolone acetonide versus bevacizumab for the treatment of refractory diffuse diabetic macular edema.

    Methods: Twenty-eight patients were randomly assigned to receive a single intravitreal injection of either 4 mg/0.1cc of triamcinolone acetonide or 1.5 mg/0.06cc of bevacizumab. Comprehensive ophthalmic evaluation was performed at baseline and at weeks 1, 4, 8±1, 12±2 and 24±2 after treatment. Main outcome measures included central macular thickness measured with optical coherence tomography (OCT) and best-corrected Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity.

    Results: Twenty-six patients (26 eyes) completed all study visits (2 patients missed 2 consecutive study visits). Central macular thickness was significantly reduced in the intravitreal triamcinolone group when compared with the bevacizumab group at weeks 4, 8, 12 and 24 (P<0.05). LogMAR best-corrected visual acuity was significantly higher at weeks 8 (0.69; ~20/100+1) and 12 (0,74; 20/100-2) in the intravitreal triamcinolone group when compared with the bevacizumab group (weeks 8 [0.83; ~20/125-1] and 12 [0,86; 20/160+2]) (P<0.05). Significant change from baseline in mean intraocular pressure (mm Hg) was seen at week 4 (+2.25) only in the intravitreal triamcinolone group (P<0.0001). No patient had observed cataract progression during the study.

    Conclusions: One single intravitreal injection of triamcinolone may offer certain advantages over bevacizumab in the short-term management of refractory DME, specifically with respect to changes in central macular thickness. The actual clinical relevance of our preliminary findings, however, remains to be determined in future larger studies.

    • anti-VEGF
    • bevacizumab
    • diabetic retinopathy
    • macular edema
    • triamcinolone

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